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”