Diseases and disorders of Nervous system Flashcards
layers of tissue covering brain
3 layers called meninges
innermost covering is the pia mater, middle layer is the archnoid and toughest, outermost covering is the dura mater
between dura mater and arachnoid membrane is subdural space
subarachnoid space btwn arachnoid membrane
pia mater is filled with cerebrospinal fluid that circulates here in the brain’s ventricles and in the subarachnoid space around the spinal cord
What is Cerebrospinal fluid (CSF)
clear liquid composed of water, protein, glucose and minerals
Regions of cerebrum?
outer region is cerebral cortex (distinctive wrinkled region described as gray matter because it consists of neuron cell bodies that appear dull gray)
inner region consists of axons and is described as white matter because axon’s myelin = white color
inner part of cerebrum also contains basal ganglia that controls muscle coordination and steady movement
3 types of neurons
interneurons - carries nervous impulses btwn neurons
sensory neurons - detect environmental stimuli like touch, light or pain and transmits messages to brain or spinal cord
motor neuron - conveys messages from CNS to muscles, causing contraction or to glands, triggering secretion
parts of the brain?
frontal lobe = voluntary muscle actions, muscles of speech, personality, judgment, memory and other cognitive function
temporal lobe = senses like hearing, taste, smell and ability to understand spoken language
parietal lobe = interpret meaning of incoming sensory signals from opposite side of bdy
occipital = interpreting visual input
thalamus = relays sensory information to correct areas of cerebral cortex
hypothalamus = controls vital body functions like temp, bp, breathing, appetite and sleep/wake cycle (produces some hormones, controls part of pituary gland, serves intermediary btwn nervous and andocrine)
cerebellum = below occipital lobe, controls smooth voluntary movements by coordinating sensory input with muscle actions (equilibrium and muscle tone)
medulla = bridges brain with spinal cord, regulates heart and respiratory rate, controls smooth muscle and bv
What is the spinal cord?
carries nerve impulses btwn brain and body (continuous with medulla oblongata through foramen magnum to first or second lumbar vertebra)
vertebrae, meninges, cerebrospinal fluid protect spinal cord
31 pairs of spinal nerves originate in spinal cord carrying bundles of sensory and motor neurons throughout the body
also directs some muscular reflexes in response to sensory input
divisions of peripheral nervous system?
somatic - controls voluntary muscle actions, receives input from sensory receptors and sensory organs (12 pairs of cranial nerves and 12 pairs o spinal nerves)
Autonomic - controls glands and involuntary muscles (cardiac muscle, smooth muscle in walls of bv, brochi, intestines and other and organs), 3 subdivisions
sympathetic - nerves arising from thoracic and lumbar areas of spinal cord (prepares organs and glands for “fight or flight” triggering causing bronchial dilation and increased heart rate and blood pressure)
parasympathetic - nerves arising from cranial and sacral regions, regulate resting functions of boy
enteric - nerves in and controlling GI organs
parts of neuron
extenstions called dendrites to carry info to cell body
axon to carrier info away from cell body
axons may have lipprotein covering called myelin sheath insulating and protecting neuron
deteriorating of myelin sheath decreases impulse velocity and impairs neuron function
What are the diagnostic tests and procedures of nervous system?
x-ray, CT, ultrasound, MRI, EEG, lumbar puncture (study CSF), myleography (radiopaque dye is injected into subarachnoid space to visualize the spinal cord sutrcture), angiography (visualization of cerebral circulation)
What is a traumatic brain injury?
damage to brain resulting from external physical forces
falls r leading cause, then motor vehicle accidents than sports and physical violence
abt 1.7 M ppl experience a TBI yrly in US
risk for TBI from fall is greatest for ppl over 65 and under 5
btwn 20 and 24 motor vehicle accidents = highest risk for TBI
s/s of mild TBI?
concussion is common type of mild brain injury (results from blow to head, sudden shaking or movement and may occur in contact sports, falls and automobile accidents)
- short-term loss of consciousness
- amnesia
- shallow respiration
- pulse rate drops
- muscle tone is flaccid
- headache
- NV
- sensitivity to light
- dizziness
- confusion
- inability to concentrate
- memory problems
- changes in mood, sadness, irritability, fatigue and sleep disturbance
2 forms of severe brain injury:
closed injury = result from sudden movement of brain in skill such as falls, automobile crashes and blows to head
open injury = result from penetrating wounds caused by firearms and sharp objects
s/s of Severe TBI?
serious short- and long-term impairments of brain function
- loss of consciousness
- amnesia
- muscle weakness and incoordination
- changes in emotion, personality and mood
1/2 of injury related deaths in US involve severe TBI
how to diagnose and treat TBI?
diagnose - assessment of brain function, info abt probable cause of injury, brain imaging, measure mental function, sensory responsiveness and motor ability with Glasgow Coma scale (Higher score = better function), and MRI and CT
treat - depends on severity, most resolve over time with rest (avoid physical and mentally strenuous activities until fully recovered
no specific treatment for severe brain injury, surgery to removed foreign objects or broken bone, drug to induce coma to reduce brain metabolism and inflammations
survives often need intensive physical, occupational, and seepch + language therapy)
how to prevent TBI?
reducing the risk for falls in the home, wearing seatbelts, and wearing helmets while playing contact sports, bicycling, and motorcycling.
What is spinal cord injury?
compression, bruising, fracture or swelling of spinal cord
causes include falls, automobile and motorcycle accidents, sports-related injuries, knife and firearm wounds and swimming in shallow water (also results from severe osteoarthritis, metastatic cancer or herniated discs)
SCI s/s
vary and depends on location of injury
motor, sensory, internal organ functions may be partly or completely lost
how to diagnose and treat SCI?
diagnose - history and assessment of motor and sensory functions, CT, x-ray and MRI determine spinal cord damage (after swelling subsides motor and sensory functions are tested again)
treat - aims to reduce risk of further injury and promote healing. immobilize neck and head, surgery to remove fluid or bone fragments or fuse broken discs (spinal ocrd damage is essentially irreversible)
s/s of cervical injury?
Inability to breathe, paralysis of the breathing muscles
Loss of bowel or bladder control
Numbness
Weakness, paralysis
Pain
Uncontrolled spastic muscle movements
s/s of thoarcic injury?
Loss of bowel or bladder control
Numbness
Changes in sensation
Pain
Weakness and paralysis
Symptoms affect the legs
s/s of lumbar and sacral injury?
Loss of bowel or bladder control
Numbness
Changes in sensation
Pain
Weakness and paralysis
What is epilepsy?
