Nervous System Diseases and Disorders PDF

Nervous System Diseases and Disorders Anatomy and Physiology - Nervous system o Brain, spinal cord, and nerves o Central nervous system (CNS) Brain Spinal cord o Peripheral nervous system (PN S) Cranial and spinal nerves Somatic Autonomic nervous system(ANS) o Parasympathetic o Sympathetic Common Si...

Nervous System Diseases and Disorders Anatomy and Physiology - Nervous system o Brain, spinal cord, and nerves o Central nervous system (CNS) Brain Spinal cord o Peripheral nervous system (PN S) Cranial and spinal nerves Somatic Autonomic nervous system(ANS) o Parasympathetic o Sympathetic Common Signs and Symptoms (1 of 3) o o o o o Headache Nausea and vomiting Weakness Mood swings Fever o Symptoms specific to CNS: ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Stiffness in neck, back, or extremities Inability to move any part of body Seizures or convulsions Paralysis Visual difficulties Inability to speak Paralysis Extreme or prolonged drowsiness Stupor, unconsciousness Amnesia or extreme forgetfulness (dementia) ❑ Infectious Diseases Encephalitis o Inflammation of brain tissue caused by bacteria and viruses o Symptoms: Headache Elevated temperature Stiff neck and back (Kernig, Brudzinski sign) Lethargy Mental confusion Coma o Treatment: Treatment is supportive Antiviral medication may be effective Meningitis o Inflammation of meninges or coverings of brain and spinal cord o Causes: Bacteria Virus Fungi Toxins o E.g., lead, arsenic o Symptoms: High fever Severe headaches Photophobia Stiffness and resistance in neck (nuchal rigidity) Drowsiness, stupor, seizures Coma Meningitis o Diagnosis Lumbar puncture to find causative agent o Treatment Antibiotics for bacterial infection Antipyretics Anticonvulsants Quiet, dark environment Infectious Diseases Polio-myelitis (ssRNA+, Picornaviridae) o Viral infection affecting brain and spinal cord o Cause: Virus spread by oropharyngeal secretions and infected feces o Almost eliminated by vaccine in United States CDC: https://www.who.int/news-room/fact-sheets/detail/ poliomyelitis: Thanks to a successful vaccination program, the United States has been polio-free since 1979. Poliomyelitis o Symptoms: Muscle weakness Neck stiffness Nausea and vomiting Muscles atrophy and become paralyzed o Diagnosis Virus culture from throat, feces, and/or spinal fluid Most infected people (90%) have no symptoms or very mild symptoms and usually go unrecognized. In others, initial symptoms include fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. (WHO) Poliomyelitis Supportive treatment: o Analgesics o Bedrest during acute phase o Long-term physical therapy and braces may be needed o If respiratory system involved, mechanical ventilation may be needed There is no cure for polio, only treatment to alleviate the symptoms. (WHO) Prevention is key: vaccine is available Polio Vaccination in the U.S. (CDC) Ideally, your child should receive a dose at ages: 2 months, 4 months, 6 through 18 months, and then a booster dose at age 4 through 6 years. Tetanus o Highly fatal infection of nerve tissue o Cause Bacteria Clostridium tetani o First symptom: Jaw stiffness Commonly called lockjaw Left: The transverse section of the vegetative form is nearly circle. At one pole, the cytoplasm swells and a spore is seen in the exosporium, to forma racket-like structure. Right: early stage of spore formation (left) and mature spore (right). Mature spore has core at its center, cortex, and inner outer spore coats Rabies o An often fatal encephalomyelitis o Caused by virus o Primarily affects animals E.g., dogs, cats, raccoons, squirrels o Transmitted to humans through bite of infected animal o Symptoms: Fever Pain Paralysis Convulsions Inability to swallow Rage Drooling of frothy saliva Spasms and paralysis of muscles for swallowing Throat spasms leading to hydrophobia Rabies Treatment: o Postexposure rabies prophylaxis Immediate washing of area with soap and water Anti-rabies injections(Ig) + vaccine o No cure - fatal Prevention: pre-exposure in high risk population – vaccine is available. In 1804, Georg Gottfried Zinke first transmitted rabies1 from a rabid dog to a normal one, and from dog to a rabbit and a hen, by injection of saliva. This proved that the disease was infectious. By 1826, Franz Christian Karl Krugelstein (1779–1864) wrote a full account of rabies, with a bibliography of 300 items.2 But the species susceptibility was unclear until Victor Galtier demonstrated