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44 Cards in this Set
- Front
- Back
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What are the most common causes of dementia in the elderly?
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1) Alzheimers
2) Multi-infarct Dementia others: folate deficiency, thiamine deficiency, neoplasia, Wilsons disease |
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What pathology is associated with Alzheimers disease?
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Extracellular senile plaques with B-amyloid core. (swollen eos. nerve cell processes cortex, hippocampus, amygdala).
Intracellular Neurofibrillary tangles (abnormally phosph tau protein) granulovacuolar degeneration (pyramidal cells hippocampus) Hirano bodies (intracytoplasmic dendritic eosinophilic actin inclusions) Amyloid Angiopathy Reduced neurons in NUCLEUS BASALIS OF MEYNERT Deficiency CAT (choline acetyl transferase) and decreased Ach in cortex & hippocampus (why tacrine and achesterase drugs used to tx) |
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What is the genetics of Alzheimers disease?
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10% familial form assoc w:
Chrom 1,14,19 (APOE4 allele) & Chromosome 21(p-App gene) APP gene product = path. AB and normal P3 (mutation = more of path. product) Chromosome 19 - APOE4 protein, 14 and 1 code for presenilens linked to family early onset alzheimers |
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Pick's disease: pathology and where localizes?
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Pick bodies (intracytoplasmic inclusion bodies)
FRONTAL and TEMPORAL lobes |
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Huntington's disease Pathology
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autosomal dominant - Chrom 4
CAG repeats, anticipation atrophy of caudate Frontal/temporal cortex (neuronal depletion gliosis) (loss Ach/Gaba-ergic) athetoid mvmnts, personality/emotional changes leads to hypertonicity, fecal/urinary incontinence, anorexia/wt loss, dementia, death |
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Parkinson's disease
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Lewy bodies
depigmented Substantia Nigra TRAP (tremor, rigidity, akinesia, postural instability) masked facies, micrographia, shuffling gait |
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Causes of Parkinson's?
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Idiopathic
MPTP/Dopa inhibiting drugs Shy-Drager Von Economo encephalitis Dementia pugilistica (trauma) |
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Friedrich's Ataxia
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Autosomal recessive
cerebellar ataxia dysarthria, nystagmus ass: scoliosis, pes cavus, heart disease, diabetes |
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Olivopontocerebellar ATROPHY
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cerebellar ataxia plus dysarthria plus PARKINSONIAN symptoms (neuronal loss Substantia Nigra and cerebellum)
poly GLN triplet repeats |
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Amyotrophic Lateral Sclerosis (ALS)
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LMN & UMN signs - Lou Gehrig's disease
LMN signs: atrophy muscles from denervation, fasciculations UMN: hyperreflexia, spasticity, Positive Babinski Usually first involves muscles hand, arm shoulder Rapid progression w/ death in 1-6 years |
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Werdnig Hoffmann disease
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birth- floppy baby
tongue fasciculations |
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Polio
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LMN signs
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Epidural Hematoma
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Middle meningeal artery rupture, 2ndary to temporal bone fracture
Biconvex disc, does not cross suture lines unconscious, lucid interval, then signs increasing ICP |
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Subdural Hematoma
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Rupture Bridging veins
delayed, insidious symptoms Elderly, Blunt Trauma, Alcoholics Crescent shaped, crosses suture lines |
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Subarachnoid Hemorrhage
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Rupture of (berry) aneurysm or AVM
"Worst headache of life" Bloody/xanthochromic spinal tap |
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Parenchymal Hematoma
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HTN (charcot-bouchard aneurysms), amyloid angiopathy, diabetes, tumor
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Berry/Saccular aneurysms
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Aneurysm at Bifurcation of
a) anterior comm carteries (most common site) RUPTURE--> hem. stroke/subarachnoid hemorrhage |
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What are Berry aneurysms associated with?
