CNS Flashcards
Common S+S
- Specific S&S depend on the cranial nerve that is affected
- Intermittent attacks of excruciating facial px
- Vertigo
- Hearing loss
- Weakness
- Paralysis
- Facial twitch
Disorders affecting olfactory nerve
- The olfactory nerve is the first cranial nerve (CN I)
- It is part of the autonomic nervous system, which regulates body functions
- Nerve enables sense of smell
- CN I is the shortest sensory nerve in your body – it starts in the brain and ends in the upper, inside part of the nose
Symptoms of impaired olfactory nerve function
Ansomia- complete loss of smell
Dysomia- aka phantosmia, unpleasant or strange odours that occurs spontaneously
Hyposmia- partial loss of smell
Parasmia- distorted sense of smell
Conditions that affect olfactory nerve
- Sinus infection
- Nasal polyps
- Tobacco use
- Poor dental hygiene
- Environmental toxins and chemicals like insecticides
- Severe head injuries, including concussions
- Medications like antibiotics
- Covid
- Head and neck cancer
- Diabetes
- Alzheimer’s disease
- Brain tumour
- Parkinson’s disease
- Epilepsy
Glaucoma
- Group of eye conditions that damage the optic nerve
- The optic nerve sends visual information from your eye to your brain and is vital for good vision
Causes of glaucoma
Develops after optic nerve damage
As nerve gradually deteriorates blind spots develop in vision
Related to inc pressure in eye- can happen as result of build up that flows through inside of eye
Fluid= aqueous humor
Open-angle glaucoma
o Most common form
o Drainage angle formed by the iris and cornea remains open
o But other parts of the drainage system don’t drain properly
o This may lead to a slow, gradual increase in eye pressure
Angle-closure glaucoma
o Occurs when the iris bulges
o The bulging iris partially or completely blocks the drainage angle
o The fluid cant circulate through the eye and pressure increases
o May occur suddenly or gradually
Glaucoma in children
o May be born with it
o Can also develop it within the first few years of life
o Blocked drainage, injury or an underlying medical condition may cause optic nerve damage
Pigmentary glaucoma
o Small pigment granules flake off from the iris and block or slow fluid drainage from the eye
o Leads to a deposit of pigment granules on tissue located at the angle where the iris and cornea meet
o Granule deposits cause an increase in pressure
Glaucoma population
- People from black, Asian and Hispanic heritage over 40
- All other people over 60
Glaucoma risks
- High internal eye pressure, also known as intraocular pressure
- Age over 55
- Black, Asian or Hispanic heritage
- Certain medical conditions
o Diabetes
o Migraines
o High blood pressure
o Sickle cell anaemia - Corneas that are thin at the centre
- Extreme near-sightedness or farsightedness
- Eye injury or certain types of eye surgery
- Taking corticosteroid medications, especially eye drops, for a long time
Open angle glaucoma S+S
Defend on type and stage
o No symptoms in early stages
o Gradually, patchy blind spots in the peripheral vision
o In later stages, difficulty seeing things in your central vision
Acute angle-closure glaucoma S+S
o Severe headache
o Severe eye px
o Nausea or vomiting
o Blurred vision
o Halos or coloured rings around lights
o Eye redness
Chronic- symptoms would have been developing for prolonged period
Normal-tension glaucoma
o No symptoms in early stages
o Gradually blurred vision
o In later stages, loss of side vision
Glaucoma in children S+S
o Dull or cloudy eye (infants)
o Increased blinking (infants)
o Tears without crying (infants)
o Blurred vision
o Near sightedness that gets worse
o Headache
Pigmentary glaucoma S+S
o Halos around lights
o Blurred vision with exercise
o Gradual loss of peripheral vision
Glaucoma prognosis
- There are treatments for glaucoma but no cures as it’s a lifelong condition
- Medications
o Eye drops- serum to dry eyes - Laser therapy
- Surgery
o MIGS (minimally invasive glaucoma surgery)
