Patho nervous system.

Question 1

Which disorder causes buldging of the optic disc due to increased intracranial pressure?

Answer 1

Papilledema

Question 2

A positive planter reflex is known as a …

What does it indicact in adults?

Answer 2

Babinsky reflex. It causes the toes to fan out.

It indicates damage to the CNS.

Question 3

Do Epidural Hematoma cross the Suture Line?

Answer 3

No

Question 4

Do Subdural Hematoma cross the Suture Line

Answer 4

Yes

Question 5

What is the classic sign of an epidural hematoma? Described it in detail

Answer 5

Temporary loss of consciousness after trauma but regains it shortly after. The consciousness period is called a lucid interval and is usually followed by another loss of consciousness that leads to a coma resulting in death.

Question 6

What runs in the epidermal space?

Answer 6

The meningeal arteries.

Question 7

Are epidural hematomas formed slowly or quickly? Why?

Answer 7

Quikly because they involve the meningeal arteries

Question 8

Are subdural Hematomas formed slowly or quickly?

Answer 8

Slowly because they involve venous blood.

Question 9

A patient complains of blurred vision, tingling sensation in left hand for the same duration of time, an unsteady gait, mild tremor, speech not affected but she seems to have trouble concentrating. Brain MRI reveals small lesions in the white matter … What is the presumptive diagnosis

Answer 9

Multiple sclerosis.

Question 10

What is Multiple sclerosis? What happens?

Answer 10

An autoimmune disease. Auto-antibodies bind to and causes destruction of the mylin sheath in the CNS

Question 11

What does Microscopic examination of multiple sclerosis lesions show?

Answer 11

Inflitrations of neural tissue w/ lymphocytes and macrophages and a markedly low number of oilgodendrocytes.

Question 12

What is the consequence of demylination?

Answer 12

It impairs the conductin of action potentials down the axons, producing the S/S of mutliple sclerosis.

Question 13

Why are the signs and symptoms of MS so varied?

Answer 13

No, they wax and wane. No rhyme or reason to which neurons are affected. Can be sensory or motor, or both. Can wax and wane: patchy and fluctuate. relapse and remission.

Question 14

What does a progressive disease mean and is MS one?

Answer 14

Yes, a disease that gets worse with time.

Question 15

What is the age of onset for MS?

Answer 15

In the 20s and 30s. It is insidious, meaning that it can slowly creep up on you w/o noticing it.

Question 16

Give the different steps in the Expanded Disability Status Scale.

Answer 16

1. No disability.
2. Moderate disability in one system or mild disability in up to 4 systems. No impairment to walking
3. Disability severe enough to impair full daily activities. Able to walk w/o aid for 200m.
4. Requires a walking aid, cane, cruth, etc- to walk 100m.
5. 5 Unable to take more than a few steps. Restricted to wheelchair.
6. 0 Confined to bed. Can still communicate and eat.
7. Death

Question 17

Chief complaint stumbling when he walks. He seems depressed and says that lately he just hasn’t been himself and has not been able to take care of business as usual. Denies any pain. A complete neurological examination reveals motor deficits in both upper and lower extremities. Foot drop is present. Some reflexes are very brisk and the muscles of his hands are somewhat stiff. A positive Babinsky reflex. No sensory abnormalities are found. Laboratory studies and brain MRI are normal and help rule out many possible disorders of the nervous system. Electromyography and nerve conduction studies confirm a diagnosis of ——-
A few months after initial visite… unable to walk, drooling constantly and his speech has become gargled and very weak. Quickly deteriorates and dies within a year of the onset of the disease.

Answer 17

ALS Amyotrophic Lateral Sclerosis.

Question 18

What does Amytrophy, Sclerosis and Lateral sclerosis mean?

Answer 18

Amyotrophy: atrophy of muscles
Sclerosis : scar tissue formation
Lateral sclerosis: scar tissue that replaces dying neurons in the lateral columns of the spinal cord.

Question 19

What happens to the skeletal muscles that ere innervated by the dying neurons?

Answer 19

They weaken and begin to atrophy or shrink.

Question 20

What is the pathogenesis?

Answer 20

Unknown but perhaps due to aggregation of misfolded proteins.

Question 21

What are the diseases that involve aggregation of misfolded proteins?

Answer 21

Alzheimer’s, Parkinson’s and Huntington’s disease.

Question 22

What are the initial Signs and progression of Amyotrophic Lateral sclerosis.

Answer 22

It is a rapidily progressing disese.

Most common initial signs are stumbling and dropping objects for no apparent reason.

Some patients may notice symptoms related to speech or swallowing.

Psychological and congitive deficits may also be present.

Question 23

Most common initial symptoms?

Answer 23

Upper or Lower extremity symptoms.

Question 24

Minority of patients will notice symptoms ….

Answer 24

relating to speech and or swallowing at first.

Question 25

What are the hallmarks of ALS?

Answer 25

Motor Deficits.

Question 26

Which neurons innervated skeletal Muscles? and where are thery cell bodies located?

Answer 26

Somatic motor neurons. The cell bodies of the Lower Motor Neurons are located in the brain stem and the anterior horns of the spinal cord.

Question 27

What is a specific name for theses somatic motor neurons that innervate skeletal muscle? and where do they extend their axons to?

Answer 27

Lower Motor neurons. Neuromuscular Junction.

Question 28

What controls these neurons?

Answer 28

Upper Motor neurons, they are neurons that are located upstream to the Lower motor neurons and are entirely in the CNS.

Question 29

Where are the majority of the cell bodies of the upper motor neurons located and describe the pathway of their tracts.

