Chapter 8 Pathological Conditions Flashcards
1
Q
Alzheimer’s disease*
A
- deterioration of a person’s intellectual functioning
- progressive and extremely debilitating disease
- begins with memory loss and progresses to complete loss of mental, emotional, and physical functioning
- often occurs in people over 65
2
Q
What occurs during the first stage of Alzheimer’s disease*?
A
Stage 1- appr. 1-3yrs;
- includes short term memory loss;
- decreased ability to pay attention or learn new information; -personality changes such as increased irritability, denial, and depression;
- difficulties in depth perception
- people often recognize and attempt to cover up the mental errors during this stage
3
Q
What occurs during Stage 2 of Alzheimer’s disease?
A
- approx. 2-10 years
- person loses the ability to write, identify objects by touch, accomplish purposeful movements, and perform simple tasks such as getting dressed
- during this stage, safety is a big concern
- the person also loses the ability to communicate socially with others (uses the wrong words, repeating phrases, and may lose language function completely{aphasia*})
4
Q
What is aphasia?
A
total loss of language function
5
Q
What occurs during stage 3 of Alzheimer’s disease?
A
- for the last 8-10 years
- person has very little (if any) communication skills due to disorientation to time, place, and person
- bowel and bladder incontinence, posture flexion, and limb rigidity also are noted
- the person is completely dependent on others to provide basic needs
- additional complications possible such as malnutrition, dehydration, and pneumonia
6
Q
What causes the changes in the brain in Alzheimer’s disease?
How is it diagnosed?
Treatment?
A
- both chemical and structural have been identified
- based on tests such as physical, psychological, neurological, and psychiatric examinations plus lab tests; can diagnose with 90% accuracy; biopsy or autopsy of the brain tissue is required for diagnosis confirmation
- tacrine hydrochloride (Cognex) used for mild to moderate cases to improve memory (works for 40% of people); antidepressants and tranquilizers used for symptoms
7
Q
amyotrophic lateral sclerosis* (ALS)
A
-severe weakening and wasting of muscle groups, usually beginning with hands and progressing to arms, shoulders, and legs
a=without my/o=muscle troph/o=development -ic=pertaining to scler/o=hard, or sclera of the eye
-osis=condition
8
Q
What is amyotrophic lateral sclerosis* (ALS) caused by?
A
- decreased nerve innervation to the muscle groups due to the loss of motor neurons in the brain stem and spinal cord
- the deficits are are specifically motor and does not involve cognitive or sensory* changes
9
Q
What are symptoms of ALS?
A
- In the beginning-worsening fatigue with uncoordinated movements, spasticity, and eventually paralysis
- as the brain stem becomes involved=severe wasting of the muscles in the tongue, and face, causing speech, chewing, and swallowing difficulties
- other difficulties=clearing airway and breathing and loss of temperament control (fluctuating emotions)
10
Q
What are complications of ALS?
A
loss of verbal communication, loss of ability to provide self-care, total immobility, depression, malnutrition, pneumonia, and inevitable respiratory failure
11
Q
How long do people live with ALS?
A
approximately 50% of people die within 3-5 years
12
Q
What is anencephaly*?
A
-the absence of the brain and spinal cord at birth, a congenital disorder
-the condition is incompatible with life
-can be detected through an amniocentesis or ultrasonography early in pregnancy
an=without, not encephal/o=brain -y=noun ending
13
Q
Bell’s palsy*
Symptoms?
A
- the temporary or permanent unilateral weakness or paralysis of the muscles of the face following trauma, an unknown infection, or a tumor pressing on the facial nerve
- drooling, inability to close the eye or regulate salivation on the affected side; loss of appetite and taste perception
- gentle massage, warm moist heat applied, exercises, prednisone to reduce swelling, and analgesics to relieve pain
- early treatment is important for success
14
Q
Brain abscess*
What is it?
What causes it?
What are the symptoms?
A
- localized accumulation of pus located anywhere in the brain tissue
- an infectious process-either primary local infection or a secondary infection from for example, bacterial endocarditis, sinusitis, otitis, or dental abscess
- initial symptom is headache from intracranial pressure (ICP); other symptoms follow according to location-vomiting, visual disturbances, seizures, neck stiffness, and unequal pupil size
15
Q
How is a brain abscess diagnosed?
How is it treated?
