Exam 1- patho

liz

A region of the cerebral cortex that has specialized areas for movement, abstract thinking, planning, memory, and judgement

frontal lobe

A region of the cerebral cortex whose functions include processing information about touch.

parietal lobe

occipital lobe

A region of the cerebral cortex that processes visual information

An area on each hemisphere of the cerebral cortex near the temples that is the primary receiving area for auditory information

temporal lobe

integration and processing of sensory data; processing and initiation of motor activities

association areas

conscious perception of auditory and olfactory stimuli

auditory and olfactory cortex (within temporal lobe)

conscious perception of visual stimuli

visual cortex (within occipital lobe)

conscious perception of touch, pressure, pain, vibration, taste, temperature

primary sensory cortex (within parietal lobe)

voluntary control over skeletal muscles

primary motor cortex (within frontal lobe)

functions of basal ganglia (3)

The subconscious control of skeletal muscle tone

Functionally linked with substantia nigra

The coordination of learned movement patterns (walking, lifting)

what carries sensory information from the nucleus cuneatus and nucleus gracilis to the thalamus?

ascending white matter tracts

what carry motor commands from higher brain centers to the motor nuclei of cranial or spinal nerves?

descending white matter tracts

where are the gracilis and cuneatus nuclei located? are they gray or white matter?what to they do?

gray matter in the medulla that relay somatic sensory information to the thalamus

What is the substantia nigra?

regulates activity in the basal nuclei

dysfunction of basal ganglia can lead to?

Parkinson's and Chorea

Chorea

sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face

A group of deep, interrelated subcortical nuclei that play an essential role in control of movement

basal ganglia

Basal ganglia receive indirect input from? direct input from?

indirect: the cerebellum and from all sensory systems, including vision

direct: motor cortex

3 pathways involving basal ganglia

1. dopamine (substantia nigra)

2. GABA (inhibitory)

3. Acetylcholine (excitatory)

what does release of dopamine from the substantia nigra do to the indirect and direct pathways present in the basal ganglia?

- stimulates the direct pathway (promotes movement)

- inhibits the indirect pathway (promotes movement)

striatum

caudate nucleus and putamen

what is the dopamine pathway?

substantia nigra to striatum (caudate nucleus and putamen)

what is the GABA pathway?

striatum -> globus pallidus -> substantia nigra

The output functions of the basal ganglia are mainly ___________ (inhibitory or excitatory?)

inhibitory

•Involuntary movements

•Alterations in muscle tone

•Disturbances in body posture

result from disorders of the?

basal ganglia

Rhythmic shaking

tremor

Irregular, uncontrollable, unwanted, and repetitive stereotypical movements

tics

Dance-like, unpatterned movements, often approximate a purpose (e.g. adjusting clothes, checking a watch)

chorea

Violent movements of extremities that look like throwing or kicking

ballismus

Sustained or repetitive muscular contractions, often produces abnormal posture.

dystonia

Complex involuntary movements that do not fit into another category of involuntary movements

dyskinesias

A degenerative disorder of basal ganglia (substantial nigra) function that results in variable combinations of tremor, rigidity, and bradykinesia

Parkinson''s

Parkinson's is characterized by decreased _______________ (hormone)

dopamine

Parkinson's is a degenerative disorder of the _____________

basal ganglia (substantia nigra)

Lewy bodies

abnormal protein deposits found in the brains of people with certain neurodegenerative diseases, such as Parkinson's disease

what results in the formation of Lewy bodies?

alpha-synuclein misfolding

Punch Drunk Syndrome

the dementia and cerebral scarring observed in boxers and other individuals who experience repeated concussions - parkinsonism

progressive supranuclear palsy

rapid progression, accumulation of tau protein in basal ganglia, brainstem, prefrontal cortex, and cerebellum

severe swallowing problems, mild to moderate memory problems, slowness of thought, apraxia, severe motor planning deficit, learning deficits

(parkinsonism)

what is associated with bradykinesia and tremor?

