Term
| What disease is the third leading cause of death in the US and #1 cause of neurologic disability? |
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Definition
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Term
| What is the most important modifiable risk factor for both ischemic and hemorrhagic stroke? |
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Definition
|
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Term
| What is the intracranial pressure controlled by? Is it independent or dependent on the systemic BP? |
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Definition
Controlled by autoregulation of cerebral vascular resistance
Independent of systemic BP (unless brain injury affects autoregulation) |
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Term
| What are the four major arteries that provide the majority of blood flow to the brain? What area of the brain do they supply? |
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Definition
L and R Carotid Arteries supplies the cerebral hemispheres
Two Vertebral Arteries supply brainstem and cerebrum |
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Term
| What part of the cerebral vasculature plays an important role in preventing ischemia due to its collateral circulation in the event of occlusion? |
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Definition
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Term
| Which artery provides collateral circulation between the internal and external carotids? |
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Definition
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Term
| At what critical cerebral perfusion level does irreversible brain damage occur? |
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Definition
|
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Term
| How do cerebral arteries accommodate when MAP decreases? ... when MAP increases? What else do cerebral arteries respond to? |
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Definition
MAP Decrease - Arterioles Dilate
MAP Increase - Arterioles Constrict
Cerebral arterioles respond to pH ad blood gas levels |
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Term
| How do cerebral arteries respond to hypercapnia, acidosis and hypoxemia? |
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Definition
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Term
| How do cerebral arteries respond to hypocapnia and alkalosis? |
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Definition
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Term
| What condition is described as any sudden neurologic insult that results from restriction or cessation of flow through the arterial system of the brain? |
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Definition
|
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Term
| What are the four pathophysiologic reasons for a stroke? |
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Definition
Blood Vessel Dx (atherosclerosis, thrombosis)
Decrease Perfusion from impaired flow
Blood flow occlusion by an embolus
Vascular Rupture |
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Term
| What is the distinguishing factor between a Stroke and a TIA? |
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Definition
| TIA has complete resolution of sx within short times (minutes to hours) |
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Term
| What is seen as a "warning sign" of impending stroke? |
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Definition
|
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Term
| Which populations have increased risk TIA incidence? |
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Definition
| African Americans and Men |
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Term
| If sx of TIA include decrease or loss of vision in one eye, what artery is affected? |
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Definition
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Term
| If sx include contralateral weakness or numbness, which artery is affected? |
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Definition
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Term
| If sx of TIA include bilateral weakness, vision loss, dizziness and falling attacks, what artery is affected? |
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Definition
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Term
| Which maneuver can cause a vertebrobasilar TIA? What artery is occluded? |
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Definition
Subclavian Steal
Subclavian artery |
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Term
| What determines an increase in the probability of future strokes? |
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Definition
| increased frequency of TIA |
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Term
| What type of stroke accounts for the majority of all strokes? |
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Definition
|
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Term
| What causes ischemic strokes? |
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Definition
| obstruction of 1 or more major arteries |
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Term
| What conditions can lead to ischemic strokes? |
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Definition
Atherosclerosis
Arteritis
Hypercoaguable states (women on OCs, CA pts)
Structural Heart Dx (A-fib, Valvular dx) |
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Term
| With sx including abrupt onset of hemiparesis or monoparesis (usually affecting one arm), contralateral hemianesthesia, homonymous hemianopsia dysphasiaand aphasia, what circulation is occluded? |
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Definition
