Untitled Quiz

Neurological Disorders

• Structures:
  • Central Nervous System (CNS) → brain and spinal cord
  • Peripheral Nervous System (PNS) → cranial and spinal nerves
  • Basic functional unit of the nervous system is the neuron
• Brain Function:
  • Controls all bodily functions (motor, sensory, autonomic, cognitive, and behavioral)
  • Frontal Lobe → cognitive function, concentration, memory, judgment, personality, social behavior
  • Temporal Lobe → auditory, visual, and interpretive processing (Wernicke's area)
  • Parietal Lobe → sensory function, spatial awareness of the body
  • Occipital Lobe → visual processing
  • Cerebellum → sensory stimuli integration, movement, and balance
  • Thalamus → relay for sensory stimuli
  • Hypothalamus → body temperature, appetite, fluid balance, sleep, and wake cycles
  • Pituitary → master gland, controls hormones
  • Brainstem → breathing, heart rate, blood pressure, arousal, consciousness, attention
  • Spinal Cord → Divided into cervical (C1-C7), thoracic (T1-T12), lumbar (L1-L5), sacral (S1-S4) regions
  • Sensory Tracts → carry impulses from periphery to the brain
  • Motor Tracts → carry impulses from the brain/spinal cord to the periphery
  • Peripheral Nerves → 31 pairs
  • Cranial Nerves → 12 pairs
  • Autonomic Nervous System → regulates internal organs and homeostasis
    • Sympathetic NS → "fight or flight"
    • Parasympathetic NS → "rest and digest"
  • Somatic Nervous System → voluntary movement
• Protective Structures:
  • Skull
  • Vertebrae
• Meninges:
  • Dura mater, arachnoid mater, pia mater
  • Cerebrospinal Fluid → supports and protects the brain
  • Blood Brain Barrier → protects the brain from pathogens
• Neurotransmitters:
  • Communicate messages between neurons
  • Acetylcholine, Serotonin, Norepinephrine, Dopamine, GABA, glutamate
  • Imbalances in neurotransmitters can cause neurological disorders
• Neuro Assessments:
  • Past medical history (previous injuries, cognitive problems, sleep disorders, chronic diseases)
  • Current history & symptoms
  • Pain
  • Dizziness or vertigo
  • Speech/swallowing difficulty
  • Weakness or numbness
  • Visual disturbance
  • Bowel and bladder difficulties
  • Seizures
  • Disorientation
  • Mental status changes
  • Risk factors for cerebrovascular disease (age, gender, ethnicity, hypertension, cardiovascular disease, high cholesterol, obesity, diabetes, oral contraceptive use, smoking, drug and alcohol use)  

Neurological Assessments and Diagnostics

• Level of Consciousness → most important part of a neuro assessment
• Glasgow Coma Scale → measures the level of consciousness
• Imaging techniques:
  • CT
  • PET
  • MRI
  • Cerebral angiography
  • Myelography
  • Carotid ultrasound
  • Transcranial Doppler
  • EEG
  • EMG
  • Nerve conduction studies
  • Evoked potential studies
• Laboratory Diagnostics:
  • CBC, BMP, glucose, ammonia levels, BUN, ABGS, CSF analysis

Infectious Neurological Disorders (Meningitis and Encephalitis)

• Meningitis: Inflammation of the meninges (membranes surrounding the brain and spinal cord)
  • Types: septic (bacterial) or aseptic (viral)
  • Manifestations: headache, fever, changes in LOC, behavioral changes, nuchal rigidity (+ Kernig and Brudzinski signs), photophobia
  • Medical management: prevention (vaccination), antibiotics, managing symptoms
• Encephalitis: Inflammation of the brain
  • Causes: viral infections, fungal infections, autoimmune conditions
• Medical management: appropriate medication and treatment for the specific cause

Degenerative Neurological Disorders (Degenerative Disc Disease, Amyotrophic Lateral Sclerosis (ALS))

• Degenerative Disk Disease: Most common neurological disorder causing lower back pain.
• Causes: acute or chronic, involves the intervertebral disks between the vertebral bodies (cervical, lumbar, thoracic).
  • Herniation: (ruptured disk), Bulging, Lumbar most common
  • Sciatica- pain, tenderness through the thigh/leg → worsens with activity.
  • Diagnosis: MRI, CT scans with myelography, neuro exam (reflexes, sensory/motor impairment)
  • Treatment: non-surgical (pain meds, PT, injections) → surgical (only severe cases) intervention → laminectomy, spinal fusion
• ALS (Lou Gehrig's Disease):
• Loss of motor neurons in the anterior horn of the spinal cord.
• Progressive weakness and atrophy of muscles over time.
• Difficulty speaking, swallowing, breathing, eventual death (2-5yrs)
• No specific test to diagnose. -Diagnosed by physical exam, electromyography (EMG), nerve conduction velocity (NCV), blood and urine studies
  • Treatment: focus on maintaining quality of life, medication to slow progression of the disease

Traumatic Brain Injuries (TBI)

• Types: open (penetrating trauma), closed (blunt trauma) → coup contrecoup
• Brain circulation:
  • The brain receives ~ 15% of cardiac output (750 mL/min)
  • Collateral circulation → Circle of Willis
  • Blood vessels in the brain → 2 layers (more vulnerable to injury)
• Assessment: Focus on immediate injury, time of cause, direction and force, neuro assessment → LOC and vital signs.
• Management:
  • Maintain airway, breathing, circulation, stabilize cervical spine, frequent Neuro checks, minimize movement, prevent secondary injuries
  • Immediate treatment, stabilize, prevent complications, minimize further injury
• Concussion: Temporary loss of neuro function, no evidence of structural damage.
• Contusion: Direct injury to the brain surface (bruising)
• Intracranial Hemorrhages/Hematomas: Collection of blood within the skull.
  • Epidural Hematoma → between the skull and dura mater (artery bleed)
  • Subdural Hematoma → between dura mater and brain (vein bleed)
  • Subarachnoid Hematoma → between the arachnoid and pia mater
  • Intracerebral Hemorrhage → within the brain tissue
• Management: removing the clot (burr holes, craniotomy), control of ICP, support vital signs and prevent secondary injury
• Skull Fracture:
  • Linear, depressed, diastatic, basilar

Other Neurological Conditions

• Brain Tumors: Benign or malignant, 100+ types.
  • Primary vs. secondary
• Guillain-Barré Syndrome: Autoimmune disorder. May follow a viral infection. Rapid demyelination of peripheral nerves causing ascending muscle weakness.
• Increased Intracranial Pressure: A condition of increased pressure in the skull space. Signs and symptoms include: changes in LOC, pupillary changes, impaired ocular movement, headaches, vomiting, cranial nerve dysfunction, neurological compromise possible herniation.