The CNS Flashcards
(253 cards)
1
Q
What is the etiology of meningitis in adults?
A
Streptococcus pneumoniae
Neisseria meningitidis
2
Q
What is postural instability?
A
an impairment of postural reflexes that cause a feeling of imbalance and a tendency to fall
3
Q
What is the risk factor for myelomeningocele?
A
folate deficiency during the first several weeks of gestation
4
Q
What are gliomas?
A
primary brain tumors that display histological features of glial cells; they generally effect the cerebral hemispheres
5
Q
What is large artery, low flow TIA associated with?
A
tightly stenotic atherosclerotic lesions
6
Q
What is an epidural hematoma?
A
occurs after blunt trauma and results from disruption of the middle meningeal artery and vein
7
Q
What are the two parts of the central nervous system (CNS)?
A
The brain
Spinal Cord
8
Q
What is loss of brain structural integrity mediated by?
A
release of various proteases, particularly the matrix metalloproteases (MMP)
9
Q
Why does a patient with meningitis get a stiff neck?
A
flexion of spine leads to stretching of meninges
traction on the inflamed meninges is painful, resulting in limited range of motion through the cervical spine
10
Q
What does tau cause?
A
inflammatory response
11
Q
What is Chronic Traumatic Encephalopathy (CTE)?
A
a dementing illness that develops after repeated head trauma
12
Q
What are the causes of intracranial hemorrhage?
A
hypertension/vascular wall injury
structural lesions
tumors
13
Q
What causes periventricular leukomalacia?
A
decreased oxygen/blood flow in teh periventricular region of the brain
Damage to the glial cells
14
Q
What is aseptic meningitis caused by?
A
viruses
15
Q
What happens when cerebral blood flow is 25 mL/100gm/min?
A
onset of anaerobic glycolysis
Tissue acidosis
16
Q
What are the leptomeninges?
A
pia and arachnoid mater
17
Q
What is the function of the spinal cord?
A
conducts signals to and from the brain
controls reflexes
18
Q
What are the consequences of hydrocephalus in children and adults?
A
expansion of the ventricles and increased ICP
19
Q
What is multiple sclerosis (MS)?
A
a heterogenous disorder with variable clinical and pathologic features; DEMYELINATION DISORDER; starts as autoimmune disorder
20
Q
What cerebrosvacular disease classes can cause Transient Ischemic Attack (TIA) or Ischemic stroke?
A
process occurs in the vessels
Process originates remotely
Process results from inadequate cerebral blood flow
21
Q
What is Bacterial Meningitis?
A
infection of the arachnoid mater and the CSF in both the subarachnoid space and cerebral ventricles
22
Q
What are the cardinal clinical symptoms of Alzheimers?
A
MEMORY IMPAIRMENT
executive function and judgement/problem soloving
behavioral and psychological symptoms
23
Q
What does a myelomeningocele cause?
A
damage to the spinal cord and nerves
physical and intellectual disabilities
24
Q
What causes the loss of brain structural integrity of brain tissue and blood vessels?
A
cerebral ischemia and infarction
25
What is the etiology of cerebral palsy?
prenatal factors and peri/postnatal factors
| Prematurity
26
What is meningoencephalitis?
inflammation of the meninges and brain parenchyma
27
What happens when cerebral blood flow is 11 mL/100 g/min?
membrane failure and cell death
28
What is the presymptomatic period of Alzheimers Disease?
between onset of biochemical changes in the brain and the development of clinical symptoms of AD
due to genetic mutations in APP, PSEN1 and PSEN2
29
What is the pathophysiology of Traumatic Vascular Injury?
injured cerebral microvasculature causing MICROTHROMBI and NEURONAL DEATH
BBB disruption, edema and FOCAL ISCHEMIA
Bridging veins being stretched in elderly
30
Brain contusion on the opposite side of brain impact are?
Contrecoup
31
What initiates most activities of the nervous system?
sensory experiences exciting sensory receptors
32
What causes vasogenic edema?
BBB disruption and increased vascular permeability
33
What is the risk factors for meningiomas?
prior radiation therapy to the head and neck; increased incidence with age
34
What is the pathogenesis of MS?
1) inflammatory immune mediated disorder with autoreactive lymphocytes
2) microglia form complex with activated T cells causing destruction of the myelin and oligodendrocytes
3)
35
What causes sporadic onset of Alzheimers Disease?
