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Chapter 15

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Michael Inzlicht

Chapter 15 • Soccer players might actually be at the most risk of neuro problems from head trauma Stroke • cerebral hemorrhage = usually bc hypertension, structural defects in arteries or due to rupture of aneurysms (ballooned arteries) or blood diseases leukemia, exposure to toxic chemicals. o Frequently fatal bc flooding areas w/ salty blood dehydrates and kills nearby neurons • Ischemia = low oxygen lvls, accounts for 80% of strokes o But actually, only certain cells seem to be damaged (middle layers of cortex and in hippo), not widespread damaged as would be assumed. o excitotoxicity (term coined by Olney) w/ excess glutamate  Magnesium blocks one type of glutamate receptor (NDMA), so it can protect cells that are undergoing ischemia  But in practice, attempting to intervene has been disappointing o Glutamate  abnormal Ca  damages energy stores, membranes, cytostructure, DNA • TIAs = 24 hrs or less of stroke systems and do not cause permanent damage. But are strong predictors of subsequent stroke • Common treatments in general for strokes = surgery, reduce formation of new thromboses/emboli, reduce bp • Some cells dies immediately following a stroke but prompt med attention can save many neurons in the ischemic penumbra (area surrounding infarct) Head Injuries • TBI = from physical damage, commonly traffic accident, gunshot wounds, falls. Divided into: o Open head injuries = fragments of bone will enter the brain usually. Injuries involving ventricle damage, both hemis, or multiple lobes most likely result in death o Closed head injuries = Concussions = impulsive force transmitted to brain  Mild  brief or no period of unconsciousness  can still have perm damage tho • Ex. Athletes, esp w/ repeated damage • Dementia pugilistica = boxer’s syndrome = type of CTBI = chronic TBI associated w/ slurred speech, mem impairment, personality change, lack of coord, and Parkinsonian symptoms. Similar patterns of degen to Alz. Boxers who carry the E4 variant of the APOE gene might be more likely to develop CTBI (E4 also increases risk of Alz).  Severe  coma  Behv, physical, cog consequence can last for months/be permanent  A severe coup/countercoup could be accompanied by bleeding or subdural hematoma = bleeding in dura matter  White matter damage can also occur due to twisting of brain within skull in response to the blow. Also damage from pressure on brain bc swelling. • PCS = Postconcussion Sysndrom = occurs in some but not all cases of concussion and includes lack of concn, reduction in processing speed, deficits of mem + attn. Also headache, emotional symptoms (depression, irritability). Correlated w/ damage in brain structures of both white (corpus callosum, fornix) and gray matter (upper brainstem, base of frontal, medial temporal) Brain Tumors • After the uterus, the brain is the most likely organ to have tumors • ~ = independent growths of new tissue that lack purpose • Usually do not grow from mature neurons because those do not replicate • Most arise from glial or meningial cells and some from cells lining ventricles • Malignant lack distinct boundaries and more likely to recur and metastasize (travel to diff area) • Many brain tumors result from metastasis from other body parts like lungs, breasts, colon • Tumors that originate in brain rarely metastasize and if they do the shed cells travel through CSF to other parts of NS, not usually to other organs • Benign tumors can still do harm, they just are isolated, less likely to recur and don’t metastasize • Symptoms mainly due to the pressure = headache, vomiting, double vision, reduced heart rate, reduced alertness, seizures. Specific location  more specific additional symptoms • 45% of tumors are GLIOMAS = often from astrocytes, oligodendrocytes, or mixtures • Meningiomas = typically benign but can exert pressure. Usually easy to remove surgically bc on surface of brain rather than subcortical • WHO has a classification system for CNS tumors between Grade 1 (least serious, benign, slow-growing, respond well to surgery) to Grade 4 (most serious, can be rapidly fatal) o Grade 2 = malignant, higher likelihood of recurrence but grow slowly o Grade 3 = malignant, require more aggressive therapies • Radiation or chemotherapy (chems that destroy tumor cells are applied via bloodstream) are some therapies. Chemotherapy is often not the best bc can’t cross blood-brain barrier. • Thalidomide is a treatment to starve tumors by reducing growth of blood vessels supporting them. This was also an infamous med for pregnant women which  serious birth defects o Often used in conjunction w/ surgery/chemo • A more experimental treatment is to insert anticancer genes into stem cells and deliver to tumor MS • Autoimmune condition where immune sys attacks CNS, specifically oligodendrocytes • Leads to sclerosis (= scarring)  demyelination of axons  damage to the axons themselves • Typically appears first in young adults, affecting twice as many women • Can affect widespread wide matter  variety of cog, sensory, motor issues • Often includes fatigue, muscle weakness, sensory changes, balance problems, depression, pain/tingling sensations in legs, • Lot of variability between patients • Enviro factors include exposures to various viruses, including Epstein-Barr which is responsible for mononucleosis, lack of Vitamin D from less exposure to sun • Also more common along people living near equator • Relapsing-remitting version of MS is most responsive to medical treatmen
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