o Can help slow down vision loss but cant restore lost vision or cure glaucoma - Glaucoma is a chronic and progressive condition that causes some degree of vision loss overtime
- Blindness is a rare complication so prognosis isn’t awful
Papilledema
- Medical term for swelling of the optic disc
- Almost always bilateral
Papilledema cause
- High intracranial pressure causes papilledema
- Other causes include
o Hypertension
o Tumours
o Infection, bleeding or inflammation in the brain or the meninges
o Cerebral venous sinus thrombosis (blood clot in a vein in your brain)
o Iron-deficiency anaemia
o Medication use
o Idiopathic intracranial hypertension
Papilledema population
Overweight women
20-44
Papilledema risks
Those which raise intracranial pressure
Space occupying lesion- tumour, subarachnoid haemorrhage, dec absorption of CSF
Risk factors for idiopathic hypertension include- recent weight gain, underlying conditions- anaemia, thyroid disease, sleep apnoea
Papilldema S+S
- Some people have no symptoms
- Headaches
o May be worse in the mornings or when lying down - Transient visual obscuration’s
o Periods of about 5 to 15 seconds when vision gets blurry, goes grey or blacks out
o Usually happen when you change posture
o Can be unilateral or bilateral - Diplopia
- Nausea
- Vomiting
- Neurological symptoms
o May include problems with movement or thinking - Vision loss worsens as the condition progresses
Papilldema prognosis
- If its due to idiopathic intracranial hypertension you may be prescribed a carbonic anhydrase inhibitor such as acetazolamide
- If this doesn’t work surgical procedures are available
- Maintaining a healthy weight is a long-term strategy
- Should treat the underlying cause (if there is one)
- If it is caught early the outlook is good
- It needs to be treated because of the potential for blindness and other neurological effects
Optic neuritis
- Occurs when inflammation damages the optic nerve
Optic neuritis cause
- Exact cause is unknown
- Believed to develop when the immune system mistakenly targets the substance covering the optic nerve, resulting in inflammation and damage to the myelin
- The following autoimmune conditions are associated with optic neuritis
o Multiple sclerosis
o Neuromyelitis optica
o Myelin oligodendrocyte glycoprotein (MOG) antibody disorder
Optic neuritis population
Females 20-40
Optic neuritis risks
20-40
Women
White people
Genetic mutations
Papilledema S+S
Unilateral
P worsened with eye movement, can feel like ache behind eye
Vision loss- develops over hours to days, improves over several weeks to months
Visual field loss
Loss of colour vision
Report of flashing lights
Optic neuritis prognosis
May spontaneously heal
Poor visual function- course of IV methylprednisolone (steroid medication) with a tapering course of oral steroids afterwards had been shown to speed recovery of visual function
Improves in about 80% of cases over few weeks
Some have continued worsening symptoms
Many people have complete resolution
Optic nerve atrophy
- Optic atrophy is a condition that affects the cranial nerve
- The cranial nerve carries impulses from the eye to the brain
- Atrophy means to waste away or deteriorate
- It is not a disease in itself but is a sign of a potentially more serious condition
Optic nerve atrophy cause
- Where something interferes with the optic nerves ability to transmit impulses
- The interference can be caused by numerous factors; including
o Glaucoma
o Stroke of the optic nerve
Anterior ischemic optic neuropathy
o A tumour that is pressing on the optic nerve
o Optic neuritis
An inflammation of the optic nerve caused by multiple sclerosis
o A hereditary condition in which the person experiences loss of vision first in one eye, and then in the other
Known as Leber’s hereditary optic neuropathy
o Improper formation of the optic nerve
Congenital problem
Optic nerve atrophy population
White people
10-50
Optic nerve atrophy risks
- High cholesterol
- High blood pressure
- Sudden drop in blood pressure or blood loss
- Swollen arteries in the head
- Clogged arteries
- Heart disease