A
- through the use of a computerized tomography scan (CT) and/or a electroencephalogram (EEG)
- aggressively with intravenous antibiotics; if ICP is apparent they use mannitol (an osmotic diuretic) to decrease pressure; if pressure does not decrease, surgical drainage may be required
16
Q
What is carpal tunnel syndrome*?
A
-a pinching or compression of the median nerve within the carpal tunnel due to inflammation and swelling of the tendons, causing intermittent or continuous pain that is greatest at night
17
Q
What is the carpal tunnel?
A
a narrow passage from the wrist to the hand that houses blood vessels, tendons, and the median nerve.
18
Q
What causes the tendon inflammation found in carpal tunnel syndrome*?
A
largely as a result of repetitious overuse of the fingers, hands, or wrists
19
Q
What is the treatment for carpal tunnel syndrome?
A
-anti-inflammatory medications, splints, physical therapy, and stopping repetitive overuse; surgery may be necessary if aforementioned does not work
20
Q
True or False: The breakdown of the word anencephaly is an = without or not, encephal– = skull, and –y makes it a noun.
A
False. Cranium is the skull. Encephal- means brain
21
Q
What is a cerebral concussion*?
What causes it?
A
- a brief interruption of brain function, usually with a loss of consciousness lasting for a few seconds
- usually by a blunt trauma (a blow) to the head
22
Q
What are the symptoms of a cerebral concussion?
A
Severe concussion=unconsciousness for a longer time, a seizure, respiratory arrest, or hypotension;
- after gaining consciousness they will likely have a headache, not remember the events that caused the injury;
- -other symptoms include blurred vision, drowsiness, confusion, visual disturbances, and dizziness
23
Q
What is the treatment for cerebral concussion?
A
observation for signs of ICP or intracranial bleeding during the period of unconsciousness and several hours after regaining consciousness; results will decide further necessary treatment
24
Q
What is a cerebral contusion?
A
a small, scattered venous hemorrhage in the brain;
a “bruise” of the brain tissue; occurs when the brain strikes the inner skull
25
What does a cerebral contusion often cause? and when is it at its worse?
What are the symptoms of a cerebral contusion?
What is the treatment?
- cerebral edema-swelling of the brain tissue
- 12-24 hours after injury
- vary according to size and location; some symptoms include >in CIP, combativeness, and altered level of consciousness
- close observation for ICP and consciousness including hospital observation to monitor IPC, maintain cerebral perfusion, and administer corticosteroids and osmotic diuretics
26
What is cerebral palsy*?
a collective term used to describe congenital (at birth) brain damage that is permanent but not progressive. It is characterized by a child's lack of control of voluntary muscles
cerebr/o=brain; cerebrum -al=pertaining to
27
What causes the lack of voluntary control seen in cerebral palsy?
injuries to the cerebrum which occur before birth, during birth, or during the first 3 to 5 years of a child's life
28
What are the four major types of cerebral palsy?
spastic
ataxic
athetoid
mixed
29
Damage to what part of the brain causes spastic cerebral palsy?
What are the symptoms of spastic cerebral palsy?
- results from damage to the cortex of the brain
- causing tense muscles and very irritable muscle tone
e. g. a very tense heel cord that forces a child to walk on his or her toes
30
Damage to what part of the brain causes ataxic cerebral palsy?
What are the symptoms of ataxic cerebral palsy?
-results from damage to the cerebellum
-involves tremors, a disturbed equilibrium, loss of coordination, and abnormal movements
forces the child to stagger when walking
31
Damage to what part of the brain causes athetoid cerebral palsy?
What are the symptoms?
- damage to the basal ganglia
- abnormal movements such as twisting or sudden jerking from any stimulus* including the increased intensity brought on by stress
32
What is mixed CP?
a combination of symptoms* of the three types of CP previously discussed
33
What is the most common type of cerebral palsy?
Spastic
34
How is intellectual function impacted by CP?
may range from extremely bright, normal to severe mental retardation.
