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Gero 310 F'09 neuro 3

Gero 310 F'09 neuro 3 - Age-related diseases in the nervous...

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Age-related diseases in the nervous system Chp 6 pp.137-147 Stroke (aka CVA: cerebrovascular accident) • third leading cause of death in the 65+ population: 1) heart disease (~40% of deaths) 2) cancer (~20%) 3) stroke (9%; 6% @ 65 years, 12% @ 85 years) • what is a stroke? - damage to brain caused by sudden interruption of blood supply
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• how does the damage occur? - neurons are highly active cells - require glucose & oxygen, which are supplied by blood - rapidly lose homeostasis w/ interruption of blood flow - result: neuronal degeneration - variety of mechanisms implicated in cell death - much degeneration can also caused by reperfusion - re-introduction of blood supply - new O 2 + high metabolism cause oxidative stress
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• atherosclerosis is most common underlying cause - formation of weak, scar-like material in vessel walls * called plaques - three major consequences: 1. narrows vessels = reduced blood flow 2. stiffens vessels = impairs vessel dilation 3. promotes clot formation (blood material) - thrombus : stationary clot; builds slowly at “sticky” spot along vessel - embolus : moving clot; detached portion of thrombus that moves until vessel narrows
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Two general types of stroke 1) ischemic - represent ~80% of all strokes - ischemia = inadequate blood flow - variety of causes for ischemia - thrombus formation : develop gradually * often associated with transient ischemic attacks (TIAs) w/ stroke-like symptoms - emboli : suddenly block blood flow when become lodged in narrowing artery * if vessel dilates, embolus just moves further and becomes lodged again * particularly damaging due to suddenness - coronary artery disease : reduced blood flow, hypoxia
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2) hemorrhagic - rupture of blood vessel, resulting in bleeding - blood vessels weakened by atherosclerosis - high blood pressure exacerbates problem - aka hypertensive hemorrhagic stroke - hypertension key risk factor for stroke - less common, accounting for ~20% of strokes - but lethal: ~80% are lethal - damage caused by not only loss of blood flow, but also 1) intracranial pressure caused by blood 2) indirect/direct damage of blood on neurons
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Prevention & treatment of stroke prevention : cerebrovascular disease; prevention involves all the approaches used in treating atherosclerosis, arteriosclerosis, hypertension treatment : combination of prevention & treatment - treatment for ischemic stroke 1. 1. Thrombolysis or ‘clot busters’ Thrombolysis or ‘clot busters’ : urokinase, streptokinase, recombinant tissue plasminogen activator (rtPA) - breakdown blood clot to restore blood flow * severe risk of hemorrhaging & death * significant increase in survival * rapid treatment - short term • problem: only ~5% of patients able to be treated within the ~3 hour window
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2. 2. Anticoagulants Anticoagulants : aspirin, warfarin - reduce risk of stroke by inhibiting clot formation 3.
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