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Term
| With sx including confusion (dementia), contralateral weakness (greater in the leg) and contralateral sensory deficits, what circulation is occluded? |
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Definition
| Anterior circulation occlusion |
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Term
| What sx including bilateral babinski sign, increased DTRs, weakness in one or all of the extremities, brainstem dysfunction (such as intention tremors or vertigo), dizziness, disorientation, syncope, stupor, coma, N/V, ataxia, dysarthria and visual defects (displopia, nystagmus, ptosis), what circulation is occluded? |
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Definition
| Posterior & Vertebrobasilar region occlusion |
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Term
| Where do lacunar infarcts commonly occur? |
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Definition
|
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Term
| Which type of ischemic strokes are the result of hypertensive small vessel disease? |
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Definition
|
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Term
| What are the majority of thrombolytic strokes caused by? |
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Definition
| Atherosclerosis with thrombosis (sx evolve over a few days as the flow decreases with the increasing size of the thrombus) |
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Term
| What are the most common sites of thrombolytic strokes? |
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Definition
Carotid Bifurcation
Origin of Middle Cerebral Artery
End of Basilar Artery |
|
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Term
| When do the majority of thrombolytic strokes occur? |
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Definition
| during nighttime while pt is sleeping |
|
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Term
| What type of onset is a thrombolytic stroke? Embolitic stroke? |
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Definition
Thrombolytic Stroke - Slow onset
Embolytic Stroke - Sudden Onset |
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Term
| Where are the most common origins of the thrombi in Embolytic strokes? |
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Definition
The heart (MI, A-Fib, Diseased or Artificial Valves, and Ischemic Cardiomyopathy)
Atherosclerotic Plaque - (Most commonly from the Carotids) |
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Term
| When do embolytic strokes typically occur? |
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Definition
|
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Term
| What do patients who have had an embolytic stroke have a higher risk for? |
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Definition
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Term
| What do cryptogenic strokes present as? |
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Definition
| Present like embolytic strokes |
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Term
| With sx including monocular blindness, hemiparesis, hemiplegia, hemianopsia, and aphasia, what circulation is occluded? |
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Definition
|
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Term
| What is the most common cause of intracerebral hemorrhage? |
|
Definition
| hypertensive vascular damage |
|
|
Term
| What can lead to hemorrhagic strokes? |
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Definition
Trauma
ruptured aneurysm
AVM - Atriovenous Malformation
Cocaine and Amphetamine Use |
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Term
| What type of stroke is a seizure indicative of? |
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Definition
|
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Term
| What type of stroke is a seizure indicative of? |
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Definition
|
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Term
| What study is "first line" in the dx of a stroke? |
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Definition
|
|
Term
| What is effective treatment for ischemic or thrombolytic strokes? |
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Definition
Aspirin (within 48 hours)
Thrombolytic Therapy (within 3 - Streptokinase, TPA) |
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Term
| What must be avoided in the acute management of ischemic strokes at ALL costs? |
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Definition
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Term
| What is the brain's recovery of stroke aided by? |
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Definition
| brain plasticity - the ability of the brain to relearn tasks |
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Term
| At what point is a carotid endarterectomy performed? |
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Definition
| When carotid vessel is over 90% occluded |
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Term
| To prevent strokes in patients with a-fib, what needs to be given to them? |
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Definition
|
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Term
| What condition is a loss of cognitive function involving changes in memory, behavior, learning and communicating that may be caused by disease or trauma? |
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Definition
|
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Term
| What disease is primary dementia? |
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Definition
|
|
Term
| What are some secondary causes of dementia? |
|
Definition
Infections
Metabolic Disorders