35
What are other common handicaps associated with CP?
oculomotor impairment, convulsive disorder (s), and hearing and speech impairments
36
Why is the disease called cerebral palsy* instead of cerebellar palsy?
a. It involves involuntary muscle.
b. It is all in the patient's head.
c. It doesn't sound as good.
d. It involves voluntary muscle.
d. The patient has no control over his or her own movement
37
What is a cerebrovascular accident* (CVA)?
death of a specific portion of brain tissue, resulting from a decrease in blood flow (ischemia) to that area of the brain; also called a stroke
cerebr/o=brain; cerebrum
38
What causes a CVA?
cerebral hemorrhage, thrombosis (clot formation), and embolism (dislodging of a clot)
39
What are transient ischemic attacks (TIA)?
brief periods of ischemia in the brain, lasting minutes to hours; "mini-strokes".
40
What is important to remember about TIAs?
they often precede a full-blown thrombotic CVA
41
What are the symptoms?
- they range depending on the amount of ischemia and vessels involved
- if TIA, may experience numbness and weakness in the extremities or corner of the mouth, difficulty communicating, visual disturbances, or a "funny feeling"
42
What is a cerebral thrombosis* (clot)?
- also called a thrombotic CVA
- usually 50% of all CVAs in people over 50 years old during rest or sleep
- typically caused by a therosclerosis, thickened fibrotic vessel wall that causes the diameter to decrease or close off
- It is often preceded my many TIAs
- Once it becomes a full blown cerebral thrombosis, things happen quickly----the occurrence is rapid but the progression is slow
43
What is a cerebral embolism*?
- when an embolus of fragments of a blood clot, fat, bacteria, or tumor lodge in a cerebral vessel and cause an occlusion* (blockage); the blocked area is then ischemic.
e. g. a piece of clot may break off in the carotid artery and move into circulation, causing a cerebral embolism*
e. g. a fat embolus can occur from the fracture of a long bone
- will cause immediate neurological dysfunction until gone
44
What is a cerebral hemorrhage?
What is the most common cause?
What are the symptoms?
- when the cerebral vessel ruptures, allowing bleeding into the CSF, brain tissue, or the subarachnoid space*
- high blood pressure
- occur rapidly and include headache and other neurological dysfunctions, numbness, dizziness, or even impaired consciousness (stupor to coma, paralysis, and aphasia); differs widely according to the degree of involvment
45
What is a degenerative disk*?
the deterioration of the intervertebral disk, usually due to constant motion and wear on the disk
46
What causes a degenerative disk?
What are the symptoms?
What are the treatments?
- vertebral misalignment that causes constant rubbing, with gradual wasting and inflammation
- pain primarily, burning and continuous; motor function loss at times; people are often unable to carry out normal daily activities b/c of pain and motor function
- bed rest, bracing the back, nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, transcutaneous electrical nerve stimulation* (TENS), and surgical interventions
47
What is encephalitis*?
| What causes it?
- the inflammation of the brain or spinal cord tissue that becomes invasive and destructive; at its worst the deterioration of nerve cells and increase of cerebral edema may result in permanent neurological damage or a comatose* state
- largely caused by a virus that enters the CNS when the person experiences a viral disease such as mumps, measles or through the bite of a mosquito or tick; other less common causes include parasites, rickettsia, fungi, or bacteria
48
What are the symptoms of encephalitis?
-symptoms similar to meningitis (but no build up of exudate) where small hemorrhages occur in the CNS tissue, causing the tissue to become necrotic; restlessness, seizure, headache, fever, stiff neck, altered mental function, and decreased level of consciousness; also could experience facial weakness, difficulty communicating and understanding verbal communication, personality changes, or weakness on one side of the body
49
what are treatments for encephalitis?
- administering medications, treating symptoms and preventing complications
- mild analgesics for pain, antipyretics for fever, anticonvulsants for seizure activity, antibiotics for intercurrent infections, and corticosteroids or osmotic diuretics to control cerebral edema
50
What is epilepsy*?
- a syndrome of recurring episodes of excessive irregular electrical activity of the brain resulting in involuntary muscle movements called seizures
- may occur w/ a diseased or structurally normal CNS and the electrical activity may involve part or all of the person's brain
51
What can epileptic seizures affect?
consciousness level, skeletal motor function, sensation, and autonomic function of the internal organs; severe seizures may produce a decrease of oxygen in the blood circulation, acidosis, and respiratory arrest
52
How are seizures classified?
according to the area of the brain or the focus, cause, and clinical signs and symptoms
53
What are the two categories of seizures?
partial seizures and generalized seizures
54
What are partial seizures?
they arise from a focal area that may be sensory*, motor, or even a diverse complex focus
55
What are generalized seizures?
often result in a loss of consciousness and involve both cerebral hemispheres
56
What are the most common generalized seizures?