APOE epsilon 4 mutation which inhibits the clearance of amyloid beta protein
36
What is cerebral autoregulation?
cerebral flow is maitained at a relatively constant level regardless of moderate variations in perfusion pressure
37
What two stroke types have athersclerotic risk factors?
Ischemic Thrombotic and Ischemic Embolic
38
What happens to the penumbra of the brain when blood flow is decreased to it?
has potential to recover because it is only undergoing apoptosis because some ATP is available
39
What is meningitis?
inflammation of the leptomeninges within the subarachnoid space
40
What are the steps of Wallerian Degeneration?
1) swelling in distal axon
2) neurofilaments hypertrophy
3) myelin sheath shrinks and disintegrates
4) axon degenerates and disappears
41
What GCS score is considered mild TBI?
13-15
42
What is the most important role of the nervous system?
control various bodily activities
43
What is a concussion/Acute Mild TBI?
GCS between 13-15 measured at approximately 30 minutes after the injury; altered mental state with or without LOC
44
What is the cause of Dismyelination?
genetics; abnormally produced myelin
45
What GCS score is considered moderate TBI?
9-12
46
What happens when autoregulation fails?
cerebral vasodilation and cerebral edema
47
The magnitude and distribution of a traumatic brain lesion depends on what three things?
the shape of the object causing the trauma
the force of impact
whether the head is in motion at the time of injury
48
What are the three mechanisms of TIA?
large artery, low Blood flow TIA
Embolic TIA
Lacunar or small penetrating vessel TIA
49
What is the pathogenesis of Meningitis?
1) Cytokine production
2) increased BBB permeability
Altered cerebral blood flow
increased ROS
3) neuronal damage, increased ICP, and cerebral edema
4) Clinical presentation of meningitis
50
What causes cytotoxic edema?
hypoxia/ischemia
51
What is Clinically Isolated Syndromes (CIS) of MS?
first attack of disease; patient hasn't had any other symptoms and there are no lesions
52
How does DAI develop?
tissue shearing at interface of grey and white matter
53
What is the most common type of TBI?
Diffuse Brain Injury (DBI)
54
What are the most common tumors of the brain?
Gliomas
55
What is Parkinson's Disease?
progressive neurodegenerative disorder in which dopamine is lacking
56
What is the function of the Cerebellum?
muscle tone, posture, and balance
57
What is the etiology of CTE?
repeated concussions
58
What occurs at the proximal end of the severed axon?
similar degeneration occurs but only back to the next node of ranvier
59
What is periventricular leukomalacia (PVL)?
necrosis of the white matter near the lateral ventricles that occurs most often in premature infants
60
What causes hydrocephalus?
reduced flow or decreased resorption of CSF
61
What are the clinical features of Metastatic brain tumors?
headache the will worsen due to Increased ICP
| Seizures
62
What is periventricular white matter?
the white matter adjacent to the ventricles
63
What causes brain stem neurologic abnormalities?
Chiari malformation
64
What types of cerebral palsy would occur if children with prematurity survive?
Periventricular Leukomalacia (PVL)
Intraventricular Hemorrhage
Bronchopulmonary Dysplasia
65
What areas of the brain have sensory areas?
```
All levels of Spinal Cord
Medulla
Pons
Mesencephalon
Cerebellum
Thalamus
Areas of Cerebral Cortex
```
66
What are upper motor neuron symptoms of ALS?
weakness with slowness
hyperreflexia
spasticity
67
The consequences of CNS trauma depend on what two things?
the location of the lesion
| limited repair
68
What is associated with severe cognitive dysfunction?
Presence of placques and tangles
69
What is the function of the astrocyte foot in the BBB?
allows small and lipophilic molecules (like alcohol) to cross
Allows water uptake
Contributes to brain swelling
70
What are the two major types of Cerebral Edema?
Vasogenic and Cytotoxic
71
What are the four main disease patterns of MS?
```
Clinically Isolated Syndromes (CIS)
Relapsing Remitting (RR)
Secondary Progressive (SP)
Primary Progressive (PP)
```
72
What does Wallerian degeneration cause?
scar formation
73
What are the motor functions of the nervous system?
