Applied Pathophysiology: Mechanisms of Disease
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Questions and Answers

Which of the following is NOT a type of brain injury?

  • Laceration (correct)
  • Hematoma
  • Concussion
  • Contusion
  • A cortical contusion always causes coma.

    False (B)

    What is the primary method to diagnose traumatic brain injury?

    Brain imaging (CT, MRI)

    The analysis of ______ and the presence of blood can be determined through a lumbar puncture.

    <p>cerebrospinal fluid (CSF)</p> Signup and view all the answers

    Match the types of brain injury with their descriptions:

    <p>Concussion = Temporary alteration in function, may experience unconsciousness or dizziness Contusion = Permanent damage to the brain tissue, potentially leading to coma if affecting the brain stem Hematoma = A collection of blood within the brain, putting pressure on surrounding tissues Edema = Swelling of brain tissue due to fluid accumulation Skull Fracture = A break in the skull bone, potentially causing damage to the underlying brain tissue</p> Signup and view all the answers

    Mature neurons are able to divide and replace damaged neurons.

    <p>False (B)</p> Signup and view all the answers

    What is the primary consequence of losing neurons?

    <p>Impaired neurologic transmission</p> Signup and view all the answers

    Which of the following is NOT a cause of neuronal injury?

    <p>New neuron growth (D)</p> Signup and view all the answers

    The process of ______ involves the swelling of a neuron and dissolution of its chromophil substance.

    <p>chromatolysis</p> Signup and view all the answers

    Match the following terms with their descriptions:

    <p>Chromatolysis = Decreased cell size Atrophy = Phagocytosis of dead neurons by neighboring cells Neuronophagia = Distinctive structures formed in the nucleus or cytoplasm Intraneuronal inclusions = Swelling of a neuron and dissolution of chromophil substance.</p> Signup and view all the answers

    What are the two main factors that determine the manifestations of neuronal injury?

    <p>Site of injury and functions controlled</p> Signup and view all the answers

    Intraneuronal inclusions are always a sign of neuronal injury.

    <p>False (B)</p> Signup and view all the answers

    Which of the following is a characteristic feature of neuronal injury at the cellular level?

    <p>Disruption of normal cell structures (A)</p> Signup and view all the answers

    Which of the following is a response to neuronal injury in support cells?

    <p>Astrogliosis (D)</p> Signup and view all the answers

    Microglial nodules form as a result of the immune response.

    <p>True (A)</p> Signup and view all the answers

    What is the main role of astrocytes in response to tissue injury?

    <p>Proliferation to form a glial scar</p> Signup and view all the answers

    The complication of unchecked proliferation of astrocytes can lead to ___________.

    <p>glioma</p> Signup and view all the answers

    Match the following injury responses with their corresponding cell types:

    <p>Astrocytes = Astrogliosis Microglia = Microglial nodules Ependymal cells = CSF production alteration Neurons = Axonal degeneration</p> Signup and view all the answers

    What is a primary consequence of nerve damage in neuropathy?

    <p>Numbness and tingling (A)</p> Signup and view all the answers

    Demyelination causes an increase in nerve conduction efficiency.

    <p>False (B)</p> Signup and view all the answers

    What is one of the main responses of peripheral nerves to traumatic injury?

    <p>Axon degeneration (D)</p> Signup and view all the answers

    Crushing injuries have a poorer prognosis compared to cutting injuries in the peripheral nervous system.

    <p>False (B)</p> Signup and view all the answers

    What are the two main categories of traumatic brain injury?

    <p>Closed head injury and open traumatic injury</p> Signup and view all the answers

    ___ is caused by necrosis and leads to the breakdown of the distal parts of axons.

    <p>Axonal degeneration</p> Signup and view all the answers

    What is the primary condition associated with excessive pressure on the median nerve?

    <p>Carpal tunnel syndrome</p> Signup and view all the answers

    Nerve injuries often result in symptoms such as pain, numbness, and __________.

    <p>paresthesia</p> Signup and view all the answers

    Match the following types of injuries with their appropriate classifications:

    <p>Coup injury = Acceleration injury Contrecoup injury = Deceleration injury Peripheral nerve injury = Traumatic Peripheral Nervous System Injury Central pressure injury = Central Nervous System Pressure Injury</p> Signup and view all the answers

    Match the conditions with their associated characteristics:

    <p>Wallerian degeneration = Degeneration of the severed nerve area Chromatolysis = Cellular changes in response to nerve injury Brachial plexus palsy = Flaccid paralysis of the arm Edema = Swelling that can lead to nerve injury</p> Signup and view all the answers

    Which of the following is NOT a type of central nervous system injury mechanism?

