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Parkinsons Disease

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Nervous System Pathology Lecture 3: Cerebrovascular Disease and Seizure Disorders Alvin V. Terry, Jr., Ph.D. Associate Professor UGA College of Pharmacy – PowerPoint PPT presentation

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Title: Parkinsons Disease


1
Nervous 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
2
Cerebrovascular Disease
  • Most Frequently Occurring Neurologic Disorder
  • Stroke (CVA) is the 3rd leading cause of death in
    US.

3
Stroke (CVA)
  • Tends to run in families
  • More common in women
  • Greater incidence in Blacks
  • Major classifications
  • Ischemic
  • Hemorrhagic

4
Major Risk Factors
  • Hypertension
  • Hyperlipidemia
  • Smoking
  • Diabetes Mellitus
  • Heart Disease

5
General Symptoms
  • Motor
  • weakness
  • hemiparesis
  • Sensory
  • numbness

6
General Symptoms(Cont)
  • Speech
  • dysarthria
  • aphasia
  • Visual
  • hemianopsia
  • diplopia

7
General Symptoms(hemorrhagic stroke)
  • Headache
  • Ataxia
  • Impaired conciousness

8
Transient Ischemic Attach
  • Defined as an ischemia-related, focal neurologic
    deficit lasting less than 24 hours.

9
Ischemic Strokes
  • Thrombotic
  • Embolic
  • Lacunar

10
Thrombosis
  • Definition-blood clot in a cerebral vessel
  • Caused by atherosclerotic plaque accumulation
  • Plaque causes endothelial damage

11
Thrombosis (cont)
  • Vessel wall degeneration occurs.
  • Damage attracts platelets and fibrin.
  • Thrombus grows leading to vessel occlusion .

12
Thrombosis (cont)
  • 60 develop during sleep.
  • 20 develop step wise over several hours to a few
    days.
  • Stroke in Evolution

13
Embolism
  • Definition-foreign substance which occludes a
    blood vessel
  • Vessel occlusion occurs down stream from source
    of embolis
  • Symptoms develop rapidly.

14
Embolism (Cont)
  • Normally do not progress
  • Usually occurs during activity.
  • Consciousness usually preserved
  • Source is almost always the left side of the
    heart.

15
Common Sources of Emboli
  • Atrial fibrillation
  • Myocardial infarction
  • Defective heart valve
  • Artificial heart valve

16
Source Mosby Clinical Neurology CD Atlas
17
Source Mosby Clinical Neurology CD Atlas
18
Anatomical Variation
Source Mosby Clinical Neurology CD Atlas
19
Source Mosby Clinical Neurology CD Atlas
20
Source Mosby Clinical Neurology CD Atlas
21
Sclerotic Basilar Artery
Source Web Path The Internet Pathology
Laboratory for Medical Education
22
Internal Carotid Increasing Stenosis
Source Web Path The Internet Pathology
Laboratory for Medical Education
23
Carotids-Atherosclerotic
Source Web Path The Internet Pathology
Laboratory for Medical Education
24
SPECT
CT
Grossly Diminished Perfusion
Early Stroke
Normal Perfusion
Source Mosby Clinical Neurology CD Atlas
25
CT
Pre-Contrast
Post-Contrast
Cerebellar Infarct
Source Mosby Clinical Neurology CD Atlas
26
Carotid Angiogram
MCA Occlusion
Source Mosby Clinical Neurology CD Atlas
27
MCA - Remote Infarct (subacute)
Source Web Path The Internet Pathology
Laboratory for Medical Education
28
Lacunar 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

29
Pons-Lacunar Infarct
Source Web Path The Internet Pathology
Laboratory for Medical Education
30
Hemorrhagic Stroke
  • Intracranial Hemorrhage
  • Sudden onset of symptoms
  • Frequently associated with severe headache
  • Loss of consciousness common (stupor, coma).

31
Hemorrhagic Stroke
  • Causes
  • Hypertension
  • Ruptured aneurysms
  • Arteriovenous malformations
  • Tumors
  • Bleeding Disorders
  • Drugs (e.g., cocaine)

32
Circle of Willis (Berry Aneurysm)
Source Web Path The Internet Pathology
Laboratory for Medical Education
33
Vascular Malformation (parietal lobe)
Source Web Path The Internet Pathology
Laboratory for Medical Education
34
Subarachnoid Hemorrhage
Source Web Path The Internet Pathology
Laboratory for Medical Education
35
Cerebral Hemorrhage-Cocaine
Source Web Path The Internet Pathology
Laboratory for Medical Education
36
CT
Hemorrhagic Infarct
High Density
Low Density
Source Mosby Clinical Neurology CD Atlas
37
Stroke-Therapy
  • Thrombolytics
  • Platelet inhibitors
  • Warfarin
  • Heparin
  • Low molecular weight heparinoids

38
Seizure Definition/Characteristics
  • Involuntary, abnormal and excessive neuronal
    discharge in the CNS.
  • Characterized by spontaneous, recurrent and
    paroxysmal episodes.
  • May involve convulsions.

