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Biomedicine II > 14. Nervous System II Pathologies > Flashcards

14. Nervous System II Pathologies Flashcards

1
Q

Raised Intracranial Pressure

A
  • Raised intracranial pressure describes an increase in the pressure within the cranial cavity.
  • Compression of blood vessels leads to reduced oxygen perfusion to the brain.
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2
Q

Raise Intracranial Pressure: Causes

A

• Tumours (e.g. glioma or
• Haemorrhage (e.g. subdural,
• Hydrocephalus (excess cerebrospinal
• Meningitis (meningeal inflammation) and
Encephalitis (inflammation of brain tissue) both causing brain swelling.
• Intracranial abscess.

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3
Q

Raise Intracranial Pressure: Signs and Symptoms

A

• Headache (worse on awakening, coughing and moving head).
• Vomiting (often without nausea earlier on).
• Visual disturbance (if damage to optic nerve, which is vulnerable due to its anatomical course through the cranium).
• Pupil fixed/dilated in one eye.
• Impaired mental state: lethargy, irritable.
• Altered speech and seizures.
•‘ Papilloedema’(“bulging of the optic disc”
seen only with ophthalmoscopy).
• Elevated blood pressure, slow &
irregular pulse, slow breathing.

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4
Q

Cushing Triad

A

Systolic Hypertension: Widening pulse pressure, systolic over 180
Bradypnea
Bradycardia -> below 50bpm

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5
Q

Hydrocephalus

A
  • An abnormal accumulation of cerebrospinal fluid (CSF) occupying the cerebral ventricles & subarachnoid
  • Usually due to impaired absorption but can be due to excessive secretion.
  • Results in ventricular dilation and subsequently CSF permeates through the ependymal lining into the surrounding white matter.
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6
Q

Hydrocephalus: Causes

A

• Small children: infection or congenital
malformation.
• Older children and adults: tumours,
trauma, meningitis.

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7
Q

Hydrocephalus: SIgns and Symptoms

A 
• Headache worse in the morning after
waking up (CSF doesn't drain well whilst
lying down).
• Increase in head circumference & dilated scalp veins in infants.
• Vomiting (& nausea)
• Blurred or double vision.
• Neck pain.
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8
Q

Hydrocephalus: Treatment

A
  • Diuretics inhibit CSF secretion.
  • Emergency (to prevent white matter scarring/brain damage/death).
  • Shunt, ventricular drain, lumbar puncture.
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9
Q

Meningitis

A
  • Infection or inflammation of the meninges.

* Can be life threatening when it leads to raised intracranial pressure - a medical emergency.

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10
Q

Meningitis: Causes

A

• Viral meningitis is the most common cause (90%) and is less severe e.g. herpes simplex.
• More severe cases may involve be bacterial.
• May also be fungal or parasitic micro
organisms.
• Affects immuno compromised populations: elderly, HIV, organ transplants, cancer patients.
• Can be non infective e.g. brain tumour.

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11
Q

Meningitis: Signs and Symptoms

A

• Fever and sudden onset of severe headache.
• Marked neck stiffness, photophobia and
vomiting.
• Petechiae: small purple/red spots on the
skin as a result of tiny haemorrhages
non blanching (does not disappear when
pressed with a finger or a glass tumbler).
• Kernig’s sign - pain resistance to knee
extension when lying with the hips fully
flexed.
• Brudzinski sign - neck flexion causes
flexion of hip & knee.

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12
Q

Meningitis: Diagnosis

A

Lumbar puncture (withdraw CSF between approx. L4-L5).

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13
Q

Mengitis: Treatment

A
  • Antibiotics, antivirals & corticosteroids.
  • Analgesics & antipyretics.
  • Intravenous fluids.
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14
Q

Meningitis: Complications

A
  • Swelling (& raised ICP).
  • Septicaemia.
  • Seizures.
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15
Q

Kernig’s Sign

A

• Kernig’s sign - pain resistance to knee
extension when lying with the hips fully
flexed.

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16
Q

Brudzinski Sign

A

• Brudzinski sign - neck flexion causes

flexion of hip & knee.

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17
Q

Concussion

A

• Concussion describes a temporary loss
of neuronal function.
• It is a reversible head injury resulting from a significant blow to the head disrupting neurological function.

