Title: Parkinsons Disease
1Nervous System Pathology
Lecture 3 Cerebrovascular Disease and Seizure
Disorders
Alvin V. Terry, Jr., Ph.D. Associate Professor
UGA College of Pharmacy and MCG Alzheimers
Research Center
2Cerebrovascular Disease
- Most Frequently Occurring Neurologic Disorder
- Stroke (CVA) is the 3rd leading cause of death in
US.
3Stroke (CVA)
- Tends to run in families
- More common in women
- Greater incidence in Blacks
- Major classifications
- Ischemic
- Hemorrhagic
4Major Risk Factors
- Hypertension
- Hyperlipidemia
- Smoking
- Diabetes Mellitus
- Heart Disease
5General Symptoms
- Motor
- weakness
- hemiparesis
- Sensory
- numbness
6General Symptoms(Cont)
- Speech
- dysarthria
- aphasia
- Visual
- hemianopsia
- diplopia
7General Symptoms(hemorrhagic stroke)
- Headache
- Ataxia
- Impaired conciousness
8Transient Ischemic Attach
- Defined as an ischemia-related, focal neurologic
deficit lasting less than 24 hours.
9Ischemic Strokes
- Thrombotic
- Embolic
- Lacunar
10Thrombosis
- Definition-blood clot in a cerebral vessel
- Caused by atherosclerotic plaque accumulation
- Plaque causes endothelial damage
11Thrombosis (cont)
- Vessel wall degeneration occurs.
- Damage attracts platelets and fibrin.
- Thrombus grows leading to vessel occlusion .
12Thrombosis (cont)
- 60 develop during sleep.
- 20 develop step wise over several hours to a few
days. - Stroke in Evolution
13Embolism
- Definition-foreign substance which occludes a
blood vessel - Vessel occlusion occurs down stream from source
of embolis - Symptoms develop rapidly.
14Embolism (Cont)
- Normally do not progress
- Usually occurs during activity.
- Consciousness usually preserved
- Source is almost always the left side of the
heart.
15Common Sources of Emboli
- Atrial fibrillation
- Myocardial infarction
- Defective heart valve
- Artificial heart valve
16Source Mosby Clinical Neurology CD Atlas
17Source Mosby Clinical Neurology CD Atlas
18Anatomical Variation
Source Mosby Clinical Neurology CD Atlas
19Source Mosby Clinical Neurology CD Atlas
20Source Mosby Clinical Neurology CD Atlas
21Sclerotic Basilar Artery
Source Web Path The Internet Pathology
Laboratory for Medical Education
22Internal Carotid Increasing Stenosis
Source Web Path The Internet Pathology
Laboratory for Medical Education
23Carotids-Atherosclerotic
Source Web Path The Internet Pathology
Laboratory for Medical Education
24SPECT
CT
Grossly Diminished Perfusion
Early Stroke
Normal Perfusion
Source Mosby Clinical Neurology CD Atlas
25CT
Pre-Contrast
Post-Contrast
Cerebellar Infarct
Source Mosby Clinical Neurology CD Atlas
26Carotid Angiogram
MCA Occlusion
Source Mosby Clinical Neurology CD Atlas
27MCA - Remote Infarct (subacute)
Source Web Path The Internet Pathology
Laboratory for Medical Education
28Lacunar Stroke
- Microinfarcts smaller than 1 cm in diameter
- Involve small perforating arteries
- Affect basal ganglia, internal capsule and pons
(most commonly) - Pure motor or sensory deficits
29Pons-Lacunar Infarct
Source Web Path The Internet Pathology
Laboratory for Medical Education
30Hemorrhagic Stroke
- Intracranial Hemorrhage
- Sudden onset of symptoms
- Frequently associated with severe headache
- Loss of consciousness common (stupor, coma).
31Hemorrhagic Stroke
- Causes
- Hypertension
- Ruptured aneurysms
- Arteriovenous malformations
- Tumors
- Bleeding Disorders
- Drugs (e.g., cocaine)
32Circle of Willis (Berry Aneurysm)
Source Web Path The Internet Pathology
Laboratory for Medical Education
33Vascular Malformation (parietal lobe)
Source Web Path The Internet Pathology
Laboratory for Medical Education
34Subarachnoid Hemorrhage
Source Web Path The Internet Pathology
Laboratory for Medical Education
35Cerebral Hemorrhage-Cocaine
Source Web Path The Internet Pathology
Laboratory for Medical Education
36CT
Hemorrhagic Infarct
High Density
Low Density
Source Mosby Clinical Neurology CD Atlas
37Stroke-Therapy
- Thrombolytics
- Platelet inhibitors
- Warfarin
- Heparin
- Low molecular weight heparinoids
38Seizure Definition/Characteristics
- Involuntary, abnormal and excessive neuronal
discharge in the CNS. - Characterized by spontaneous, recurrent and
paroxysmal episodes. - May involve convulsions.