Grand mal and petit seizures
57
How are seizures treated?
| How are they diagnosed?
- anticonvulsant medications (to reduce or control)
| - complete neurological exam, ambulatory electroencephalogram, MRI, and CT
58
What is a grand mal seizure*?
an epileptic seizure characterized by a sudden loss of consciousness and by generalized involuntary muscular contraction, vacillating between rigid body extension and an alternating contracting and relaxing of mucsles
-most common seizure in adults and children
59
What is the other name for grand mal seizure?
tonic-clonic seizure*
60
What is an aura*?
an indication of some kind that a seizure is going to happen which precedes the onset of the tonic phase of the seizure
61
What does the tonic phase consist of?
- begins with a sudden loss of consciousness, person falling to the floor
- muscles contract causing rigid extension of the head, legs, and arms and clenching of the teeth
- eyes roll back, pupils are dilated and fixed
- breathing is stopped as diaphragm contracts
- urinary and bowl incontinence can happen
62
How long does the tonic phase last?
up to 1 minute but average is 15 seconds before the clonic phase begins
63
What does the clonic phase consist of?
contraction and relaxation of muscles groups in arms and legs, rapid shallow breathing called hyperventilation, excessive salivation
64
What is a petit mal seizure*?
- a small seizure in which there is a sudden temporary loss of consciousness lasting only a few seconds; also known as an absence seizure*
- people have a blank expression and blink eyes rapidly but do not lose consciousness
- usually lasts 5 to 10 seconds
- occur more often in children prior to puberty, beginning about the age of 5
65
What is Guillain-Barre syndrome*?
- acute polyneuritis of the PNS
- the myelin sheaths on the axons are destroyed resulting in decreased nerve impulses, loss of reflex, response, and sudden muscle weakness
- usually follows a viral gastrointestinal or respiratory infection
66
What are the symptoms of Guillain-Barre syndrome?
- begins with symmetric motor and sensory loss in the lower extremities, goes up the torso, upper extremities, and cranial nerves
- the person retains mental ability while experiencing pain, weakness, and numbness
- sometimes respiratory function is compromised
67
What is the treatment of Guillain-Barre syndrome?
- for most people the disease resolves itself in a couple of weeks
- therefore treatment is symptomatic, supportive, and aimed at preventing complications related to extended immobility, pain, anxiety, powerlessness, and respiratory dysfunction
68
True or False: A cerebrovascular accident is a misfiring of the electrical impulses in the brain.
False. Vascular means vessel, so this involves lack of blood flow to the brain.
69
What is cephalalgia?
-a headache; involves pain (varying in intensity) anywhere in the cranial cavity
-may be chronic or acute
-may be the result of a disease or totally benign
-most are transient and produce mild pain treated with an analgesic*
cephal/o=head -algia=pain
70
```
What are migraine headaches?
What are they characterized by?
Symptoms?
What age group?
What are they affected by?
```
- a recurring, pulsating, vascular headache usually on one side of the head
- characterized by a slow onset that may be preceded by an aura*, during which a sensory disturbance occurs
- as pain intensifies, a person can experience nausea, vomiting, irritability, fatigue, sweating, or chills
- can occur at any age; family history can exist
- affected by stress, crisis, and the menstrual cycle
71
What is another name for migraine headaches?
| Why?
- vascular headaches
- dilation of the vessels int he head along with a drop in the serotonin level ( which is a vasoconstrictor and neurotransmitter*) occur on the onset of the migraine and can last hours or days
72
What is the treatment for migraines?
medication to stop them from occurring and medication to relieve the pain
73
What is a cluster headache?
When does it usually occur?
What are the symptoms?
How long do they last?
- extreme pain around one eye with no prodromal (or early) signs
- typically 2 to 3 hours after falling asleep and wakes the person up
- associated symptoms include discharge of nasal fluid, tearing, sweating, flushing, facial edema
- duration is 30 minutes to several hours and the episodes are clustered
74
What is a tension headache?
- occurs from long, endured contraction of the skeletal muscles around the face, scalp, upper back, and neck; described as viselike, pressing, or tight
- most common headache
- related to excessive emotional tension
- begin in adolescence but most common in middle age
- relieved with acetaminophen or aspirin, or tranquilizers to relax the muscles
75
What is a hematoma*?