    <p>Demyelination (D)</p> Signup and view all the answers

    Traumatic brain injuries can only occur due to external factors such as accidents.

    <p>True (A)</p> Signup and view all the answers

    What risk is associated with open traumatic brain injuries?

    <p>Risk of infection</p> Signup and view all the answers

    What is a common clinical manifestation of a spinal cord injury (SCI)?

    <p>Mild paresthesia (A)</p> Signup and view all the answers

    Treatment for ischemic central nervous system injury does not include thrombolytic therapy.

    <p>False (B)</p> Signup and view all the answers

    What role does glutamate play in excitation injury?

    <p>Glutamate is the main excitatory neurotransmitter that leads to prolonged action potentials and can cause tissue damage.</p> Signup and view all the answers

    One cause of global ischemia is _____ arrest.

    <p>cardiac</p> Signup and view all the answers

    Match the type of spinal injury position with the corresponding brain damage:

    <p>Decorticate position = Damage to cerebral hemispheres above midbrain Decerebrate position = Damage to brain stem (midbrain)</p> Signup and view all the answers

    Which diagnostic tool is NOT typically used for diagnosing ischemic blockage?

    <p>Ultrasound (B)</p> Signup and view all the answers

    Increased intracranial pressure (ICP) can lead to tissue necrosis.

    <p>True (A)</p> Signup and view all the answers

    What are the treatment methods mentioned for traumatic spinal cord injury?

    <p>Immediate immobilization, corticosteroids, traction, casting, and surgery.</p> Signup and view all the answers

    Impaired blood flow lasting longer than a few minutes causes brain tissue _____ .

    <p>infarction</p> Signup and view all the answers

    Which statement accurately describes excitation injury?

    <p>Results in increased impulse frequency and cascade of transmission (D)</p> Signup and view all the answers

    Flashcards

    Neuronal Injury

    Damage to nerve cells affecting their function; responses vary by cell type.

    Astrogliosis

    Response of astrocytes to injury resulting in glial scar formation in brain tissue.

    Microglial nodules

    Clusters of reactive microglia and lymphocytes formed in response to injury or disease.

    Axonal degeneration

    Loss of the axon portion of a neuron, often leading to loss of function.

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    Ependymal cell damage

    Injury to ependymal cells leading to altered CSF production due to infections or hemorrhage.

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    Mature neurons

    Neurons that do not divide or regenerate.

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    Neuron loss effects

    Leads to impaired neurologic transmission and disorders.

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    Chromatolysis

    Swelling of a neuron with dissolution of its substance.

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    Neuronophagia

    Phagocytosis of dead neurons causing inflammation.

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    Intraneuronal inclusions

    Distinctive structures formed within neurons.

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    Atrophy

    Decrease in cell size, often due to injury.

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    Ageing effects on neurons

    Age can lead to neuron damage and loss.

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    Neurologic transmission impairment

    Failure in signaling due to neuron loss.

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    Neuropathy

    Condition resulting from damage to nerves, disrupting communication.

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    Demyelination

    Damage to myelin sheath impacting nerve conduction efficiency.

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    Traumatic CNS Injury

    Injuries affecting the central nervous system due to trauma.

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    Closed Head Injury

    A type of traumatic brain injury without skull penetration.

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    Open Traumatic Injury

    Injury type exposing brain structures, increasing infection risk.

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    Coup and Contrecoup Injury

    Coup is injury from impact; contrecoup is injury from rebound.

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    Traumatic Brain Injury Causes

    Main causes include accidents, falls, and sports injuries.

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    Peripheral Nervous System

    Part of the nervous system outside the brain and spinal cord, includes nerves and support cells.

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    Wallerian Degeneration

    Degeneration process after a nerve is cut, involving the distal segment of the axon.

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    Traumatic Peripheral Nerve Injury

    Injury caused by crushing or cutting, leading to symptoms like numbness and pain.

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    Carpal Tunnel Syndrome

    Nerve compression at the wrist causing pain and paresthesia, linked to edema.

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    Concussion

    A temporary alteration in brain function, leading to symptoms like unconsciousness or dizziness.

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    Contusion

    Permanent damage to the brain, can be cortical or brain stem, affecting consciousness.

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    Hematoma

    A collection of blood outside of blood vessels, often requiring surgical evacuation.

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    Increased ICP

    Increased intracranial pressure, a serious condition affecting brain function and can lead to herniation.

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    Traumatic Brain Injury (TBI)

    An injury to the brain from external force, often diagnosed with imaging and EEG.