39
Definition andCharacteristics (Cont)
  • Usually are brief lasting a few seconds to 3
    minutes.
  • Seizure and convulsion are not synonymous

40
EpilepsyDefinition/Characteristics
  • Epilepsy A syndrome of recurrent seizures.
  • Epileptic Focus Location of sudden electrical
    activity.
  • spontaneous depolarization

41
SeizureCharacteristics (Cont)
  • Usually originates in cerebral cortex.
  • medial temporal lobe most common site

42
Background (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

43
Background (Cont)
  • Occurs in all races with equal distribution in
    males and females.
  • 30 of Idiopathic type have genetic history

44
Epilepsy Diagnosis
  • H and P
  • Neurologic Exam
  • Blood Tests
  • Electrolytes
  • BUN
  • Creatinine
  • Drugs and Alcohol
  • Procedures
  • EEG
  • CT
  • MRI
  • PET
  • SPECT

45
Seizure Classification
  • Generalized Seizures
  • Generalized Tonic-Clonic (GTCS)
  • Absence
  • Myoclonic
  • Atonic

46
Seizure Classification
  • Partial Seizures
  • Simple Partial
  • Complex Partial
  • Complex Partial with Secondary Generalization

47
Generalized Tonic-Clonic (GTCS)
  • Most Severe Form
  • Prodrome
  • Ictus
  • Tonic Phase
  • Clonic Phase

48
Normal Tracing
49
Generalized Tonic Clonic Seizure
50
GTCS (Cont)
  • Post-Ictal Period
  • First Line Drugs
  • phenytoin (Dilantin)
  • carbamazepine (Tegretol)
  • sodium valproate (Depakote)

51
Absence Seizures
  • Exclusively found in children
  • Duration 5-30 seconds
  • No prodrome

52
Absence Seizure
53
Absence Seizures(Cont)
  • Characterized by a lapse in mental function
  • First Line Drugs
  • sodium valproate (Depakote)
  • ethosuximde (Zarontin)

54
Myoclonic
  • Brief, non repetitive shock like contractions
  • First Line Drug
  • sodium valproate

55
Atonic
  • Sudden Loss of Muscle tone
  • May be generalized or confined to the neck
  • First Line Drug
  • clonazepam (Klonopin)

56
Partial Seizures
  • Simple Partial
  • Involves Single Hemisphere
  • Locus is often close to a structural abnormality
  • Patient Remains Conscious

57
Partial Seizure
58
Simple Partial (Cont)
  • Duration several seconds to several minutes
  • Often involves a single limb or other part of body

59
Complex Partial
  • Psychomotor or Temporal Lobe Epilepsy
  • Complex characteristics and behavior
  • Lip Smacking, Fumbling with Objects
  • Fits of Emotion

60
Complex Partial (Cont)
  • Impaired Consciousness followed by disorientation
    and confusion
  • Complex Partial with 20 Generalization

61
Partial Seizures
  • First Line Drugs
  • carbamazepine, phenytoin, combinations
  • Adjunctive Agents
  • gabapentin, topiramate, lamotrigine, tiagabine,
    levetiracetam, others.

62
Status 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

63
Status Epilepticus
  • Is a life threatening Situation
  • Causes
  • anticonvulsant withdrawal
  • alcohol withdrawal
  • cerebrovascular disease

64
Status Epilepticus (Therapy)
  • Restrain Patient
  • Support Respiration
  • IV diazepam or lorazepam
  • Follow with phenytoin or phenobarbital
  • May require general anesthesia in some cases

65
Alcohol 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.

66
Alcohol 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

67
Febrile Seizures
  • Affects children between ages of 6 months to 5
    years.
  • Usually occur with temperatures gt 390C (1020F)

68
Febrile Seizures (cont)
  • Therapy
  • Primary- Treat Underlying cause if Known (e.g.,
    antibiotics)
  • Fever reduction- acetaminophen
  • Rectal diazepam to control seizure
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