Parkinson's

•MPTP (1-methyl-4 phenyl-1,2,3,6-tetrahydropyridine)

•Post infection (meningitis, encephalitis)

•Striatonigral degeneration - multi system atrophy

•Progressive Supranuclear palsy - Brainstem, cerebral cortex, cerebellum and basal ganglia

•Trauma - Punch Drunk syndrome

what are these?

parkinsonisms

what drugs can produce parkinsonisms?

antipsychotics (block D2 receptors)

some symptoms you might see with Parkinson's

- masked face

- shuffling gait

- hand tremor

- flexed elbows and wrists

masked face and shuffling gait

Parkinson's

•Migraine headache

•Cluster headache

•Tension-type headache

primary headaches

•Meningitis

•brain tumor

•cerebral aneurysm

•Head trauma

secondary headaches

how do migraines without aura present? how long do they last? what aggravates them?

•Pulsatile, throbbing, unilateral headache

• Typically lasts 1 to 2 days

•Aggravated by routine physical activity

do migraines present bilaterally or unilaterally?

unilateral

migraines present ______________ while tension headaches present ______________

unilaterally; bilaterally

how do migraines with aura present?

all of the symptoms of migraine without aura...

PLUS

•Visual symptoms - flickering lights, spots, or loss

•Sensory symptoms - feeling of pins or needles

•Speech disturbances

•Neurologic symptoms

various studies show that _________ vasoconstricts the nerve endings & blood vessels and in this way affect nociceptive pain and causes migraines

serotonin

migraines could be caused by neurogenic inflammation within the meningeal vasculature due to stimulation of CN __________

cranial nerve V

It has been postulated that low ___________ levels dilate blood vessels & initiate migraine

serotonin

Studies suggest that migraine attack is characterized by a relative depletion of ____________________ stores in conjunction with an increase in the release of other sympathetic co-transmitters such as ________________________

sympathetic norepinephrine

dopamine, prostaglandins, ATP & adenosine

are cluster headaches common? more frequent in?

not common; more frequent in men

least common primary headache

cluster

how and when do cluster headaches occur? how do they present?

•In clusters over weeks or months

•lasting for 15 to 180 minutes

•Followed by a long, headache-free remission period

•Severe, unrelenting, unilateral pain

suicide headache - severe, unrelenting, unilateral pain

cluster headache

which primary headache is bilateral?

tension

associated symptoms with cluster headaches

•Restlessness or agitation

•Conjunctival redness

•Lacrimation specifically on one side,

•rhinorrhea,

•Miosis, ptosis, and eyelid edema.

lacrimation, rhinorrhea, ptosis are associated with what headache?

cluster

most common headache

tension headache

•Muscle Spasm

•Oromandibular Dysfunction

•Psychogenic Stress

•Anxiety

•Depression

•Muscular Stress

•Overuse of Analgesics or Caffeine

can cause what type of headache?

tension

how do tension headaches present? episodic or chronic?

•can be episodic or chronic

•Dull, aching, diffuse, nondescript headaches

•Occurring in a hatband distribution around the head

•Not associated with nausea or vomiting

•Not worsened by activity

are tension headaches associated with nausea or vomiting?

no

an overall term for a decline in mental function severe enough to interfere with a person's ability to perform usual daily activities

neurocognitive disorder (dementia)

hatband distribution of pain - what kind of headache?

tension

are tension headaches worsened with activity?

no

is dementia part of the normal aging process?

no

neurocognitive disorder can be caused by any disorder that permanently damages ______________

large association areas serving memory and learning

Impairment of short and long term memory, associated with abstract thinking, impaired judgment, language issues (word retrieval), other higher cortical functions, or personality change

neurocognitive disorder (dementia)

__________ of people aged 72 and older have some form of neurocognitive disorder.

13.8%

what are the reversible forms of demetia?

Drugs (drugs with anticholinergic activity)

Emotional (depression)

Metabolic (hypothyroidism)

Eyes and ears (declining vision and hearing)

Normal-pressure hydrocephalus

Tumor or other space-occupying lesions

Infection (human immunodeficiency virus or syphilis)

Anemia (vitamin B12 or folate deficiency)

what are some kinds of dementia?

