ALU 201: Intermediate Medical Life Insurance Writing PDF

DISORDERS OF THE NERVOUS SYSTEM Introduction important that the underwriter be equipped with the proper knowledge in order to reach a judgment 1. 2. the investigations and tests that can be used to aid in reaching a diagnosis 3. Essentials of Anatomy and Physiology textbook. nerves that connect the...

DISORDERS OF THE NERVOUS SYSTEM Introduction important that the underwriter be equipped with the proper knowledge in order to reach a judgment 1. 2. the investigations and tests that can be used to aid in reaching a diagnosis 3. Essentials of Anatomy and Physiology textbook. nerves that connect the central nervous system with sensory receptors and muscles in the periphery neurons. There are approximately 200 Page 153 ALU 201: Intermediate Medical Life Insurance Writing www.brainexplorer.org/brain_atlas/Brainatlas_index.shtml#image synapses called neurotransmitters. myelin are known as “gray matter.” The Brain cord. cause permanent damage or even death. Page 154 1. are received and analyzed. Memories are also stored here, and processes such as conscious thought, reasoning, deliberation, and judgment are all said to take place within the cerebral cortex. 2. 3. The hindbrain includes the medulla oblongata, which is joined to the spinal cord and is swallowing. Also included in the hindbrain, the cerebellum coordinates movement and is The Spinal Cord the body. Page 155 ALU 201: Intermediate Medical Life Insurance Writing Source: www.merck.com The peripheral nervous system is split into two main separate systems, the somatic and autonomic 1. legs. The somatic nervous system also connects sensory organs with the brain, including 2. The autonomic nervous system connects the brain and spinal cord with the internal organs and all the processes within the body that are not under voluntary control, such as heart as the enteric autonomic nervous system. There are two parts to the autonomic nervous maintains the internal status quo in everyday scenarios and will reduce heart rate and blood Page 156 Diagnostic Investigations neurological disorders. The most important diagnostic techniques are the history taking and the Physical Examination 1. pain – headache, neck pain, back pain 2. muscle problems – paralysis, weakness, abnormality in gait, clumsiness and/or poor coordination, muscle spasms, tremor, rigidity 3. 4. coma, vegetative state. Page 157 ALU 201: Intermediate Medical Life Insurance Writing In addition to physical symptoms, the physician can also test individuals’mental status by asking 1. 2. 3. 4. 5. 6. describing an event in the recent past and one in the distant past 7. sclerosis, brain tumors, or stroke. latter circumstance, the results will not be as detailed as those produced by the closed version. Computerized Tomography Scanning Computerized tomography (CT) scanning, otherwise known as computerized axial tomography Page 158 within key areas such as the brain, general head and neck circulation, heart, and lungs. Computerized Tomography Angiography takes place so that the blood vessels in the area under examination will be highlighted. radiation as does a CTA. Cerebral Angiography used, it can enable treatment to take place at the same time as the diagnostic investigations. Positron Emission Tomography as tumors, appearing brighter than normal tissues. Page 159 ALU 201: Intermediate Medical Life Insurance Writing PET is commonly used to detect tumors throughout the body, but it can also be used to evaluate In a lumbar puncture, or spinal tap, a needle is inserted into the spinal canal to extract cerebrospinal measured. Elevated CSF pressure can be seen with tumors, bleeding, and venous thrombosis. Evoked response tests measure electrical activity in the brain in response to stimulation by 1. 2. 3. Electroencephalogram stroke or head injury. Electromyography at rest and during contraction. In a normal muscle, there is no electrical activity at rest. Minor Page 160 neuromuscular junction, although both nerve and muscle are normal, as happens in myasthenia gravis. Neurological Disorders Carotid Artery Stenosis dyslipidemia, obesity, diabetes, and smoking. tomographic angiography (CTA). treated by endarterectomy. 1. 2. 3. 4. Cerebrovascular Accident and Transient Ischemic Attack is through the two carotid arteries in the neck, which then branch within the brain into multiple Page 161 ALU 201: Intermediate Medical Life Insurance Writing can be reversible, as in a TIA. Stroke 1. primary ischemic stroke 2. primary intracerebral hemorrhage. Ischemic Stroke Page 162 Warlow et al. 2003 1. atherosclerosis 2. 