- Diabetes
- Sleep apnoea
- Smoking
- Migraines
- Glaucoma
Optic nerve atrophy S+S
- Symptoms relate to a change in vision
- Specifically
o Blurred vision
o Difficulties with peripheral vision
o Difficulties with colour vision
o Reduction in sharpness of vision
Optic nerve atrophy prognosis
- No real cure or treatment
- Important to have regular eye exams
- Prognosis depends on what is causing the problem
o E.g. if the problem is optic neuritis, the pt can usually count on getting their vision back when the inflammation goes away
o If the cause is something else, the pt vision might not improve
Optic nerve neuropathy
- Sudden loss of vision due to an interruption of blood flow to the anterior of the optic nerve
- 2 types
o Arteritic AION
Caused by inflammation of arteries supplying blood to the optic nerve
o Nonarteritic AION
Caused by reasons other than inflammation of the arteries
Optic nerve neuropathy cause- arthritic AION
o Dangerous condition
o Caused by inflammation of arteries supplying blood to the optic nerve
o Inflammation is due to a condition called giant cell arteritis (GCA) or temporal arteritis, which caused inflammation of medium and large sized arteries
o 3x more common in women
o Most often affects people over the age of 55
Optic nerve neuropathy- non-arteritic AION
o Most common form of AION
o Majority of people affected are over 50
o Both men and women affected equally
o Caused by one of the following
A drop in blood pressure to such a degree that blood supply to the optic nerve is devreased
Increased pressure inside the eyeball
Narrowed arteries
Increased blood viscosity
Decreased blood flow to the optic nerve where it leaves the back of the eye
Optic nerve neuropathy population
- Adults over 50
- A-AION – women more than men
Optic nerve neuropathy risks
- High blood pressure
- Biabetes mellitus
- High cholesterol
- Smoking
- Sleep apnoea
- Heart disease
- Blocked arteries
- Anaemia or sudden blood loss
- Sudden drop in blood pressure
- Sickle cell trait
- Vasculitis
Optic nerve neuropathy S+S- NA-AION
o Sudden, painless loss or blurring of vision in one eye
Usually noticed upon waking from a nights sleep or a nap
o Decreased visual activity
o Dyschromatopsia
o A RAPD
Relative afferent pupillary defect
o Swollen optic nerve with splinter haemorrhages
o Visual field defect
Optic nerve neuropathy S+S- A-AION
o Px in the temples
o Px when chewing
o Scalp px or tingling
o Neck px
o Muscle aches and pains
Esp in upper legs or arms
o General fatigue
o Loss of appetite
o Unexplained loss of weight
o Fever
Optic nerve neuropathy prognosis
A-AION usually causes greater degree of vision loss
Degree of loss depends on location and amount of optic nerve that is damaged
In NA-AION about 40% show some amount of improvement in central vision in months after loss of vision or visual fields
Optic nerve neuropathy treatment
o A-AION = basically the same treatment as giant cell arteritis (corticosteroid therapy)
o NA-AION = treatment is for the underlying cardiovascular disease or the risk factors that help trigger and aggravate NA-AION
Macular degeneration
- Also known as age-related macular degeneration
- An eye disease that affects central vision
- Top cause of vision loss in people over 50
- 2 types
o Dry (atrophic)
Up to 90% have the dry form
o Wet (exudative)
Macular degeneration cause- dry
- Inherited eye disease
- Occurs when the macula at the back of the eye starts to deteriorate for an unknown reason
o Develops when tiny yellow protein deposits called drusen form under the macula
o The build-up deposits dry and thin the macula
o Vision loss tends to occur gradually
o Most people don’t completely lose central vision
Causes macular degeneration- wet
o Occurs when abnormal blood vessels develop under the retina and macula
o The blood vessels leak blood and fluid
o Because of the fluid build-up a bulge forms in the macula
o May see dark spots in centre of vision
o Can quickly lead to total loss of central vision loss
Macular degeneration population
White people over 50
