* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download NEURO-FOR-THE-NOT-SO-NEURO
Synaptic gating wikipedia , lookup
Embodied language processing wikipedia , lookup
Neuroanatomy wikipedia , lookup
Neuroregeneration wikipedia , lookup
Emotional lateralization wikipedia , lookup
End-plate potential wikipedia , lookup
Visual selective attention in dementia wikipedia , lookup
Microneurography wikipedia , lookup
Neuroeconomics wikipedia , lookup
Human brain wikipedia , lookup
Neuromuscular junction wikipedia , lookup
Neuroplasticity wikipedia , lookup
Neuropsychopharmacology wikipedia , lookup
Basal ganglia wikipedia , lookup
Anatomy of the cerebellum wikipedia , lookup
Cognitive neuroscience of music wikipedia , lookup
Aging brain wikipedia , lookup
Biochemistry of Alzheimer's disease wikipedia , lookup
Premovement neuronal activity wikipedia , lookup
Inferior temporal gyrus wikipedia , lookup
NEURO-FOR-THE-NOTSO-NEURO-MINDED Barb Bancroft, RN, MSN, PNP CPP Associates, Chicago, IL [email protected] www.barbbancroft.com THE FRONTAL LOBES… • Prime real estate of the brain • Comprises one-third of the cerebral cortex • This is your “Mother” • “No, negative, don’t, stop…” She is inhibitory.. • Socialization “Mom” and socialization • Frontal lobes are not mature in babies and young children…it actually takes about 17-22 years for full maturity of the frontal lobes • “Don’t scratch, don’t pick, don’t dig..” • Judgment • Insight FRONTAL LOBES… • Alcohol and socialization • Loss of inhibitions with .05 blood alcohol levels • Baso-orbital region and the loss of inhibitions in patients with dementia Acetylcholine…cognitive function • Alzheimer’s disease—90% of acetylcholine is lost with destruction of brain tissue • Amyloid plaques and neurofibrillary tangles • BAP v.s. TAU • Tumeric (cucurmin) and beta amyloid • Acetylcholinesterase inhibitors Alzheimer’s… • • • • • The Alzheimer’s brain Cortical atrophy Sulcal widening Atrophy of gyri Brain weight Quick mental status check… • Time and Change Test Clock with hands—What time is it? 3 quarters, 7 dimes, 7 nickels—Can you give me change in the amount of $1.00? 97% negative predictive value if correct on both parts of the test Clock drawing…global function Frontal lobes… • Voluntary speech center • Dr. Pierre Paul Broca • Broca’s aphasia • Non-fluent aphasia—telegraphic, staccato speech Frontal lobes… • Pre-central gyrus (motor cortex—upper motor neurons) • Voluntary movement center Upper Motor Neurons/CS tract • Contralateral hemiparesis • Pronator drift • Hemiparalysis (spastic paralysis) • Head injury, stroke,tumors • “And that’s why we always stand to the side when we check reflexes…” • Hyperreflexia • Babinski—extensor plantar reflex TEMPORAL LOBES… • • • • • Wernicke’s area—reception of speech Do you understand what I am telling you? Interpretation of speech and sounds Coins jingling in pocket Auditory agnosia TEMPORAL LOBES… • Cranial Nerve VIII (Acoustic Nerve) “hears” for you…(primary sensory modality) • The Superior Temporal Gyrus (STG) interprets what you are hearing (higher cortical function) • What am I hearing? TEMPORAL LOBES… • Cranial Nerve I “smells” for you (primary sensory modality) • The uncus interprets what you are smelling (higher cortical function) • The uncus is connected to the hippocampus (memory) TEMPORAL LOBES… • Inferior surface of frontal and temporal lobes--a meningioma displacing the olfactory nerve (cranial nerve 1) • Loss of smell • Loss of inhibitions (baso-orbital frontal lobe) TEMPORAL LOBES… • An “aura”—the beginning of a temporal lobe seizure with a funny taste or smell (rotten eggs) • Anosmia—loss of smell or the loss of the ability to interpret smell may be the first sign of a neurodegenerative disease (PD, DAT) TEMPORAL LOBES… • Déjà vu—feeling like you’re been there before • Jamais vu—familiar place becomes totally unfamiliar • Hallucinations—seeing or hearing something that is not there • Illusions—distortion of an ongoing stimuli • Drugs and hallucinations—boosting dopamine triggers hallucinations—drugs for Parkinson’s disease, hallucinogenic drugs and mushrooms, ETOH withdrawal, Herpes encephalitis • Marijuana and illusions TEMPORAL LOBES… • Self-preservation and preservation of the species—the autonomic nervous system • The 4 F’s…fight, flight • Feeding activities • And…. And… • Sexual Function Sexual function in the brain and dopamine… • SSRIs increase serotonin and you’re happy, but… • When serotonin goes up, dopamine goes down TEMPORAL LOBES… • Self-preservation and preservation of the species—The other 2 F’s • Flight—Fright (epi, NE) • Episodic dyscontrol syndrome—TBI patients TEMPORAL LOBES… • • • • • Recent memory (hippocampus) Remember 3 items… Red ball, clock, tennis shoe Repeat them after me… Red ball, clock, tennis shoe • Continue with exam for 10 minutes and ask them to repeat those 3 items • Post-traumatic stress disorder (cortisol receptors) • Depression and neurogenesis Loss of hippocampal cell function • Loss of recent memory • This is the first neurologic function to go with the aging process • When does this process begin? • When do you reach your peak mental capacity? TEMPORAL LOBES… • Partial complex seizures—altered state of consciousness; most common cause is a closed head injury; also consider a history of shaken baby syndrome; mid-forceps delivery • Automatisms • Semi-purposeful behavior PARIETAL