- a collection of blood
| - collected from a torn artery, usually the middle meningeal artery, or a skull fracture or contusion
76
What is a epidural hematoma?
What are the symptoms?
Treatment?
-a hematoma located ABOVE the dura mater and just BELOW the skull; it develops rapidly
epi=upon, over dur/o=dura mater -al=pertaining to hemat/o=blood -oma=tumor
-initial symptom is unconsciousness followed by a lucid period of 1hr to 2days followed by a rapid decline in consciousness accompanied by one or all of these: progressively severe headache, drowsiness, confusion, seizures, paralysis, one fixed pupil, an increase in blood pressure, a decrease in pulse rate, and even coma
-a craniology to repair the damaged blood vessels and remove pooled blood or burr holes to evacuate clots and ligate the artery
77
What is a subdural hematoma?
a collection of blood below the dura mater and above the arachnoid layer of the meninges*
sub=below, under dur/o=dura mater -al=pertaining to hemat/o=blood oma-tumor
78
What causes a subdural hematoma?
Symptoms?
Treatment?
- usually as a result of a closed head injury, an acceleration-deceleration injury, a cerebral atrophy in older adults, use of anticoagulants, a contusion, and/or chronic subdural hematoma(which can evolve over weeks to months)
- agitation, drowsiness, confusion, headache, dilation and sluggishness of one pupil, possible seizures, ICP, and paralysis
- diuretic medications, may be removed through burr holes, chronic subdural hematoma through a craniotomy (because the blood collects slowly and solidifies making it difficult to extract through burr holes)
79
What is a herniated disk?
it is a nucleus pulposus; it is a rupture or herniation of the disk center through the disk wall and into the spinal canal, causing pressure on the spinal cord or nerve roots
80
What causes a herniated disk?
Where does it occur most frequently and sometimes?
How is it diagnosed?
- can be a trauma or by sudden straining or lifting in an unusual position
- occurs most frequently in the lumbasacral area, causing symptoms of sciatica*; occasionally in the cervical area
- with a CT scan, an MRI, or a myelogram
81
What is Huntington's chorea*?
- an inherited neurological disease characterized by rapid, jerky, involuntary movements and increasing dementia due to the effects of the basal ganglia on the neurons
- it is progressive and degenerative without a cure
- presents around age 30-40
82
What are the first symptoms of Huntington's chorea?
What aggravates the symptoms?
What happens as the disease progresses?
How long can someone live with the disease?
What do they generally die of?
- irritability, periods of alternating emotions, posture and positioning problems, protruding tongue, speech problems, restlessness, and complaints of a "fidgety" feeling
- stress, emotional situations, attempts to perform voluntary movements
- the diaphragm becomes impaired creating the possibility of choking aspiration, poor oxygenation, and malnutrition
- 15-20yrs from onset
- infectious process or aspiration pneumonia
83
What type of headache would be most common in a profession such as medical transcription, which involves being in the same position for an extended period of time?
a. cluster
b. migraine
c. tension
d. all of the above
c. It is very important to take time to stretch these tense muscles as often as possible to minimize more pain and injury.
84
What is hydrocephalus?
- Abnormal increase of cerebrospinal fluid in the brain that causes the ventricles of the brain to dilate
- Results in increased head circumference in infant with open fontanel
- Congenital disorder
85
What causes hydrocephalus*?
What are the symptoms in infants?
Treatment?
- can be an increased production of CSF; a decreased absorption of CSF, or a blockage in the normal flow of CSF
- frontal bossing (forehead protrudes out) which may cause "setting sun" sign where the sclerae are visible, high-pitched cry, a bulging fontanel, extreme irritability, and an inability to sleep for long periods of time, increased head circumference
- to remove the obstruction or if there is no obstruction then a shunt is used to relieve the intracranial pressure that must be replaced as the child grows
86
What are the other diseases that hydrocephalus* is often a complication of?
spina bifida cystica*, rubella, or syphilis
87
What are intracranial tumors*?
- Tumors occurring in any structural region of the brain, causing the normal tissue to be displaced or compressed and compromised
- May be malignant or benign
- Classified as primary or secondary
- Named according to the tissue from which they originate
88
What are the symptoms of intracranial tumors*?
| Treatment?
