Neurological Disorders and ALS Overview

Neurological Disorders

• Diagnostic Procedures: Lumbar puncture (LP) analyzes cerebrospinal fluid (CSF) to detect infections or multiple sclerosis (MS). Normal CSF protein levels are 15-60 mg/dL, and white blood cells (WBCs) are typically less than 5 cells/mm³. Post-procedure, patients should lie flat to prevent headaches.
• Neurological Diagnostics: Computed tomography (CT) and magnetic resonance imaging (MRI) scans can identify strokes or tumors.
• Neurological function tests: Electromyography (EMG) measures neuromuscular function, and evoked potentials determine nerve conduction speed.

Amyotrophic Lateral Sclerosis (ALS)

• Pathophysiology: Degeneration of motor neurons causes muscle weakness and atrophy in the brain and spinal cord.
• Clinical Manifestations: Weakness, spasticity, difficulty speaking (dysarthria), swallowing (dysphagia), and respiratory failure are common.
• Diagnostics: EMG shows decreased nerve conduction, and MRI helps rule out other conditions. Riluzole slows disease progression.
• Medical Management: Symptom management with respiratory support, physical therapy, and communication aids.
• Nursing Interventions: Close monitoring of respiratory function and prevention of aspiration are crucial. Communication aids and assistance with daily activities are important.

Guillain-Barre Syndrome (GBS)

• Pathophysiology: Post-infectious autoimmune demyelination of peripheral nerves.
• Clinical Manifestations: Ascending weakness, areflexia, paresthesias, and respiratory compromise.
• Diagnostics: Elevated protein in cerebrospinal fluid (CSF) on lumbar puncture, and reduced nerve conduction velocity on EMG.
• Medical Management: Plasmapheresis or intravenous immunoglobulin (IVIG) are common treatments.
• Nursing Interventions: Monitoring respiratory function (e.g., arterial blood gases, vital capacity), preventing immobility complications (e.g., deep vein thrombosis), and providing comfort are essential.

Multiple Sclerosis (MS)

• Pathophysiology: Autoimmune demyelination of central nervous system (CNS) neurons.
• Clinical Manifestations: Fatigue, vision problems, spasticity, and bowel/bladder dysfunction.
• Diagnostics: MRI detects CNS lesions (plaques), and lumbar puncture identifies oligoclonal bands in CSF.
• Medical Management: Immunomodulators (e.g., interferon, corticosteroids) and symptom management.
• Nursing Interventions: Addressing fatigue and spasticity, educating patients about disease triggers (e.g., heat, stress), and preventing complications like immobility and infections are key.

Myasthenia Gravis (MG)

• Pathophysiology: Autoimmune destruction of acetylcholine receptors.
• Clinical Manifestations: Muscle weakness, ptosis, and difficulty swallowing.
• Diagnostics: Acetylcholine receptor antibody testing, Tensilon test (edrophonium).
• Medical Management: Pyridostigmine, corticosteroids, and plasmapheresis during crises.
• Nursing Interventions: Administering medications, frequent monitoring for myasthenic crises or cholinergic crisis, and supporting respiratory function are essential.

Cerebrovascular Accidents (CVAs)

• Transient Ischemic Attack (TIA): Temporary ischemia with reversible symptoms. Treatment includes antiplatelets or statins.
• Ischemic Stroke: Blood flow blockage to the brain. Treatment potentially includes tissue plasminogen activator (tPA) within certain timeframes or anticoagulants.
• Hemorrhagic Stroke: Vessel rupture causing bleeding in the brain. Treatment focuses on surgery or controlling blood pressure.

Head Injury

• Increased intracranial pressure (ICP) is monitored for changes in level of consciousness (LOC), and Cushing's triad (hypertension, bradycardia, irregular respirations). Osmotic diuretics (e.g., Mannitol) are administered to lower ICP. Prevent aspiration.

Hematological Disorders

• Iron Deficiency Anemia: Insufficient iron for hemoglobin production. Causes vary and include inadequate dietary intake, blood loss, and increased demand (pregnancy, growth). Iron supplementation treats IDA.
• Anemia in Renal Disease: Decreased erythropoietin (EPO) production in chronic kidney disease (CKD) causes anemia. EPO stimulates red blood cell production.
• Aplastic Anemia: Bone marrow failure to produce blood cells (RBCs, WBCs, and platelets), often idiopathic or due to autoimmune conditions. Treatment may involve bone marrow transplant.
• Folic Acid Deficiency Anemia: Insufficient folic acid for DNA replication and red blood cell production. Causes include dietary deficiency, increased demand, or malabsorption. Treatment involves folic acid supplementation.
• Pernicious Anemia: Autoimmune destruction of intrinsic factor, leading to vitamin B12 malabsorption and megaloblastic anemia. Treated with lifelong vitamin B12 supplementation.

Coagulation Disorders

• Thrombocytopenia: Low platelet count, which prevents clotting. Causes include decreased production, increased destruction, or sequestration (e.g., spleen enlargement).
• Bleeding Disorders: Impaired clotting factor function. vWD, Hemophilia A/B, and Vitamin K deficiency are included.
• Disseminated Intravascular Coagulation (DIC): Widespread clotting and bleeding due to an overactivation of the coagulation cascade. Needs to be treated by addressing the underlying cause and supporting with blood transfusions.

Explore the key diagnostic procedures and pathophysiology of neurological disorders, including Amyotrophic Lateral Sclerosis (ALS). This quiz covers lumbar punctures, imaging techniques, and the clinical manifestations of ALS. Test your understanding of these critical neurological concepts.