CNS disorder characterized by abn electrical activity in brain
may cause seizures, including loss of consciousness, loss of motor control, and sensory disturbance
cause is related t abnormal brain electrical activity
what are risk factors of epilepsy?
family history of epilepsy, stroke, brain injury and infections like meningitis, age (early childhood and after age 60)
s/s of epilepsiy?
vary widely, epilepsy has been classificed by location and characteristics of seizure (if focal than affecting 1 part of brain, if general then abn electrical activity on both sides and in many areas)
seizure characteristics wary from staring spells to complete loss of motor function and unconsciousness
may entail ivoluntary contraction of muscles w/ disturbances in consciousness and sensory phenomena
how to diagnose and treat epilepsy?
diagnose - EEG, MRI and CT, cerebral angiography may identify vascular changes, skull radiography for fractur, blood serum
treatment - anticonvulsant meds (no cure tho) (in rare cases, surgical intervention to excise identified lesion in brain, implanted vagus nerve stimulator (VNS) which sends impulses of elecetrical energy through vegus nerve to brain to prevent seizures)
What is a stroke>
aka cerebrovascular accident or brain attack
sudden interruption of blood flow to part of the brain caused by a blood clot or a burst blood vessel within the brain (Lack of oxygen causes brain cells to die within minutes
of a stroke’s onset)
each yr stroke affects 800,000 and kills 130,000 ppl in the US
vascular disease so stroke and heart disease have similar risk factors
more strkoes r caused by a blood clot, r classified as ischemic stroke
About 15% of strokes result from a
burst blood vessel and are described as hemorrhagic strokes. These may be caused by a brain
aneurysm
What are types of epilepsy?
Focal:
Simple focal - No loss of consciousness; minor sensory and motor disturbances; tingling and flashing lights, involuntary movements
Dyscognitive focal seizure - Loss of awareness or consciousness; staring and purposeless movements
Generalized seizures
Absence seizure - Petit mal seizure: staring into space or “daydreaming”
Tonic seizure - Stiffening of muscles
Clonic seizure - Repeated jerking movements of muscles on both sides of the body
Myoclonic seizure - Jerking or twitching the upper body, arms, or legs
Atonic seizure - Loss of normal muscle tone
Tonic-clonic seizure - Grand mal seizure: mixture of all symptoms
risk factors for stroke?
Controllable
- high bp
- atrial fibrillation
- high cholesterol
- diabetes
- atherosclerosis
- tobacco use and smoking
- alcohol use
- physical inactivity
- obesity
Uncontrollable risk factors
- age
- gender
- family history
- prior stroke or TIA
- patent foramen ovale
s/s of stroke?
- numbness
- loss of vision
- muscle weakness on one side of face or body
- confusion
- difficulty walking, speaking and understanding
- sudden severe headache
- sudden aphasia, dysphasia, difficulty understanding language
- diplopia
- sudden onset of dizziness, loss of balance, loss of coordination
how to diagnose and treat stroke?
diagnose - assessment of cognitive, motor and sensory function to determine the extent and location of stroke. CT, MRI and cerebral angiography, electroencephalography, to pinpoint location of strkoen and whether itś stroke is ischemic or hemorrhagic
treat - ischemic stroke (treated with clot-busting drugs injected IV or directly into brainś bv near the blood clots using a catheter)
hemorrhagic strokes (treated with medicine to reduce bp, control Intracranial pressure or counteract blood-thinning meds if pt was taking those) may need surgery to repair blood vessels in brain (intense rehabilitation may be needed for physical, speech, cognitive and emotional complications of a stroke)
What is a transient ischemic attack (TIA)?
mini-stroke a temproary interruption of blood flow to brain (cause is embolus formed by atheroscelrosis)
less severe s/s (sudden weakness, numbness down 1 side of body, dizziness, dysphagia, confusion, difficulty seeing w/ one eye, loss of balance, suddenonset headache, recurring) but may require immediate medical attention bc it may be a precursor to stroke
What do disorders of cranial neves?
may affect eyes, hearing, balanace and muscles of face or shoulder
inflammation to the cranial nerves is commonly associated with facial or ocular palsy as well as facial pain
etiology of cranial nerve inflammation is often idiopathic but may include viral or bacterial infections of stroke
most common known cranial nerve disorders r trigeminal neuralgia and Bellś Palsy
What is trigeminal Neuralgia?
severe chronic pain resulting from dysfunction of the 5th cranial nerve, known trigeminal nerve which transmits sensory info from face and jaw (one side)
aka tic douloreux, rare, after 50 mostly
pain may be triggered by touching face, chewing, drinking, or talking
most painful medical condition
etiology is uncertain, thought to be compression of nerve root by trumor or vascular lesion, sequeala of multiple sclerosis or herpes zoster, demyelination of trigeminal neurons
diagnose and treat trigeminal neuralgia
diagnose - physical exam and history (protect face and avoid temp extremes)
treat - antiseizure med, antidepressants, muscle relaxants, and analgesics
What is Bell´s Palsy?
paralysis of facial muscles caused by inflammation of the facial nerve.
r
isk factors include recent respiratory infections
and pregnancy.
A viral infection or immune disorder probably triggers the nerve inflammation (compression of the nerve in the bony canal) that causes Bell’s palsy.
s/s of bell´s palsy?
inability to salivate, form tears, blink and move facial muscles which results in a drooping eyelid, lips and expressionless face
diagnose and treat bell´s palsy?
diagnose - physical exam of the face and a history to rule out stroke, Lyme disease, and tumors, CT or MRI to confirm and to view possible structural causes of inflammation
treat - anti-inflammatory medication and antiviral meds if paralysis is related to a viral infection (most ppl recover within a few weeks) (warm moist heat, gentle massaage, facial exercise, analgesics, artifical tears and eye patch, electrotherapy)
What is meningitis?
acute inflammation of the first two meninges that cover the brain and spinal cord: the pia mater and the arachnoid mater
most common r acute bacterial meningitis and viral meningitis
in recent yrs bacterial meningitis has caused more than 4,000 causes and abt 500 deaths annually in US
rare auses of meningitis include fungi and cancer
What is bacterial meningitis?
severe infectionthat requires immediate medical attention ot prevent serious complication or death
What bacterias cause bacterial meningitis?
The most common bacterial cause is Streptococcus pneumoniae (the pneumococcus).
Other bacterial causes include Group B streptococci, Neisseria meningitides (the meningococcus), Listeria monocytogenes, and Haemophilus influenzae type b (Hib).
spread in respiratory droplets and secretion (usually during close contact as when kissing)
(listeria monocytogenes is acquired through contaiminated food)
s/s of bacterial meningitis?
