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107 Cards in this Set
- Front
- Back
Inflammation of pia and arachnoid
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meningitis
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sparse exudate with numerous organisms with severe congestion of the leptomeninges characterizes what?
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hyperacute meningitis; death within 24 hrs
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most common infection of the CNS?
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bacterial acute meningitis secondary to hematogenous spread
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What is waterhouse-friderichsen syndrome?
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Septicemia with meningitis and adrenal gland hemorrhagic infarcion
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subacute/chronic meningitis is defined as?
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>1 week where PMNs are less and lymphocytes/plasma cells appear with macrophages
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complications of subacute/chronic meingitis?
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leptomeningeal fibrosis, hydrocephalus, and chronic adhesive arachnoiditis
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Most common meningeal bacterial in neonates?
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GBS and EColi
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MCC of meningitis in young adults?
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N. meningitides
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MCC of bacterial meningitis in adults and elders?
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Strep Pnemoniae and l monocytogenes
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Which is more fulminant? Viral or bacterial meningitis?
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Bacteiral
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MCC of viral meningitis?
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enterovirus (echovirus/ coxsackie/nonparalytic polio also)
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Pathologic finding in acute viral meningitis?
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lymphocytic infiltrate in leptomeninges and brain swelling
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Causative agents of brain abscesses?
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bacteria or fungi
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MCC of brain abcesses?
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strep and staph
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MCC of brain abcesses in IC?
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toxo, nocardia, listeria, GM-bacilli, mycobacteira, fungi
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Empyemas of epidural and subdural spaces caused by?
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local extension of infective process outside CNS MC steph or staph
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Inflammation of brain and spinal crod tissue?
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meningoencephalitis
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TB infections involve CNS how?
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meningoencephalitis
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Mycobacterial stain of CNS is how reliable?
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its only positive 5-30% of the time.
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complication of TB?
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obliterative endarteritis of meningeal vessels, causing infarcts
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What is seen in a tuberculoma?
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mass lesion of caseating necrosis surrounded by capsule of fibroblasts, epithelioid cells, giant cells, lymphocytes, with SPARSE bacilli in necrotic center
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what is TB in the vertebrae?
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Pott's Disease (spondylitis) where TB causes granulomatous processes in vertebral bodies and intervertebral discs
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Major forms of neurosyphilis?
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general paresis, meningovascular, and tabes dorsalis
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thickened meninges and atrophic brain with gradual impariment of cognition and attention, STD?
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general paresis ak aparetic neurosyphilis
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chronic meningitis and multifocal arteritis?
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heubner's arteritis of neurosyphilis
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lightning pains, loss of position and vibration, and paresthesias with syphilis?
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tabes dorsalis
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Perivascular and parenchymal mononuclear cell infiltrates?
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typical of viral meningoencephalitis
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neuronophagia and microglial nodules?
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typical of viral meningoencephalitis (macrophages eating infected neurons)
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important cause of epidemic encephalitis?
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arbovirus (EE WEE VEE, sLE, west nile, and california)
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hemorrhagic necorisis of temporal lobe? MCC?
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HSV-1
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eosinophilic cowdry Type A?
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HSV-1
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chronic phase of HSV-1?
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cavitaiton, glial scar, sparse lymphocytes
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HSV-2 causing meningitis in what instances?
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neonate passage through birht canal
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MC viral infection in AIDS pts?
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CMV
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Periventricular necrosis, microcephaly, and periventricular calcifications in a fetus?
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CMV infection
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predominant cell type infected by HIV in CNS?
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microglia (macrophage, CCR5)
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microglial nodule with multinucleated microglial cells?
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found in gray and white matter in HIV encephalitis
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vacuolation of white matter in AIDS patiens is called what?
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vacuolar myelopathy causing vib and prop deficits
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PML caused by and infects what?
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JC infection of oligodendrocytes to cause demyelination
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large astrocytes with bizzare pleomorphic hyperchromatic nuclei and intranuclear oligodendrocytic inclusions?
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progressive multifocal leukoencephalopathy
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Most common fungal meningitis
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crytococcus neoformans
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method of CNS infection by cryptococcus?
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infection by lungs and hematogenous spread to the brain
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diagnosis of cryptococcus?
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lumbar puncture, +lymphocytes, mild protein elevation, mild/normal glucose
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Multiple intraparenchymal cysts that resemble soap bubbles?
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cryptococcal CNS infection
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small buds and stain with mucicarmine?
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cryptococcal
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vascular CNS damage by fungi caused by?
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Mucormycosis and Aspergillus
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most common cause of CNS mass lesions in AIDS patients?
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toxoplasma
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most common cause of space occupying lesions in CNS?
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cryptococcus
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most common aids defining illness?
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crypto
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idiopathic spongiform encephalopathy?
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sporadic CJD
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what is GSS?
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inherited spongiform encephalopathy which is AD and onset is around 25 yrs.
gerstman-straussler-scheinker |
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acquired/transmissible spongiform encephalopathy?
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iatrogenic CJD due to corneal transplants etc, OR dietary
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what is a prion?