•Alzheimer disease

•Vascular dementia

•Creutzfeldt-Jakob disease

•Wernicke-Korsakoff syndrome

•Huntington disease

most common form of dementia

Alzheimer's

60% to 80% of all cases of NCD are?

Alzheimer's

what part of the brain is mostly responsible for memory?

cortex

Average survival of _________ years after Alzheimer's diagnosis

8-10 years

individuals with Down Syndrome develop what neurological disease?

Alzheimer's

•Memory loss that disrupts daily life

•Difficulty completing familiar tasks

•Challenges in planning and problem-solving

•New problems with words in speaking & writing

•Trouble with visual images or spatial relationships

•Changes in mood or personality

•Misplacing things, losing ability to retrace steps

•Decreased or poor judgement

•Withdrawal from work or social activities

•Confusion with time and place

characteristics of Alzheimer's

what histologically would you see with Alzheimer's?

•Characterized by cortical atrophy and loss of neurons, particularly in the parietal and temporal lobes.

•Ventricular enlargement (i.e., hydrocephalus) from the loss of brain tissue.

Alzheimer disease has been associated with a decrease in the level of ________________ in the cortex and hippocampus

choline acetyltransferase activity

the reduction in choline acetyltransferase is quantitatively related to the numbers of ______________ and severity of dementia

neuritic plaques

This enzyme is required for the synthesis of acetylcholine, a neurotransmitter that is associated with memory

choline acetyltransferase

Classic Neuropathologic Findings in AD (3)

•Neurofibrillary tangles (tau protein)

•Beta amyloid (neuritic) plaque build up

•Amyloid precursor protein (APP) gene

•Acetylcholine

•GABA

•L-arginine

these neurotransmitters play a significant role in what disease?

Alzheimer's

Pathogenic aspects of AD are thought to be a combination of these three things

1. neurotransmission disruption

2. oxidative stress

3. neuroinflammation

Aggregates of hyperphosphorylated tau protein seen in?

Alzheimer's

Neuritic (senile) (amyloid) plaques seen in AD are _______________ plaques outside of neurons

Beta-amyloid

an axonal microtubule-associated protein that enhances microtubule assembly

tau protein

first stage of Alzheimer's symptoms

•Short-term memory loss

•Mild changes in personality

•Randomly forget important and unimportant details

moderate stage of Alzheimer's symptoms

•Global impairment of cognitive functioning

•Changes in higher cortical functioning needed for language, spatial relationships, and problem solving; disorientation, lack of insight, and inability to carry out the activities of daily living, extreme confusion

severe stage of Alzheimer's

•A loss of ability to respond to the environment

•Require total care

•Bedridden

Formerly known as multi-infarct dementia

Vascular dementia

Approximately 10% of all NCD types

Vascular dementia

what causes vascular dementia?

Due to ischemic or hemorrhagic damage of the brain

•Damage to large vessels may cause sudden symptoms

•Small vessel damage leading to a slower onset of symptoms.

***can lead to mini strokes and neuronal cell death

•Stroke

•Hypertension

•Arrhythmias

•Myocardial infarction

•Peripheral vascular disease

•Lipid abnormalities

•Diabetes mellitus

•Autoimmune

•Infectious vasculitis

•Smoking

conditions associated with what NCD?

Vascular dementia

cognitive domains affected by vascular dementia?

- perceptual motor

- complex attention

- executive function

- symptoms of depression

Prion diseases

misfolding of endogenous protein into an infectious pathologic protein

spongiform encephalopathies

disease caused by prion aggregates that cause nervous degradation

Creutzfeld-Jacobs Disease, Mad Cow, Scrapie

unable to maintain information and to manipulate that information over a short period

unable to plan, focus attention, remember instructions, and juggle multiple tasks

depression

characteristics of what kind of dementia?

vascular dementia