neurological disorders tumors - 24,000/yr cerebrovascular accidents - 500,000/yr seizure disorders -...
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Neurological Disorders
Tumors - 24,000/yr
Cerebrovascular Accidents - 500,000/yr
Seizure Disorders - 2,000,000 in US
Traumatic Brain Injury - 1/1000 - 50,000 die/yr
Infectious Diseases
Degenerative Disorders
Types of Tumors
Malignant - cancerous = infiltratingBenign - noninfiltrating (encapsulated)
Gliomas (60%)Glioblastoma - worstAstrocytoma (70%)(same etiology - just severity really)
Meningioma
Metastatic carcinoma (35%)- skin, lung, breast, prostrate
Treatment - neuro-oncology
Surgerycraniotomy
Radiosurgery(radiation treatment)- goal - tumor only
Chemotherapy (less in brain cases)- drugs taken up my tumor cells- blood-brain barrier
Neurological Disorders
Cerebrovascular Accidents
Trauma
Infectious Diseases
Degenerative Disorders
Stroke - cerebrovascular accidents
Ischemic (80%)thrombus - 50%embolus - 30%
TIA
infarct
Hemorrhage (20%)intracerebral - 14%subarachnoid - 6%
hypertension, aneurism, AVM
Stroke - cerebrovascular accidents
The glutamate cascade (ischemic cascade)-anoxia - starving or flood with blood- release glutamate- stimululate - calcium enters
mitochondria - iron released??oxygen free-radicals
Treatments - prevent or in acute phase-antithrombotic - aspirin-anticoagulants - warfarin, heparin- thrombolytic - tissue plasminogen activator (t-PA)-calcium antagonist-glutamate antagonist
Psychoactive Drugs
Psychedelics Phencyclidine - PCP or angel dust
- ketamine is similar- analgesic- amnesiac- anesthestic (powerful)
- NMDA receptor - antagonistvery good amnesiac
- prevent Ca influx and cell death from stroke?
3401
Rostral
Anterior cerebral arteryInternal carotid artery
Temporal lobePituitary gland
Pons
Medulla
Cerebellum
caudal
Olfactory bulb
Optic nerves (cut off)
Middle cerebral artery
End of temporal lobe removed
Mammiliary bodies
Posterior cerebral artery
Basilar artery
Vertebral artery
3402
Each of the three major arteries of the cerebral hemispheres-the anterior, middle, and posterior- provides blood to a different region of the cerebrum.
3403
3416
3417 - ischemic infarct Mid Cerebral - 24hr, 72hr
3418 - cerebellar
3419 - hemorrhage - basal ganglia
3423 - left AVM
3424 - AVM - acute, 2yrs
3425 - AVM
3426 - hypertensive - excess water & watershed lesions- eclampsia like
34N27
34N28 - thrombophlebitis
Atropine Injectors
Why is this relevant? (war, nerve gas??)
Atropine - anticholineric - blocks Ach receptors- competitive inhibitor- more muscarinic than nicotinic
Counters Nerve Gases - Sarin, Soman, VX- irreversible AchE inhibitors - organophosphates (1800’s)- like malathion - insects
(mammals inactivate the drug)
Atropine Injectors
Nerve Gas
- Ach accumulates - autonomic (parasym) - all faucets on- somatic - twitch & contractions, weakness- brain - anxiety, confusion, ataxia, seizures
Death- continual depolarization of diaphram- die due to respiratory failure- also cardiac arrest
- Pralidoxime treatment - fixes AchE
Seizure Disorders (epilepsy)
Sudden excessive activity of cerebral neurons
Seizure Disorders
GeneralizedTonic-clonic (grand mal)Absence (petit mal)Atonic (loss of muscle tone)
PartialSimple (normal consciousness)
localized (partial) motorMotor seizureSensoryPsychicAutonomic
Complex (altered conciousness)automatisms
Seizure Disorders
GeneralizedTonic-clonic (grand mal)Absence (petit mal)Atonic (loss of muscle tone)
PartialSimple (normal consciousness)
localized (partial) motorMotor seizureSensoryPsychicAutonomic
Complex (altered conciousness)
Seizure Disorders
GeneralizedTonic-clonic (grand mal)Absence (petit mal)Atonic (loss of muscle tone)
PartialSimple (normal consciousness)
localized (partial) motorMotor seizureSensoryPsychicAutonomic
Complex (altered conciousness)automatisms
Infantile Spasms - West Syndrome- start before 12mo - cease 4y- arms flap , body bends forward
Seizure Disorders
Daiagnosisbrain imaging (MRI)electrical recording (EEG)
TreatmentVariety of Drugs
Anticonvulsants (Dilantin, Tegretol)
Surgery- map- record- cut
Neurological Disorders
Tumors - 24,000/yr
Cerebrovascular Accidents - 500,000/yr
Seizure Disorders - 2,000,000 in US
Traumatic Brain Injury - 1/1000 - 50,000 die/yr
Degenerative Disorders
Infectious Diseases
Trauma
Lots of causes
Lots of effects- damage- contusion- hemorrhage
3501
3504
3505
3506 0 subdural hematoma
3507 - chronic subdural hematoma
3508 - chronic subdural hematoma - frontal lobes
Degenerative Diseases
Parkinson’s Disease - 500,000 folksdegeneration of dopamine neurons from S.N.- pesticides/toxins- destroy mitochondrial complex 1 (enzyme)- rotenone - affects all, kills dopamine neurons (rats)
Huntington’s Chorea (heredity - chromosome 4) - 30,000- degeneration of putatmen and caudate nucleus (N.O. ?)- lose inhibitory control
Multiple Sclerosis - 350,000- autoimmune demyelinating disease
Alzheimer’s Disease (linked to Ach neurons)- dementia- neuritic plaques (beta amyloid) & neurofibrillary tangles
Beta amyloid plaque and neurofibrillary tangles
Multiple sclerosis - sclerotic plaques in white matter
Infectious Diseases
EncephalitisViral infectionArboviruses (insects)Herpes SimplexpoliomyelitisRabiesAIDS - toxoplamosis - protozoa parasite“Prion” Diseases (proteinaceous infectious partic.)
Spongiform EncephalopathiesCreutzfeldt-JakobKuru
Meningitisviral - usually not badbacterial - can be bad
- Hib vacine in kids
3302 - herpes encephalitis - left insula and temporal
33N23 - HIV
Animal Models of Human Neuropsychological Disease
Animals - easier way to study
Kindling Model - Epilepsy- repeated elect stim to amygdala- long lived changes- distributed, not massed, stimulation
Transagenic Mice - AD- develop plaques (but not tangles)
MPTP - for parkinson’s- metabolized into MPP+- kills DA neurons & Deprenyl blocks it
Neural Degeneration- anterograde - distal part- proximal - towards cell body
Neural Regeneration- not great- a little in PNS - guided by Schwann cells- how much guidance determines outcome
Neural Reorganization- yes, it happens, big area of work- mostly sensory & motor- even new neurons - hippocampus
Recovery after brain damage
- neural function - not a lot really
- reduced edema & swelling- when cells die they are gone
- learn new strategies- e.g., new path to old end point- cognitive reserve
Neuroplasticity & Treatment
- prevent damage- clear the blockage- block Ca++ uptake- other proteins involved
- promote regeneration- kill oligodendrocytes- promote Schwann cells
- neurotransplantation- usually dopamine cells - Parkinson’s- stem cells - “pluripotent”