- headaches, dizziness, vomiting, problems with coordination and muscle strength, changes in personality, altered mental function, seizures, paralysis, and sensory disturbances
- surgical removal is desired when possible or radiation or chemotherapy
89
What are primary intracranial tumors*?
Tumors that arise from gliomas and the meninges
90
What are gliomas?
malignant glial cells that are a support for nerve tissue
91
How are gliomas classified?
| What are the five discussed?
- according to the principal cell type, shape, and size
| - glioblastoma multiformes; astrocytomas; ependymomas; oligodendrogliomas; medulloblastomas
92
What glioma is the most frequent and rapidly growing intracranial tumor arising in the cerebral hemisphere?
glioblastoma multiformes
93
What glioma is the most common type of primary brain tumor that are usually slow growing noncancerous tumors made of astrocytes?
astrocytomas
| -they invade the surrounding structures and over time become more anaplastic (revert to a more primitive form)
94
What glioma comprises appr. 6% of al intracranial tumors more commonly found in children and adolescents and is usually encapsulated and benign?
ependymomas
| -they arise from ependymonal cells that line the fourth ventricle wall and extend into the spinal cord
95
What glioma comprises appr. 5% of al intracranial tumors and usually slow growing?
oligodendrogliomas
| -occur most often in the frontal lobe
96
What glioma is the most common type of childhood brain cancer occurring most frequently in children between 5-9, more boys than girls, and arise from the cerebellum rapidly?
medulloblastomas
| -prognosis is poor
97
What are meningiomas?
they are the intracranial tumors that arise from the meninges, often benign, comprise 15% of all intracranial tumors, grow slowly and are vascular. occur largely in adults
98
What is metastatic intracranial tumors* (secondary)?
Tumors occurring as a result of metastasis from a primary site such as the lung or breast
99
What do brain metastasis most frequently arise from as a secondary tumor?
-lungs and breast cancer
100
meningitis (acute bacterial)
- Serious bacterial infection of the meninges
- Can have residual debilitating effects or even a fatal outcome
- Must be diagnosed and treated promptly with appropriate antibiotic therapy
101
How does bacteria enter the meninges?
| What happens once it enters the meninges?
- through the bloodstream from an infection in another part of the body or through a penetrating wound such as an operative procedure, a skull fracture, or a break in the skin covering a structural defect such as a meningomyelocele
- rapid multiplication of the bacteria leads to swelling in the brain tissue, congestion in the blood circulation of the CNS, and clumps of exudate may collect around the brain stem
102
Symptoms of meningitis
> in ICP; irritability; extremely stiff neck (nuchal rigidity*); headache, fever; pain with eye movement; light sensitivity; nausea and vomiting; diarrhea; drowsiness; confusion; and possibly seizures; in infants-not wanting to be cuddled, high-pitched cry, crying iwth position changes, decreased activity, bulging tense fontanel and poor sleeping and feeding
103
How is CSF obtained from infants?
| What will the CSF look like?
- by a lumbar puncture if they have an open fontanel
- appear cloudy, showing the presence of white blood cells
- there will also be an increase in protein and a decrease in glucose
104
treatment for bacterial meningitis?
| treatment success?
- intravenous antibiotics for at least 10 days, hospitalization in isolation for 24-48 hours, an environment that is quiet and dark, with very little stimuli
- depends of severity and age; can be complete recovery or long-term complications of learning disabilities to severe mental and physical handicaps, cranial nerve malfunctions, peripheral circulatory collapse, arthritis, and subdural effusion
105
Viral meningitis
caused by viruses; also called aseptic meningitis and usually mild
106
True or False: A biopsy of a tumor in the brain shows cells compatible with breast tissue. This means it is a primary tumor.
False. It did not originate within the brain.
107
Multiple sclerosis* (MS)
- Degenerative inflammatory disease of the central nervous system attacking the myelin sheath in the spinal cord and brain
- Leaves area sclerosed (hardened) or scarred and interrupting the flow of nerve impulses
- affects young adults 20-40 years old, females more than males
- the course of the disease varies greatly, approx. 30 years
108
Two types of MS
- the exacerbation-remitting type (where onset is followed by complete remission)
- the chronic progressive type (steady loss of neurological function)
109
symptoms of MS
- unsteady balance, poor coordination, vertigo
- numbness or weakness
- speech, visual and auditory disturbance
- urinary incontinence or urgency
- facial pain or numbness and difficulty chewing or swallowing
- fatigue, spasticity, and muscular wasting or atrophy
- impaired sensation to temperature
- impotence in males
- emotional disturbances
110
complication risks with MS?
| treatment?