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18
Q

Concussion: Signs and Symptoms

A
  • Vary from mild to severe and depending on area of brain. Could ultimately lead to a haemorrhage.
  • Loss of consciousness, memory loss of events surrounding the injury, headache, disorientation.
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19
Q

Concussion: Treatment

A
  • Emergency: Rest, if consciousness was lost avoid any vigorous activity for ~ 3 months.
  • Homeopathy (i.e. arnica is excellent).
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20
Q

Cerebral Contusion

A
  • A type of traumatic brain injury that causes bruising of the brain with ruptured blood vessels and oedema.
  • Usually caused by a blunt blow to the head.
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21
Q

Cerebral Contusion: Signs and Symptoms

A
  • Headache, confusion, sleepiness, dizziness, loss of consciousness, nausea, vomiting, seizures, difficulty with coordination & movement.
  • Impaired memory, vision, speech, hearing.
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22
Q

Cerebral Contusion: Treatment

A
  • Allopathic: Medical emergency.

* Alternative: Homeopathy ( Arnica & others in high potency).

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23
Q

Coup and Contrecoup injury

A

• A coup contrecoup injury is a term
applied to traumatic head injuries and
most often cerebral contusions.
• It refers to the common pattern of injury,
as summarised below:
• Coup : injury to the site of primary impact.
• Contrecoup : damage to the brain at a
site contra lateral to the site of trauma.
• The skull acts to stop acceleration of the
brain away from the site of impact,
causing damage on the opposite side.

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24
Q

Headaches

A
  • Common type of head pain with many causes.
  • A new onset of a worsening headache that is of high pain intensity and associated with pupil dilation is a concerning presentation.
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25
Q

Headaches: Causes

A
  • Dehydration.
  • Cervicogenic (from the neck)
  • TMJ (structural problems)
  • Tension headache.
  • Congested sinuses.
  • Hypoglycaemia.
  • Migraines & cluster headaches.
  • Medication induced i.e. paracetamol.
  • Intra cranial: e.g. brain tumour, haemorrhage etc.
  • Organ referral.
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26
Q

Cervicogenic Headache

A

Location: Occipital to frontal/temporal.
Retro orbital frontal.
Duration: 1 hour to weeks.
Severity: Moderate - severe.
Pain character: Non- throbbing. Usually starts in neck.
Aggravating factors: Neck movement,
sustained postures. (tender/reproduced
when palpating upper cervical spine).
Relieving factors: Stretching and supporting neck, massage
Associated symptoms: Reduced neck ROM, (+/- neck discomfort)

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27
Q

Migraine

A

Location: Retro orbital frontal.
Duration: 4- 72 hrs (usually <24 hrs)
Severity: Moderate - severe.
Mild - moderate.
Pain character: Throbbing, pulsating.
Aggravating factors: Exertuibm certain foods (dairy, caffeine), stress, light, noise
Relieving factors: Being in a dark room, rest, sleep
Associated symptoms: Photophobia, phonophobia, nausea/vomiting, visual changes, tingling (aura).

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28
Q

Tension Headache

A

Location: Diffuse (bilateral)
Duration: Hours to days.
Severity: Mild - moderate.
Pain character: Dull.
Aggravating factors: Stress, muscle tension
Relieving factors: Rest massage, relaxation
Associated symptoms: Occasionally decreased appetite and photophobia

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29
Q

MIgraine

A
  • A neurological condition that results in recurrent, severe headaches.
  • More common in women, usually beginning in childhood. Strong links with family history (genetics).
30
Q

Migraine: Causes

A

• Hypothesised that a complex series of intracranial vascular changes occurs, including initial vasoconstriction (aura) and subsequent vasodilation (headache) headache). Induced by cerebral depolarisation (this secretes vasodilators and pain
• Low levels of serotonin.
• Food allergies, food additives (tyramine,
nitrates, MSG, aspartame), histamine, alcohol.
• Emotions (stress), hormonal changes, poor sleep.

31
Q

Migraine: Signs and Symptoms

A
  • Aura (15%) occurs hours to days before headache: unusual visual, olfactory & sensory experiences preceding the headache.
  • Unilateral, pulsating headache with a moderate severe intensity, worsened by movements.
  • Associated with photophobia & phonophobia.
  • Nausea & vomiting (in up to 60%).
32
Q

Migraine: Treatment

A

Analgesics (i.e. ibuprofen, 5 HT agonists).

33
Q

Brain Tumour

A

• Even benign tumours can be life threatening as they increase intracranial pressure.
• Often secondary malignant tumours but can be primary (originate within the brain).
• Mostly gliomas (most common type is
astrocytoma). Other, less aggressive tumours include meningiomas and pituitary tumours.

34
Q

Brain Tumour: Signs and Symptoms

A
  • Morning headaches , increasing in
  • Nausea & vomiting.
  • Uneven pupils & double vision.
  • Papilloedema.
35
Q

Headache red flags

A
  • First onset of headache over 50 years of age.
  • “Thunderclap headache” subarachnoid haemorrhage.
  • Signs of meningitis Headache, neck stiffness, non blanching rash, positive Kernig/Brudzinski sign.
  • Signs of increased intra cranial pressure- Worsening morning headaches, uneven pupils, double vision, tunnel vision,
36
Q

Epilepsy

A

Sudden, hyper excitable and uncontrolled neuronal activity in the brain. It is a symptom of a disease.