Contraction of SKELETAL and SMOOTH (organs) Muscle
Secretion of chemical substances by exocrine and endocrine glands
74
How does sensory information enter the CNS?
by peripheral nerves
75
Why does a patient with meningitis have fever?
cytokines affect the thermoregulatory neurons of the hypothalamus
invading pathogens produce pyrogens that can reset the hypothalamic thermal set point
76
How do astrocytes react to acute nerve injury?
cellular swelling
77
What is the etiology of meningiomas?
abnormal chromosome 22
78
What is caused by severe global cerebral ischemia?
BRAIN DEATH including irreversible cortical injury and brainstem damage
79
What are the three major levels of CNS Function?
Spinal Cord Level
Subcortical/Lower Brain Level
Higher Brain/Cortical Level
80
What is traumatic brain injury (TBI)?
a heterogenous disease determined by the Glasgow Goma Scale
81
What are the areas of CNS affected by MS called?
placques or lesions
82
What is a myelomeningocele?
cleft in the vertebral column with a corresponding defect in the skin so that the meninges and spinal cord are exposed
83
What are neurons?
The brains immune cells; protect brain from injury and disease
84
What is ischemia?
Decrease in blood flow to the brain
85
What is the pathophysiology of Bacterial Meningitis and what is it called?
1) pathogen penetration
2) NF-kB activation
3) leukocyte transmigration that occur at the BBB
Mechanistic TRIAD
86
What is cerebrovascular disease?
pathophysiological process involving the blood vessels of the brain
87
What is the pathophysiology of a concussion/Acute Mild TBI?
direct external contact forces or from the brain being slapped against intracranial surfaces with acceleration/deceleration trauma
88
What grade are primary tumors?
Grade 1 or 2
89
What is the function of the cerebral cortex?
performs associative activities such as thinking, learning, and remembering
90
What is lacunar/small penetrating vessel TIA induced by?
stenosis
91
What causes hypoxia?
low a low partial pressure of oxygen
Impaired oxygen carrying capacity
Toxins that interfere with oxygen use
92
In what area of the severed axon does Wallerian degeneration occur?
the distal axon
93
What causes Diffuse Brain Injury (DBI)?
impact, acceleration, and deceleration forces
94
What grades are malignant or high grade tumors?
Grade 3 or 4
95
What is herniation?
the displacement of brain tissue past dural folds or through openings in the skull
96
What is Focal Cerebral Ischemia?
reductino or complete blockage of blood flow to a LOCALIZED area of the brain; cerebral arterial occlusion leads first to focal ischemia and then to infarction
97
What is Amyotrophic Lateral Sclerosis (ALS)?
persistently progressive neurodegenerative disorder causing:
Muscle weakness
disability
Eventually death
98
What are the clinical outcomes of global cerebral ischemia?
transient confusional state to irreversible damage to CNS tissue
99
What is TIA?
a TRANSIENT episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia WITHOUT ACUTE INFARCTION
100
What is the pathogenesis of Alzheimer's Disease?
amyloid precursor protein (APP) is cleaved by beta-secretases and gamma secretases
PSEN1 and 2 mutations cause production of amyloid beta
Tau is hyperphosphorylated and aggregates
101
Why does a patient with meningitis have nausea and vomiting?
increased ICP stimulates the vomiting center
102
What is primary brain damage after ICH?
Tissue dysruption
Mechanical damage due to mass effect
Elevated ICP
These cause damage to the BBB and cerebral edema
103
Name the cells of the Nervous system
Neurons
| Neuroglia
104
What are the three stages of compensation during presymptomatic period of Parkinsons?
1) early period = dopamine homeostatic mechniams capable of masking the disease
2) increased activity of basal ganglia
3) increased intensity of compensation in motor cortex as parkinsonian motor abnormalites emerge
105
What is the function of the brain?
```
Receives and Processes Sensory Info
Initiates Responses
Memories
Thoughts
Emotions
```
106
What tumors commonly metastisize to the brain?
```
Lung
Skin (melanoma)
Breast
Kidney
GI tract
```
107
What are the causes of Focal Cerebral Ischemia?