Nutritional Deficiencies
Space Occupying Lesions
Strokes (Brain Infarcts)
Toxic Substances
Vascular Disorders
Diseases (Parkinson's, Huntington's, Wilson's, depression, head injury) |
|
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Term
| What is the most common form of dementia? |
|
Definition
| Primary Dementia (Alzheimer's Dx) |
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Term
| What condition is described as a degenerative, progressive disease that causes defects in neurons, impaired memory and reasoning and behavior changes? |
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Definition
|
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Term
| What are the 3 key processes of nerve cells that Alzheimer's disease disrupts? |
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Definition
Communication
Metabolism
Repair |
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Term
| Which type of neurons does Alheimer's disease target FIRST? What part of the brain? |
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Definition
| Neurons for memory on the Hippocampus |
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Term
| What neurons are attacked by Alzheimer's following its attack on the hippocampus? What sx of this occur in the patient? |
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Definition
Neurons in the cerebral cortex are destroyed
Causing loss of language skills, poor judgement, and personality changes |
|
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Term
| What is the life expectancy from onset of Alzheimer's dx? |
|
Definition
|
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Term
| What disease is Alzheimer's frequently accompanied by? |
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Definition
|
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Term
| What are the pathologic findings found in the brain on autopsy with Alzheimer's dx? |
|
Definition
| Amyloid plaques and neurofibrillary tangles |
|
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Term
| What stage of Alzheimer's is associated with signs including emotional outbursts, agitation, wandering, disturbing behavior, incontinence and inability to interact with others? |
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Definition
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Term
| What is early or familial Alzheimer's linked to? What is the approximate age of onset? |
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Definition
| Genetic mutations in families; 40 - 50 y/o |
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Term
| What is late or sporadic Alzheimer's linked to? What is the typical age of onset? |
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Definition
| linked to an inherited allele on chromosome 19; Age of onset = 65y/o |
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Term
| What is the confirmatory test for Alzheimer's dx? |
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Definition
| The only confirmatory test is autopsy when amyloid plaques and neurofibrillary tangles are found |
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Term
| What is the primary goal of Alzheimer's treatment? |
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Definition
| To look for reversible causes! (Syphillis, Thyroid dx, Vit B12) |
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Term
| What is a condition with characteristic symptoms including constant uncontrollable writhing, twisting and turning movements that progressively worsen throughout the course of the disease? |
|
Definition
|
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Term
| What does Huntington's disease result from? What is it linked to? |
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Definition
Genetically programmed neurodegenration of the basal ganglia deficiency of gamma-aminobutyric acid (GABA)
Linked to a deficiency on chromosome 4 |
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Term
| Which meds are given to Alzheimer's pts to slow the progression of the disease? What is their MOA? |
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Definition
Aricept (donepezil HCL) and Cognex (tacrine)
MOA - inhibits acetylcholinesterase |
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Term
| What condition has insidious onset of signs and sx including emotional liability, intellectual deterioration, lack of attention to appearance, forgetfulness, and chorea-like movements? |
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Definition
|
|
Term
| What can be given to a Huntington's pt to minimize chorea? |
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Definition
| Haloperidol and chloropromazine |
|
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Term
| What is Amyotrophic Lateral Sclerosis caused by? |
|
Definition
| Degeneration of Upper and Lower MOTOR neurons |
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Term
| What condition is characterized by muscle weakness, atrophy, fasciculations and total loss of voluntary muscle control? |
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Definition
| Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig's Dx |
|
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Term
| What occurs to the ALS pt's mental capacity? |
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Definition
| They retain it, they only lose motor function |
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Term
| What is thought to be the cause of sporadic or idiopathic ALS? |
|
Definition
| slow latent virus, autoimmune dx or reoccurring severe head trauma |
|
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Term
| What happens to the sensory neurons in ALS? What does that mean to the patients? |
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Definition
| They are retained; they are still able to sense pain and touch) |