- positive Kernig sign (resistance to leg extension after flexing thighs on the body)
- Brudzinski sign (neck flexion causing flexion of hips from supin poistion)
- severe headache
- stiff neck (nuchal rigidity)
- high fever
- chills
- vomiting
- confusion
- sensitivity to light
- increased DTR
- irritability
- hypersensitivity of skin
In infants: - bulging fontanel
- irritablity
- poor reflexes
Meningingococcal meningitis also causes a skin rash
how to diagnose and treat bacterial meningitis?
diagnose - physical exam, history and analysis of cerebrospinal fluid obtained by lumbar puncture (splinal tap) for bacteria. in bacterial meningitis CSF has low glucose and elevated leukocytes and proteins + CT
treat - IV antibiotics, anticonvulsive, glucocorticoids, aspirin or acetaminophen, corticosteriods to control swelling, immediate treatment is needed (even with treatment complicatations like hearing loss, cranial nerve damage, mental disabilites or paralysis can occur)
What is viral meningitis?
more common rhan bacterial meningitis
enteroviruses r most cases of viral meningitis
other causes r herpes simplex virus, HIV, West Nile virus, and mumps
no specific treatment, s/s r treated with rest, analgesics and antiinflammatories
What is encephalitis + cause?
inflammation of brain, most often caused by viral infection
rare in US, most cases r mild, if severe than v. dnagerous and brings serious compplications
viral causes include arboviruses (transmitted by mosquitoes, enterovriuses, and viruses that cause herpes simplex, chickenpox and shignel)
West Nile virus causes a type of encephaliytis
only way to prevent is avoid mosquitoes
s/s of encephalitis?
- headache
- stiffness of neck and back
- visual disturbances
- lethargy
- fever
- muscle and joint aches
- weakness
Rarely, severe cases occur and include symptoms: - severe headache
- confusion
- perceptual changes
- weakness
- seizures
Diagnosis and treatment encephalitis?
diagnose - lumbar puncture for analysis of CSF, blood may be drawn for analysis, CT or MRI for brain swelling, EEG
treatment - no specific, s/s r treated with rest, analgesics and anti-inflammatories, antipyretic, anticonvulsants, antibiotics, antiviral for HSV encephalitis,
What is poliomyelitis?
aka polio, crippling, potentially fatal viral infection of anteroir horm cells of gray matter of spinal cord, causing selective destruction of the motor neurons
last case of polio in US occurred in 1979
risk factors for polio include lack of vaccination and travel to areas with endemic polio
transmitted orally and infects motor neurons = muscles weaken, atrophy and may become paralyzed (Death floows respiratory and cardiac failure)
s/s of poli?
- fever
- sore throat
- malaise
- flaccid paralysis
- headahce
- weakness
- vomiting
- stiff neck
- back ache
What is rabies?
viral infectio nof brain in wild mammals (mainly bats, raccoons, coyotes, foxes and skunks) can also unvaccinated domestic dogs and cats
can be transmitted to humans through bite, scratch, saliva or urine of an infected animal
affects abt 1 person a yr in US
risk is highest for people who work with animals, such as veterinarians, animal control officers, and wildlife biologists
following entry into human tissue, typically through bite or scratch the virus moves to spinal cord and brain (incubation is 1 motnh to yr based on location)
s/s of rabies?
occur late in course of disease (days before death0
- fever
- headache
- agitiation
- confusion
- hallucination
- difficulty swallowing
- excess salivation
- fear of water (hydrophobia)
- insomnia
- partial paralysis
how to treat rabies?
begin as soon as exposure is suspected
- immunoglobulin injectoins near wound (neutralize virus before it can move into nervous system)
- series of five vaccination are given in arm to stimulate the body’s immune system to fight the virus
- prevented by vaccinating domestic dogs and cats
What is shingles?
aka herpes zoster
acute painful dermatomal inflammation of sensory neurons caused by reactivation of latent chickenpox virus (varicella zoster virus)
affects nearly 1 M ppl
mainly in ppl over 50 and those who are immunocompromised (risk is associated with prior chickenpox infection and with age)
incubation is 7 to 21 days, onset to recovery is 10 days to 5 weeks, if all vesicles appear within 24 hours total duration is usally shorter, mostly skin overlyign thoracic dermatomes, can occur on face, neck and salp
s/s of shingles?
painful, red, watery blisters around trunk, often on one side along the course of the peripheral nerves or dermatmes that r affected
these may occur on face around eyes or other areas
burning or tingling 2-3 days before appearance of lesions and sometinmes accompanied by fever
in some cases pain continues after rash clears, a condition called postherpetic neuralgia
diagnosis and treatment for shingles?
diagnose - characteristic pattern and painful viesicles, clutre of virus, blood sample for VZV antibodies
treatment - no specific treatment, antiviral agents, ice, lotions and anti-inflammatories, analgesics, mild tranquilizers or sedatives, antipruritic steroids, drying agents
prevented with chickenpox vaccine in children or shingles vaccine in adults
What is tetanus?
aka lockjaw
acute muscle rigidity and paralysis caused by bacterial nerve toxin
rare, affects 30 ppl yrly (1 M throughout world, mainly in underdeveloped nations w/o vaccination)
caused by tetanus toxin, a nerve toxin produced by bacterium Clostridium tetani (binds with motor neurons, stimulates them and causes muscles to be continually stimulated to contract)
35% mortality rate
s/s of tetanus?
characteristic muscle rigidity
painful muscle spasms
difficulty swallowing (oisthotonos)
respiratory failure
rigid, flexed jaw called trismus
extremely febrile (temp > 101F)
irrritable
sweats profusely
face spans
what is the tetanus bacteria (where is it found, etc.)
bacteria live in animal and human intestines
bc retanus bacteria r excreted in animal feces and can persist in soil bacterial is often found in manure or in soils fertilized with manure
deep, penetrating wound containing contaminated soil can introduce bacteria into tissue
bc tetanus bacteria is anaerobic (not required o2) they thrive in deep wounds that lack oxygen
how to diagnose and treat tetanus?
diagnose - usin pt history (inadequate immunization, acutely ill)
tetnus - can be cured, need to clean and disinfect wound, if person is unimmunized than immunoglobulin injections to neutralize toxins, if person last tetanus vaccination was 10+ yrs ago than immunization with inactive toxin is needed, sedatives, muscle relaxants for spasms and seizures, quire, dark environment for rest
What is botulism?
condition of muscle weakness and paralysis caused by bacterial nerve toxin (rare in US, affects abt 145 ppl annually)
occurs in 3 forms: Infant botulism (most common), foodborne and wound
muscles become weak and paralyzed and r unable to contract (condition called flaccid paralysis)
risk factor for botulism?
for infants: eating honey
- consuming home-canned foods
- injection drug use (esp heroin)
s/s of botulism
infants:
- constipation
- floppy babies (unable to hold up head and move muscles)
- difficulty crying and swallowing
- may drool and having difficulty sucking and feeding
Food born botulism (Wound botulism resembles it) :
- droppy facial and eye muscles
- difficulty swallowing or speaking
- nausea
- double vision
- vomiting and cramps
- difficulty breathing
botulism bacteria (what is it, where is it)
nerve toxin produced by the bacterium Clostridium botulinum that binds motor neurons and
prevents them from sending signals to muscles
for contraction
thrive in anaerobic conditions, found in soil and can contaminate food and wounds
infants may digest bacteria or their spores in soil to honey
foodborne botulism is usually transmitted by eating improperly canned low-acid foods like green beans, beets, corn
garlic-infused oil has been linked to botulism
wound botulism follows a deep, contaminated wound that permits bacteria to grow in anaerobic conditions (mostly in heroin users)
how to diagnose and treat botulism?
diagnose - physical exam and pt history
treat - infants can be treated with botulism immunoglobulin, foodborne botulism can be treated with meds to promote vomiting and bowel movement, botulism can also be treated with injected antitowxin, respiratory assitane ma be needed , restoration of nerve and muscle function may be slow and require phscial therapy
What is Reye syndrome?