Macular degeneration risks
- Older age
o Over 50 - Family hx
- Being overweight
- Smoking
- Hypertension
- Diet high in saturated fats
- Being of European descent
Macular degeneration S+S
- Many people don’t have symptoms until the disease progresses
- Blurred vision
- Blank or dark spots in field of vision
- The appearance of waves or curves in straight lines
Macular degeneration prognosis
- No cure
- Prognosis depends on degree of vision loss
- Not everyone will experience significant vision loss
Vision rehab programme
Macular degeneration treatment
o Nutritional supplements- A, C, + E
o Antivascular endothelial growth factor (anti-VEGF)
o Photodynamic therapy (PDT)
Macular degeneration precautions you can take
o Quit smoking
o Lose weight
o Stay physically active
o Maintain healthy blood pressure and cholesterol levels
o Eat a healthy diet
Macular degeneration things that help day to day
o Wear eyeglasses or contact lenses
o Use brighter lights at home or at work
o Read with a magnifying device
Occulomotor palsy
- The oculomotor nerve is the 3rd of 12 cranial nerves (CN III)
- It is part of the autonomic nervous system
- It allows movement of the eye muscles, constriction of the pupil, focusing the eyes and the position of the upper eyelid
Function of oculomotor
- Controls 4 of the 6 muscles that enable eye movement
- Elevate the upper eyelid
- Focus the eyes
- Respond to light by making the pupil smaller
- Move your eyes inward, outward, up and down and control torsion
Cause of oculomotor palsy
Cause
- Oculomotor palsy is a group of disorders affecting the CN III
- They occur when the third cranial nerve becomes paralyzed
- Can be present at birth
- May occur later in life due to
o Inadequate blood flow – causes a lack of oxygen that nerves need to function properly
o Nerve compression – abnormal pressure on a nerve
Conditions which may cause oculomotor palsy
o Brain aneurysm
o Brain tumour
o Head injuries
o Demyelinating disease
Multiple sclerosis
o Microvascular disease
Diabetes
High blood pressure
o Infections
HIV
Lyme disease
o Migraine
Trochlear nerve plays
- The trochlear nerve is the 4th of 12 cranial nerves (CN IV)
- It is part of the autonomic nervous system
- It innervates many of the organs, including the eyes
- It is a motor nerve that sends signals from the brain to the muscles
- CN IV works with the oculomotor nerve and other eye muscles to control eye movement
Trochlear nerve palsy
- A palsy occurs when illness or injury paralyzes nerves that control muscle movements
Congenital
Trauma
More fragile- long and thin
Can occur after minor injuries
Treatment of trochlear nerve
- Treatment depends on what is causing symptoms
- Vision injuries causes by minor injuries often go away on their own
- For more severe palsy, treatments may include
o Eye patch to help the eye rest
o Special glasses to correct double vision
o Surgery to repair cranial nerve 4
Trigeminal neuralgia
- Causes painful sensations like an electric shock on side of face
- Chronic P affects trigeminal nerve, which carries sensations from face to brain
- Variety of treatment, effectively manage it- medications, injections or surgery
Trigeminal neuralgia cause
- Trigeminal nerve function disrupted
- Contact between blood vessel and nerve at base of brain
- Contact puts pressure on nerve and causes it to malfunction
- Sometimes related to MS
- Tumour compressing nerve
Trigeminal neuralgia population
50+
More common in women
Trigeminal neuralgia risk
- Hypertension
- Arteriosclerotic changes
- Aging
- Family Hx
Trigeminal neuralgia S+S
- Episodes of severe, shotting or jabbing P that may feel like and electric shock
- Spontaneous attacks triggered by things such as touching your face
- Attacks of P lasting a few seconds to several mins
- P occurs with facial spasms
- P in areas supplied by trigeminal- jaw, cheek, teeth, gums, lips or forehead
- P rarely occurs at night while sleeping
Trigeminal neuralgia prognosis
- Episodes can occur daily or weekly or months
