Class 17 - Alterations in Neuro: Stoke, Tumours, Infection, Seizures Flashcards
Parkinson’s Disease
Severe degeneration of substantia nigra (part of the basal nuclei) resulting in a decrease in the neurotransmitter dopamine
Secondary Parkinsonism - similar to Parkinson’s but caused by trauma, infection, drugs (antipsychotics, antiemetics)
Both result in a syndrome of abnormal movement called Parkinsonism “Trap”
Tremor - At rest, unilateral bilateral
Rigidity
Akinesia or bradykinesia - no/slow initiation of movement
Postural distrubances
Autonomic and neuroendocrine symtpoms
- Abnormal sweating
- Constipation
- Urinary retention
- Orthostatic hypotension
Cognitive-affective symptoms
- Concentrating
- Sleeping
- Excessive fatigue
- Depression
Incidence
- Onset after 40, peak between 58-62
- Slightly more men than women
Diagnosis
- History and physical examination
- Drug trial: if it get’s better on medication, it’s Parkinson’s
Treatment:
- Drug therapy to decrease symptoms
- Increase dopamine levels and or block Ach
- Deep brain stimulation
- Stem cell transplantation
Delirium
Acute confusional state
- Elderly population
- Can be due to bladder/respiratory infection
- Reversible
- Functional in nature - due to drug and or alcohol withdrawal, medication adverse effects, sepsis, fever, pain etc
- Develops over 2-3 days
- Can be treated/reversed
Dementia
Progressive and irreversible
- Impaired memory, reasoning, judgement and language
- Behavioural changes
- Supportive treatment only
Associated with Parkinson’s disease, CNS, infection and atherosclerosis
Types
- Alzheimers
- Fronto-temporal dementia
- Creutzfeldt-Jakob disease
- Vascular dementia
- Dementia with Lewy bodies
Alzheimer’s Disease
Most common type of dementia, over 50%
4th leading cause of death in Canada
Affects 15% of the general population over 65 years of age
Pathophysiology
- Amyloid (senile) plaques made of amyloid beta protein
- Neurofibrillary tangles made of tau protein
- Degeneration of cholingeric neuron (atrophy, loss of Ach)
Manifestations
- Early - forgetfulness, memory loss, missing appointments, getting lost, personality changes (emotional upset, flat affect, no sense of humor)
- Later - language impairment, disorientation, confusion, lack of concentration, decline in absraction, problem solving and judgement, hygiene neglect, wandering
- Sundown syndrome. Manifestations get worse at night
- People with Alzheimer’s can’t backtrack or remember where they came from - End stage - incontinence, apathy, loss of interest in food, can’t recognize family and friends
Diagnosis
- By ruling out other causes of dementia
Multiple Sclerosis
Acquired chronic demyelinating disease of the white matter within the CNS.
Onset is young adulthood
Disrupted nerve conduction with death of neurons and brain atrophy
Prevalence
- Increased in northern latitudes
- Women affected twice as much as men
- Northern European ancestry
Autoimmune disease
- T cells and B cells cross the BBB
- Inflammation induced loss of oligodendrocytes (secrete myelin sheath in the CNS)
Manifestations
- Depends what part of the CNS is being affected
- Could be visual impairments, sensations, weakness, bowel/bladder, mental changes, depression, paranoia, muscle spasms
Diagnosis:
- History and physical exam
- MRI
- Evoked response studies (stimulating and waiting for a response)
- Elevated IgG in the CSF (autoimmune)
Treatment
- Medications to reduce relapses
- Symptom management therapies (bladder, bowel, fatigue, pain)
- Treatments in development (stem cells)
Glaucoma
Increased pressure in the posterior chamber of the eye puts pressure on the optic nerve. Nerve is deprived of oxygen
Second most common cause of blindness
Risk factors:
- Far sightedness
- Age over 60
- History of eye injuries or infection
- African descent, Asian, Hispanic
Caused by:
- The failure of aqueous humour to drain properly. This occurs when the canal of schlem is blocked.
- Open angle: occurs with eye infection, age or debris. Slow progression over months or years
- Closed angle: acute, short term, lens will push iris forwards and will block off the drainage area. More common in Asian and Inuit ancestry
Management
- Early recognition and screening
- Check peripheral vision with lights
- Testing pressure in your eye with a puff of air
- Medication to decrease fluid (reduces the production of aqueous humour)
- Surgery (used to clear discharge
Cataracts
Cloudiness of the lens
Can have glaucoma and cataracts
Risk factors
- Diabetes
- Old age
- Genetics
- Sun exposure
Manifestations
- Cloudy/foggy vision
- Appearance of the eye is cloudy
Treatment
- Surgery
Macular Degeneration
Degeneration of the central part of the retina (macula)
Risk factors
- Age
- Smoking
- Obesity
- Low intake of: lutein, omega 3 fatty acids, zinc, vitamins A, C, E
- Genetics
Hearing Loss in Children
Risk factors
- If the mom had rubella during pregnancy
- Premature
- Traumatic deliveyr
- Ototoxic
- If they have hearing deficiency, speech patterns will be impacted
- If they don’t respond to a startling sound, it may be a sign of hearing loss
Diagnosis
- Tympanogram: tests the flexibility of the ear drum
- Audiography: tests different pitches, sounds, phrases
- Weber and Rinne tests: uses a tuning fork
Conductive Hearing Loss
Changes in the outer and middle ear affects the ability of sound to travel to the inner ear
Can be anything that interferes with the conduction of sound waves
Causes
- Ear infection
- Foreign bodies
- Tumors
Manifestations
- Decreased hearing
- Soft voice
Middle Ear Infection: Otitis Media
Risk factors:
- Prematurity
- Day care
- Older siblings who bring home infections
- Second hand smoke
Types
- Acute Otitis Media. Inflammation 5 signs
- Otitis Media with Effusion (with fluid, no inflammation)
Treatment
- Vaccines to prevent
- Acetaminophen
- Antibiotics are NOT effective
- Myringotommy (a small incision in the tympanic membrane)
- Tymapnostomy (insertig a small tube)
Sensorineural Hearing Loss
Impairment of the part of the inner ear, or auditory nerve (Cranial Nerve VIII)
- Issues with cochlea, auditory nerve, inner ear
Causes
- Age (presbycusis)
- Loud noises
- Drugs (lots of aspirin)
Manifestation
- High-tone hearing loss
- Tinnitus (ringing in the ear)