UNCOMMON BUT POTENTIALLY DISTABLING OR FATAL NEUROLOGICAL ILLNESS THAT OCCURS IN CHILDREN AFTER A VIRAL INFECTION
infants who use aspirin during flu and chickepox infection r at risk for RS
liver and brain inflimmation (persistant vomiting, rash, lethargy abt 1 wk after viral infection, serious cases = seizure)
How to diagnose and treat Reye Syndrome?
diagnose - pt history, liver biopsy for defintive diagnosis (shows fatty changes in the microvasculature in liver tissue), blood tests may reveal elevated fatty acid
treat - nonspecific, aims to lower intracranial pressire, many children recover but w/ intellectuall disability, seizure diorder, cranial nerve damage and motor nerve damage
What is Alzheimer’s disease (AD)?
most common form of dementia, result of progressive destruction of memory and nearly all other important brain function
risk is linked with age (abt 1/2 of ppl over 85 have AD)
causes r unknown: only 5% of cases r linked to known genes and considered heredity (bnormality found on chroosome 21)
in AD connections btwn neurons die as do neurons themselves + tangles of protein called neuro-fibrillary tangles
Death results from pneumonia, other infections, or injuries from falls and accidents.
s/s of AD?
often begin with memory loss and confusion
loss of short-term memory, inabiltiy to concentrate, incapabicty to learn new info, impairement of reasoning, subtle changes in personality
inherited forms may have an early onset (in the 40s or 50s)
over time ppl lose memory, spatial and temporal orientation, become more confused and exhibit swings in emotion and personality changes
how to diagnose AD?
exam and history, neurological exam for sesory and motor deficiets, blood tests, CT and MRI, brain scans which reveal brain atrophy, widened sulci, enlarged cerebral ventricles (in later stages)
What is multiple sclerosis?
chronic, progressive, degenerative, autoimmune disorder of the CNS in which muelin sheath is attaacked = sclerosis that debilitates nerves
affects 400,000 ppl in US with estimated 10,00 new cases annually
risk is associated with age, mostly btwn 15 and 50, particularly 20-40
women r at greater risk
several types, most forms have periods of remission and exacerabtion
s/s of MS?
numbness or weakness in 1 or more limbs
optic neuritis
fatigue
double vision (diplopia)
unsteady gait
vertigo
difficulty with urination = UTI
facial numbness or pain
speech problems
dysphagia
hearing loss
impotence in men
fatigue
emotional disturbances
depression
irrritabilty
short-tempered
vision loss in 1 eye
As disease progresses:
= Loss of motor function, bladder and bowel control and cognitive decline
how to diagnose and treat MS?
diagnose - history, neurological exam, MRI to visualize nerve tissue, characteristic cerebral or spinal plaque, CSF may show elevated Ig levels and oligoclonal bands on an MS panel
treat - physical therapy, occupational therapy, antispasmodic to control muscle spasm, corticosteroids to control inflammation, antiseizure meds to suppress tingling and numbness and immune system modulators to suppress immune-mediated exacerabtions
What is Amyotrophic lateral sclerosis (ALS)/
aka Lou Gehrig’s disease, progressive loss of motor functions
affects abt 30,000 ppl in US
risk is associated witha age (30+) and more in men a(could be genetic - autosomal inherite traits)
s/s of ALS?
- fasciculations (small local involuntary muscular contraction)
- atrophy
- twitching
- weakness in limbs
- slurred speech
with progression comes: - paralysis - inability to chew, swallow, speak and breath
how to diagnose and treat ALS?
diagnose - history of s/s, electromyogram to study muscle activity, muscle biopsy, nerve conduction study to meausre motor nerve function, MRI to visualize nervous system changes and damages
no treatment, 1 med to slow progression of ALS by lowering level fo neurotransmitter glutamate, Riluzokle shows promise in slowig progression, tizanidne and baclofen r muscle relaxants other meds treat various symptoms
What is parkinson’s disease (PD)?
a degenerative disease characterized by progressive loss of control over muscle coordination and movement.
affects about half a million people in the United
States, but experts feel PD may be more prevalent because many cases remain undiagnosed.
Early-onset PD, occurring before age 50, accounts for about 5% of PD cases.
cause is related to reduced levels of neurotransmitters dopamine and nirepinephrine (caused by death of dopamine-producing neurons in substantia nigra)
risk factors for PD?
Risk factors for PD include age and sex. The average age of onset is 60 and the risk increases with age.
Men are at higher risk than women
What happens in brain without dopamine and norepinephrine?
dopamine - substantia nigra can’t communicate with motor regions that produce smooth, coordingated muscle movement
norepinephrine - loss is due to death of neuron endings responsible for its productions, affects heart rate, bp
s/s PD
fatigue;
irregular heartbeat;
low blood pressure;
associated dizziness, especially upon standing
- noticeable shaking in hand
- rigid, masklike facial muscles
progresses into:
- tremors
- stiffness
- inabilty to initiate movement
- uncoordinated, shiffling gait
- loss of reflexes
- problems swallowing and chewing
- difficulty speaking, hunched posture
- cognitive impairements
- sexual dysfunction
- depression
possible effects of parkinson’s disease?:
Difficulty in swallowing
headache
visual degeneration
masklike expression
pill-rolling tremor
joint rigidity
loss of appetite
leg cramps
muscle weakness
constipatio
involuntarily hurried gate
loss of libido, impoten ce
aching back
monotone speech
How to diagnose and treat PD?
diagnose - physical exam, neurologic exam, and history. No blood tests can detect PD but urine can show decreased dopamine. Imaging tests do not usually help diagnosis because MRI or CT appear normal in PD.
treat - main medical treatment for PD is levodopa
(L-dopa (L-dopa can cross blood-brain barrier which dopamine can’t cross and is converted into dopamine in brain), L-dopa levels can be prolonged by carbidopa, deep brain stimulation (DBS), counseling and meds
what is essential tremor?
disorder characterized by shaking of hands and head, esp during voluntary movement
5+ million peopel have essential tremor
risk facotr is relatied to age and genetics (over 40)
s/s of essential tremor?
shaking hads and head in a yes, no pattern
makes it hard to eat, drink, write and grasp
how to diagnose and treat essential tremor?
diagnose - history and physical
exam. The ability to perform simple movements
and draw are used to diagnose essential tremor.