- seizures, and dementia*, blindness, recurring urinary tract infections, bowel and bladder incontinence, respiratory infections, and injuries from falls
- no cure; medication have helped to prolong remissions; goal is to slow the immune response, decrease inflammation, and promote muscle relaxation
111
What is myasthenia gravis?
- Chronic progressive neuromuscular disorder
- Causes skeletal muscle weakness (without atrophy) and fatigue
- Occurring at different levels of severity
- considered an autoimmune disease because antibodies block or destroy some acetylcholine* receptor sites
- happens to women more often between 20-40 years of age (in men between 50-60 yrs old)
112
Why are the muscles weak with myasthenia gravis?
the nerve impulses is not transmitted successfully to the muscle cell from the nerve cell
113
What are the symptoms of myasthenia gravis?
| Treatments?
- occur suddenly or gradually; facial muscle weakness; drooping eyelids; difficulty in swallowing and speaking; weakness eventually becomes paralysis
- medications, restricted activity, and a soft or liquid diet
114
What is narcolepsy?
-Rare syndrome of uncontrolled, sudden attacks of sleep
-Main features of narcolepsy are daytime sleepiness and
cataplexy
-can last minutes to hours at any time of the day but usually during monotonous activities
-medications can control it
115
What is cataplexy?
sudden loss of muscle tone
116
what is a polysomnogram?
used to evaluate sleep disorders such as narcolepsy
117
what is a neuroblastoma?
- highly malignant tumor of the sympathetic nervous system
- most commonly occurs in the adrenal medulla with early metastasis spreading widely to the liver, lungs, lymph nodes, and bone
118
What is Parkinson's disease?
- Degenerative, slowly progressive deterioration of nerves in the brain stem’s motor system, characterized by a gradual onset of symptoms
- Classic symptoms: stooped posture with body flexed forward, bowed head, shuffling gait, pill-rolling gestures, expressionless, mask-like facial appearance
119
What causes Parkinson's disease?
found more in which sex? at what age?
what are the three groups of symptoms?
- unknown but people usually have a neurotransmitter deficiency (dopamine)
- more often seen in males, 50-60 yrs old
- motor dysfunction; autonomic system dysfunction; and mental and emotional dysfunction
120
What does the motor dysfunction group of Parkinson's disease symptoms include?
-tremors, slowed movements, inability to start voluntary movements, speech problems, muscle rigidity, and gait* and posture disturbances
121
What does the autonomic system dysfunction group of Parkinson's disease symptoms include?
mottled skin, problems from seborrhea and excess sweating on the upper neck and face but absent sweating on lower body, abnormally low blood pressure, heat intolerance, and constipation
122
What does the mental and emotional dysfunction group of Parkinson's disease symptoms include?
loss of memory, declining mental processes, lack of problem-solving skills, uneasiness, and depression
123
What is pallidotomy?
a procedure used for Parkinson's disease that involves the destruction of the involved tissue in the brain to reduce tremors and severe dyskinesia
124
What is peripheral neuritis?
- Inflammation of one or more peripheral nerves
- Effects are dependent upon particular nerve involved
- peripheral nerve disorders discussed are trigeminal neuralgia (tic douloureux), Bell's palsy, and carpal tunnel syndrome
125
What is poliomyelitis?
-Infectious viral disease that affects the ability of spinal cord and brain motor neurons to receive stimulation
-Virus enters through the upper respiratory tract
-Muscles affected become paralyzed without the motor nerve stimulation
-virtually eliminated through vaccines and immunization programs of Salk and Sabin
prevention is the key still with vaccine for all three forms of poliomyelitis
126
Symptoms of poliomyelitits
nasal secretion, low-grade fever, progressive muscle weakness, nausea and vomiting, still neck, flaccid paralysis of muscles involved, muscle atrophy
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Postpolio syndrome
- Progressive weakness occurring at least 30 years after the initial poliomyelitis attack
- affect originally affected muscles and they deteriorate
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What is Reye's syndrome?
- Acute brain encephalopathy along with fatty infiltration of the internal organs that may follow acute viral infections
- Occurs in children under the age of 18; often with a fatal result
- Linked to aspirin administration during a viral illness
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What are the Reye's syndrome symptom stages?