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    Flexion-Extension Injury

    Spinal cord injury caused by bending of the spine, often from accidents or trauma.

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    Laceration

    A rip or tear in the spinal cord from fractures or trauma.

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    Concussion (Spinal Cord)

    A violent blow to the spinal cord with no obvious damage, may cause temporary deficits.

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    Traumatic Spinal Cord Injury

    Injury to the spinal cord causing a range of symptoms from mild paresthesia to quadriplegia.

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    Paresthesia

    Abnormal sensations such as tingling or numbness that can occur after a spinal cord injury.

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    Spinal Cord Injury Diagnosis

    Methods used to diagnose spinal cord injuries including X-ray, neurologic examination, and imaging techniques.

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    Immediate Treatment for SCI

    Initial treatment for spinal cord injuries involves immobilization and corticosteroids to prevent further damage.

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    Ischemic Injury

    Inadequate blood supply to the central nervous system leading to tissue damage and necrosis.

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    Global Ischemia

    Inadequate blood supply affecting the entire brain, often due to cardiac arrest or severe hemorrhage.

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    Excitation Injury

    Pathological effects caused by increased neuronal activity and neurotransmitter release, leading to cellular damage.

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    Glutamate

    The main excitatory neurotransmitter implicated in excitation injury and prolonged action potentials.

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    Inflammatory Response

    Body's reaction to injury; leads to edema, increased intracranial pressure, and further complications.

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    Decerebrate Position

    A posture indicating severe brain injury with damage to the brainstem, characterized by arms and legs extended.

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    Study Notes

    Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease

    • This lecture series covers the mechanisms of disease in the nervous system.
    • Specific topics within this series are alterations of neuronal transmission, alterations in CNS functions, and alterations in PNS functions.

    Processes of Neuronal Injury

    • Mature neurons do not divide. New neurons do not replace damaged neurons.
    • Loss of neurons leads to impaired neurologic transmission.
    • Impaired neurologic transmission leads to neurologic disorders.
    • Cell damage can occur from aging, injury site, and functions under control.
    • Manifestations reflect the site of injury.

    Result of Injury at the Cellular Level

    • Chromatolysis is part of apoptosis; it involves the swelling of a neuron and the dissolution of chromophil substance in neurons.
    • This can happen in certain pathological conditions or following injury to a neuron or its axon.
    • Atrophy is the decrease of cell size.
    • Neuronophagia is the process of phagocytosis and inflammatory responses caused by a dead neuron damaging neighboring cells.
    • Intraneuronal inclusions are distinctive structures formed in the nucleus or cytoplasm of a neuron.

    Neuronal Injury

    • The response to injury depends on the specific cell type involved and mirrors the cell's properties.
    • Injury responses of support cells often involve astrogliosis, a process where astrocytes proliferate in response to local tissue injury which forms a glial scar.
    • Uncontrolled astrogliosis can lead to tumors such as gliomas, which are types of brain cancer.
    • Microglia, an immune response cell, also respond to injury through reactive changes, expanding their nucleus to form "rod cells" and join with astrocytes to produce microglial nodules.
    • Ependymal damage in the central nervous system can result from infection or hemorrhage in ventricles, and this can interfere with CSF production and transfer.
    • Injury responses of neurons can involve neuropathy resulting from nerve damage or destruction that leads to muscle weakness and numbness.
    • Axonal degeneration involves the breakdown of distal parts of the axons, which is caused by necrosis and leads to inflammatory responses that lead to phagocytosis of cell debris, removing dead material.
    • Demyelination in neurons is caused by myelin damage causing nerve conduction interruption.
    • Ependymal cell damage can cause issues with CSF (cerebrospinal fluid) alterations.

    Central and Peripheral Nervous System Neuronal Injury

    • Mechanisms of injury in the central nervous system (CNS) can include traumatic CNS injuries (e.g., traumatic brain injury (TBI), traumatic spinal cord injury (SCI)).
    • Mechanisms of injury in the peripheral nervous system (PNS) can include traumatic peripheral nerve injuries.

    Traumatic Central Nervous System Injury

    • Impaired neurologic function can stem from local or systemic causes.
    • Injury in a specific area produces a local effect, whereas injury affecting the regions responsible for integrating impulses to multiple distant sites causes a systemic effect.
    • Causes of TBI include automobile accidents, falls, sports-related injuries, and shaken baby syndrome, which presents in two categories: closed and open traumatic injuries.