Blood tests and imaging tests may be used to
rule out other diseases.
treat - beta blockers, antiseizure meds, tranquizliers, botox to improve head and voice tremors, physical and occupational therapy, deep brain stimulation
What is Huntington’s disease?
aka huntington’s chorea
progressive degenerative disease of brain that affects motor and cognitive function
chorea = involuntary, ceaselless, rapid and jerky movements
affects abt 30,000 ppl in US
chief risk factor is having parent with HD is caused by a defective gene on chromosome 4 resulting in death of specific neurons in brain
s/s HD?
begin in 40s
- motor functions degenerate
- jerking, writhing movements
- involuntary sustained muscle contractions
- difficulty walking, speaking, swallowing and moving eyes
- cognitive and mental degeneration
- difficulty planning
- loss of visual perception
- inflexible thinking
- impaired mumeory
- loss of judgment
- impulse control
- angry outburst
- personality changes
high risk for depression and sucide, death 10-30 urs after onset
diagnose and treat HD?
diagnose - history, pt intervuew, neurological exam, psychiatric exam (MRI normal early) (EEG can revela changes, genetic test can confirms presence of defective gene)
treat - aimed at restoring muscle flexibility and movement and treating depression and related psychiatric and psychological conditions (drug therapy is SSRI antidepressants, antipsychotic), physical therapy, occupational therapy, speech therapy, psychoscoial support.
There is no cure for Huntington’s chorea
What is spina bifida
- group of malformations of spine in which posteroir prtion of bony canal contaiing spinal cord (usually in lumbar region) is completely or partially absent
- type of neural tube defect, a developmental structural abnormality in the formation of the vertebrae and spinal cord.
- occurs during early weeks of gestation as spinal cord and bony canal develop (vertebrae fail to fuse correctly, producing a weak spot over the spinal cord or an opening that exposes the spinal cord, allwoing meninges and spinal cord to hernaite)
- most common neural tube defect in the United States (occurs in about 1,500 of the 4 million babies born each year in the US)
risk factors spina bifida>
- having previous child with spina bifida
- folate deficienct (vitamin B9)
- maternal obesity
- diabetes
- cause is unknown
s/s of spina bifida?
motor weakness,
paralysis, and loss of bowel and bladder control.
how to diagnose and treat spina bifida?
diagnose - exam, measuring maternal levels of apha-feto protei (presence of spina bifida), iltrasound, amniocentesis to visualize defect in fetus
treatment - surgery for meningocele, meningomyelocele, myelcole, prenatal surgery,physical therapy, occupational therapy, counseling help children adapt and develop classroom, mobility and bathroom skills, folic acid supplementation before and during pregnanct
What is hydrocephalus?
condition of the buildup of CSF around the brain = abn enlargement of head and pressure changes in brain (pediatric and adults)
Hydrocephalus is among the most common birth defects, affecting about
1 in 500 births in the United States.
Around 70–90% of children with spina bifida also have hydrocephalus.
accumulation can be triggered by congenital defects in strucutre of brain’s ventricles and vessels, inflammation, infection or trauma
risk factors hydrocephalus?
having
spina bifida, brain trauma, and infections such
as meningitis, mumps, and rubella or syphilis during pregancy
s/s of hydrocephalus?
in infants:
- bulging fontanel
- sutures of skull separate
- scalp veins become distended
- head circumference increases at faster rate than normal
- high-pitched cry
- irritable
- large head
- downward-facing eyes
- projectile vomiting
- seizures
- abnormal muscle tone of legs
- poor feeding
- uncoordinated movements
(can lead to permanent motor and cognitive impairments)
how to diagnose and treat hydrocephalus?
diagnose - physical exam, clinical picture, radiographic skull studies and imaging with MRI or CT
treat - implanted shunt to help move and drain CSD into jugular vein or peritoneal cavity (shunt for life), some catheters empty into peritoneal cavity and others into right atrium of heart
What is cerebral palsy?
congenital disorder characterized by impaired muscle movement, tone,
and posture (involves cerebral nervous sustem function dealing w/ movement, learning, hearing, sight and thinking)
CP is almost always present at birth and affects about 1 in 300 children (most common crippling condition in children)
Cerebral palsy is usually apparent before 3 years of age.
(congential, acquire, bilateral or unilateral in form of nonprogressive paralysis)
more common in premature infants and in male babies
cause remains unknown. CP is probably triggered by low oxygen supply to the brain during fetal develoment, birth process or early childhood up until 9 y/o, interruption of blood circulation to brain during labor, infection, hed trauma inflammation
risk facotrs for cerebral palsy?
preterm birth
breech birth,
low birth weight.
Infant illnesses such as
meningitis, encephalitis, and jaundice raise the
risk for CP.
Other risk factors include maternal
infections such as rubella, chickenpox, cytomegalovirus, toxoplasmosis syphilis, and maternal
exposure to toxins such as methyl mercury.
s/s of CP
vary and depend on type and extent of damage (doesnt progress)
- muscle problems like abnormal rigidty
- floppiness of muscle
- Muscle movement is jerky, stiff, and writhing w/ reduced voluntary movement
- People with CP have trouble walking, grasping objects,
and producing smooth, fine movements
- Excessive drooling and difficulty swallowing, sucking and chewing occur
- Other problems include hearing and visual
- when infant is lifted from behind legs may be difficult to seperate and infant may cross their legs
how to diagnose and treat CP?
diagnose - physical and neurological exam, CT, MRI, brain ultraosund
treatment - depends on nautre and severity, anticonvulsant drugs to reduce seuzres, cast or braces to aid walking, muscle relaxants to relive spasms along with traction or surgery, physical therapy, occupational therapy, speech therapy
CP is uncurable
What is a brain tumor?
abnormal masses of tissue growing in the brain.
An estimated 23,000 new cases occur each year in the United States and about
14,000 people die from brain tumors annually
cause is genetic damage
risk factors for brain tumors?
increasing age, race (mostly in caucasians), expousre to chemicals and radiation, family history
s/s of brain tumor?
s vary and depend on the
area of the brain affected.
- More frequent and severe headaches
- vision loss and double vision,
- confusion
- dizziness
- unexplained vomiting
- loss of coordination
- Speech and hearing problems and personality changes can also occur.
