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52 year old female with muscle weakness having difficulty completing…
52 year old female with muscle weakness having difficulty completing normal tasks (ALS)
ALS affects nerve cells in brain & spinal cord
atrophied muscle
atrophied = no muscle nourishment
genetic ALS
inherited from parents
sporadic ALS
random with no clear risk factors
90% of cases occur without family history
age
symptoms usually develop between ages 55 and 75
gender
20% more common in men than in women
race & ethnicity
Caucasians & non-hispanics
veterans are 1.5 to 2 times more likely to develop
exposure to lead
pesticides
environmental toxins
chemicals
traumatic injuries
viral infections
neurodegenerative disease that affects nerve cells
currently no cure
environmental factors that might trigger ALS
smoking
toxin exposure
lead
other substances in workplace or home
muscle cramps
medication
physical therapy
tight/stiff muscles
physical therapy
medication
muscle twitches
medication
nutritional support
muscle weakness
physical therapy
medication
nutritional support
slurred speech
speech therapy
medication
difficulty chewing or swallowing
medication
physical therapy
nutritional support
high risk of getting food, liquids or saliva into the lungs
can cause pneumonia
feeding tube can reduce the risks
background information
anatomy
cerebrum
hindbrain
composed of white matter
thin outer layer of densely folded gray matter
made of two hemispheres (halves)
spinal cord
connects to the medulla oblongata
ends around the L1 and L2 vertebra
part of the central nervous system
layers
dura mater
arachnoid
pia mater
divided into 4 parts
cervical
thoracic
lumbar
sacral
cervical enlargement
enlargement from which the nerves going to the arm arise
lumbar enlargement
enlargement from which the nerves going to the leg originate
cauda equine
group of spinal nerves that extend off the end
often called "horse's tail"
conus medullaris
cone-shaped end of the spinal cord itself
filum terminale
extension of the pia mater that anchors the spinal cord in place
central canal
middle open space contains cerebrospinal fluid
dorsal gray horn
region of gray matter posterior in spinal cord
contains cell bodies of interneurons
ventral root
bundle of motor neurons that leaves the anterior side
travels to muscles & glands
ventral gray horn
region of gray matter
anterior in the spinal cord
contains cell bodies of motor neurons traveling to skeletal muscles & glands
white matter funiculi
columns of myelinated axons on the outer surface
surrounding the gray matter horns
dorsal root
bundle of sensory neurons
posterior side of the spinal cord
lateral gray horns
region of gray matter
lateral in spinal cord
autonomic motor neurons
dorsal root gangion
enlargement along dorsal root
sensory neuron cell bodies are found
dorsal median sulcus
narrow groove on posterior side
ventral median fissure
slightly wider groove
anterior side
gray matter
neuron cell bodies
dendrites
unmyelinated axons
nerves
obturator
adductor muscle group
axillary nerve
deltoid muscle
ulnar nerve
flexor carpi ulnaris muscle
femoral nerve
rectus femoris muscle
common fibular nerve
tibialis anterior muscle
ascending tracts
spinothalamic tracts
starts in spinal cord
ends in parietal lobe
anterior
front
lateral
side
spinocerebellar tract
starts in the spinal cord
ends in cerebellum
has 3 neurons
1st order neuron
spinal cord
2nd order neuron
dorsal horn
3rd order neuron
thalamus that connects to cerebral cortex
descending tracts
corticospinal tract
cerebral cortex
gray matter of brain
spinal cord
vestibulospinal tract
brainstem
spinal cord
motor tracts
motor neurons in brain
skeletal muscles
tracts have 2 neurons
upper motor neuron
in the brain or brainstem
lower motor neuron
neuron that synapses with the muscle
the spinal cord
31 pairs of spinal nerves
8 cervical nerves
12 thoracic nerves
5 lumbar nerves
5 sacral nerves
1 coccygeal
extends from L1 to L5
extends from T1 to T12
physiology
cerebrum
controls movement
balance
equilibrium
muscle tone
relays information between body muscles & cerebral cortex
nerves
obturator nerve
collects info from the skin of the medial thigh
femoral nerve
collects info from the skin of the anterior thigh
radial nerve
collects info form the skin of the lateral forearm
tibial nerve
collects info from the skin of the posterior leg & foot
axillary nerve
collects info from the skin of the shoulder