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PRNP on chromosome 20 that becomes mutated to form the protein PrPsc which has a abnormal amyloid formation
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PRNP gene polymorphism?
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at 129 Met or Val.
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BSE?
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bovine spongiform encephalopathy
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rapidly progressive dementia in 7th decade, myoclonic jerking. What is used for proper Dx?
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EEG and MRI showing increased basal ganglia signals
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What are kuru plaques?
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amyloid plaques seen in spongiform encephalopathy
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what is notable about CJD histology?
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NO inflammatory response! only reactive astrocytosis and degeneration
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most common cause of dementia in elderly?
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alzheimer's
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Avg disease duration of alzheimer's?
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7 years (to tibet)
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CT showing diffuse symmetric cortical atrophy?
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alzheimers
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EEG only with mild generalized abnormality, imparied attention, no impared labs or CSf examination?
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alzheimers
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gross pathology of alzheimer's brain
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atrophy of gyri with wide sulci, decrease in brain weight (cortical atrophy)
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What is a senile plaque?
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an EXTRAcellular BA4 amyloid plaque derived from APP (amyloid precursor protein)
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What is tau?
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a microtubular associated protein that accumulates in neurons if abnormal. the abnormal form is called PHF (paired helical filament)
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what is diffuse plaque?
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betaA4 protein without PHF
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What is neuritic plaque
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betaA4 protein WITH PHF in axons and dendrites
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What kind of plaques are more closely associated with cognitive decline?
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neuritic plaque (the betaA4 with PHF)
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Hypothesized progression of plaque formations?
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diffuse forms first then neuritic plaques develop from diffuse ones.
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intraneuronal cytoplasmic aggregation of PHF. What is it and what does it look like?
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neurofibrillary tangles, flameshaped
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NFT occur first where?
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medial temporal lobe then cortex.
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The degree of cognitive impairment in AD is correlated to?
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NFT densities.
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pathological diagnosis of AD utilize what criteria?
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density of neuritic plaques and braak stage of NFT.
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What is the relationship between snile plaques and NFT?
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unknown
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AD pattern of inheritance?
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sporadic, nonmendelian inheritance, 1-2% familial AD which is autosomal dominant (AD!hehe)
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AD characterized how?
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familial or sporadic, early or late onset.
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what is early onset AD?
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less than 60 years age of onset
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most cases of FAD have mutation of?
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1) amyloid precursor protein gene
2) presenilin 1 gene 3) presenilin 2 gene |
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APP is associated with?
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amyloid precursor protein is on chromosome 21 so many down's pts get AD mid 30's.
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What is amyloid precursor protein?
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a membrane glycoprotein. mutations of this yield betaA4 amyloid.
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how do mutations of preselilins affect APP?
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they are cofactors for proper gamma cleavage of APP
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where are betaA4 proteins located?
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extracellularly in plaques and also intraneuronal where it is toxic
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Responsible for 50% of all FAD?
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presenilin 1 on chromosome 14.
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What gene is associated with late onset AD?
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ApoE on Ch 19.
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which genotype influences an earlier onset of late AD?
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Apolipoprotein e4 homozygous.
mnemonic: e4 is beeee4 |
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What does Apo e4 do?
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increases deposition of betaamyloid
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severe atrophy of frontal and temporal lobes, sparing parietal and occipital?
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pick's disease
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Clinical presentation of pick's disease?
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behavioral and speech before memory disturbances
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What are pick bodies?
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tau protein cytoplasmic bodies (remember, tau is NORMAL but PFT are tangles of tau)
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Progressive supranuclear palsy presents how?
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50-70 yr old male with parkinsonial signs, impaired vertical gaze and some dementia
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lesions found in progressive supranuclear palsy?
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abnormal tau accumulations in subthalamic nucleus, substantia nigra, globus pallidus, basal ganglia, PAG.
and astrocytes! |
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what are glial tangles?
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astrocytes with tau accumulations seen in progressive supranuclear palsy (not exclusively)
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What is vascular dementia?
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infarcs that cause diffuse white matter damage
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Pallor of substantia nigra in midbrain?
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parkinson's dz
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lewy bodies are?
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cytplasmic inclusions with a halo, composed of alpha synuclein
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what are lewy bWhat are alpha synuclein?odies made of
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alpha synuclein
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what causes dementia in parkinson's?
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lewy bodies in cortical neurons
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What is alpha synuclein?
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a normal presynaptic terminal protein
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Huntington's disease genetics?
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AD on Ch4, gene making huntingtin protein, paternal anticipation (only fathers go huntin)
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atrophy of caudate and putamen?
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huntington's dz
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Loss of GABA neurons?
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huntington's disease, loss of striatal inhibitory neurons
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Abnormality accounting for up to half of all hereditary ataxias?
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friedrich's: Ch9, a gene that codes for frataxin, a mitochondrial protein that regulates iron flow and ATP production
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GAA
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freidrich's ataxia
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CGG
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fragile X
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CAG
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huntington's
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Ataxia, loss of position and vibration sense before age 20?
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Friedrich's ataxia
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SOD1 mutation?
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ALS - fatal disorder of corticospinal degeneration.
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