39Definition andCharacteristics (Cont)
- Usually are brief lasting a few seconds to 3
minutes. - Seizure and convulsion are not synonymous
40EpilepsyDefinition/Characteristics
- Epilepsy A syndrome of recurrent seizures.
- Epileptic Focus Location of sudden electrical
activity. - spontaneous depolarization
41SeizureCharacteristics (Cont)
- Usually originates in cerebral cortex.
- medial temporal lobe most common site
42Background (Epidemiology)
- 8-10 of the population will experience a single
seizure during life. - 1-2 of population will go on to have recurrent
seizures (epilepsy) - 2-4 million in US
43Background (Cont)
- Occurs in all races with equal distribution in
males and females. - 30 of Idiopathic type have genetic history
44Epilepsy Diagnosis
- H and P
- Neurologic Exam
- Blood Tests
- Electrolytes
- BUN
- Creatinine
- Drugs and Alcohol
- Procedures
- EEG
- CT
- MRI
- PET
- SPECT
45Seizure Classification
- Generalized Seizures
- Generalized Tonic-Clonic (GTCS)
- Absence
- Myoclonic
- Atonic
46Seizure Classification
- Partial Seizures
- Simple Partial
- Complex Partial
- Complex Partial with Secondary Generalization
47Generalized Tonic-Clonic (GTCS)
- Most Severe Form
- Prodrome
- Ictus
- Tonic Phase
- Clonic Phase
48Normal Tracing
49Generalized Tonic Clonic Seizure
50GTCS (Cont)
- Post-Ictal Period
- First Line Drugs
- phenytoin (Dilantin)
- carbamazepine (Tegretol)
- sodium valproate (Depakote)
51Absence Seizures
- Exclusively found in children
- Duration 5-30 seconds
- No prodrome
52Absence Seizure
53Absence Seizures(Cont)
- Characterized by a lapse in mental function
- First Line Drugs
- sodium valproate (Depakote)
- ethosuximde (Zarontin)
54Myoclonic
- Brief, non repetitive shock like contractions
- First Line Drug
- sodium valproate
55Atonic
- Sudden Loss of Muscle tone
- May be generalized or confined to the neck
- First Line Drug
- clonazepam (Klonopin)
56Partial Seizures
- Simple Partial
- Involves Single Hemisphere
- Locus is often close to a structural abnormality
- Patient Remains Conscious
57Partial Seizure
58Simple Partial (Cont)
- Duration several seconds to several minutes
- Often involves a single limb or other part of body
59Complex Partial
- Psychomotor or Temporal Lobe Epilepsy
- Complex characteristics and behavior
- Lip Smacking, Fumbling with Objects
- Fits of Emotion
60Complex Partial (Cont)
- Impaired Consciousness followed by disorientation
and confusion - Complex Partial with 20 Generalization
61Partial Seizures
- First Line Drugs
- carbamazepine, phenytoin, combinations
- Adjunctive Agents
- gabapentin, topiramate, lamotrigine, tiagabine,
levetiracetam, others.
62Status Epilepticus
- Defined as a single seizure lasting more than 30
minutes or intermittent seizures lasting for more
than 30 minutes in which the patient does not
regain consciousness
63Status Epilepticus
- Is a life threatening Situation
- Causes
- anticonvulsant withdrawal
- alcohol withdrawal
- cerebrovascular disease
64Status Epilepticus (Therapy)
- Restrain Patient
- Support Respiration
- IV diazepam or lorazepam
- Follow with phenytoin or phenobarbital
- May require general anesthesia in some cases
65Alcohol Withdrawal Seizures
- Up to 15 of Alcoholics will experience at least
one seizure - Usually is a GTCS type occurring 7-48 hours after
alcohol cessation.
66Alcohol WD Seizures (Cont)
- Generally is a single seizure but may involve 2-6
seizures in a 6 hour period. - First Line therapy- IV diazepam
- Thiamine
- Nutritional Support
67Febrile Seizures
- Affects children between ages of 6 months to 5
years. - Usually occur with temperatures gt 390C (1020F)
68Febrile Seizures (cont)
- Therapy
- Primary- Treat Underlying cause if Known (e.g.,
antibiotics) - Fever reduction- acetaminophen
- Rectal diazepam to control seizure