the transmission from dog to rabbit to rabbit, in series.3 He then immunised sheep by inoculating rabid saliva intravenously. This did not produce the disease but interestingly, protected the animals from the effects of a further inoculation.4 His work aroused the interest of Louis Pasteur who with C Chamberland, PPE Roux, and T Thuillier wrote the first of their papers in 1881,5 heralding the beginning of Pasteur's studies on rabies. In further work,6 they showed indications of the rabies virus in the blood. Shingles o Viral disease caused by herpes zoster (Varicella Zoster chicken pox virus, VZV) o Symptoms Itchy, painful, red rash and small vesicles on sensory nerve paths Symptoms last 10 days to several weeks o Diagnosis Made based on the appearance of lesions Viral culture test Shingles oTreatment: There is no cure Treatment is symptomatic o Antivirals (acyclovir, famciclovir, valacyclovir) o Analgesics o Antipyretics o Antipruritics o Vaccine recommended by CDC for adults over age 60: Prevention. Zostavax®, a vaccine to prevent shingles, has been available for individuals over age 60 since it was licensed by the (FDA) in 2006. (Textbook) CDC recommends Shingrix (recombinant zoster vaccine) for the prevention of herpes zoster (shingles) and related complications. CDC recommends two doses of Shingrix separated by 2 to 6 months for immunocompetent adults age 50 years and older (CDC) ❑ Vascular Disorders (1 of 6) Cerebrovascular accident (CVA) o Also known as stroke o Is due to a poor blood supply to the brain o Causes Cerebral thrombus Cerebral embolism Cerebral hemorrhage CVA o Symptoms: numerous symptoms depending on the area of the brain affected and the severity of the CVA Sudden loss of consciousness Confusion Poor coordination Dysphasia (language) Dysphagia (food) Hemiparesis (contra-lateral) CVA o Diagnosis Physical exam, EEG, CT scan, and MRI o Treatment: Anticoagulant Hypertensive medications Rehabilitation program (PT) o Risk factors: Smoking High-fat diet Obesity Lack of exercise o Surgical prevention treatment: Carotid endarterectomy Vascular Disorders Transient ischemic attacks (T I A s) o Also known as mini-strokes o Due to insufficient blood supply to brain o Symptoms: Weakness of arm and/or leg Dizziness Slurred speech Mild loss of consciousness o Symptoms last few minutes to 1 hour and may resolve o Diagnosis by angiogram o Treatment: Surgery to improve blood flow Functional Disorders (1 of 13) ❑Degenerative disk disease ❑Headaches ❑Epilepsy ❑Bell’s palsy ❑Parkinson’s disease Degenerative Disk Disease o Degeneration or wearing away of intervertebral disk Allows vertebrae to bump or rub against each other o Symptoms: Difficulty walking Radiating pain in back and in one or both legs Degenerative Disk Disease o Diagnosis by X-ray, myelogram, CT scan, and MRI o Treatment: Rest back and legs Back brace Analgesics Anti-inflammatories Exercise to ease pain Surgery Headaches https://www.who.int/news-room/fact-sheets/detail/headache-disorders o Cephalalgia, one of the most common disorders in humans o Usually a symptom of another disease rather than a disorder in and of itself o Disorders that typically have headaches as a symptom include: Sinusitis Meningitis Encephalitis Hypertension Anemia Constipation Premenstrual tension Tumors Red flag: severe HA ! stroke Headaches o Caused by two mechanisms: Tension on facial, neck, and scalp muscles Vascular changes in arterial size of vessels inside head o Contributing factors: Stress Toxic fumes Noise Lack of sleep Alcohol consumption Headaches o Headaches may be acute or chronic o Pain may be mild to unbearable and incapacitating o Pain may be constant, pressure, throbbing, stabbing, or intermittent o Types: Tension: caused by stress, strain, and tension on the facial, neck, and scalp muscles. Occipital Pain Cluster: excruciating, unilateral periorbital or temporal pain, with ipsilateral autonomic symptoms (ptosis, lacrimation, rhinorrhea, nasal congestion) Following lumbar puncture Migraine: severe, incapacitating headache commonly accompanied by nausea, vomiting, and visual disturbances. o Individuals affected by migraines can experience a visual aura, a sensation that precedes the event, including flashing light, dim vision, or photophobia. Headaches o Diagnosis: History and physical, X-ray, EEG, MRI, and CT o Treatment: Lifestyle changes – improved diet, sleep, exercise Analgesics Bedrest Muscle massage Muscle relaxants Warm baths Biofeedback Acupuncture Epilepsy