Neuropathophysiology

Question 1

What is a stroke?

Answer 1

A disruption of the blood supply to a part of the brain

Question 2

Ischemic vs haemorrhagic

Answer 2

Ischemic: blockage
Haemorrhagic: blood vessel bursts

Question 3

What are the risk factors for a stroke (12)

Answer 3

Hypertension
Atrial fibrillation
Smoking
Diabetes
High cholesterol
Age
Gender
Diet
Excessive alcohol 
Obesity
Lack of exercise
Birth control

Question 4

What is a common cause of an ischemic stroke?

Answer 4

atherosclerosis

-plaque (easy for clot to form)

Question 5

What are 2 examples of clots forming outside of the brain

Answer 5

• DVT

- Atrial fibrillation

Question 6

List the symptoms of a stroke (6)

Answer 6

Severe headache
Vision change
Dizziness
Swallowing difficulties
Confusion/ speaking difficulties
Numbness/ Weakness

Question 7

What does motor cortex damage lead to?

Answer 7

Paralysis on the opposite side

Question 8

What does sensory cortex damage lead to?

Answer 8

Partial loss of sensation on arm and leg (opposite side)

Question 9

Explain a transient ischemic attack (TIA)

Answer 9

• Mini stroke
• few seconds < 24hrs
• hidden problem with blood flow

Question 10

What is the F.A.S.T. test?

Answer 10

F.ace (droopy smile)
A.rms (one side can’t life)
S.peech (slur/repeat)
T.ime critical (brain damage)

Question 11

What is the treatment for an ischemic stroke?

Answer 11

Aspirin: within 48hrs w/ clopidogrel (blood thinner)
Thrombolytics (tpa)
Heparin iv
Warfarin (maybe)

Question 12

What is brain herniation?

Answer 12

• Increased IC pressure pushes brain out of position

- Brain tissue compressed against bone or rigid folds

Question 13

What are symptoms of brain herniation?

Answer 13

Compression of oculomotor nerve

• Disabled eye movement
• Drop of eyelid + pupil dilation
• Brain stem hernia = death

Question 14

What is the management of a haemorrhage stroke?

Answer 14

• Airway management
• Avoid constipation
• Correction of coagulopathies
• Blood pressure management
• Surgery (maybe)

Question 15

What drugs are used for stroke prevention?

Answer 15

• ACE inhibitors (control HBP)
• Statins (lower blood cholesterols)
• Aspirin (blood thinner)

Question 16

What surgery can assist with stroke prevention?

Answer 16

Carotid endarterectomy
Angioplasty (Stent)
For aneurysm: clipping/ coiling

Question 17

What are the two primary traumatic brain injury types?

Answer 17

Focal (deep cut/ bruise): single location

Diffuse (concussion/ axonal injury (tearing))

Question 18

What are 4 secondary traumatic brain injuries?

Answer 18

Increased IC pressure
Ischemia
Edema
Infection

Question 19

What is a contusion?

Answer 19

A bruise to cortical surface of brain (primary focal injury)

- Can have permanent damage

Question 20

Why can contusions cause permanent damage?

Answer 20

Bruised dead tissue is phagocytized –> scarring

Question 21

What is a concussion?

Answer 21

brief loss of brain function (primary diffuse injury)
-Recovery: 24 hrs
Symptoms may last

Question 22

What is a diffuse axonal injury?

Answer 22

Primary diffuse injury

(stretch/ tear of nerve cell) Microscopic damage to axons in cerebral hemi, corpus callosum, brain stem

Question 23

What is responsible for most causes of post traumatic dementia?

Answer 23

Diffuse axonal injury

Question 24

What is a hematoma?

Answer 24

When blood leaks from a blood vessel

-If removed before loss of consciousness prognosis is good

Question 25

What are risk factors for Alzheimer's disease

Answer 25

- Genetics - Smoking - Type 2 DM

Question 26

Explain alzheimer's disease

Answer 26

- Irreversible - Tau abnormal proteins (beta amyloid plaques) accumulate outside neurons - Ach neurons affected - Progressive shrinkage of cerebral cortex (frontal + temporal lobes) - Grey matter (cell bodies) disappears

Question 27

Which lobe shows no change in alzheimers

Answer 27

Occipital

Question 28

What are the stages of alzheimers disease?

Answer 28

1. Short-term memory loss 2. Confusional stage 3. Incontinence, can't recognise people, loss ability to speak

Question 29

How do you manage alzheimer's disease (5)?

Answer 29

-Cholinesterase inhibitors (donepezil) -NMDA blocks (memantine) (reduce effects of glutamate) -Vitamin E (slow degenerative process) - Anti-inflammatories, activin A (promote stem cell regeneration) - Some coffee/ alcohol

Question 30

What is parkinson's disease

Answer 30

Selective deterioration of Dopamine in basal ganglia/ nuclei -Increase in cholinergic activity --> causes hypertonia (stiff) + involuntary movement

Question 31

What are the symptoms of parkinsons?

Answer 31

- tremor - pill rolling tremor - rigidity - stooped posture - akinesia (difficulty initiating movement) - braykinesia (slow movement) - Dementia

Question 32

How do you manage parkinsons (5)?

Answer 32

- Increase dopamine levels (Levodopa) - Carbidopa (inhibit breakdown of dopamine) - Amantidine (release of dop) - Pergloide + bromocriptine (agonists) - Deep brain stimulation