Embolic infarctions and thrombotic occlusions
108
What limits the regeneration of axons in the CNS?
increased incidence in scar formation
Different nature of myelin formed by the oligodendrocyte
109
What is cytotoxic edema?
potentially REVERSIBLE increase in INTRACELLULAR fluid SECONDARY TO neuronal, glial, or endothelial membrane INJURY
110
What is the effect of the scar formation from the Wallerian degeneration?
blocking of passage of neuronal impulses
111
What is secondary brain damage after ICH?
thrombin activation
lysis of RBCs causing release of hemoglobin--> heme and iron by oxidative stress
Inflammatory reaction --> release of proinflammatory mediators
112
What is the function of the thalamus?
interprets certain sensory messages such as those of pain, temperature, and pressure
113
What are the four types of Focal Brain Injury?
Brain contusion
Intraparenchymal Brain Hemorrhage
Subdural Hematoma
Epidural Hematoma/Extradural Hematoma
114
What is normal ICP in adults?
less than or equal to 15 mmHg
115
What is intracranial compliance?
The balance of volume betweent the three compartments being maintained by:
displacement of CSF into thecal sac or
decrease in volume of the cerebral venous blood via venoconstriction and extracranial drainage
116
What is cause of demyelination?
inflammation
117
What happens when cerebral blood flow is 17 mL/100 g/min?
neuronal electrical failure
118
What does VEGF do?
controls angiogenesis and is upregulated in GBM;
| Increases vascular permeability, endothelial gaps, adn fenestrations which causes rapid growth of the tumor
119
What is the DSM-5 definition of dementia?
Significant acquired cognitive impairment in one or more cognitive domains that represents a significant decline from previous baseline and interferes with independence in daily activities
120
What are the clinical features of meningiomas?
Slow growing tumors
| Express progesterone receptors and may grow more rapidly during pregnancy
121
Brain contusions in the location of impact are?
Coup
122
What are three common clinical settings of herniation?
Cerebral Edema
Increased CSF volume/Hydrocephalus
Mass Lesions
123
What are the clinical consequences of CTE?
neuropsychologic deficits
speech and gait abnormalities
parkinsonism
124
What is a subdural hematoma?
bridging blood vessels are severed in subdural space or cerebral cortical hemorrhage occurs by direct brain trauma
125
What are the two types of intracranial hemorrhage?
```
intracerebral hemorrhage (ICH)
Subarachnoid hemorrhage
```
126
What is Global Cerebral Ischemia?
occurs in the setting of severe systemic hypotension ( <50mmHg)
127
What does a mutation in IDH1 or IDH2 cause?
accumulation of the oncometabolite 2-hydroxyglutarate (2-HG)
128
What is a brain contusion?
blunt trauma between the brain and the skull after accleration and deceleration of the head
129
What is intraparenchymal brain Hemorrhage?
develops from tears in teh brain tissue and/or vasculature
130
What causes upper motor neuron symptoms?
degeneration of frontal motor neurons
131
What cerebrovascular disease class can cause primary hemorrhagic stroke?
process resulting from rupture of a vessel in the subarachnoid space or intercerebral tissue
132
What is the function of the spinal cord level?
upper levels send signals to control centers within it
Control movement, reflexes, blood vessels, and GI tract
133
What is rigidity?
Increased resistance to passive movement of a joint
134
What blood pressure range is cerebral blood flow kept at in autoregulation?
60-150 mmHg
135
What is critically important in regards to CSF?
that there is a balance between its absorption and production
136
By what week of gestation is the neural tube formed?
week 4
137
What is cerebral palsy?
heterogenous group of conditions involving permanent non-progressive central motor dysfunction that effects muscle tone, posture, and movement
138
What happens when cerebral blood flow is 50 mL/100g/min?
Inhibition of protein synthesis begins
139
What is pyrogenic meningitis caused by?
bacteria
140
How does the infection damage the nervous system?
directly through injury of neurons or glia by the infectious agent
Indirectly through microbial toxins
The destructive effects of inflammatory response
The result of immune mediated mechanisms
141
What is chronic meningitis caused by?
TB
Spirochetal
Cryptococcal
142
What is the most common way microbes access the CNS?
hematogenous spread
143
What causes global cerebral ischemia?
SHOCK
cardiac arrest
When blood flow to the brain is stopped or reduced
144
What is Primary Progressive?
