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