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Chapter 34
Patho: Chronic and Degenerative Neurological Disorders
| Term | Definition |
|---|---|
| how common are headache | 30 million a year, women are more common |
| seizure vs. epilepsy | seizure= whole body convulsion (10%) epilepsy= disorder of seizures (3%) |
| generative neurological diseases | diminish neurological impulse transmission |
| epilepsy | chronic disease characterized by recurrent seizure |
| seizure | sudden, abnormal, disorderly discharge of neurons within the brain that is characterized by a sudden transient alteration in brain function |
| who is affected by seizure and some causes | infants less than a year old, greater than 65 years, all genders and ethnic groups caused by head trauma, hypoglycemia, altzeimer's |
| generalized vs. focal seizure | focal only affects on area-- can be completely or partially aware generalized affects other areas- no awareness/always impaired (tonic/clonic) |
| stages of seizure | 1. aura 2. ictal 3. post ictal 4. interictal (repeat) |
| why are EEGs not a reliable source for diagnosis | does not rule out seizures- 50% don't show; especially if not seizure activity |
| secondary headaches | another primary condition causes these- concussion, aneurysm, disease, medications, brain tumor |
| most common types of primary headaches | tension headaches and trigeminal autonomic cephalgia |
| tension type headache (TTH) | infrequent episodic (less than a day a month), frequent episodic (10 a month for three months), chronic TTH (15 days or more a month) |
| presenting symptoms of TTH | bilateral pain, does not worsen with activity |
| migraines | unilateral, certain odors trigger, n/v, severe pain, more in women, disabling |
| four phases of migraine headaches | 1: prodrome- neural hyper-excitability in the brain (fatigue) 2: aura- cortical spreading depression occurs 3: pain- trigeminovascular complex activation accounting for the pain 4: postdrome- sensitization of the trigeminal vascular complex |
| serotonin and calcitonin gene related peptides | released in a migraine; known to be a potent vasodilators |
| Parkinson's disease | anyone can get it, 50/60s diagnosed, young onset is younger than 40 cells of substantial nigra produces dopamine |
| imbalance of what two neurotransmitters leads to parkinson | acetoycholine and dopamine; dopamine is low and Ach is high meaning uncontrolled stimulation |
| symptoms of parkinsons | orthostatic hypotension, constipathion, insomnia, night terrors TRAP |
| TRAP | T: tremor= abnormal spasms and muscle movements; non intentional at rest R: rigidity= tightness/stiffness in arms, legs, trunks A: bradykinesia/akinesia= slow movements P: postural instability= loss of reflex/balance, gait |
| neuropsychiatric concerns | depression, cognitive dysfunction, dementia, apathy, anxiety |
| Parkinson's diagnosis | TRAP criteria, imaging is not good, PET scan, medications response |
| Amyotrophic Lateral Sclerosis | progressive fatal/neurogenerative disease resulting in loss of upper and lower motor neuron's, ultimately leading to respiratory failure progressive muscle weakness and atrophy |
| risk factors for ALS | men, occupation, heavy metal, smoking, physical trauma, caucasian (40-60) |
| 2 types of ALS | familial/inherited sporadic (80%)- mutation of gene |
| patho of ALS | UMN and LMN become sclerotic ventilator to assist with breathing can develop dementia only damage motor neurons NOT sensory neurons |
| symptoms of ALS | weakness upper and lower extremities, difficulty speaking/swallowing upper= muscle spasm, hyperreflexia lower= muscle cramps |
| diagnosing ALS | based on symptomology- no biomarkers or tests no cure |
| Huntington's disease | an inherited progressive neurogenerative disease (autosomal dominant)- each child has 50% chance of inheriting, higher survival than ALS (10-20 years) |
| patho of Huntington | Huntington protein accumulates in the cytoplasm of brain cells causing cellular deterioration |
| manifestations of HD | involuntary motor symptoms: chorea, dystonia, dyskinesia emotional and behavior symptoms: depression, mania, irritability cognitive: apathy, impaired decisions, slow- dementia/lack judgement |
| HD diagnosed | genetic testing in blood; biomarkers absent |
| Guillain Barre Syndrome | happens after an infection (viral or bacterial) antecedent infections: epstein barr, mycoplasma pneumonia, s. jejuni men most common, older people |
| patho of GBS | acute peripheral neuropathy- motor neurons affected autoimmune- antibodies attack myelin sheath impacting conduction of signals |
| presentation of GBS | progressive, symmetric ascending weakness that progresses for days and usually stops after 4 weeks more of an event rather than a disease it starts with paresthesia and travels up the limbs or nerves mild-severe (ventilation) recovery after 2 years |
| Myasthenia Gravis | descending weakness, attacks Ach, T and B cell mediated reduction in receptors of Ach in the neuromuscular junction |
| symptoms | decreased muscle force with receptive motion and improves with rest muscle fatigue fluctuates muscle weakness gets worse as day goes on |
| myasthenia crisis | exacerbation of symptoms; cannot breath on own tired + fatigued |
| diagnosing GBS | edrophonium testing; help them become stronger can also do EMG and serum Ach receptors |
| complications or causes of death GBS | aspiration and respiratory failure can be a complication |
| ocular presentation of GBS | eye drooping; 50% in 2 years to get generalized |
| generalized presentation of GBS | muscle weakness all over |
| multiple sclerosis (MS) | most common;, young adults, 2x woemen, cooler climates, further from equator |
| patho of MS | demyelinization resulting in inflammation and damage to myelin sheaths remissions and exacerbations T cells attack myelin sensory and motor neurons |
| symptoms of MS | numbness and tingling, painful motor movements, blurred vision, balance, fatigue, motor impairment optic nerves impacted--loss of vision, painful extra-ocular movement |
| diagnose MS | MRI will show myelinating lesions blood tests show IG and infection evoked potential -- record timing of response to stimuli (pain) |
| two forms of MS | remitting and relapsing (85%)- episodes several weeks to 3 months (every 1-3 years) PPMS without remission (15%) |
| disabilities with MS | paralysis (hemiparlysis), sexual dysfunction, urinary and fecal incontinence |
| complications of MS | 50% ger depression, 45-65% memory and executive dysfunction 50% develop PPMS |
| ataxia | uncoordinated/imbalance |
| myoclonus | muscle tetany- twitching |
| tonic | toned muscle |
| clonic | rhythmic jerking movement |
Created by:
ELoranger