COSI 357 Midterm: Blood Work, Etiologies, and incidence and prevalence of ANDs

What are the three main bloodwork tests?

• Three main tests 

  • Tests that look at red blood cells 

  • Test that look at white blood cells 

  • Tests that look at platelets

What is RBC?

RBC = red blood count → how many red blood cells do we have

What does hemoglobin do?

• Hemoglobin → how we are able to carry oxygen to other parts of our body 

What happens if hemoglobin is low?

• If number is low it means that our brain is potentially not getting the oxygen from the blood that it needs 

  • Hypoxia → brain isn't getting the oxygen it needs (low hemoglobin, blood loss, respiratory distress)

  • A blood transfusion may be necessary 

  • Is it acute or chronic?

What can it mean if hemoglobin is chronically low?

• If hemoglobin is chronically low can mean something like anemia 

  • Can result, again, in hypoxia → make sure anemia is being treated 

  • Iron deficient anemia → if hemoglobin is low can result in other problems 

    • Iron is crucial for the synthesis of several neurotransmitters 

    • need for serotonin, dopamine, GABA

  • Vitamin B-12 Anemia → can result in demyelination of the neurons and things will begin to move really slowly 

What if hemoglobin is high?

A high hemoglobin → polycythemia → blood becomes super thick and it causes a problem for clotting → increases risk of clots, TIAs/CVAs

What does hematocrit tell us?

% of RBCs

What is mean corpuscular volume?

size of red blood cell

• it can determine anemia type

What do white blood cells do?

increase infection and immune response

• There are different types of WBC that fight different things and helps create a differential for that specific cause

What does it mean if white blood cells are high?

In WBC are high that means that the body is producing a lot in order to try and fight something like an Infection

What does a metabolic panel assess?

• assesses kidney + liver function + risk factors of heart issues

What does a renal function test look at?

• Looks at creatine levels

  • waste product from muscles filtered through kidneys

  • high levels can indicate a kidney infection

• Kidney will filter creatinine and if it doesn't do that there will be a lot of creatinine in the body → indicative of poor renal function

• Renal function is important because so much of metabolically what happens with our NS happens because of our renal system 

  • UTI’s → neurological symptoms 

What do liver function tests look at?

• Bilirubin

  • hemoglobin breakdown metabolized by liver

  • Waste from muscles that has synthesized through your liver 

  • If liver has not synthesized the bilirubin there will be a lot of excess in the body and it will make you look yellow → jaundice 

    • increased levels = jaundice

• Albumin

  • decreased levels = malnutrition, liver disease

Why do we look at sodium in a metabolic panel?

• Looks at sodium levels

  • increased sodium = hypernatremia

    • this means dehydration (too much salt)

  • decreased sodium = hyponatremia

    • failure to excrete water normally

• Can make you look confused, irritable, muscle twitches

Why do we look at potassium in a metabolic panel?

• Looks at potassium levels

  • important for heart function

  • increased potassium = hyperkalemia

    • AKL or CKD

      • confusion, numbness, and tingling

  • decreased potassium = hypokalemia

    • water pills

    • committing

• Arrhythmias

Why do we measure CO2 levels?

increased CO2 = respiratory failure and hypoxia

What is alkaline phosphate? What does it do?

• Alkaline phosphatase

  • Comes from the linings of your cells in your biliary tract and bones 

  • If high then it means there is a blockage in your biliary tract 

    • Gallstone, tumor, blood supply occlusion

  • Basically tells us something is going on w the liver and that's a problem 

What causes acquired neurogenic communication?

Acquired neurogenic communication disorders are caused by damage to the nervous system

What are the three classifications of acquired neurogenic disorders?

• Acute onset 

  • Did it come out of nowhere and progressed really fast

• Chronic 

  • Has developed over a long period of time

• Degenerative/progressive onset 

  • Chronic but over time it's going to get worse 

What ANDs are related to the CNS?

• Central nervous system 

  • Aphasia 

  • Cognitive communication disorders 

  • Motor speech disorder 

  • Dysphagia

what ANDs are related to the PNS?

• Peripheral Nervous System

  • Motor speech disorder

  • Dysphagia

What are the two types of strokes?

• Ischemic (blockage) or Hemorrhagic 

What is a hemorrhagic stroke?

• Aneurysm → a bubble outside of the artery wall that pops and the blood goes everywhere → whatever the blood touches it kills the brain tissue → our brain is not surrounded by blood 

  • Aneurysm Clipping → suffocates the area from oxygen so it won’t continue to bleed 

  • People dont die from the aneurysm but from the hemorrhage 

  • The aneurysm is just the bubble → when it pops that's the hemorrhage 

• Hematoma → a collection of blood → increases pressure on the brain → no more buoyancy bc spaces are filled with blood → increased intracranial pressure is hard to get rid of on its own → take off piece of skull

  • Seen often in TBIs 

  • Can be found in subdural, subarachnoid, and epidural space

What is a transient ischemic attach (TIA)?

• Mini stroke 

• Some kind of clot that moves in the brain and then stops 

• The moment it stops it creates a blockage and the person experiences stroke symptoms but then moves again

What are the common causes of TBI?

• Transportation Related

• Falls (#1)

• Assaults

• Sports related injuries

• abuse

What are the two types of TBI?

closed (shape) vs open (penetrating) TBIs

What is secondary damage associated with TBIs?

• increased intracranial pressure

• edema

• seizure

• hemorrhage

• ischemia/hypoxia

• Anoxia not due to TBI → respiratory failure, COPD

Caused by the contra-coup

What is coup/contra-coup?

• coup/contra-coup

  • When you get hit (coup) and everything after that is the contra coup 

    • Contra-coup → secondary damage

What are degenerative diseases?