- 50% of people experience remission of at least 6 months
Abducens palsy
- Most common ocular motor paralysis in adults and second-most common in children
- Causes problems with eye movements
Abducens palsy risks
- Inflammatory and microvascular conditions
- MS
- Meningitis
Abducens palsy S+S
Headache, P around eyes, nausea, vomiting, pulse synchronous tinnitus
Abducens palsy prognosis
Usual recovery between 3-6 months
Treatment- prisms, occlusion, botulinum toxin or surgery
Facial nerve palsy
- Causes sudden weakness in muscle of one side of face
Facial nerve palsy cause
- Not clear
- Often related to viral infection
- Viruses sought to be linked:
1. Cold sores and genital herpes
2. Herpes zoster
3. Influenza
4. Hand-foot-and-mouth disease
Facial nerve palsy population
- Pregnant, diabetic, influenza
Facial nerve palsy risks
- Pregnancy- especially third trimester
- Have upper respiratory infection- such as flu or cold
- Have diabetes
- Have high blood pressure
- Obesity
Facial nerve palsy S+S
- Rapid onset of mild weakness to total paralysis of one side of face
- Facial droop and difficulty making facial expressions
- Drooling
- P around jaw or behind ear
- Inc sensitivity to sound on affected side
- Headache
Facial nerve palsy prognosis
Full recovery usually 6 months
Vestibular disorders- acoustic neuroma
- Noncancerous, slow-growing tumour that develops on vestibular nerve leading from inner ear to brain
- Branches directly influence balance and hearing
Acoustic neuroma cause
- Linked with defect of gene on chromosome 22
- Normally this gene produces tumour suppressor protein that helps control growth of Schwan cells covering nerves
- Most cases, no known cause
Acoustic neuroma risks
- Neurofibromatosis type 2- parent with rare genetic disorder neurofibromatosis type 2
Acoustic neuroma clinical presentation
- Easy to miss and may take years to develop
- Hearing loss- usually gradually worsening over months to years
- Tinnitus
- Unsteadiness/loss of balance
- Vertigo
- Facial numbness/loss of muscle movement
Acoustic neuroma prognosis
- Treatment includes regular monitoring, radiation and surgical removal
Vestibular disorder- Benign paroxysmal positional vertigo (BPPV)
- Most common cause of vertigo
BPPV causes
- Idiopathic
- Associated with minor to severe blow to head
- Less common causes include disorders that damage inner ear
BPPV risks
- 50+
- Women
- Head injury
BPPV S+S
- Dizziness
- Vertigo
- Loss of balance/unsteadiness
- Nausea/vomiting
- Come and go, commonly last less than one minute
BPPV prognosis
- Bothersome but rarely serious except when it inc chance of falls
- Can receive treatment during doctor visits
Epley manoeuvre
Vestibular disorder- labrynthitis
- Inflammation of labyrinth- part of inner ear
- Inner ear infection- responsible for hearing and balance
Labrynthitis cause
- Mostly caused by virus, sometimes bacteria
- Bronchitis or other respiratory illness
- Viral infection of ear
- Herpes virus
- Stomach viruses
- Bacterial infections
- Measles, mumps, rubella, polio
Labrynthitis S+S
- Loss of balance
- Dizziness
- Vertigo
- Nausea/vomiting
- Blurry vision
- Hearing loss
- Tinnitus
Labrynthitis prognosis
- Most people completely better within 2-3 months
- Symptoms usually go away within a week
Vestibular disorders- Menderes disease
- Inner ear problem that can cause vertigo and hearing loss
Menieres disease cause
- Unknown
- May be due to extra fluid in inner ear called endolymph
- Isn’t clear what causes liquid build up
Menieres disease population
- Can happen at any age
- Usually starts between 40-60
Menieres disease risks
- Family Hx
- Pressure changes
- Stress
- Changes hormones
- Problems sleeping
Menieres disease S+S
- Regular dizzy spells
- Hearing loss
- Ringing in ear
- Feeling of fullness in ear
Menieres disease prognosis
- No cure
- Progressive disease which worsens over time
Vestibular migraine
- Nervous system problem that causes vertigo in people who have a Hx of migraine symptoms
Vestibular migraine cause
- Unsure
- Potential misfires between nerve cells in brain