1. sudden, continuos vomiting, confusion and lethargy*
2. irritability, hyperactive reflexes, delirium, and hyperventilation
3. changes in level of consciousness progressing to a coma
4. fixed, dilated pupils; continued loss of cerebral function and periods of absent breathing
5. seizures, loss of deep tendon reflexes, and respiratory arrest
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What is shingles (herpes zoster)?
- Acute viral infection characterized by inflammation of the underlying spinal or cranial nerve pathway producing painful, vesicular eruptions on the skin along these nerve pathways
- Seen mainly in adults
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Skull fracture (depressed)
- Broken segment of the skull bone thrust into the brain as a result of a direct force, usually a blunt object
- auto and industrial accidents potential causes
- treated with a craniotomy to remove the depressed segment and raise it back into position
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What is spina bifida cystica?
- Back portion of one or more vertebrae is not closed normally and a cyst protrudes through the opening in the back, usually at the level of the 5th lumbar or 1st sacral vertebrae
- Congenital defect of the CNS
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What are the two types of spina bifida cystica?
meningocele and meningomyelocele
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What is meningocele?
- Cyst-like sac covered with skin or a thin membrane protruding through the bony defect in the vertebrae containing meninges and CSF
- spinal nerves may be displaced, but function is still sound
- hydrocephalus is possible complication after surgical closure of the meningocele
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What is meningomyelocele?
- Cyst-like sac covered with skin or a thin membrane protruding through the bony defect in the vertebrae that contains meninges, CSF, and spinal cord segments
- there are neurological symptoms such as weakness or paralysis of the legs as well as altered bowel and bladder control
- hydrocephalus is generally present
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There have been 3 disorders mentioned so far that only affect peripheral nerves. They are:
A. Parkinson's, poliomyelitis, and Bells' palsy
b. Myasthenia gravis, shingles, and carpal tunnel syndrome
C. Bell's palsy, carpal tunnel syndrome, and peripheral neuritis
D. Shingles, peripheral neuritis, and poliomyelitis
c. Bell's palsy affects facial nerves, carpal tunnel syndrome affects the median nerve in the forearm, and peripheral neuritis affects one or more.
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spina bifida occulta
- Congenital defect of the central nervous system in which the back portion of one or more vertebrae is not closed
- A dimpling over the area may occur
- hair grows out of the area, a port wine nevus (pigmented blemish) over the area, and/or a subcutaneous lipoma (fatty tumor)
- can occur anywhere along the spinal column
- no treatment necessary as there are usually very few neurological symptoms present
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spinal cord injuries
- severe injuries to the spinal cord
- trauma to the spinal cord occurring above the level of C3 and C4 often result in a fatality due to the loss of innervation to the diaphragm and intercostal muscles
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What is paraplegia?
- Paralysis of the lower extremities caused by severe injury to the spinal cord in the thoracic or lumbar region
- Results in loss of sensory and motor control below the level of the injury
- other problems include loss of bladder, bowel, and sexual control
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What is quadriplegia?
- Paralysis of the trunk, legs, and pelvic organs with partial or total paralysis in the upper extremities caused by severe injury to the spinal cord between the 5th and 8th cervical vertebrae
- The higher the trauma, the more debilitating the motor and sensory impairments
- also results in cardiovascular complications, low body temperature, impaired peristalsis, inability to perspire, and loss of control of bladder, bowel, and sexual functions
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What is Tay-Sachs disease?
- Congenital disorder caused by altered lipid metabolism, resulting from an enzyme deficiency
- Accumulation of this type of lipid occurs in the brain, leading to progressive neurological deterioration with both physical and mental retardation
- symptoms begin around 6 months-deafness, blindness with a cherry red spot on each retina, and paralysis
- most often affects people of jewish descent
- can be diagnosed in utero through amniocentesis
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What is trigeminal neuralgia* (tix douloureux*)?
- Short periods of severe unilateral pain which radiates along the 5th cranial nerve (trigeminal nerve); three branches of the nerve can be affected (eye pain=ophthalmic branch; lower lip pain=mandibular branch; upper lip, nose, and cheek pain=maxillary branch)
- Heat, chewing, or touching of the affected area activates the pain
- analgesics control the pain; if pain not controlled, nerve roots can be dissected