3. another location. the brain. vessels. This is similar to what occurs in the coronary arteries during a heart attack. Thrombotic ischemic heart disease or diabetes. Embolic Strokes Strokes caused by embolism are most commonly due to cardiogenic emboli, that is, clots that considered. Page 163 ALU 201: Intermediate Medical Life Insurance Writing ruptures and blood escapes into the brain. For underwriting purposes, embolic strokes should be treated in the same way as ischemic strokes. Vertebrobasilar Strokes 1. cerebellar signs (e.g., ataxia) 2. dysarthria and dysphagia 3. vertigo, nausea, and vomiting. occur in the subcortical white matter, the basal ganglia or the pons. 1. 2. 3. 4. 5. Page 164 smoking). 1. 2. 3. when a blood vessel blocked by an embolism burst 4. controls analytical and perceptual tasks, such as judging distance, size, speed, or position. the stroke. properly. The same person can be completely unimpaired when it comes to writing, reading, or understanding speech. Page 165 ALU 201: Intermediate Medical Life Insurance Writing and problems with conceptualizing. Transient Ischemic Attack (TIA) cerebrovascular event. Underwriting Considerations 1. 2. time elapsed since episode occurred 3. 4. 5. 6. Subarachnoid Hemorrhage 1. Page 166 2. event. 1. 2. nausea and vomiting 3. photophobia 4. 5. bleed. 1. 2. 3. 4. Page 167 ALU 201: Intermediate Medical Life Insurance Writing Multiple Sclerosis rises to approximately 3%. Studies suggest an incidence as high as 4% among siblings, due to 1. 2. characterized by insidious neurological deterioration, with or without superimposed 3. Page 168 disease course. Page 169 ALU 201: Intermediate Medical Life Insurance Writing and problems with bladder and bowel control. Calabrese PA. Am Fam Physician 2004. ventricular and white matter lesions Page 170 Calabrese PA. Am Fam Physician 2004. characteristic high signal white matter lesions over time. Page 171 ALU 201: Intermediate Medical Life Insurance Writing Calabrese PA. Am Fam Physician 2004. signal lesions (arrows) within the spinal cord consistent with demyelination. vertebral body in length. The lesions rarely cause cord swelling. >2 clinical attacks >2 clinical attacks >2 clinical attacks Page 172 objective clinical evidence >2 previous attack involving a lesion in a distinct anatomical location†) 1 Dissemination in space demonstrated by an additional clinical attack implicating a 1 clinical attack 1 clinical attack >2 1 Dissemination in space demonstrated by an additional oligoclonal bands¶ Dissemination in time demonstrated by an additional clinical attack implicating a Dissemination in time demonstrated by an additional a clinically isolated syndrome but the 2017 McDonald Criteria are not completely met, the better explains the clinical presentation, the diagnosis is not multiple sclerosis. synonyms. multiple sclerosis, with a presentation other than a typically clinically isolated syndrome, or diagnoses should be considered. needed. brain regions, and the spinal cord. Page 173 ALU 201: Intermediate Medical Life Insurance Writing 1. 2. 3. possible multiple sclerosis – Symptoms are similar to those seen in multiple sclerosis, but the paraclinical evidence does not yet support this diagnosis. Additionally, alternate 4. not multiple sclerosis – Symptoms are able to be attributed to a cause other than multiple sclerosis. accumulate, with many individuals exhibiting progressively increasing disability. progression. 1. term prognosis. 2. a. ® Betaseron ) and glatiramer acetate [Copaxone ® ® b. , Campath® or Tysabri® ® ® than relapsing disease. Page 174 ® and c. and, Aubagio is becoming more wide spread. These treatments are easier to administer ® ® ® These treatments are still relatively new, but it is hoped that they will reduce the severity and leads to severe disability or death. symptoms, particularly muscle spasms and spasticity. Products based on marijuana, including medical marijuana and Sativex, a sublingual spray Financial and Emotional Impact with multiple sclerosis remain employed. Most individuals with multiple sclerosis are diagnosed with the disease as young adults, during the time period when they would ordinarily be marrying EDSS Disability Scale Disability in multiple sclerosis is measured using the Expanded Disability Status Scale, which Grade 0 1.0 2.0 3.0 Status Page 175 ALU 201: Intermediate Medical Life Insurance Writing 4.0 5.0 6.0 7.0 8.0 9.0 10.0 daily activities. Intermittent and unilateral assistance (cane, crutch, or brace) required to walk about 100 meters. Death due to MS. Underwriting Considerations Female Male Progressive Sensory symptoms only at onset Bowel or bladder involvement Frequent attacks 1. 