Trigeminal Neuralgia and Parkinson's Disease Lecture Slides PDF

Okay, here is the transcription of the provided text into a structured markdown format: ## Trigeminal Neuralgia/tic douloureux (painful twitch) * Chronic irritation of the 5th cranial nerve characterized by paroxysmal unilateral pain in the area in any of the branches of Trigeminal never. * Mo...

Okay, here is the transcription of the provided text into a structured markdown format: ## Trigeminal Neuralgia/tic douloureux (painful twitch) * Chronic irritation of the 5th cranial nerve characterized by paroxysmal unilateral pain in the area in any of the branches of Trigeminal never. * Most in common in 50-70 years old. 60% of clients are women. **Image:** Illustration of the trigeminal nerve, with labels pointing to the Ophthalmic (eyes) branch, Maxillary (upper jaw) branch, and Mandibular (lower jaw) branch. ## Etiology * Mechanical nerve compression by tumors * Vascular abnormalities * Dental abscesses * Jaw malformation ## Incidence * TN is 400 times more common in patients with MS affecting men at higher rate than women. **Image:** Illustration of the trigeminal nerve, with labels pointing to the Ophthalmic (eyes) branch, Maxillary (upper jaw) branch, and Mandibular (lower jaw) branch. ## Manifestations * Intermittent, sudden onset intense characterized by: a. Triggered by touch, facial hygiene, and even talking. b. Prevalent in maxilla and mandible and on the right side of face. c. Pain can be so intense that client ponders suicide. **Image:** Image of a face with the trigeminal nerve visible. ## Diagnosis * CT scan, MRI ### Basis of Diagnosis * In-depth history with attention paid to triggering stimuli. * Client's dental and nutritional intake are evaluated * The unilateral nature of the pain is an important diagnostic characteristic. ## Management * Carbamazepine (Tegretol) or Phenytoin for initial treatment. It slows the reactivity of neurons. * Baclofen (antispasmodic) * Alcohol or phenol injection in peripheral branches of the trigeminal nerve relieves pain for several months. **Image:** Image of the side of a mans face that shows how alcohol or phenol injections relieve pain. * Surgery includes: * Peripheral neurectomy * Rhizotomy-resection of the root of the nerve **Image:** Image of teeth, with the teeth and roots of the teeth visible. ## Management * Clients must test food temperature before putting it into their mouth. They should chew on the unaffected side. * Apply eyedrops and protective shield during the acute post-op period ## Bell's Palsy * Bell's palsy affects the motor aspect of the facial nerve (7th) that results in a unilateral paralysis of the facial muscle of expression. * Affects both men and women in all age groups commonly between 20-40 years. **Image:** Image of a person whose facial paralysis on the right side of the face from eye to mouth. ## Etiology * Unknown cause Possible cause: * Reactivation of Herpes virus (simplex or zoster) * Autoimmune diseases * Vascular Ischemia * Exposure to cold ## Clinical Manifestations * Upward movement of the eyeball on closing the eye (Bell's phenomenon) * Flattening of nasolabial fold * Widening of palpebral fissure * Slight lag in closing the eye * Difficulty eating **Image:** Image of a woman whose facial paralysis on the right side of the face from eye to mouth. Inability to wrinkle brow. Drooping eyelid: inability to close eye. Inability to puff cheeks no muscle tone. Drooping mouth: Inability to smile or pecker. ## Management * No known cure, care is palliative * Analgesics for discomforts caused by herpetic lesions * Corticosteroids in combination with acyclovir to decrease nerve tissue edema. * Moist heat, gentle massage ## Management * Cornea is protected with artificial tears, sunglasses, eye patch at night, and periodic gentle closure of the eye. * anastomosis of 7th CN to XI and XII * Allows closure of eyes during sleep * Restores tone to facial muscles ## Degenerative Neurologic Disorder ## Parkinson's Disease * PD is a chronic, progressive, neurologic disorder that results from loss of dopamine in relation to ACH that control movement. PD is associated with degeneration of basal ganglia of the brain. * Tremor * Rigidity * Bradykinesia * Shuffling gait **Image:** Image of person with Parkinson's diease walking. ## Neurotransmitters Involved in PD ### Acetylcholine * A widely distributed excitatory neurotransmitter that triggers muscle contraction * In the CNS, it is involved in wakefulness, attentiveness, anger, aggression, sexuality, and thirst. ### Dopamine * Produce in the substantia nigra of basal ganglia. (tyrosine- levodopa- dopamine) * Modifies and modulates voluntary movements * Loss of dopamine causes muscle rigidity. ## Etiology * Severe shortage of dopamine in relation to ACH due to degeneration of substantia nigra in the basal ganglia. * The cause of degeneration is not known. ### Risk Factors * People in their 60's **Image:** Image that show's the difference between Non-Parkinson's & Parkinson's, labels are red nucleus, reticular formation, cerebral aqueduct, and Substantia Nigra. The image also has the cross section of a brain. ## Pathophysiology * When degeneration of Dopamine-producing cells in substantia nigra reaches 80%, * Dopamine decreases in relation to ACH. * Manifestations Appear **Image:** Visually