Answer 29

Majority of the Cell bodies of the upper motor Neurons are located in the PRE-CENTRAL GYRUS, motor cortex and the tracts extend down to the Medulla oblongata where they cross over to the opposite side, pyramidal decussation to the contralateral side. They continue to the spinal coard and to the lateral corticospinal tract until they synapse with the lower motor neurons at the appropiate level of the spine.

Question 30

Where are another set of motor neurons found that are responsible for planning and co-ordination of the upper motor neurons and lower motors neurons?

Answer 30

PRE - FRONTAL CORTEX

Question 31

UMN Disease has the following symptoms?

Answer 31

Spasticity, stiffness, brisk reflexes and mild weakness

Question 32

LMN disease has the following symptoms?

Answer 32

EXtreme muscle weakness, atrophy and loss of reflexes and muscle tone.

Question 33

Can a patient with ALS have be effected in Upper Motor Neurons or the Lower Motor neurons or Both at the same time.

Answer 33

Both. Upper and Lower motor neuron signs can actually coexist.

Question 34

What does the normal Planter Reflex rely on? What is normal planter reflex? Describe and name an abnormal planter reflex.

Answer 34

On an uninterrupted CORTICOSPINAL TRACT. | In adults, toes fans down. An abnormal planter reflex, the toes fan out. This called a positve Babinski sign.

Question 35

What does a Postive Babinski sign indicate?

Answer 35

A upper motor neuron disease.

Question 36

What is Paresthesia?

Answer 36

Sensory abnormalites such as pain, itiching or numbness.

Question 37

Does paresthesia accompany his motor deficits?

Answer 37

No, but as the disease progress the stiffness and spasticity of his muscles and joints may cause pain. Not a primary abnormality in ALS.

Question 38

Is ALS a purely motor disease?

Answer 38

Yes

Question 39

What are the names of the four regions of the body affected by ALS.

Answer 39

Bulbar: refers to the medulla oblongata. Neurons that innervate 1 muscles of facial expression, muscles of 2mastication or swallowing, and 3 muscles of vocalization. If this region is affected patient will have problems swallowing, chewing, and speaking. Cervical Region of the spine: the motor deficits in the arms. Thoracic Region: Neurons of the thoracic region of the spine -->There will be truncal weakness and motor deficits in the respiratory muscles of the chest-->difficulty in breathing. Lumbosacral region : Neurons of the lumborsacral region is affected --> motor deficits will be seen in the feet and legs.

Question 40

What is Alzheimer's

Answer 40

A common neurodegenerative disease.

Question 41

What is the most common form of dementia?

Answer 41

Alzheimer's, more than half the cases of dementia

Question 42

What is Dementia?

Answer 42

A progressive, irreversible cognitive decline

Question 43

Aphasia?

Answer 43

Inability to use language

Question 44

Apraxia?

Answer 44

Inability to perform previously learned skills, like drinking from a cup or tying one's shoes.

Question 45

Agnosia?

Answer 45

Inability to recognise people and objects

Question 46

What is the progression of Alzheimer's

Answer 46

Mild short term memory lost, progresses to interfere with one's daily activities as Aphasia, Apraxia, and agnosia.

Question 47

What are the psychological and emotional disturbances of Alzheimer's disease or dementia?

Answer 47

Irritability, Anxiety, Depression, Paranoia

Question 48

What are the two histological hallmarks of AD

Answer 48

Beta-Amyloid plaques and Neurofibrillary tangles

Question 49

What are Beta Amyloid plaques?

Answer 49

Abnormal extra cellular aggregations of a piece of a normal membrane protein called Amyloid precursor protein or APP that gets cleaned off by an enzyme. The cleaved part is called Beta amyloid protein and they form the senile plaques or the Beta Amyloid plaques.

Question 50

Are Beta amyloid plaques seen in individuals w/o Alzheimer's?

Answer 50

Yes

Question 51

Are the Beta amyloid plaques markers or causes of Alzheimer's?

Answer 51

Don't know yet ...

Question 52

What do we know for certain about beta amyloid plaques?

Answer 52

People w/ Alzheimer's disease have more Beta amyloid plaques especially in the parts of the brain involved in memory, planning and cognition.

Question 53

What are Neurofibrillary Tangles?

Answer 53

Abnormal aggregations of a normal protein, Tau.

Question 54

What is the function of Tau?

Answer 54

It stabilises the intercellular proteins of the microtubules.

Question 55

What is one role of the microtubules?

Answer 55

Provides structure for the cell and allows for the transport of material up or down the axons between the cell body and the axon terminals.

Question 56

What happens to the neuron when the tau proteins aggregate in abnormal tangles ?

Answer 56

i. Neuron will not be able to release its neurotransmitters | ii. Its metabolism will be affected and it will die.

Question 57

Is cerebral atrophy present in Alzheimer's?

Answer 57

Yes.

Question 58

Where are most of the damaged neutrons located in AD? What is the consequence of thisP

Answer 58

In the hippocampus, the area of the brain that is responsible for consolidation of memory. Memory loss.

Question 59

Is the memory loss of AD pervasive?

Answer 59

Yes and will include familiar people, familiar objects and familiar tasks.

Question 60

Does research show any genetic mutation responsible for Alzheimer's disease. What are the factors that play a role in the pathogenesis of Alzheimer's disease.

Answer 60

Yes. There are several genes whose mutations leads to alzheimer's disease. Environmental factors also play a role.

Question 61

How do you dx AD. What is the prognosis.

Answer 61

Taking a careful history of the patient and preforming a mental status examination. Prognosis is poor. Fatal condition within a few years of its onset.

Question 62

What is the name of mental status examination?

Answer 62

Mini-Mental State Examination. (MMSE)