Progressive accumulation of disability from disease onset with occasional plateus, temporary minor improvements, or acute relapses
145
What is effected by spinal cord abnormalities in myelomeningocele?
the trunk, legs, bladder, and bowel
146
What produces CSF?
the choroid plexus of each ventricle
147
What are the two most common causes of Cerebral palsy?
premature birth and low birth weight
148
What does elevated HG-2 cause?
Global changes in DNA and histone methylation
Impairment of cellular differentiation
Tumorigenesis
149
What is the pathophysiology of GBM?
upregulation of vascular endothelial growth factor (VEGF)
150
What is the function of the brain stem?
regulates Heartbeat and breathing; plays a role in consciousness
151
What are the causes of early onset dementia?
```
Alzheimers Disease
presenilin 1 and 2 mututations
Amyloid precursor protein mutation
APOE-E4-associated disease
Parkinson disease dementia
Infectious diseases like prions
Inflammatory and autoimmune diseases like multiple sclerosis
```
152
What is the function of oligodendrocytes?
produce myelin
153
What is late onset Alzheimers Disease and what causes it?
happens to people older than 65
APOE e4
154
What is clinical evidence found in viral meningitis?
there are NO bacterial pathogens in CSF of a patient who hasn't yet received an antibiotic
155
What is relapsing remitting?
there are clearly defined relapses with full recovery and remission; 85%
156
What are the functions of CSF?
Acts as cushion/shock absorber which keeps the brain tissue buoyant
Delivers nutrients to the brain
Removes waste from the brain
Compensates for changes in intracranial blood volume
157
What is Traumatic Vascular Injury?
```
near universal feature of sever TBI
direct trauma and disruption of the vessel wall taht lead to hemorrhage in:
epidural space
subdural space
subarachnoid space
intra-parenchymal compartments
```
158
What is tonsilar herniation?
brain passes through foramen magnum and crushes brainstem compromising vital respiratory and cardiac centers in the medulla
159
What is the pathogenesis of Cerebral palsy?
focal white matter injuries
160
What is perinatal?
end of 22 weeks gestation to 7 days after birth
161
What are the 4 classes of cerebrovascular disease?
Process occurs in vessels = athrosclerosis
Process originates remotely = emboli
Process results from inadequate cerebral blood flow
Process results from rupture of a vessel in the subarachnoid space or intercerebral tissue
162
What are ependymal cells?
line the spinal cord and ventricles of the brain
Crease CSF
Form choroid plexus
163
What is the etiology of Viral meningitis?
ENTEROVIRUSES
Mumps virus
herpes simplex virus
164
How can microbes access the CNS?
Hematogenous spread
Direct Implantation
Local extension
Peripheral Nerves
165
What are the cognitive domains effected in dementia?
```
Learning and memory
Language
Executive Functin
Complex attention
Perceptual-motor function
Social cognition
```
166
What is a grade 2 astrocytoma associated with?
Inactivation of TP53 tumor suppressor gene
Point mutations in isocitrate dehydrogenase I (IDH1)
Mutation in the chromatin regulator gene
167
What is hydrocephalus?
increase in volume of CSF within the ventricles
168
What is intracerebral hemorrhage (ICH)?
blood goes directly to brain parenchyma
169
What is the etiology of myelomeningocele?
unknown; theory is that it is due to defects in timing of DNA synthesis and epigenetic regulations
170
What is the function of the cortical level?
complicated multifunctioning; it cannot function by itself and needs the help of the other two levels; it also helps the other two levels
171
What is the core diagnostic criteria for MS?
brain lesions
172
What type of meningitis is most common and least severe?
Viral Meningitis
173
What are symptoms of MS?
Sensory in Limbs
Visual Loss
Motor Loss
Polysymptomatic onset
174
What happens when cerebral blood flow is 35 mL/100g/min?
protein synthesis ceases
| Glucose utilization transiently increases
175
What should you not call Grade 2 tumors?
benign or low grade because they aren't; they actually tend to reoccur
176
What causes subarachnoid hemorrhage?
rupture of an aneurysm from base of the brain
177
What is the pathology of ALS?
intracellular inclusions in degenerating neurons and glia
motor neuron degeneration and death with gliosis
spinal cord becomes atrophied
affected muscles show denervation atrophy
178
At what cerebral blood pressure does autoregulation fail?
180 mmHg
179
What are the consequences of hydrocephalus in infants?
enlargement of the head
180
What are the major pathological mechanisms of MS?