Vestibular migraines population
- More common in women
- Symptoms tend to strike around 40
Vestibular migraine risks
- Mood- stress/anxiety
- Poor sleep
- Dehydration/hunger
- Dietary triggers- e.g., caffeine
- Hormonal changes
Vestibular migraine S+S
- Headaches and dizziness which comes and goes
- Nausea and vomiting
- Balance problems
- Sensitivity to sound
Vestibular migraine prognosis
- No cure, management of triggers can lead to normal life
MS
- Potentially disabling disease of CNS
- Immune system attacks myelin sheath that covers nerve fibres and axons
- Causes communication problems between brain and rest of body
Causes physical disability for 20-25 years in 30% of Px
MS cause
- Unknown
- Considered to be autoimmune
- Reduced myelin exposes nerve fibres, interfering with speed and efficiency of message delivery
- Combination of genetic and environmental factors
Infections- e.g. virus
MS population
- White women aged between 20-40
MS risks
- Age- 20-40
- Women 2-3x more likely
- Family Hx
- Certain infections- Epstein-Barr
- Race- white people
- Low vitamin D
- Chromosome 6p21 defect
- Smoking
MS S+S
First
Blurry vision
Diplopia
Red-green colour distortion
Optic neuritis- P and loss of vision
Trouble walking
Paresthesia
Other- muscle weakness in appendices, trouble w concentration, spasticity, fatigue, loss of sensation, speech problems, tremor, dizziness
About 50% have have cognitive problems- concentration, attention, memory
MS Primary, secondary, tertiary
Primary- occur as a result of myelin destruction
Weakness
Numbness
Tremors
Loss of vision
P, paralysis
Loss of balance
Bladder problems
Secondary- as a result of primary
Paralysis–> bedsores
Bladder problems- repeated UTIs
Inactivity- poor posture, decreased bone density
Tertiary- external factors which are affected
Unable to to work- may lose livelihood
Strain of chronic illness may disrupt relationships
MS prognosis
- Can eventually cause permanent damage or deterioration of nerve fibres
- No cure however there are treatments to help speed up recovery from attacks, modify course of disease and manage symptoms
Temporal arteritis
- Inflammation of lining of arteries
- Aka giant cell arteritis
Temporal arteritis cause
- Caused by inflammation of blood vessels
- This narrows blood vessels reducing amount of blood and oxygen to reach body tissue
- Almost any artery can be affected, most common in temples
- Cause unknown
- Believed to be due to abnormal attacks on artery walls by immune system
- Certain genes and enviro factors might be involved
Temporal arteritis risks
- 70-80
- Women 2x
- White people
- PMR
- Family Hx
Temporal arteritis S+S
- Head P and tenderness
- Scalp tenderness
- Jaw P when chewing or opening mouth wide
- Fever
- Fatigue
- Vision loss/double vision
- Sudden permanent loss of vision
Temporal arteritis prognosis
- Prompt treatment with corticosteroid medication usually relives symptoms and might prevent vision loss
- Relapse common even with treatment
Meningitis
- Infection and inflammation of the fluid membranes surrounding the brain and spinal cord
- These membranes are called meninges
Meningitis causes
- Viral infections are most common cause of meningitis
- Followed by bacterial infections and rarely fungal and parasitic infections
Meningitis bacterial
o Bacteria that enters the bloodstream and travels to the brain and spinal cord
o Can also occur when bacteria directly invades the meninges
o May be caused by an ear or sinus infection or a skull fracture
Common bacterial meningitis strains
Streptococcus pneumoniae- most common in infants, young children, adults. Vaccine helps prevent
Neisseria meningitidis- Commonly causes upper respiratory infection but can cause meningococcal meningitis when they enter the bloodstream
Haemophilus influenzae- Was once the leading cause in young children, vaccines have greatly reduced the number of cases
Listeria monocytogenes- Pregnant people, new-borns, older adults and people with weakened immune systems are most susceptible
Viral meningitis