- cerebral edema
- increased ICP
- herniation
- gocal or generalized seizures
diagnose and treat brain tumors?
diagnose - neurological exam, imaging via MRI and CT
treatment - chemo, immunotherapy, surgery, radiation, after treatment pt may need rehabilitation, physical therapy, occupational
therapy, and speech therapy
types of cerebral palsy>
- spastic CP - hyperactive reflexes or rapid contraction, older children hav scissor gait (walking on toes and crossing foot over other) (70% of pt w/ CP)
- Athetoid CP - involuntary muscle movement, esp during times of stress and reduced muscle tone, difficulty speaking (20%)
- Ataxic CP - lack of control over voluntary movements, poor balance and wide gait
what is spina bifida occulta
- psoterior arches of verebrae, commonly in lumbosacral area, fail to fuse but no herniation
- asymptomatic, only evidence is dimpling, tuft of hair or hemangioma
- etiology is associated w/ ionizing radiation, reduced levels of vitamin A and folic acid, metabolic imbalance
- maternal blood lvels of AFP may be measured to detect possible neral tube defects
- diagnos w/ prenatal ultrasonography or w/ ostnala physical exam, detection of neurologic symptoms, visual inspection of spin and spinal ultrasonography
- usually don’t need intervetion, only if neurologic problems
What is meningocele
- rare, protrusion of the meninges through a small opening in spinal column, thus forming a sac that becomes filled with cerebrospinal fluid (repaired surgically)
- no nerve involvement so no neurologica problems
- skin over area may be fragile so rupture of sac is potential problem
- cause could be metabolic abnormality w/ reduced levels of vitamin A and folic acid
- diganoed with visual exam of spinal area and verification of presence of sac + radiographic studies if spin
- treat w/ surgical intervention in first 24 to 48 hours
- paralysis usually doesn’t occur
What is myelomeningocele?
- aka spina bifida cystica
- most common and srs defect in which opening exposes spinal cord
- usually in lumbar region
- maybe neurologic symptoms
- musculoskeletal malformation, immobile joints, paralysis of lower extremities, bowel or bladder control may be affected
- etiology is nerual tube fails to close during fetal development, allowing meninges, spinal nerves and spinal cord to herniate, may be genetic or related to excposure to agent orange
- diagnose w/ physical exam and iamging findings, surgical exploration for severity
- treat w/ suurgical interveiton in first 24 hrs of life
- may need phyiscal therapy, leg braces, cruttches, ambulaton training, helps increase child’s mobility, bladder and bowel
etiology of hydrocephalus?
- large amt of CSF in brain’s ventricles due to an imbalaance btwn CSF production and drainage
- impairment of circulation of CSF in ventricular circulation may be caused by lesion, congenital strucutre defect, imapirement of flow of CSD in subarchnoid space prevents CSD from reaching areas where it normally would be reabsorbed by arachnoid villi = intracranial hemorrhage resulitng from ehad trauma, blood clot, prematurity or infeciton (meningitis)
etiology of hydrocephalus?
- large amt of CSF in brain’s ventricles due to an imbalaance btwn CSF production and drainage
- impairment of circulation of CSF in ventricular circulation may be caused by lesion, congenital strucutre defect, imapirement of flow of CSD in subarchnoid space prevents CSD from reaching areas where it normally would be reabsorbed by arachnoid villi = intracranial hemorrhage resulitng from ehad trauma, blood clot, prematurity or infeciton (meningitis)
etiology of MS?
- common theory hold that unknown virus triggers immune system to turn against body and attack myelin (no virus have been conclusively implicated)
- risk increases as one moves from S to N
- greater risk in yt populaton
- 2/3 of cases develop in ppl btwn 20 and 40 and rarely in ppl over 60
types of MS?
relapsing-remitting: relapses followed by recovery w/ no prgression of neurologic dysfunction btwn relapses
primary-progressive: disease progression w/ no remissions
secondary-progressiveL disease begisn as relapsing-remitting but later becomes progressive w/ few remissions
progressive-relapsingL progressive disease from onset w/ relapses and siease progression during period btwn relapses
meds to treat MS?
- interferon beta-1a (Avonex, Rebif), interferon beta-1b (betaseron), glatiramer (Copaxone) and mitoxantrone (Novantrone)
- immunosuppresive tehrapies (radiation, steroids, immune globulin, cytotoxic drugs)
- nuewer treatments r biolgoci meds such as natalizumab (Tysabri)
- siponimod and cladribine for both secondary-progressive MS and relapsing-remitting MS (orally administratied)
etiology of stroke?
1) occlusion of an artery caused by atheroma
2) sudden obstruction by an embolus, including cerebral thrombosis (clot), embolism (moving clot), other moving emobli
3) cerebral bleeding
most often caused by atherosclerosis and hypertension as well as blood disorders, arrhythmias, systemic disease, hyperlipidemia, rheumatic heart disease, head trauma, high-fat diet, lack of exercise, cig smoking, obesity, fmily histroy of atherosclerotic disease
CVA caused by embolus or hemorrhage often have sudden onset wherease strokes caused by thrombus may appear more gradually
cerebral thrombosis occurs if one of the cerebral arteries become narrowed bc of plaque buildup from atherosclerotic
thromus or clot can enlarge until it partially or completely blocks blood flow to artery
What is arteriovenous malformations
- congenital, abn structures of bv in which arterial blood moves directly into veins, giving bv appearance of tangled mass of arteries and veins = tendency to hemorrhage
- s/s r N&V, stiff neck, confusion, lethargy, generalzied weakness, visual problems, irritability, impaired pseech, muscle weakness, paralysis, ringing in ears, dizziness, syncope
diagnose and treat arteroiveous malformations
diagnose - clincial signs, CT, MR
treat - surigcal intervention, radiation therpay, emobolization of involved vessel
diagnose and treat TIA?
diagnose - phyiscla exam, history, cranial MRI, CT, carotid ultrasonography, EEG
treat - anticoagulants, pt chew aspirin tablet
What is epidural and subdural hematoma?
- collection or mass of blood that forms btwn skull and dura mater (outermost of the 3 meningeal layers covering brain)
- subdural hematoma r when blood collects or pools btwn dura mater an arachnoid membrane (second meniungeal membrane)
- head trauma is cause (blow to head = epidural or head striking immovable objects = subdural hematoma)
s/s of epidural hemoatoma?
- within few hours of head trauma
sudden headache
dilated pupils
n&v
increased drowsiness
hemiparesis
unconsciousness
coma
death
s/s of subdural hematomas?
- similar to epidural hematoma excpet onset is delayed bc of slower accumulatio nof blood (may mimic symtpoms of TIA, stroke, dementia), diplopia is common
diagnose and treat epidermal and subdermal hematomas?
diagnose - examination of pt, history of recent head trauma, cranial radiography, CT, cerebral arteriography,
treat - craniotomy (cranial trephination - burr hole in skull w/ drill to relieve pressure by draining off blood that accumulates), remove accumulated blood, cauterize bleeding vessels
What is cerebral contusion?