    Traumatic Brain Injury: Closed Head Injury

    • A coup injury refers to the acceleration injury when the brain moves inside the skull.
    • A contrecoup injury refers to the deceleration injury from the brain striking the opposite side of the skull.

    Traumatic Brain Injury: Lacerations and Contusions

    • Brain tissue can be subject to contusions and lacerations as a result of forces caused by the head impact.

    Traumatic Brain Injury: Open Traumatic Injury

    • Injuries to central nervous system structures (meninges and brain) can be exposed during open traumatic injuries.
    • There is a risk of infection.

    Traumatic Brain Injury: (Diagnosis and Treatment)

    • Diagnosing traumatic brain injuries involves imaging (CT, MRI), examining brain activity (EEG), performing lumbar punctures (spinal tap) to check for CSF and blood content (intracranial hemorrhage), and other procedures.
    • Treatment for traumatic brain injuries focuses on specific injuries, including surgical removal of hematomas or foreign materials, reducing ICP, using pain control, administering anticonvulsant medications, providing respiratory support, and administering antibiotics for infection prevention.

    Traumatic Spinal Cord Injury (SCI)

    • Most common causes of SCI include fractures, contusions, spinal column compression (trauma to the head or neck), and pulling, twisting, or severing of the spinal cord tissue.
    • SCI damage can manifest from mild paresthesia (abnormal sensations) to paralysis in all four extremities. The level and severity of the injury contribute to neurologic deficits.

    Spinal Cord Injury: Diagnosis

    • Diagnostic tools for SCI include X-rays for fractures, neurological examination to identify deficits, lumbar puncture to assess cerebrospinal fluid, and imaging methods (CT, MRI).

    Spinal Cord Injury: Treatment

    • Treatment often involves initial immobilization, followed by corticosteroid therapy to reduce inflammation. Further treatments such as traction and surgery may be undertaken.

    Ischemic Central Nervous System Injury:

    • Inadequate perfusion to the CNS causes tissue necrosis.
    • Causes of ischemia include local ischemia (occlusion of blood supply by thrombus or embolus) and global ischemia (inadequate blood supply).
    • Global ischemia leads to hypoxia, which can be triggered by cardiac arrest or severe hemorrhage.

    Central Nervous System Pressure Injury

    • Increased intracranial pressure (ICP) can result from excessive cerebrospinal fluid (CSF) volume, cerebral edema, or space-occupying lesions (tumors).
    • Increased intracranial pressure (ICP) leads to reduced blood flow (ischemia), death of brain cells, and brain tissue damage.

    Excitation Injury

    • Neurons that easily depolarize or hyperpolarize can cause altered transmission and lead to excitation injury.
    • The pathologic consequences of increasing impulse frequency, especially in intense excitation, lead to cascade effects involving glutamate (the main excitatory neurotransmitter).
    • Prolonged action potentials may stimulate protein breakdown and formation of free radicals leading to DNA damage.
    • This can lead to metabolic demand inability and tissue sensitivity to hypoxia, resulting in permanent damage to the hippocampus, cerebral cortex, and reduction in higher order cognitive (cognitive and memory) functions.

    Peripheral Nervous System Injury

    • Peripheral nerves are vulnerable due to the lack of protection compared to the CNS.
    • Injury commonly results from trauma, pressure, or compression, leading to limited responses when compared to the CNS as nerves have limited regenerative capacity.

    Traumatic Peripheral Nerve Injury

    • Crushing or cutting a nerve causes the section of the severed nerve to degenerate (Wallerian degeneration).
    • Traumatic injury can induce inflammatory processes. Also, Chromatolysis—the reaction of nerve cell bodies to damage—occurs in the neuron.
    • The severity of the sensory symptoms can depend on the number of axons involved.
    • Peripheral nerve regeneration is dependent on the level of injury, and a shorter injury has a better recovery prognosis than a longer injury.

    Peripheral Nervous System Pressure Injury

    • Nerve compression can result from edema in constricted spaces, such as carpal tunnel syndrome.
    • Nerve trauma can contribute to edema impinging the nerve plexus and potentially lead to brachial plexus palsy.

    Neuronal injury summarized

    • Neuronal injury can be caused by a number of different mechanisms, such as trauma, ischemia, excitation, and pressure.
    • The type of injury, its location, and the affected part of the nervous system (central or peripheral) determine the resultant manifestations including mental status alterations, impaired movement, sensor disorders, etc.

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    Description

    This quiz explores the mechanisms of disease specifically in the nervous system, focusing on neuronal transmission and the effects of injuries. Delve into concepts such as neuronal injury processes, chromatolysis, and the implications of neuron loss on neurologic functions.

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