 Welcome back to our meds smarter question of the week where we're taking a smarter approach to preparing future physicians Before we get started if you'll click that like button and also Subscribe and turn the bell on so that you'll be notified when we post new videos. So let's get started with that question As always we start with the last sentence of the vignette and then read the rest so we know what we're looking for Which of the following changes would most likely be seen in the brain of this patient a 43-year-old female comes to the physician because of the gradual onset of involuntary facial and extremity movements Increasing mood swings and difficulty with her memory. She says that her mother displayed similar symptoms when she was in her fifties Which the following changes would most likely be seen in the brain of this patient? So let's take a quick look at our answer choices a accumulation of neurotic plaques B copper accumulation in the basal ganglia C Gliosis of the caudate nucleus D loss of pigmentation of the substantia nigra or E scattered plaques of demyelination take a minute Read the question and answer choices again come up with your answer and write it in the comment box below So some important things to look at in this question is that we have a 43-year-old female and That she is having facial and extremity movements that are involuntary increasing mood swings and memory issues She did say that her mother had the same symptoms when she was in her fifties. That's an important key factor here So what we're seeing Between fifties of her mother and then 43 of the patient. We're seeing something called anticipation This is where we're getting the disease onset earlier in the successive generations. So what? disease has Extremity facial movements mood swings and memory issues along with it shows anticipation. I think we're dealing with Huntington's disease And if you can remember Huntington's disease is a trinucleotide repeat of CAG. So going to this question What are we looking for as far as changes in the brain of this patient? All right So I remember that Huntington's disease affects the caudate and the putamen mostly so let's see which answer choices can Fit with that information Accumulation of neurotic plaques. Nope. These are not neurotic plaques. That's an Alzheimer's issue Copper accumulation in the basal ganglia. Nope. That would be Wilson's disease Gliosis of the caudate nucleus. There's our caudate that we were looking for so that might be our answer Let's continue on and make sure that we don't have any other possible answer choices before we select that one Loss of pigmentation the substantia nigra. We all know that that is Parkinson's disease So that is not the case and then scattered plaques of demyelination, which is multiple sclerosis. That's not our answer choice Therefore we're going to go with C. Gliosis of the caudate nucleus And that is the correct answer. Gliosis of the caudate nucleus So as I said earlier, this is Huntington's disease And it has that trinucleotide repeat Can you remember which one it is? CAG So our classic presentation here is career form movements dystonia altered behavior in dementia So this is an autosomal dominant inheritance So therefore coming from the mother to the daughter and showing anticipation where we're seeing it arrive earlier through each successive generation and then as we mentioned the caudate and the putamen Are the affected areas in the brain specifically what's going on here is Gliosis And that Gliosis is causing the hyperkinesia If you found this material helpful for your studying, please like and consider subscribing to the channel Also, share this video so that more people can benefit from it like you have