|
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Term
| What is the direction of degeneration of motor neurons in ALS? |
|
Definition
| From top to bottom - Neck, tongue, pharyngeal and laryngeal muscles, then trunk and lower extremities |
|
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Term
| What is the survival range after dx of ALS? What is the common COD in ALS pts? |
|
Definition
2 - 10 ys
COD from Respiratory failure |
|
|
Term
| Which extrapyramidal syndrome is described as involuntary movement due to excess neuronal activity in one area as a result of unopposed activity in another area? |
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Definition
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|
Term
| Which extrapyramidal syndrome is described as tremor occurring at rest but disappearing with voluntary movement? |
|
Definition
|
|
Term
| Which extrapyramidal syndrome is described as an intension tremor that increases with voluntary movement? |
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Definition
|
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Term
| Which extrapyramidal syndrome is described as a smooth constant resistance to forceful stretching? What condition is this a feature of? |
|
Definition
|
|
Term
| Which extrapyramidal syndrome is described as a movement that may start as an intentional movement but normal progression is lacking and the movement is disorganized? |
|
Definition
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|
Term
| Which extrapyramidal syndrome is described as involuntary movements combined with instability of posture, slow, rhythmic, writhing, worm-like movements that occur in upper extremities (hands and fingers)? |
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Definition
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|
Term
| Which extrapyramidal syndrome is described as sustained muscle contractions of larger axial muscles causing abnormal postures and involuntary twisting and other repetitive movements, voluntary movements are also seriously impaired and the entire body may go into painful full body spasms? What med is this condition common with? |
|
Definition
| Dystonia; Common with Compazine |
|
|
Term
| Which extrapyramidal syndrome is described as involuntary violent movement of a large body area (entire leg, shoulder, pelvic girdle), usually occurring unilateral and often is fatal? |
|
Definition
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|
Term
| Which extrapyramidal syndrome is described as general term to describe abnormal involuntary movements seen in multiple disorders including Huntington's, Tourette's, Parkinson's and others? |
|
Definition
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|
Term
| What condition is characterized by symptoms including rhythmic tremors, cognitive/behavioral deficits, bradykinesia, rigidity, sleep disorders, loss of postural reflexes (DTRs affected), speech difficulties and micrographia? |
|
Definition
|
|
Term
| Where is the defect of a Parkinson's patient? |
|
Definition
| a defect in the dopaminergic pathway that connects the substantia nigra to the corpus striatum (basal ganglia) |
|
|
Term
| Where is dopamine first released? |
|
Definition
|
|
Term
| What is the HALLMARK of Parkinson's Dx? Where is it found? |
|
Definition
| Lewy Bodies found in the substantia nigra |
|
|
Term
| With a defective Parkinson's gene, what doesn't occur? What does this lead to? |
|
Definition
| Cell Death does not occur; synuclein accumulates in Lewy bodies and a build up of fibrin tissue occurs |
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Term
| What factor has been found to increase the build-up of synuclein and may explain the co-existence between Alzheimer's and Parkinson's Dx? |
|
Definition
|
|
Term
| How do you tx Parkinson's Dx with? What is important about the dosing? |
|
Definition
| Dopaminergic drugs (Sinemet - combo of Carbidopa and levodopa); Needs high doses b/c it doesn't cross the BBB additionally you will have to increase the doses over the time of the treatment |
|
|
Term
| What type of resting tremor is characteristic of Parkinson's disease? When can these tremors be increased? |
|
Definition
| "Pill Rolling" movement; Increased with fatigue and emotional stress |
|
|
Term
| Describe the walking posture and movements of a Parkinson's pt. |
|
Definition
Forward tilt of trunk
Reduced arm swing
Masked Facies (Expressionless Face)
Shuffling gait with short steps
Rigidity and trembling of extremities and head
Turning "en bloc" |
|
|
Term
| What is one of the most common neurologic disorders affecting young patients, especially women? |
|
Definition
|
|
Term
| What is the cause of Multiple Sclerosis? |
|
Definition
| Autoimmune attack on myelin sheath of CNS neuron that is thought to be triggered by a virus or environmental toxin. |
|
|
Term
| What are some precipitating factors of Multiple Sclerosis? |
|
Definition
Pregnancy
Infection
Emotional Stress
Injury |
|
|
Term
| What sx is the most common presenting symptoms in pts with Multiple Sclerosis? |
|
Definition
| Visual disturbances (including diplopia, blurred vision, blind spots, unilateral vision loss for hrs to days, nystagmus) due to Optic Nerve Tract destruction |
|
|
Term
| What are some sensory disorders characteristic of MS? |
|
Definition
Paresthesias
shocklike sensations down neck and spinal chord
proprioception disorders
Vibratory sensation diminished |
|
|
Term
| What are some mood disorders associated with MS? |
|
Definition
Euphoria
Memory Loss
Dementia |
|
|
Term
| What type of lesions in MS are irreversible? |
|
Definition
| lesions occurring in the white matter of the CNS |
|
|
Term
|
Definition
Syptomatic Meds (ACTH, Immunosuppressants, and glucocorticoids)
Plasmapheresis (has been shown to slow the deterioration of MS) |
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