depicting the dopamine levels in in a normal and a Parkinson's affected neuron.. ## Clinical Manifestations Cardinal features * Tremor at rest on one side ("pill-rolling") * Cogwheel rigidity, increased tone, and stiffness in the muscles at rest **Images:** Image of hand tremor due to Parkinson's. Image of person with Parkinson's, labels include Stooped posture, Masklike facial features, and back rigidity. * Bradykinesia (Slow movements) a. Fine movements become clumsy and makes voluntary movement difficult. b. Shuffling gait with short steps c. Lack of associated swinging of arms while walking **Images:** Image of person with Parkinson's signs, the labels include Forward tilt of trunk, Reduced arm swinging, and Shuffling gait with short steps. * Akinesia (Freezing movement) a. Client is literally frozen in one spot b. Face appears stiff, mask-like, and without expression c. Words are poorly articulated (dysarthria) d. Speech is low in volume, monotonous in tone, and slow. **Images:** Images of Muhamad Ali and Michael J Fox. ## Medications * Levodopa (precursor) * Mainstay of treatment for PD. It crosses the BBB, where it is converted to dopamine. * Given in combination with carbidopa E.G Sinemet * Carbidopa * Inhibits peripheral conversion of levodopa to dopamine by dopa carboxylase(DDC) **Image:** Graph of Levodopa/DDC Inhibitor pathway. * Monoamine oxidase inhibitor (MAOI-B) * Catechol-O-methyltransferase inhibitors * Inhibit metabolism of Dopamine * Anticholinergic * Inhibits the action of ACH **Image:** A diagram showing how PD medications work. ## Parkinsonian Crisis * Cause: a. Sudden withdrawal of antiparkinson medication * Symptoms * severe exacerbation of tremor * rigidity and Bradykinesia accompanied with sweating, tachycardia, and hyperpnoea. * Poor muscle coordination during swallowing and coughing * Interventions include: a. Respiratory and cardiac support b. Barbiturates ## Nursing Management Prevent constipation by: * Maintaining 2L of fluid per day * Increasing dietary fiber * Observing regular time for BM * Stool softener or laxative * Teach various techniques to enhance voluntary movement, such as: * Grasping coins in their pockets to reduce tremors. * Grip the arms of a chair * Rocking back and forth * Encourage daily ROM to avoid rigidity and contractures. * Maintain good posture. * Encourage rest periods during meals to avoid aspiration. * Exercise or ADL should be performed at the peak effect of the drugs to avoid injury to client * Teach client about home safety, such as: a. Loose carpet should be removed b. Grab bars should be placed in bathrooms c. Client with tremors should avoid carrying hot liquids d. Provide walking aids to add stability ## HUNTINGTON'S DIEASE ## Huntington's Disease/Chorea * Degenerative neurologic disease characterized by: * abnormal movements (chorea) * Hypotonia * emotional disturbance * The disease is progressive, leading to disability and death within 15-20 years. * Death usually results from aspiration pneumonia ## Etiology/Risk Factors * The disease is autosomal dominant; offspring of affected person have 50% chance of inheriting the disease.(quintessential family disease) * Men and women at their 30s and 40s are equally affected. ## Pathophysiology **Image:** Representation of Degeneration of striatum. * Degeneration of striatum (caudate) in the basal ganglia leads to reduction of several neurotransmitters (GABA, Ach) while relatively raising other neurotransmitters (dopamine and norepinephrine) * Excess in Dopamine produces excess movement (a contrast to lack of dopamine in PD, which lacks movement) ## Clinical Manifestations * Subtle development of abnormal movements * subtle problems with mood or mental abilities (earliest symptom) * appears restless and fidgety. * Rapid, jerky choreiform movement ((Chorea) that involves all muscles. Client is in constant motion * Person become negative, suspicious, and irritable which may progress to depression and psychosis. * Dysphagia- most common and dangerous problem ## Diagnosis * No specific diagnostic test * Diagnosis is made on the basis of clinical manifestations and family history. ## Medical Management * No pharmacologic treatment for HD * Haloperidol- an antipsychotic that blocks dopamine receptors in the brain thereby controlling abnormal movements * Diazepam- controls anxiety and movements * Antidepressant- controls depression **Image:** Image depicting the difference between Dendrite, Neuronal Synapse, Axon, (Presynaptic membrang, and Neurotransmitters. ## Nursing Management * Dysphagia is common and dangerous. * Mealtime should be free of stress and have an unhurried atmosphere. * Diet should include foods that are easy to swallow and form a bolus in the mouth * Eat frequent, small meals containing high-calorie foods (5000 cal./day) * Prevent aspiration by: * Sitting upright when eating *Train client to hold breath before swallowing and cough after swallowing * Thicken fluids * NGT is necessary if client loses weight. * Poor control of oral and respiratory muscles make communication difficult. Assist family in developing methods of communication. * Excessive movements may cause injury. Pads on wheelchairs and beds, shin guards, and walking belts. * Clothing should be light and simple to put on and take off. Let me know if you need further assistance!