o Chronic disease of brain o Intermittent episodes of abnormal electrical activity in brain o Symptoms: Seizure: a sudden attack, but it is commonly indicate a convulsive seizure Convulsions: abnormal muscle contraction. o Common types of seizures Petit mal Grand mal Status epilepticus : medical emergency! Epilepsy o Diagnosis by E E G, C T scan, cerebral angiogram, and blood tests o Treatment: Anticonvulsive medications Close monitoring and adjusting of medication Bell’s Palsy o Affects facial nerve (7th cranial) leading to unilateral (onesided) paralysis o Affects individuals 20 to 60 years of age o Symptoms: Drooping weakness of eye and mouth Inability to close the affected eye Drooling of saliva Smoothing of the forehead o Symptoms: Unable to whistle or smile Distorted facial appearance o Diagnosis by history and symptoms o Treatment: Analgesics Anti-inflammatories Parkinson’s Disease o Slow, progressive brain degeneration o Cause is unknown, but may be related to a decrease of brain neurotransmitter – dopamine o Symptoms: Rigidity and immobility of hand Pill-rolling motion of fingers (Resting tremor) slow and decreased movement (bradykinesia) Very slow speech pattern Expressionless facial appearance Parkinson’s Disease o Symptoms: Abnormal bent-forward posture Short, fast-running steps with shufflinggait appearance o Symptomatic treatment: Dopamine replacement Physical and psychological therapy Dementias Loss of mental ability due to loss of neurons or brain cells Types of dementia ❑ Senile (old age) Alzheimer’s disease – the most common type of senile dementia Senile and Alzheimer’s disease are often used synonymously, but they are not the same. ❑ Vascular ❑ Head trauma ❑ Substance induced Alzheimer’s disease o A form of senile dementia o Usually affects individuals age 60 and older o Early symptoms: Short-term memory loss Inability to concentrate Slight changes in personality o Symptoms of disease progression: Diminished communication skills Meaningless words Inability to form sentences Increased forgetfulness Irritability and agitation Alzheimer’s disease o Diagnosis Positive only by autopsy Initially, diagnosis may be made by ruling out other brain diseases o Treatment Supportive, no known cure Focused on safety, maintaining nutrition, hydration, personal hygiene Emotional support for family and caregivers Vascular Dementia o Atrophy and death of brain cells due to decreased blood flow o Atherosclerotic plaque can cause decreased blood flow Common with aging o Symptoms: Changes in memory, personality, and judgment Irritability Depression Sleeplessness Lack of personal hygiene o Diagnosis: History and physical, blood flow testing o Treatment: Increasing blood flow to brain Carotid endarterectomy Dementia due to Head trauma o Diagnosis: History, cranial X-rays, CT scan, and MRI o Treatment: Correct damage, if possible Therapy and rehabilitation o Prevention: Is often easy to prevent with proper use of protective equipment Substance-induced Dementia o Brain cell death from drug toxicity and toxins o Toxic substances include: Alcohol Cocaine Heroine Lead Mercury Paint fumes and thinner Insecticides o Symptoms: Mental impairment Decreased cognitive ability ❑ Sleep Disorders Insomnia o The most common form of sleep disorder o Inability to fall or stay asleep o Cause: Stress, pain, fear depression caffeine, alcohol nicotine, and bronchodilators o Treatment: Identifying and removing cause Sleep Apnea o Characterized by periods of breathlessness o Cause: o Symptoms: More common in men Obesity Hypertension Airway obstruction Alcohol ingestion Cigarette smoking Daytime sleepiness Extreme snoring Changes in personality Depression Impotence Sleep Apnea o Diagnosis: Monitoring affected individual during sleep for apnea and low blood oxygen levels o Treatment: Based on cause Weight loss Surgery to correct nasal obstruction Oxygen during sleep Medications to stimulate breathing o Prevention: Most cases can be prevented by maintaining a healthy weight, avoiding alcohol, not smoking, and avoiding environmental smoke Tumors (1 of 2) Brain tumor o Classified as primary and secondary o Primary tumors are called brain tumors Meningiomas – 30% of all brain tumors, usually benign These tumors originate in the meninges, which are the outer three layers of tissue between the skull and the brain Gliomas: glial (supportive) tissue – Glioblastoma (astrocytes), most lethal Schwannomas Craniopharyngiomas - occur most often in children and