DEMYELINATION
inflammation
axonal degeneration
181
What are Astrocytes?
metabolic buffers and detoxifiers within the brain
modulate how neurons communicate
182
Why does a patient with meningitis get a headache?
bacterial exotoxins, cytokines, and increase ICP stimulate nocireceptors in the meninges
183
What is a neural tube defect?
portion of neural tube does not close or reopening of a region of the tube after closure
Can happen anywhere in NS: brain, spine, spinal column
184
What is viral meningitis?
a feverish illness with clinical signs and symptoms of meningeal irritation
self-limiting
inflammation of meninges surrounding the brain and spinal cord
185
What are the two types of traumatic brain injury (TBI)?
Diffuse Brain Injury (DBI)
and
Focal Brain Injury (FBI)
186
What occurs when an axon is severed?
Wallerian Degeneration
187
What is the transition from low-grade to malignant glioma associated with?
Cell cycle checkpoint inactivation
Tumor suppressor gene inactivation
Angiogenesis
188
What are the clinical features or Parkinson's?
rest tremor
Bradykinesia
Rigidity
Postural instability
189
What are the three symptoms most commonly associated with bacterial meningitis?
Fever
Neck Stiffness
Altered Mental State
190
What makes up primary brain tumor?
glial cells
191
What are the clinical consequences of the loss of integrity of brain structural integrity?
breakdown of BBB
Development of cerebral edema
hemorrhage into brain parenchyma
192
What is intracranial pressure (ICP)?
produced by the interaction between the three intracranial compartments
193
What is the Blood Brain Barrier (BBB)?
cellular structures that selectively inhibit certain potentially harmful substances in the blood from entering the brain or CSF
limits substances to reach the brain
194
What is the most common cause of dementia in older adults?
Alzheimer's Disease
195
What is the function of the subcortical level?
Subconscious activities
196
What is subarachnoid hemorrhage?
blood goes directly into CSF under arterial pressure causing increased ICP
197
What are the risk factors for ALS?
age
| family history
198
What is gliobastoma (GBM)?
The 'monster'; is the most malignant form of astrocytoma
199
What is the most common type of neural tube defect?
Spina Bifida
200
What causes herniation?
increased ICP
201
What is early onset Alzheimers and what causes it?
occurs in individuals younger than 65
Mutations in APP, PSEN1, and PSEN2
202
What are the two types of brain damage after ICH?
primary and secondary brain damage
203
What is vasogenic edema?
IRREVERSIBLE increase in EXTRACELLULAR FLUID
204
What other genetic factors can cause Alzheimer's Disease?
Mutations in ApoEe4 allele
205
Sensory receptors take their information to what portion of the brain?
The somatostatin region
206
What are the common symptoms of meningiomas?
headache and weakness in an arm or leg
207
Where is dopamine found?
in basal ganglia in substantia niagra
208
What is bradykinesia?
generalized slowness of movement
209
What are the three intracranial compartments?
Cerebral Parenchyma 80%
CSF 10%
Blood 10%
210
What disorder commonly features injury or apoptosis of oligodendrocytes?
acquired demyelinating disorders
211
What is the function of the capillaries in the BBB?
they have continuous tight junctions which limits the passage of most substances to the brain
212
What are the clinical hallmarks of ALS?
combination of upper and lower motor neuron signs and symptoms
213
How Alzheimers Disease neuropathologic change ranked?
Amyloid beta placque distribution score
Neurofibrillary tangle distribution stage
Neuritic placque density score
214
Why does a patient with meningitis have an altered mental status?
increased ICP causes brain herniation which causes damage to the reticular formation
215
What are the three types of cells of the Neuroglia?
Astrocytes
Oligodendrocytes
Ependymal Cells
216
How does the cell body respond to trauma?
swelling and apoptosis
217
What is the pathophysiology behind Parkinson's Disease?
basal Ganglia circuits
| Compensatory mechanisms
218
What occurs in basal ganglia circuits that causes Parkinsons Disease?
dopamine depletion in substantia nigra an nigrostatial pathways causes:
INCREASED INHIBITION of thalamus and REDUCED EXCITATORY input to the motor cortex
219
What is the severe form of Diffuse Brain Injury (DBI)?