2. age at onset 3. 4. 5. 6. Epilepsy or consciousness caused by sudden synchronous, inappropriate, and excessive electrical discharges epilepsy unprovoked seizures. Page 176 1. brain tumors 2. 3. stroke. 1. a. b. c. neurological abnormalities (e.g., weakness/poor coordination) d. 3. cerebral palsy with mental handicap 5. alcohol abuse. Types of Seizures into generalized seizures. Focal or Partial Seizures 1. simple seizures (including temporal lobe, psychomotor, and Jacksonian seizures), in which 2. complicated movements). In generalized seizures, there is abnormal electrical activity that is spread throughout the brain. Page 177 ALU 201: Intermediate Medical Life Insurance Writing 1. 2. attacks that always commence in childhood. Typical absence seizures or petit mal attacks are characterized by altered consciousness (i.e., absence). They can occur up to 100 times a day and can pass unnoticed (atypical absence seizures). 3. Epilepsy is a chronic cerebral disorder with many medical and social implications. There 1. 2. 3. 4. carbamazepine phenobarbitol valproic acid phenytoin. Underwriting Considerations Well controlled Frequent seizures Compliant with treatment Consistent employment record Page 178 Inconsistent employment record 1. 2. 3. 4. 5. 6. compliance with treatment 7. occupational history. Intracranial Tumors cancers, but they are statistically more common in those under age 15 and in older adults, with each year. Benign tumors do occur. They are usually slow growing, have distinct borders and rarely spread cells, they are commonly known as gliomas. This broad category includes astrocytomas, which are 1. grade I – pilocytic astrocytoma 2. 3. grade III – anaplastic astrocytoma 4. Prognosis in intracranial tumors is extremely variable and depends principally upon be cured by radiotherapy and/or chemotherapy, while survival in primary central nervous system Page 179 ALU 201: Intermediate Medical Life Insurance Writing Meningioma Acoustic neuroma Pinealoma Astrocytoma Medulloblastoma Sarcoma 1. precise histology 2. 3. treatment given 4. 5. any residual neurological or psychological impairment. headache syndromes such as migraine, cluster, and tension types are rarely associated with any supplying the scalp. Cervical disc disease can produce neck pain radiating up to the head, causing pain and headache symptoms. as vascular causes or tumors. 1. Page 180 2. 3. treatment 4. Encephalitis brain and/or spinal cord). 1. 2. 3. 4. 5. 6. 7. severe headache photophobia nausea and vomiting seizures. 1. 2. common childhood illnesses (e.g., measles, mumps, rubella) 3. encephalitis). ® ) will be administered. spinal cord. The condition can be caused by a virus or by bacteria. Viral meningitis, while a severe Page 181 ALU 201: Intermediate Medical Life Insurance Writing 1. 2. 3. 4. 5. 6. 7. 8. severe headache photophobia nausea and vomiting seizures. 1. 2. 3. 4. Hydrocephalus the ventricles swell, compressing normal brain tissue. Page 182 common. 1. 2. 3. 4. diseases such as carotid artery stenosis and transient ischemic attacks (TIAs), may not themselves 1. hemiparesis (50%) 2. 3. hemianopsia (20%) 4. aphasia (19%) 5. 1. 2. 3. 4. 5. depressive symptoms (35%) inability to walk unassisted (31%) social disability (30%) institutionalization (26%) bladder incontinence (22%). Page 183 ALU 201: Intermediate Medical Life Insurance Writing Score 0 1 Description activities 2 3 4 to own bodily needs without assistance 5 6 Activity& Score Feeding 0 5 10 Bathing 0 5 Grooming 0 5 Dressing 0 5 10 Bowels 0 5 10 Bladder 0 5 10 Toilet use 0 5 Page 184 attention Dead Independent. Dependent. Independent (or in shower). Dependent. Independent (including buttons, zips, laces, etc.). Incontinent. Continent. Incontinent, or catheterized and unable to manage alone. Continent. Dependent. 10 Transfers (bed to chair and back) 0 5 10 15 surfaces) 0 5 10 15 Stairs 0 5 10 Major help (one or two people, physical), can sit. Minor help (verbal or physical). Independent. Wheelchair independent, including corners, >50 yards. Independent (but may use aid, e.g., a stick or cane), >50 yards. Independent. bleed. consider the morbidity implications. In addition to any disability caused by the disease process The more obvious morbidity risks associated with epilepsy are well documented, such as the hypertension, obesity, and atherosclerosis. problems, and psychological problems such as depression. In children, there can be endocrinological complications. Page 185 ALU 201: Intermediate Medical Life Insurance Writing Conclusion always present in the same way, and that the disease process can be as individual as the person Page 186