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Adult Polycystic Kidney Disease
Ehler's Dahnlos Marfan's |
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Demyelinating Diseases:
Multiple Sclerosis - Pathology |
Periventricular plaques
preservation of axons loss of oligodendroglia reactive astrocytic gliosis Protein (IgG) in CSF (oligoclonal bands on analysis) |
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MS - Presentation
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SIN (scanning speech, intention tremor, nystagmus)
Optic Neuritis MLF-Internuclear Ophthalmoplegia Hemiparesis Hemisensory symptoms Bladder/bowel incontinence |
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Who gets MS and treatment
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Women in 20s or 30s
Greater prevalence further from equator TX - prednisone, IFN B, natalizub (tysabri) - Ab to integrin adhesion molecules |
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Demyelinating Diseases:
Progressive Multifocal Leukoencephalopathy |
PML - JC virus
2-4 percent AIDS patients- reactivation of latent virus |
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Demyelinating Disease
Metachromic Leukodystrophy |
Sphingolipidosis
Deficiency Arylsulfatase A, acculumulation cerebroside sulfate Central and peripheral demyelination with ataxia, dementia |
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Guillan Barre Pathology
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Inflammation and demyelination of peripheral nerves and motor fibers of ventral roots (more motor than sensory)
Assoc w: Infections (herpes, C.jejuni) Inoculations Stress |
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Guillan Barre Symptoms/presentation
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Symmetric ascending muscle weakness beginning distal lower extremeties
50% facial diplegia Autonomic affected - cardiac irreg, HTN, hypotension ALBUMINO-CYTOLOGIC DISSOCIATION (elevated CSF protein with normal cell cnt) elevated protein-->papilledema |
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Poliomyelitis - virus pathology
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Fecal-oral transmission
replicates oropharynx & S.Int Through blood to CSF Destroys anterior horn cells ->LMN destruction Virus can be recovered from stool or throat |
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Poliovirus symptoms
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Malaise, headache, fever
nausea, abd pain, sore throat LMN signs - muscle wknss/atrophy fasciculations fibrillation hyporeflexia |
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Polio Findings
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CSF w/ lymphocytic pleocytosis
Slight elevation protein |
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Simple Partial Seizure
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Awareness intact
motor/sensory/autonomic/ psychic Partial = affects one area of brain, can secondarily generalize |
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Complex Partial
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Impaired awareness
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Type of seizure? Action?
Absence Myoclonic |
both are generalized
absence=petit mal=blank stare Abrupt Onset, 3-4 HZ spike&wave EEG common in kids, 80% grow out of myoclonic=quick, repet jerks |
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Tonic-Clonic
Tonic Atonic |
Tonic-Clonic=GrandMal= alternating stiffness & mvmnt
Tonic=Stiffening (NOT BREATHING DURING THIS PHASE) Atonic=drop seizure All are Generalized |
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Causes of seizures in following groups:
Children |
Genetic
Infections/Febrile Trauma Congenital Birth Trauma Metabolic |
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Causes of seizures in ADULTS
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Tumors
Trauma Stroke Infection |
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Causes seizures in Elderly
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Stroke
Trauma Tumor Metabolic Infection |
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Broca's Aphasia
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expressive
nonfluent aphasia w/ intact comprehension INFERIOR FRONTAL GYRUS |
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Wernicke's Aphasia
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Receptive
Fluent with impaired comprehension SUPERIOR TEMPORAL GYRUS |
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Horner's Syndrome
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Sympathectomy of face (lesion above T1)
Ptosis Anhidrosis (absence sweating and flushing-rubor one side face) Miosis PAM is Horny (horners) Hypothalamus projects to interomediolateral column, which then projects to sup cervical ganglion and then to sweat glands/eye/etc. |
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Syringomyelia
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Enlargement of central canal of spinal cord
BILATERAL loss Pain and Temp (crossing fibers ant. comm lost) in upper extremities w/ Touch preserved |
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What does syringomyelia often present with?
What level is it common? |
Arnold Chiari malformation
C8-T1 |
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Tabes Dorsalis
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Degeneration dorsal columns&dorsal roots due to tertiary SYPHILIS (dorsal roots/ganglia degen first followed by wallerian degen of dorsal columns)
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What symptoms are associated with Tabes Dorsalis?
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impaired proprioception
locomotor ataxia Charcot's joints (loss position sense = stumbling) shooting/lightning pain Argyll-Robertson pupils Absence DTR |
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What other forms of neurologic disease can Syphilis demonstrate?
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Meningovascular (perivascular infiltrates, necrotic granulomas on meninges)
General Paralysis of Insane- shrunken, firm cortex w/ thick leptomeninges |
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What forms of neuro disease can TB produce?
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Pott's Disease - epidural TB abscess leads to vertebral collapse (TB spondylitis)
can cause chord compression Intraparenchymal Tuberculoma Tuberculous Meningitis (basilar fibrosing) |