adolescents. o Secondary tumors are named after the organ of origin – metastatic (M/C) o Cause: Unknown Tumors o Symptoms: o Diagnosis: Headache Clinical symptoms Vomiting X-ray Seizures CT scan Changes in mood and personality MRI Visual disturbance Biopsy Loss of memory o Treatment: Surgery Radiation Chemotherapy ❑ Trauma Concussions vs Contusions A concussion: is the less serious, does not involve injury to the brain. A contusion: is a physical bruising of the brain tissue. - often accompanied by skull fractures. o Cause Blow to head by object, fall, or other trauma o E.g., automobile accident o Symptoms: Disruption of normal electrical activity in brain – unconsciousness Unconsciousness may last a few seconds to several hours Headache Blurred vision Concussions vs Contusions o Symptoms: Irritability Draw up knees and begin vomiting o Contusions can lead to: Hematoma Increased intracranial pressure (ICP) Permanent brain damage o Coup and contrecoup contusions Concussions vs Contusions o Diagnosis: History of injury, neurologic examination, cranial X-ray, CT scan, and MRI o Treatment: Bedrest Direct observation o Individual should be checked every 2 to 4 hours Monitoring of changes in consciousness, eye pupil size, mood, and behavior Analgesics, stimulants, and sedatives should not be given o Medications may mask symptoms and make assessment difficult Skull fracture o A break in a cranial (skull bone) o Greatest danger: Brain tissue damage from bony fragments Potential of cutting brain, severing vessels, causing hematoma o Brain damage may be temporary or permanent Skull fracture o Symptoms: Variety of symptoms depending on location of fracture Fracture near base of skull may cause impaired breathing Hemiparesis Seizures Infection o Treatment: Dependent on type and position of fracture Craniotomy may be necessary to relieve ICP Protective headgear may be necessary until fracture healed https://www.hopkinsmedicine.org/health/treatment-tests-andtherapies/craniotomy EPIDURAL (EDH) & SUBDURAL (SDH) HEMATOMAS ❖ SDH occurs twice more than EDH ❑EDH A blow to the head Blood vessels are ruptured and hemorrhage or seep blood between the bony skull and the first, or outer, meninges, the dura mater Symptoms: o occur within a few hours after injury and can include headache, dilated pupils, nausea, vomiting, and dizziness. o As the hematoma grows, an increase in ICP individual might lose consciousness Dementia due to Head trauma o Death of brain cells due to head trauma o Symptoms: Decrease in mental intellect and cognitive function Loss of ability to reason, remember, or show appropriate emotions Changes in personality Spinal Cord Injury Spinal cord injury o Usually results when bony spinal column is injured or fractured o The cord can be injured at any level Neck area is most vulnerable Etiology. Automobile accidents – leading cause Gunshot and knife wounds Falls and sports injuries Spinal cord injury Symptoms. o Varying degrees of injury o Injury to C1-C3 is usually fatal o Quadriplegia - Injuries to the cervical spine or neck area (C1–C4) Loss of movement and feeling in trunk and all four extremities Loss of bowel, bladder, and sexual function If severe, respiratory ! ventilation o Paraplegia - Injury to the thoracic or lumbar section of the spinal cord Loss of movement and feeling in trunk and both legs Loss of bladder, bowel, and sexual function is common Spinal Cord Injury o Diagnosis: History of injury, neurologic exam, spinal X-rays, CT scan, and MRI o Emergency treatment: Immediate treatment necessary Do not move individual unless surroundings unsafe Maintain position of spine with special collars and backboards o Treatment: Realignment and stabilization of bony spinal column Decompression or release of pressure on spinal cord Prevent further injury ❑ Rare Diseases Multiple Sclerosis (M S) o Causes: Demyelination of CNS nerves Allows information to leak from nerve pathway Leads to poor or absent nerve transmission (conduction) o Symptoms: Muscle weakness and lack of coordination Paresthesia Speech difficulty Loss of bladder function Visual disturbance, especially diplopia Multiple Sclerosis o Affects adults between ages 20 and 40 o Periods of remission and exacerbation o Treatment: Physical therapy Muscle relaxants to maintain muscle tone and reduce spastic movement Effects of Aging Decreased nervous system activity in brain and spinal cord Loss of short-term memory Loss of visual acuity and peripheral vision Altered sleep patterns