o Usually mild and often clears on its own
o Most cases are due to a group of viruses called enteroviruses
o Most common in late summer and early fall
Chronic meningitis
o Long lasting
o Can be caused by slow growing organisms such as fungi and Mycobacterium tuberculosis
o Invade the membranes and fluid surrounding the brain
o Develops over 2 weeks or more
o Symptoms are similar to acute meningitis
Fungal meningitis
o Isn’t common in western countries
o May mimic acute bacterial meningitis
o Often contracted by breathing in fungal spores that may be found in soil, decaying wood and bird droppings
o Isn’t spread from person to person
o Affects people with a weakened immune system
o Can come back even after treatment
Parasitic meningitis
o Causes a rare type of meningitis called eosinophilic meningitis
o Can be caused by a tape worm infection in the brain or cerebral malaria
o Isn’t spread between people
Meningitis population
- Viral – children under 5
- Bacterial – people under 20
Meningitis risks
- Skipping vaccinations
- Age
o Most cases of viral meningitis occur in children under 5
o Bacterial meningitis is common in those under 20 - Living in a community setting
o College students living in dorms
o Personnel on military bases
o Children in boarding school or care facilities - Pregnancy
o Increases the risk of an infection caused by listeria bacteria
o Increased the risk of miscarriage, still birth and premature delivery - Weakened immune system
o AIDS
o Alcohol use disorder
o Diabetes
o Use of immunosuppressant drugs
o Having spleen removed
Meningitis S+S
- Early meningitis symptoms may be similar to the flu
- Symptoms may develop over several hours or over a few days
- Possible symptoms in anyone older than 2 years include
o Sudden high fever
o Stiff neck
o Severe headache
o Nausea or vomiting
o Confusion
o Trouble concentrating
o Seizures
o Sleepiness or trouble waking
o Sensitivity to light
o No appetite or thirst
o Skin rash in some cases, such as in meningococcal meningitis
Signs of meningitis in new borns
o Nigh fever
o Constant crying
o Being very sleepy or irritable
o Trouble waking from sleep
o Being inactive or sluggish
o Not waking to eat
o Poor feeding
o Vomiting
o A bulge in the soft spot on top of the baby’s head
o Stiffness in the body and neck
Meningitis prognosis
- Viral meningitis can go away on its own within about a week
- You can survive most forms of meningitis, though it is a very serious illness that requires immediate treatment
- Treatment depends on the cause
- You should start to feel better within a few days to a week after starting treatment for meningitis
- Full recovery can take weeks to months
Meningitis treatment
o Antibiotics for bacterial meningitis
o Antifungal for fungal meningitis
o Antivirals for certain cases of viral meningitis, like herpesvirus and influenza
o Corticosteroids, like dexamethasone or prednisone, to reduce inflammation
o Pain relievers
o IV fluids to keep hydrated
Epilepsy
- A CNS (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behaviour, sensations and sometimes loss of awareness
Epilepsy causes
- No identifiable cause in about half of people with the condition
Contributing factors- brain abnormalities (e.g., tumours, stroke in 35+), infections (meningitis, HIV), prenatal injury (poor nutrition, O2 deficit), developmental disorders (autism)
Epilepsy population
- Anyone
- Can affect people of all genders, races, ethnic backgrounds and ages
Epilepsy risks
Age- children and older adults
Family Hx
Head injury
Stroke
Dementia
Brain infection (meningitis)
Seizures in childhood
Epilepsy clinical presentation
o Temporary confusion
o Staring spell
o Stiff muscles
o Uncontrollable jerking movements of the arms and legs
o Loss of consciousness or awareness
o Psychological symptoms such as fear, anxiety or déjà vu
Focal seizure S+S
Can occur with consciousness or with impaired awareness
Confusion
Migraine
Narcolepsy
Mental illness
Generalised seizures
Absence- staring into space
Tonic- stiff muscles and may affect consciousness