LOBES… • Integration of tactile sensations—touch, pressure, vibration, and proprioception (do you know where your left buttocks is, right now?) PARIETAL LOBES..testing • Double simultaneous stimuli—kids vs. adults • Touch two areas at the same time.. • Kids will always neglect their body and will recognize touch on the face • The neglect syndrome in adults PARIETAL LOBES..testing • • • • Ability to localize stimuli Sharp vs. dull Tests for proprioception Graphesthesia • Apraxia—example: a dressing apraxia ideomotor apraxia constructional apraxia Abstraction… • What does “Don’t cry over spilled milk” mean? • HUH? • How are a car, plane and boat alike? • Cow, horse, and pig? OCCIPITAL LOBES… • Visual integration—problems manifest as cortical blindness (visual agnosia) • Do you see this object? • If they can see it, CN2 (the optic nerve) • What is it? The occipital cortex QUIZ… • What were those 3 items I asked you to remember? The BASAL GANGLIA… • The 2nd area of the motor “triad” The basal ganglia… • Paired nuclei at the base of the brain • 50:50 balance between acetylcholine and dopamine • All dopamine is made in the substantia nigra from melanin • Gamma-amino butyric acid (GABA) keeps dopamine in check Caudate nucleus Globus pallidus Substantia nigra Subthalamic nucleus Dopamine • Dopamine levels decrease with aging gradually—we all slow down (loss of 45%) • Dopamine loss of greater than 80% results in signs and symptoms of Parkinson’s disease The BASAL GANGLIA The functions of the basal ganglia depend on a balance between various neurotransmitters GABA-↓ dopamine:acetylcholine 50:50 When this balance is disturbed, movement disorders occur The BASAL GANGLIA… • Control of movement, initiation and cessation of movement • Postural reflexes—the righting reflex Clinical symptoms • Resting tremor (70%)—unilateral or bilateral (unopposed acetylcholine in Parkinson’s patients) • Rigidity (decreased dopamine) (vs. spasticity of stroke patients) • Loss of voluntary movements (spontaneous) • Bradykinesia (decreased dopamine) (check gait) • Postural instability (sternal push) • Presence of severe seborrheic dermatitis suggests PD (unopposed acetylcholine) • Anosmia Huntington’s chorea…chromosome #4 • Excess dopamine due to the loss of GABAminergic input from the degeneration of the caudate nucleus • Chorea—rapid, jerky movements of muscle groups • Dementia • Neuroleptic drugs to block dopamine Other movement disorders • Tourette’s syndrome • Athetoid Cerebral Palsy • Tardive dyskinesia The cerebellum—the 3rd area of the motor “triad” The cerebellum… • • • • Coordination Synergy Balance Equilibrium The cerebellum… • Romberg test—stand up with your feet together and close your eyes • Tandem walk • Close your eyes and touch your finger to your nose • Rapid alternating movements The cerebellum… • Truncal ataxia—wide, staggering gait • Dysdiadochokinesia—inability to make rapid alternating movements • Dysmetria—inability to light on an object (touching nose with finger, for example) • Dysarthria • Puppet-like movements The cerebellum… • THINK BOOZE and the CEREBELLUM The CEREBELLUM… • Multiple sclerosis • Down syndrome • Spinocerebellar ataxia • (The cerebellum is not “strictly” motor—it also monitors sensory input from “the outside”—may play a role in autism and schizophrenia) Small cell carcinoma of the lung with mets to the cerebellum The BRAINSTEM…(the “bulb”) • Cardiorespiratory center—C2, C3 “Hangman’s fracture) • ARAS (Ascending reticular activating system) • Cranial Nerves III – XII (I and II are not located in the brainstem) The BRAINSTEM…(the “bulb”) • II (Optic) and III (Oculomotor)—light reflex, accommodation, and the optic disk (papilla) The BRAINSTEM…(the “bulb”) • II (Optic) and III (Oculomotor)—light reflex, accommodation, and the optic disk (papilla) • The Argyll Robertson pupil—it will accommodate but not react (to light) The BRAINSTEM… • CN III, IV, VI—follow my finger (extraocular movements) The BRAINSTEM… • V (Trigeminal) and VII (Facial) • Corneal reflex—touch cornea with a cotton wisp and the patient blinks • VII (Bell’s palsy)—paralysis of facial muscles – smile, puff cheeks, frown The BRAINSTEM… • • • • • IX (Glossopharyngeal) and X (Vagus) The gag reflex The uvula Closing off nasopharynx—say “K, K, K” Cleft palate The BRAINSTEM… • CN XII (Hypoglossal)— tongue movement and strength The PERIPHERAL NERVOUS SYSTEM • Dermatome chart • Stocking-glove distribution with peripheral neuropathy • The reflex arc—S1,2 (Achilles), L3,4(Patellar), C5,6 (Biceps), • C7,8 (Triceps) Know your dermatome chart… OR draw your own… Neuromuscular junction • Disease of the neuromuscular junction— myasthenia gravis • Muscle weakness—consider thyroid disease, drug-induced myopathy, polymyositis, inherited muscular dystrophies The reflex arc… • Sensory information into the spinal cord • Synapses in same spinal cord segment • Sent right back out via lower motor neuron to • Peripheral motor nerve • S1,2 (Achilles); L3,4 (Patellar); C5,6 (Biceps); C7,8 (Triceps) • 50% of the elderly (over 75) do NOT have an Achilles reflex Disease of the lower motor neuron or it’s pathway to the peripheral nervous system • Diabetes, alcoholism (thiamine deficiency), trauma, B12 deficiency • Heavy metals • Chemotherapy • others Thanks. • • • • • Barb Bancroft, RN, MSN, PNP CPP Associates, Inc. Chicago, IL. [email protected] www.barbbancroft.com