- more serious than concussion (involves brusing of tissue along or just beneath he surface of brain = may also be termed a contrecoup insult)
- s/s range from temportary loss of consciousness to coma, severe headache, hemiparesis, droswy, letargic or hostile and combative
- caused by blow to the head or by impact against a hard surface, as occurs in automobile accident (twisting or shearing force against the 2 hemisphere of brain that occurs when it collides w/ cranial bones)
diagnose and treat cerebral contusion?
diagnose - thorough neuroligc exam, CT, cranial radiography
treat - need to be hospitalized so that their vital signs can be monitored and rapid medical intervention can be provided
What is depressed skull fracture?
- occurs with a break or fracture in one of the bones of the cranium
- when the skull bones r depressed or torn loose they r pushed below the normal surface of the skull
s/s orf depressed skull fracture?
bruising behind ears (Battle sign)
raccoon eyes
hemiplegia
seizures
bleeding from wound, ears, nose, around eyes
changes in pupil
clear or bloody drainage from the ear or the nose
headache
stiff neck
nuchal rigidity
N&V
visual disturbances
slurred speech
confusion
restlessness
irritability
difficulrty balancing
drowsiness
seizures
loss of consciousness
diagnoser and treat depressed fractures?
diagnose -physcal exam, cranial radiography, CT
treat - relieving intracranial pressure, craniotomy, elevate depressed bone, head protection
What is parapeglia and quadriplegia
- injuries to spinal cord = effect on innervation of any spinal nerve distal to point of insult
- extent of injury and consequential edema often results in faiulure of sponal nerve functioning w/ resulting loss of motor and senosry function
- paraplegia = loss of nerve function in areas gleow waist and paralysis of lower trunk and legs
- quadriplegia/tetraplegia is loss of nerve functions at cervical region resultign in paralysis of arms, hands, trunk, legs
- caused by veretebral fractures or vertebral dislocation
s/s of paraplegia and quadriplegia/
paraplegia: loss of motor and sensory control of the trunk of the body and lwoer extremities, loss of bowel, bladder, sexual function
quadriplegia: paralysis of lower extremities and usually trunk w/ either partial or total paralysis of upper limbs
hypotension, hypothermia, bradycardia and respiratroy problems als o may be present
truam to what areas = what kind of paralysis?
trauma to thoracic and lumbar regiosn of spina (T1 and below) = paraplegia Z(vertical compression and hyperflexcion of spin usually produces this injury)
trauma to cerbical vertevra e (C5 or above) = quadriplegia
injuries btwn C5 and C7 = paresis to shouler and arms
damage above C3 is usually fatal (usual cause is hyperextension or flexion of tha portion of the spine)
diagnose and treat paraplegia and quadripelgia/
diagnse - neurologic funciton, spinal radiography, MRI, CT
treat - restoration of normal alignemnt, stabiltiy of spine, decompression of spinal cord, nerves, verebrae, surgery or using specialized meds and procedures, imediate spinal cord truama itnervention includes stabilization of neeck and spine, corticosteroids, hypothermic state to injured area
degenerative disk disease?
- DEGENERATION OR DETERIORATON OF AN INTERVETRTEBRAL disk may result in pain in the areas served by the sinal nerves exiting at or below that disk space
s/s of degenerative disk diseasease
- when pain occurs it radiates down the nerve path (dermatome)
- pain may be describes as burning, can become intractable
==- constant back pain and severe pain that radiates down one or both legs may be accompanied by loss of some motor mfuncitons in legs - numbness
- tingling associated with weakenss
- bowel or bladder issues (incontinence or constipation)
etiology of degenerative disk disease
- natural part of aging (as person ages fluid in disk decreases, causing disease- could be mechanical and the result of ocnstant wearing on the disk, mislaignmnet of vertebrae causes continual rubbing on the disk involved, resulting n inflammation and gradual desrtuction of the disk - inflammation eventually involves the spinal nerve roos and may cause scarring, sequela is spinal stenosis, in which there is narrowing of the vertebral canal, nerve root canals (foramen), or intravertebra; fpra,oma. causing nerve root to become trapped in formane as they leave the spinal canal)
diagnose and treat degenerative disk disease?
diagnose - clinical findings, histroy of previosu back injury, MRI, myelography with contrast to show disk status, CT, electromyography, neurologic examination
treat - as active as possible, narctoci analgesics, NSAIDs, oral steroids, epidurals or selective nerve root blocks, physical therapy, Transcutaneous electrical nerve stimulation (TENS), bracing of spine, spinal fusion, freeing of the spinal nerve root, lidocain topical, ablation, pain pumps (last resort), implanation of a spinal cord stimulator (SCS), device that masks pain
What is herniated and bluging disk
aka ruptured or slipped disk
- rupture of nucleus pulposus through annular wall of the disk and into spinal canal
=- usually result from accumulated trauma (eg improper body mechanics when lifting) or sudden impact, poor posture and aging process
s/s of herniated and bulging disks
- intervertebral disk r soft pads of cartilage and gelatinous material located btwn each of the vertebrae that make up the spine (acts as shock absorber and gives back flexibilty for movement)
- each disk has gelatunous center called the nucleus pulosa which is surrounded with an annulus (circular wall-like)
- bulging is less severe (rupture can cause sevre back pain and even disabiltiy if it presses against or pinches the spinal nerves)
- sudden, sharp pain that worsens with movement or in certain positions may radiate from the back to the butt, thighs, legs foollowing the course of the impinged nerve, causing pain, paresthesia, muscle weakness in the leg in a dermatomal pattern
- when this pain results from pinching of nerve roots that form sciatic nerve, it is known as sciatica
- herniation of disk occurs in the lower back, btwn 4th and 5th lumbar vertebrae or btwn 5th lumar and first sacral, ruptured disk in the cerbical region = pain and weakness in the arms and neck
- pain is either unilater or bilateral
diagnose and treat bulging and herniated disk?
diagnose - thorough history of the back pain, physical exam of back, diagnosis of lumbar disk hernitiont can be consideered if the pt has sciatic pain when physicican peforms straight leg raise test, MRI, CT, myelography
treat - hot or cold packs, muscles relaxants, analgesics, epidural injections and physical therapy, surgical excision of herniated disk (percutaneous diskectomy - needle into intraverebral splaceand aspirate bulging prat, microdiskectomy - small surgical incision, allowing material t be aspiration, diskectomy - lasar ablation and evaporation of disk, removal of disk w/ laminectomy w/ fusion of vertebrae)
What is sciatic nerve injury-spinal stenosis
- sciatic nerve injury is pathologic condition caused by trauma, degeneration, rupture of nuclues pulposus within Intervertebral disk
- spinal stenosis, narrowing of spinal canal or nerve root foramen is often termed sciatica bc of the compression the spinal cord and spinal nerve roots
- trauma to sciatic nerve from fall, poor body mechanics, gunshot, stab wounds, aging process, inflammatory autoimmune response, osteophytes on forame, congenital
s/s of sicatic nerve injury?