Atonic- drop seizures, loss of muscle control
Clonic- repeated or rhythmic, jerking muscle movement
Myoclonic- usually appear as sudden or brief jerks or twitches
Tonic-clonic- abrupt loss of consciousness and body stiffening, twitching and shaking- most dramatic
Epilepsy prognosis
No cure but lots of treatment
Anti seizure meds- controls 60-70%
Diet therapy- high in fat, moderate protein and low carbs
Surgery- severance of corpus colosseum
PD
- A progressive disorder that affects the nervous system and the parts of the body controlled by the nerves
PD cause
- Certain nerve cells (neurons) in the brain gradually break down or die
- Many of the symptoms are due to a loss of neurons that produce a chemical messenger in your brain – dopamine
- When dopamine levels decrease, it causes atypical brain activity, leading to impaired movement and other symptoms of Parkinson’s disease
- Exact cause is unknown but several factors appear to play a role
o Genes
o Environmental triggers
Certain toxins or environmental factors
PD population
- Men at middle to late age
PD risk factors
Age- middle-later life
Family Hx
Sex- men
Exposure to toxins- herbicides/pesticides
PD clinical presentation
Variable
Early signs are mild and may go unnoticed
Often begins unilaterally
Tremor- starts in hand
Bradykinesia- slow movement
Rigid muscles
Stoop posture
Speech changes- monotone
PD prognosis
No cure, manageable
Meds- levodopa
Deep brain stimulation
Experimental treatment- stem cell transplant, neuron-repair treatment
Dizziness and vertigo cause
- Inner ear problems- house sensors that help detect gravity and back and fourth motion
- Eyes- help determine where body is in space
- Sensory nerves- sends messages to brain about body movements and positions
- Circulation problems that cause dizziness- drop in blood pressure, poor blood circulation
- Neurological conditions- e.g., Parkinson’s
- Medication
- Anxiety disorders
- Anaemia
- Damage to CN8
Dizziness and vertigo population
65+
Dizziness/vertigo risks
- Older adults
- Past episodes of dizziness
Dizziness/vertigo S+S
- False sense of motion or spinning (vertigo)
- Light-headedness of feeling faint
- Unsteadiness or loss of balance
- Feeling of floating, wooziness or heavy headedness
Dizziness/vertigo prognosis
- Most people get better without treatment
- Treatment will depend on cause
- ABs may be prescribed if caused by infection
- Exercises to improve balance
Myasthenia gravis
- Characterised by weakness and rapid fatigue of any muscle under voluntary control
Most commonly affects eye/eye lid muscles
Myasthenia gravis cause- antibodies
o Immune system produces antibodies that blocks or destroys muscle receptor sites for neurotransmitter acetylcholine
o With fewer receptor sites available, muscle receives fewer signals, resulting in weakness
o Can also impair function of protein called muscle-specific receptor tyrosine kinase (MuSK)
o This protein is involved in forming nerve-muscle junction
Myasthenia gravis cause- thymus gland
o Believed that thymus gland can trigger or maintain production pf antibodies which block Ach
o Common to have tumour in thymus gland, usually aren’t cancerous
Myasthenia gravis other cause
- Mother to child- if treated promptly child usually recovers within two months after birth
Myasthenia gravis population
- Can affect anyone
- Women more likely under 40
- Men over 60
Myasthenia gravis risks
- Women between 20-30
- Men 60-70
Myasthenia gravis S+S
- Muscle weakness worsens as affected muscle is used
- Usually improves with rest
- Muscle weakness can come and go
- Eye muscles
o Usually first sign
o Drooping of one or both eyelids
o Double vision - Facial and throat muscles
o 15% of peoples symptoms involve throat/face
o Impaired speaking
o Difficulty swallowing
o Affects chewing
o Changes facial expressions - Neck and limb muscles
o General weakness
o Can affect walking
o Weak neck muscles make it hard to hold head up
Myasthenia gravis prognosis
- No cure but treatment can help relieve signs and symptoms