• Last for a long time and get worse and worse 

• Alzheimer’s Disease 

• Parkinson's Disease 

• ALS 

• MS

What is the number one cause of death for degenerative diseases?

• The number one cause of death for these diseases is aspiration 

  • As the disease progresses swallowing is gone and then they aspirate and cant fight it off 

  • Don't die of the disease but rather something caused by the disease

What are some other causes of ANDs?

• Other possibilities 

  • Tumor 

  • Seizure

  • Neurosurgical excision or other surgical complication 

  • Medication interaction (reversible) 

    • Interaction can cause things like dizziness and other cognitive deficits 

How can surgical trauma cause an AND?

• Surgical Trauma 

  • Damage to brain tissue that may occur during surgery to the brian 

  • May result in acquired speech, language, cognitive, and swallowing deficits 

How can infection cause an AND?

• Infection 

  • Can damage CNS and PNS 

  • May be viral, fungal, bacterial, parasitic 

    • Julian barre → body gets an infection where autoimmune cells start to attack your nerves → person becomes paralyzed 

  • Impacts cognition, motor, and language 

    • Depends on site, nature and damage infection

What is encephalitis?

• Encephalitis 

  • Acute infection and inflammation of the brain or spinal cord 

  • Caused by a virus or bacterial infection 

  • Symptoms will reflect the type and location of the infection

What are the two types of encephalitis?

• Two types of Encephalitis 

  • Encephalitis lethargica 

    • Inflammation and damage to midbrain, basal ganglia, and substantia nigra 

    • Display parkinsonian features 

    • Difficulty

      • initiating/controlling volitional movement, inhibiting non volitional movement 

      • This is acute unlike parkinsons 

        • If this is acute and they are being put on parkinson's medication → dont want that to happen

  • Rasmussen’s 

    • Idiopathic

    • Inflammation in left or right cerebral hemisphere

    • Unilateral tremor in an extremity contralateral to affected hemisphere

    • Hemispherectomy 

      • Removal of portions of or entire hemisphere

How can HIV/AIDS cause and AND?

• HIV/AIDS

  • Sexually transmitted disease 

  • Weakens the immune system 

  • Neurological symptoms 

    • Inability to learn new information, slowed processing, disfluent speech, impaired recall, reduced attention 

  • Language is often unaffected 

    • Mild to sever language deficits have been reported

What is Creutzfeldt Jakob Disease?

• Degenerative and fatal brain disease caused by a prion 

• Affects CNS 

• Rapid dementia symptoms and some strange involuntary movement (big movements)

How can syphilis cause an AND?

• Sexually transmitted disease 

• Caused by bacteria called spirochetes

• Neurosyphilis 

  • Version of syphilis that affects the nervous system

  • occurs years after initial infection and treatment

• Symptoms include

  • Meningitis, headaches, stiff neck, visual changes, facial weakness, cognitive deficits

• Simultaneous HIV and syphilis infection are common

How can polio cause AND?

• Polio 

  • Virus that attacks motor nerve tracts of the PNS 

    • Also known as polio 

  • Primarily infects children 

  • Preventable with a vaccine 

  • Symptoms include

    • Non Symmetrical paralysis with diminished or absent reflexes

What are risk factors for stroke?

• Stroke 

  • Hypertension 

  • High cholesterol 

  • Cigarette smoking 

  • Diabetes mellitus 

    • Type 2 more likely 

  • Alcohol 

  • Male 

  • African american 

What are risk factors for TBI?

• TBI 

  • Males ages 15-24 Why? 

    • Age group is more impulsive and lack inhibition 

  • At least twice as likely in males 

  • People over 65 – why 

    • Falls, the demographic that has the highest rate of suicide 

  • Children under 5 

    • abuse 

  • Associated with 

    • Lower socioeconomic factors 

    • Poor academic vocational achievement

    • Less than high school education 

  • 3x more likely to have a 2nd TBI after first incidence 

  • Increased risk for dementia following TBI

What are degenerative risk factors?

• Degenerative Risk Factors 

  • family/genetic history 

  • Heart disease, high cholesterol, diabetes 

  • Age 

  • environment/toxic agents

What is the incidence and prevalence of a stroke?

• Stroke 

  • 750000 people will suffer a stroke this year 

    • 3rd highest cause of death 

    • Every 45 seconds someone in the US has a stroke 

  • 160000 will die 

  • ⅔ of those who survive will live with disabilities

    • Leading cause of disability in the US

What is the incidence and prevalence of TBIs?

• Current data:
• Accounts for more than 50,000 deaths in the US
• Accounts for nearly 50% of all injury deaths
• Many people are surviving and living with long-term
consequences of TBI
• Leading cause of both injury death & disability among
children & young adults
• CDC, 1999
• 1.5 million TBI’s each year
• 250,000 hospitalized each year
• 80-90,000 experience long-term disability
• Total of 5.3 million Americans live with TBI related disability
• Direct & indirect medical costs estimated at 56.3 billion/year

What is the incidence and prevalence of alzheimer’s disease?

• Estimated 5.4 million people currently have AD
• 1 in 8 American’s 65 and over diagnosed
• Expected to increase to 11-16 million by 2050 given the overall aging
of the population
• 10% - 20% of people over 70 have significant memory problems
• 1/2 due to AD
• This doubles every decade after 70 yrs.
• 40-50% of people over 85 would likely meet the criteria for AD
• Newest research focusing on the oldest-old are pointing to different risk
factors/mechanisms in this group

• 5th leading cause of death for those 65 and over
• Average survival is 4-8 years after dx – can be up to 20 years
• 80% of care is provided at home by family (unpaid) caregivers
– resulting in emotional and physical stress than can lead to
stress-induced health conditions
• Projected cost of care by 2050 – 1.1 TRILLION dollars