Diffuse traumatic axonal injury (DAI)
220
What causes hydrocephalus in 90% of children with myelomeningocele?
Chiari 2 malformation
221
What are the three compensatory mechanisms of Parkinson's Disease?
increased synthesis of Dopamine in surviving neurons
Proliferation of dopamine receptors
Gap Junctions allowing rapid communication between neurons increases dramatically
222
What Symptoms are associated with both types of meningitis?
```
Fever
Headache
Stiff Neck
Altered Mental Status
Nausea and Vomiting
```
223
What are muscles and glands that carry out motor functions called?
Effectors
224
What GCS score is considered severe TBI?
8 or less
225
What is secondary brain injury that causes TBI?
CELLULAR MECHANISM CASCADE happenings over days; can be decreased by preventing hypoxia and hyperperfusion
NT mediated excitotoxcity causing Glu, free radical injury to cell membranes
Electrolyte imbalances
Mitchondrial Dysfunction
Inflammatory Responses
Apoptosis
Secondary ischemia from vasospasm, focal microvascular occlusion
226
What happens to the brain parenchyma when blood flow is decreased to it?
immediate death by necrosis because there isn't any ATP
227
What is the pathophysiology of Diffuse axonal injury (DAI)?
AXONAL SWELLING due to disruption of axonal neurofilament impairing axonal transport
SECONDARY INJURY due to release of excitatory NTs ACh, Glu, and generation of free radicals
228
What is the milder form of DBI?
concussion
229
What are the two types of ischemia?
Global and Focal
230
What is primary brain injury that causes TBI?
TRAUMA
shearing mechanisms lead to DAI
focal cerebral contusions
Extra-axial hematomas - epidural, subdural, or subarachnoid
231
What is secondary progressive?
initially has pattern of RR but then it gradually gets worse; with or without occasional relapses, remissions, or plateus
232
What are the environmental risk factors for ALS?
smoking
environmental toxin exposure
military service
233
What are three tumors produced from normal glial cells?
Astrocytomas
Oligodendrogliomas
Ependymomas
234
What is the function of the Efflux transporters of the BBB?
help to expel foreign substances taht might sneak through the capillary membrane
235
What is Chiari 2 malformation/
cerebellum and brainstem are pushed through the foramen magnum and ventricles are also enlarged
236
What is the function of the hypothalamus?
controls carious homeostatic functions sucha s body temperature, respiration, and heartbeat
237
What is ischemic stroke?
an infarction of CNS tissue due to ischemia, based on neuropathologic, neuroimagin, and/or clinical evidence of PERMANENT injury
238
What changes occur in Alzheimer's Disease?
neuritic placques
extracellular deposits of Amyloid beta peptides
Neurofibrillary degeneration seen as tau proteins
239
What is the neuropathology of CTE?
extensive Tau immunoreactive degenerative changes that can be found in the superficial cortical layers of the brain
240
Who are most prone to getting subdural hematomas?
the elderly and infants
241
What are the four stroke types?
Intracerebral hemorrhage
Subarachnoid hemorrhage
Ischemic thrombotic
Ischemic Embolic
242
What is early onset dementia?
occurs in adults ages 18-65
243
What are the components of the BBB?
Capillaries
Astrocyte foot
Efflux transporters
244
What do clinical deficits depend on when it comes to hypoxia and ischemia?
duration and magnitude and rapidity of the reduction of flow
245
What is hypoxia?
decreased oxygen to the brain
246
What is pathologic intrcranial hypertension (ICH)?
greater than or equal to 20 mmHg
247
What causes lower motor neuron symptoms of ALS?
degeneration of lower motor neurons in brainstem and spinal cord
248
What is a meningioma?
predominantly benign tumors of adults arising from the meninges
249
What is the etiology of ALS?
abnormalities in RNA metabolism
excitotoxicity
Viral infections
Inflammatory responses
250
What occurs 7 10 14 days after injury in the PNS?
new terminal sprouts project from proximal segment of the axon
251
What are lower motor neuron symptoms of ALS?
weakness
atrophy
Fasciculations
252
What causes intracerebral hemorrhage (ICH)?
HTN
trauma
vascular malformations
253
Where can injury of the brain parenchyma be?
In frontal lobe = silent
Severely in the spinal cord
fatal in brainstem
