NBMS2402_T09.pdf

TOPIC 9 Pathophysiologic Disruptions in Neurosensory and Integrative Functions PATHOPHYSIOLOGY NBMS2402 Illustration by Smart-Servier MISS NOREEN CHE KHALIN Medical Art Topic Outlines No Contents...

TOPIC 9 Pathophysiologic Disruptions in Neurosensory and Integrative Functions PATHOPHYSIOLOGY NBMS2402 Illustration by Smart-Servier MISS NOREEN CHE KHALIN Medical Art Topic Outlines No Contents Slide Number 9.1 Alterations in Neurosensory and Integrative Functions 4 9.1.1 Alterations in Brain Functions 12 9.1.2 Alterations in Neurologic Functions 21 9.1.3 Alterations in Spinal cord and Peripheral Nervous System Functions 24 9.1.4 Alterations in functions of Special Sense Organs 26 2 Learning Outcomes 1 Identify the alterations in neurosensory and integrative functions Describe the corresponding clinical manifestations for the 2 specific alterations in neurosensory and integrative functions 3  9.1 Alterations in Neurosensory and Integrative Functions Nervous System Central Peripheral nervous nervous system system All the nerve Brain & outside brain Spinal cord & spinal cord 4 9.1 Alterations in Neurosensory and Integrative Functions Functions of nervous system Maintain the homeostasis of human body Central nervous system to integrate and coordinate sensory and motor information for the purpose of controlling of various tissues, organs and organ systems of the body, responsible for higher neural functions (memory, learning & emotion) Peripheral nervous system carries sensory and motor information between the central nervous system and all other organs and tissues of the body Sensing the Transmitting Processing Producing a world information information response 5 9.1 Alterations in Neurosensory and Integrative Functions STIMULUS is the specific change in the IMPULSE is the outside or inside change of the electrical environment, that affect processes that excite the nervous system in tissues, and that can a way that result in the spread via nerves or generation of an conductive membranes impulse 6 https://byjus-answer-creation.s3.amazonaws.com/ 9.1 Alterations in Neurosensory and Integrative Functions The Cells specialized for the reception of stimuli from the outside or inside environments (receptors, sensors) nervous system is composed Cells specialized for processing the received information, providing the contact and handling information in the network along with other parts of by many the nervous architecture (interneurons) types of cells: Nerve cells: the neurons themselves, that gives the orders and reach the effect organ via their peripheral nerve endings (for example endocrine glands) or those reaching tissues (muscle) – effector neurons Cells having only supporting or helping function in the nervous system (glial and satellite cells) 7 8  9 https://image.slidesharecdn.com/ No Cranial Nerves Functions 1 Olfactory Smell 2 Optic Vision 3 Oculomotor Eyes movements 4 Trochlear Aid muscles that move the eyes Eyes, tear gland, scalp, forehead, 5 Trigeminal teeth, gum, lips & mouth muscles 6 Abducens Muscle conditioning Taste, facial expressions, tear & 7 Facial salivary glands 8 Vestibulocochlear Hearing & equilibrium Pharynx, tonsil tongue & carotid 9 Glossopharyngeal arteries, stimulate salivary glands Speech, swallowing, heart muscles, 10 Vagus smooth muscles, certain glands Muscles of soft palate, pharynx, 11 Accessory larynx & neck 12 Hypoglossal Tongue movement  11 https://image.slidesharecdn.com/  9.1.1 Alterations in Brain Functions Mechanisms of Brain Injury Primary injury Secondary injury occurs immediately at the onset of brain injury development of further neurologic damage head trauma, some tissues will be irreversibly subsequent to the primary injury damaged at the time of impact owing to may progress over days or weeks mechanical forces delayed cell death may involve necrosis from sudden cessation of blood flow to an area of further acute injury or may be a delayed brain tissue, as occurs in stroke, an area of consequence of the primary injury irreversible ischemia in cells may develop cells that die slowly after injury are said to quickly undergo apoptosis or programmed cell death brain tissue necrosis occurs rapidly as cells lose membrane integrity, rupture, and release their intracellular contents into the extracellular space cytotoxic edema quickly follows, which can cause deleterious effects to surrounding brain tissue.  