37
Q

Epilepsy: Causes

A
  • Idiopathic, brain tumours, cerebral infarction or haemorrhage.
  • Congenital malformation, head trauma (loss of consciousness).
  • CNS infections (i.e. meningitis), degenerative brain disease, some drugs, chemical imbalances (i.e. hypoglycaemia/calcaemia).
38
Q

Epilepsy: Triggers

A

• Hypoglycaemia , fever (febrile seizures), sleep deprivation, dehydration, stress, flickering lights, drugs and alcohol
(alters brain chemistry). Pesticides (they can inhibit GABA!)

39
Q

Epilepsy: Signs and Symptoms

A

• Petit mal seizures (non convulsive), grand mal seizures (convulsive).

40
Q

Grand mal seizures

A

• A ‘tonic clonic’ seizure.
• Tonic phase: contraction of all body muscles (causing patient to fall if sitting or standing)
• Clonic phase: rapid contraction &
relaxation of muscles causing convulsions.
• Ranges from exaggerated twitches to violent shaking.
• Usually lasts around a minute.
• Followed by physical and nervous exhaustion.

41
Q

Petit mal seizures

A
  • Absence seizure.
  • Lasts 10 30 seconds.
  • Seen mainly in children.
  • Abnormal neuronal activity in brain.
  • Usually no lingering confusion.
  • Can be idiopathic or due to birth trauma, brain injury or family history
42
Q

Epilepsy: Treatment

A

Anti epileptic drugs anti convulsants
such as Gabapentin, sodium valproate
side effects! effects!). Emergency care.

43
Q

Spina Bifida

A

• Incomplete closure of the embryonic
neural tube resulting in failure of the
spinal column to fully enclose the spinal cord .
• Most commonly occurs at the lumbosacral junction (L5/S1).
• Divided into spina bifida ‘occulta’ (overlying skin intact) & ‘cystica’ (visible cystic mass).

44
Q

Spina Bifida: Risk factors

A

Lack of folate (vitamin B9) during and before pregnancy. Sodium valproate linked.

45
Q

Spina Bifida: Complications

A

Meningitis, hydrocephalus, reduced bowel & bladder function.

46
Q

Herniated Disc

A
  • The nucleus pulposus of the disc leaks through the annulus fibrosis, often compressing on spinal nerves.
  • Most commonly occurs between 30 40 years of age. Commonly in low lumbar spine (L4/5/S1).
  • The classic mechanism of injury is combined lumbar spine flexion and rotation (bending and twisting).
47
Q

Herniated Disc: Signs and Symptoms

A

Radiating pain (sharp & ‘linear’), positive straight leg raise rest. Pain aggravated by coughing/sneezing.

48
Q

Herniated Disc: Treatment

A

Manual therapy, muscle strengthening, anti inflammatory diet & supplements, homeopathy, herbs, acupuncture.

49
Q

Sciatica

A

• Sciatica is pain due to the compression
or irritation of the sciatic nerve.
• The sciatic nerve is the longest and widest nerve in the body.

50
Q

Sciatica: Signs and Symptoms

A 
• Pain in the lower back & buttock.
• Pain radiating down the posterior leg ,
often into the foot. Usually unilateral.
• ‘Pins and needles’ and
• Weak calf muscles & ‘foot drop’.
• Often absent ankle jerk reflex.
51
Q

Sciatica: Causes

A

• Disc herniation at L4/5 or L5/S1.
• Compression against ‘ muscle
(in buttock).
• Tumours in the spinal canal or pelvis.

52
Q

Sciatica: Diagnosis

A

Straight leg raise test, loss of sensation
in sciatic nerve dermatome, absent ankle
jerk reflex.

53
Q

Sciatica: Treatment

A

Steriod injection, surgery

54
Q

Straight Leg Raise Test (SLRT)

A

• The straight leg raise test is used to assist the diagnosis of nerve tethering in the lower lumbar spine
• A positive SLRT is generally suggestive
of a disc herniation. A positive result includes reproduced pain/symptoms into the buttock and posterior leg (sciatic nerve
• To perform this test, the patient lies supine, whilst the practitioner raises one leg at a time.
Symptoms experienced up to about 45 degrees indicate a positive result.

55
Q

Aspartame

A

• Aspartame is a non carbohydrate artificial
sweetener, 200 times sweeter than sugar.
• Used in approximately 6000 foods & drinks.
• Aspartame has been the subject of much
controversy its toxic side effects are well
documented. It has also been shown not to
help with weight loss but cause weight gain!
• Aspartame is a neurotoxin with neuro
excitatory properties.
• Linked to wide spread neurological damage and a variety of symptoms/conditions:
• MS, Parkinson’s, Balance problems.