reflexes
neural pathway responsible for body's response to stimuli
essential for homeostasis and survival
reflex arc component
receptor
dendrites of sensory neurons detect stimuli (temperature, pain, pressure)
sensory neuron
transmits sensory impulses to the central nervous system
interneuron
processes/integrates sensory impulses
predicts the correct motor response
motor neuron
transmits motor impulses from the CNS to the effector
effector
muscles or glands
the patellar reflex
stretch reflex
the flexor withdrawal reflex
intended to protect the body from damaging stimuli
coordinates the contractions of all the flexor muscles
relaxations of the extensors in that limb
causing sudden withdrawal from the potentially damaging stimulus
the crossed extensor reflex
a reflex in which the contralateral limb compensates for loss of support
when the ipsilateral limb withdraws from painful stimulus in a withdrawal reflex
the blinking reflex
designed to naturally protect the eyes
precentral gyrus
commands voluntary movements of skeletal muscles within the body
enables all bodily movement after receiving signals from another area of the brain
basal nuclei
processing movement-related information
ascending neurons
1st order neuron
2nd order neuron
3rd order neuron
connects with the cerebral cortex
interneuron processes info
brings the information
descending tracts
corticospinal tract
direct motor tract
directions for movement came from cerebral cortex
vestibulospinal tract
indirect motor tract
decision for movements came from brainstem not cerebellum
balance
motor tracts
motor neurons in brain give directions
skeletal muscles respond to these directions
normal cellular process
slow ATPase enzymes
liberate energy more slowly, but also use ATP more slowly
fast ATPase enzymes
liberate energy quickly but also burn through ATP very fast
from electron transport chain
requires oxygen
slow oxidative fibers
contract slowly & build ATP from ETC
fast oxidative fibers
contract quickly & build ATP with electron transport chain
from glycolysis
glycolytic fibers can only make ATP if there's sugar
breaking down glucose
fast glycolytic fibers
contracts quickly & builds ATP from glycogen
excitation contraction coupling
neuron releases ACh
chemically gated sodium channels open
membrane of a muscle fiber depolarizes
calcium binds to troponin
tropomyosin unblocks the myosin-binding sites on actin
summation
no summation
slowly firing presynaptic neuron causes EPSPs that are far apart in time
spatial summation
more than one presynaptic neuron fires at same time, EPSPs are generated at different locations on the neuron
temporal summation
rapidly firing presynaptic neuron causes EPSPs that are close in time
mitosis
interphase
DNA is copied in prep for cell division
prophase
chromosomes condense into x-shaped structures
each chromosome is composed of two sister chromatids
contains identical genetic information
metaphase
chromosomes line up in center
centrioles are now at opposite poles of the cell
mitotic spindle fibers attach to each sister chromatid
anaphase
sister chromatids pull part by mitotic spindle
telophase
2 more items...
chromosomes in nucleus are evenly divided
two cells
descending tracts
upper motor tracts
brain or brainsten
lower motor neuron
neuron that synapses with muscle
motor tracts
ascending tracts
1st order neuron
brings info to spinal cord
2nd order neuron
interneuron In dorsal horn of spinal cord
3rd order neuron
neuron in thalamus that connects with cerebral cortex
sensory tracts
reflexes
the patellar reflex
spinal reflex
monosynaptic
patellar tendon
the flexor withdrawal reflex
ipsilateral reflex
polysynaptic
spinal reflex
the crossed extensor reflex
contralateral reflex
spinal reflex
the blinking reflex
cranial reflex
trigeminal nerve
cranial nerve 5
facial nerve
cranial nerve 7
4 drugs are currently FDA approved
riluzole
nuedexta
radicava
tiglutik
areas affected
limbs
trunk
areas that control vital functions such as;
speech
swallowing
breathing
nerve cells
brain
spinal cord
motor neurons damaged
they stop sending messages to muscles
muscles can't contract
gene mutation
mutations in the DNA can lead to ALS
breathing problems
paralyzes the muscles you use to breath
CPAP machine would help
BiPAP machine would help
tracheostomy
surgically created hole in trachea
most common cause of death in ALS
respiratory failure
dementia
problems with memory & decision making
frontotemporal dementia