9.1.1 Alterations in Brain Functions Alterations in Causes Pathophysiology Brain Function Increased Mass (such as a tumor), Expansion of fluids and tissues increases pressure bleeding into the brain Intracranial or fluid around the brain, within the brain itself Pressure (ICP) Produces ischemia and infarction or swelling of the brain Displacement of brain tissue Occurs when increased intracranial pressure Large mass, like a clot Herniation or a tumor causes the abnormal protrusion of brain tissue through openings in rigid intracranial barriers (eg: tentorial notch) Abnormal and uncontrolled growth of cells in the Some brain and spinal brain cord tumors are more Brain Direct compression of adjacent tissue by the tumor common in people with Tumor Increased intracranial pressure (because the tumor certain inherited or occupies space within the skull) genetic conditions Bleeding within or outside the tumor  9.1.1 Alterations in Brain Functions Alterations in Causes Pathophysiology Brain Function Hemorrhagic = stroke that occurs because of Ischemic stroke sudden bleeding in the brain (Increased Intracranial Hemorrhagic stroke Stroke Transient Ischemic Pressure) Ischemic = stroke that occurs because blood flow Attack (TIA) to the brain is blocked (Atherosclerosis) Transient Blood vessels that Temporary reduction of blood flow in the brain Ischemic supply your brain with Small mini strokes occur continually Attacks oxygen-rich blood Connected to dementia (TIA) becomes blocked An area of the brain Infarction of the brain due to lacking blood supply Cerebro- becomes damaged from Treatment: clot busting agents, surgery, lack of blood supply to glucocorticoids vascular the brain due to a accidents blocked or ruptured blood vessel 14  9.1.1 Alterations in Brain Functions Alterations in Brain Causes Pathophysiology Function Localized balloon like dilation in the wall of artery Due to blood flowing through If aneurysm expands & blood vessel wall becomes Cerebral the blood vessel puts too thin, the aneurysm will rupture and bleed into Aneurysm pressure on a weak area of the space around the brain the vessel wall Treatment: surgery (before rupture) or anti- hypersensitive drugs Bacteria or fungi make their Localized infection and necrosis of tissue Brain way into the brain, either Swelling caused by the abscess can disrupt the Abscess through bloodstream or from blood and oxygen supply to the brain an infected area in head Treatment: surgical drainage or anti-microbial (ears or sinuses) therapy Bacterial infection in the protective membranes that surround the brain and spinal cord (meninges) of Due to a viral, bacterial or Meningitis the CNS fungal infection Treatment: anti-microbial therapy, glucocorticoids, vaccines Viral or bacterial infections, Infection of the parenchymal or connective tissue in infections from insect bites or the brain or spinal cord Encephalitis by immune cells mistakenly Treatment: anti-microbial therapy or anti-viral drugs, attacking the brain depend on the cause  9.1.1 Alterations in Brain Functions Hydrocephalus Excess cerebrospinal fluid (CSF) in the ventricles deep within the brain Ventricles to widen, putting harmful pressure on the brain's tissues Non – communicating Flow of CSF through the ventricular system is blocked Communicating Absorption of CSF through the subarachnoid villi is impaired  9.1.1 Alterations in Brain Functions Cerebral Palsy Most impairment is due to brain damage (abnormality or disruption in brain development) Affecting muscle coordination, balance and voluntary movement Intellectual function, behavior, visual/ hearing deficits Communication/speech, seizures Causes : genetic mutation, abnormal fetal formation, brain damage, hypoxia/ ischemia Types: spastic paralysis (hyperreflexia), dyskinetic (loss coordination with fine movement), ataxia (loss of balance & coordination) 17 https://orthodyna.com/wp-content/  9.1.1 Alterations in Brain Functions Parkinson’s Disease Age-related degenerative brain disease (parts of the brain to deteriorate) Associated with the gradual loss of cells in the substantia nigra of the brain (responsible for the production of dopamine) Deficiency of dopamine cause individual unable to direct or control movements As the disease progresses, other areas of the brain and nervous system degenerate as well Causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination. Signs / symptoms: difficulty initiating movement, postural instability, decreased flexibility, muscular rigidity, fatigue, lack of facial expressions  9.1.1 Alterations in Brain Functions Huntington’s Disease Rapid, jerky movements (chorea) Chronic progressive neurodegenerative chorea (causes nerve cells in the brain to decay over time) Chorea = involuntary movements affecting all the muscles of the body, https://media.healthdirect.org.au/ specifically the arms and legs, the face and the tongue. Also can affect the ability to make voluntary movement Progressive atrophy of the brain Present around 40 years old, hereditary and autosomal dominant Signs/ symptoms: mood swings, personality changes, restlessness, choreiform movement in arms/ face, and intellectual impairments 19  9.1.1 Alterations in Brain Functions Dementia Alzheimer Progressive cortical Intellectual deterioration atrophy of neurofibrillary that interfere with tangles and amyloid occupational or social plaques function Causes unknown Causes: vascular Insidious onset disease, infections, Signs / symptoms: toxins, genetic disorders behavioral changes, Signs/ symptoms: gradual loss of memory impaired cognitive skills, and lack of concentration, impaired thinking/ impaired learning, poor learning/ judgement, judgement, decline in memory loss, confusion, cognitive function, inability behavioral/ personality to recognize family, changes incontinence, environmental unawareness  9.1.2 Alterations in Neurologic Functions Amyotrophic Lateral Sclerosis (ALS) / Lou Gehrig’s Disease Progressive degenerative disease affecting motor neurons and producing muscle wasting Causes unknown Cognition, sensory neurons, neuron of the eyes = unaffected Loss of motor neurons = Upper = spastic paralysis, hyperreflexia Lower = flaccid paralysis, decrease muscle tone, decreased reflexes https://pharmaceutical-journal.com/ https://my.clevelandclinic.org/  9.1.2 Alterations in Neurologic Functions Multiple Sclerosis (MS) Progressive de-myelination of neurons in the brain, spinal cord, and cranial nerves Result from immune system incorrectly attacking the myelin protective coating of nerve fibers Causes unknown Signs / symptoms: blurred vision, weakness in legs, progressive weakness and paralysis, diplopia, scotoma, bowel/ bladder/ sexual dysfunction, loss coordination https://kanehallbarry.com/wp-content/uploads/ https://d2jx2rerrg6sh3.cloudfront.net 9.1.2 Alterations in Neurologic Functions Myasthenia Gravis Autoimmune disorder in which there are auto antibodies to acetylcholine receptors at neuromuscular junction. Signs/ symptoms: muscle weakness in face/ eyes/ arms/ trunk, impaired speech/ vision, difficulty chewing/ swallowing, head drooping, frequent upper respiratory infections https://lonestarneurology.net/ 23 https://www.medicoverhospitals.in/ 9.1.3 Alterations in Spinal cord and Peripheral Nervous System Functions Guillain – Barre Syndrome Inflammatory condition of the parasympathetic nervous system A condition in which the body's immune system attacks the nerves Leads to symptoms like numbness, tingling and muscle weakness that can progress to paralysis Recovery is spontaneous Provide supportive care https://my.clevelandclinic.org/  9.1.3 Alterations in Spinal cord and Peripheral Nervous System Functions Failure of posterior spinous processes to fuse Spina Bifida Spine and spinal cord don't form properly (neural tube defect) Meninges and spinal cord herniated Diagnosis: Alphafetoprotein (AFP) elevated, ultrasound Treatment: Surgical repair with OT/ PT afterwards 25  9.1.4 Alterations in Functions of Special Sense Organs Alterations in Pupil Responses The ability of our eyes to dilate or constrict, rapidly and equally, depend on intact brainstem Cerebral hypoxia and drugs Change pupil size and reactivity. Therefore, pupil size and reactivity offer valuable information concerning brain integrity and function Important pupil changes seen with brain damage are pinpoint pupils seen with opiate (heroin) overdose and bilaterally fixed and dilated pupils usually seen with severe hypoxia Fixed pupils are typically seen with barbiturate overdose Brainstem injury presents with pupils 26 fixed bilaterally in the mid-position  9.1.4 Alterations in Functions of Special Sense Organs b) Disorders of Retinal Blood Supply Blood supply for retina is derived from the central retinal artery which supplies blood flow for the entire inside of the retina, and from vessel in the choroid which supply the rods and cones Central retina occlusal = interrupt blood flow to the inner retina and results in unilateral blindness The retinopathies (disorders of retina vessel) = interrupt blood flow to the visual receptors, leading to visual impairment Retina detachment = separates the visual receptors from the choroid, which provides their major blood supply  9.1.4 Alterations in Functions of Special Sense Organs c) Disorders of the Middle Ears Otitis Media Inflammation of middle ears Usually associated with acute infection (acute OM) or accumulation of fluid (OME) Commonly associated with disorders of Eustachian tube function Impaired conduction of sound waves and hearing loss occur when the tympanic membrane has been perforated; air in the middle ear has been replaced with fluid (OME) or the function of bony ossicles has been impaired (otosclerosis) Eustachian tube = lined with mucous membrane that is continuous with the nasopharynx, provides a passageway for pathogens to enter the middle ears. 28  9.1.4 Alterations in Functions of Special Sense Organs d) Hearing Loss Represent the impairment of the ability to detect or perceive sound Conductive hearing loss Caused by disorder in which auditory stimuli are not transmitted through the structures of the outer and middle ears to the sensory receptors in the inner ears Sensorineural hearing loss Cause by disorders that affect the inner ear, auditory nerve or auditory pathways Thank You