56
Q

Neurological Examination

A

• A neurological examination will assess
for the presence of abnormal
neurological function and might highlight
the location/source of a session.
Testing might include the following:
• Observation of signs (e.g. tremor, rigidity).
• Motor (power) testing (corticospinal
• Cranial nerve exam.
• Dorsal columns testing: light touch, vibration, proprioception.
• Spinothalamic tract testing: pin prick,
temperature.
• Gait analysis & Romberg’s (proprioception).
• Cutaneous (i.e. foot) and deep tendon reflexes.

57
Q

Romberg’s Test

A

• Romberg’s test assess proprioception
(awareness of body
• Ask the patient to stand with feet together.
• The patient should be able to do this easily because of eye and ear input (indicates good cerebellar function).
• Ask the patient to now close their eyes. If the patient sways after closing their eyes -> Positive Romberg’s
• A positive test indicates a problem with the proprioceptive system i.e. damage of dorsal columns in spinal cord (often a B12 deficiency).

58
Q

Deep Tendon Reflexes: Knee Jerk

A 
The knee jerk:
• Tapping the patellar tendon triggers a
stretch reflex to stimulate contraction of
the quadriceps muscles.
• This is a protective mechanism to stop
excessive joint movement.
• An absent knee jerk can indicate:
Disc herniation, peripheral nerve
compression. Slowed in hypothyroidism.
• An exaggerated knee jerk can
indicate:
CNS lesion e.g. spinal cord or
hyperthyroidism.
59
Q

Deep Tendon Reflexes: Ankle Jerk

A

The ankle jerk (Achilles reflex):
• Tapping the Achilles tendon whilst the foot is dorsiflexed triggers a stretch reflex to stimulate plantar flexion of the foot.
• An absent reflex can indicate:
Nerve damage (peripheral neuropathy, Sciatic nerve compression). Hypothyroidism.
• An exaggerated reflex may indicate:
CNS lesion e.g. spinal cord, MND.

60
Q

Cutaneous Reflexes: Plantar

A

Plantar response / Babinski sign:
• Stroking the lateral margin of the sole of the foot normally causes the toes to flex.
• In patients with an abnormal response, the stimulus will cause the big toe to extend (dorsiflex) and the other toes to fan out.
• This is called the ‘Babinski
• An up going plantar response is normal in infants due to incomplete myelination of nerve fibres, but pathological after.
• An abnormal response indicates:
Corticospinal tract damage, Multiple Sclerosis (MS) & Motor Neuron Disease (MND).

61
Q

Cutaneous Reflexes: Abdominal

A

• The patient should be supine and relaxed.
• Stroke medially across the upper and
lower quadrant of the abdomen towards
the umbilicus.
• This should result in brisk contraction of
abdominal muscles.
• This reflex can be lost in corticospinal tract damage, MS and MND.
• An absent abdominal reflex may be
physiological.

62
Q

Homeostasis: Whole Body

A

The nervous system works closely with the endocrine system to regulate most body functions.

63
Q

Homeostasis: Integumentary

A

Controls sweating and arrector pili

64
Q

Homeostasis: Skeletal

A

Pain receptors in bone tissue warn of trauma or damage.

65
Q

Homeostasis: Muscular

A
  • Motor neurons stimulate muscular contractions.

* The cerebellum co ordinates skilled movements.

66
Q

Homeostasis: Cardiovascular

A

Medulla oblongata is the home of the CV control centre. It governs cardiac output and regulates blood pressure.

67
Q

Homeostasis: Endocrine

A
  • Hypothalamus regulates the pituitary gland.

* ANS regulate hormone (e.g. adrenaline).

68
Q

Homeostasis: Lymphatic and immune

A

Certain neurotransmitters help regulate

immune response.

69
Q

Homeostasis: Respiratory

A
  • Respiratory areas in the brain stem control breathing rate and depth.
  • ANS regulates airway diameter.
70
Q

Homeostasis: Digestive

A
  • ANS & enteric nervous system regulate digestion.

* PNS stimulates digestive processes.

71
Q

Homeostasis: Urinary

A
  • The ANS regulate blood flow to the kidneys.

* The CNS governs emptying of the urinary bladder.

72
Q

Homeostasis: Reproductive System

A
  • Hypothalamus and limbic system govern sexual behaviour.
  • The ANS governs erection and ejaculation.
  • Hypothalamus regulates the release of pituitary hormones which influence the gonads.
  • Nerve impulses elicited by suckling cause the release of oxytocin and milk ejection in nursing mothers.

Biomedicine II (16 decks)

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