- causes pressure directly on sicatic nerve or on other closely positioned spinal nerves, sending impulses down the nerves
- severe, sharp pain radiating from sciatic nerve down leg and foot (continous or intermittent)
- rupture of nucleus pulposus posteriorly toward nerual canal, pressure on nerve root causing sciatic symtpoms or affects sciatic nerve, causing low back pain and leg pain (anterior and later ruptures may or may not porduce symtopoms)
s/s of spinal stenosis?
- pain in the back
- radiating down the legs
- pain in the butt, thighs, calves
- pain increases with standing, walking or exercise
- numbness in areas that become worse when standing, wlaking or exercisitng
- weakness in legs
- relfex in lower extremities often r asymmetric
diagnose and treat sciatic nerve injury
diagnose - medical history, physical exam, spinal radiography (degenerative changes and narrowed spinal canal) , MRI, CT, myelography, blood serum, vascular integriy s assessed and insufficieny is ruled out, EMG (neurologicla changes)
treat - oral corticosteroids, physical therapy, ultrasound diathermy with massage or acupuncture, exercise to strenghten back and abd, analgesics, muscle relaxants, antiinflammaotry meds, heat and cold or gentle massage (myofascial release), corticosteroids epidural injections, leaning forward or sitting often helps relieve back pain, diskectomy or microdiskectomy, spinal fusion, chemical dissolving with an enzyme of the nucleus pulposus (chemonucleolysis), decompression of the spinal nerve f oramen q
What is headace
- cephaglia is pain in the head that is not confinedto nay one specific nerve distribution area
- cause is stress, too little or too mch sleep, overeating or overdrinking, stuffy or noisy environment, heavy physical labor, caffein withdrawal, sensitivty to scents, strain on facial, neck and scalp resulting from tension (tension ehadahche), edema within blood vessels of head (vascualr headache)
s/s of headache
- acute or chornic and located in the frontal, temportal and/ or occipital region
- may be confined to only one side of head or may be located above one or both eyes
- type of [ain may vary from dull and aching ot almost unbearable
- intense intermittent painm throbbing pain, pressure pain or penttrating pain
- sensitivity area exists in only meninges, skin, muscles covering skull, numerous nerves that travel from the brain to the head and face
- usually self-limiting and underlying symptoms
what headaches be a symtpom of ?
- sinus infection or congestion, temporomandibular joint syndrome, hypertension, stroke, brain tumor, encehalitis, mostly r symtpms of fatigue or tension
what are cluster ehadache?
- severe pain developing around or behind one eye, having abrupt onset and cessation
- affected eye may tear
- usually occur at night, continue occuring for several weeks or months and them disappear for some time, even years
- more common in men and r associated w/ nasal congestion and partial Horner syndrome
diagnose ad treat headache
diagnose - medical history, physical exam, neurologic testing, cranial and spinal radiography, EEG, cranial CT
treat - treat underlying cause, analgesics, muscle relaxants, minor tranquilizers, muscle massages, relaxation w/ warm bath
What is a migraine?
- periodic severe headaches that may be completely incapacittating and almost always r accompanied by other symptoms such as nausea and vomiting, sensitivity to light, anorexia, intense hemicranial or bilater throbbing pain, visual signs and symtoms
s/s of migraine?
- visual auras (flashing lights, zigzaggin lines, areas of total darkness)
- photophiba
- usually warming period during which the person feels abn fatigued and irritable
-occassional symtpoms r numbess or tingling in one arm or one side, dizziness, temporary mental confusion
etiology of migraines
- etiology s iodiopathic, certain factors: inherited or genetic aspect, certain foods
- biologic cause may be changes in cerebral blood flow, attributable to vasocontrisctionfollowed by vasodilation of the cerebral and cranial
diagnose and treat migraines?
idangose - recrring, severe headaches, preceed by any combination by s/s, EEG, CT, MRI to rule out other conditions
treat - bed rest in quiet, darkened room, analgesics, vasoconstrictors, antiemetics, biofeedback, calcitonin gene-related peptide (CGRP) inhibitors (CGRP causes nerve cells more sensitive to painful stimuli)
What is partial seizures?
- dont involve entire brain but arise from localized area in brain
- effects may involve hand or face w/ motor signs, such as a rhythmic twitching of a group of muscles or compulsive lip smacking or picking at clothing, behavioral, psychic and sensory manifestations (auras) can occur, amnesia
What is generalized seizures?
- diffuse electrical abnormality within the brain and include absnece (petit mal) and tonic-clonic (grand mal) attack
What are status epilepticus?
- one seizure follows another with no recovery of consciousness btwn attacks
- medical emergency hat requires immediate anticonvulsant therapy to prevent cerebral anoxia, hyperpyrexia, vascular collapse and even death
what can cause symptomatic epilepsy?
- pathologic conditions such as scar tissu on cerebral cortex frmo ifnection or trauma, cortical neoplasms, cerebral edema, TIAs, CVAs, birth trauma (cerebral palsy), drug toxicit, diabetes, hypoglycemia, other conditions that depreive brain of oxygen
What is restless legs syndrome?
- neurologic condition characterized by an overwheliming urge to move the legs (is to stop an uncomfortable or odd sensation)
- feelings r itching, burning, jittery, creepy-crawly, pulling, tugging and/or painful sensation (usually in leggs, ocassional in arms, hips or face), inabilty to sit for extended periods, walking or moving legs = relieve symptoms
- exact cause is unknown, increases after 40 or 50, maybe anemia
diagnose and treat restless legs syndrome?
diagnose - medical history, physical exam, mostly in evening or at night, moving legs = temp relief, daily diary of symtpoms, blood tests
treat - no cure, treat w/ underlying cause, levodoa, dopamine agonists, ropinirole, opiods, benzodiazepine, regular exercise, cold or hot application
ehat can blood tests show for restless legs syndrome?
(irone deficiency, varicose veins, folate, magnesium deficiencies, sleep apnea, uremia, diaetes, peripheral neuroathy, Parkinson disease, thyroid disease, certai autoimmune idsorders)
What is transient global amnesi?
- temproary amnesia abt entire moemory of current events for 1-6 (up to 12) hrs
- s/s r repetitive asking of questions, memory loss for preceding 3 t 5 yr and sepcific events, normal neurologic signs, PERLA, no recall of period of amnesic experience after memory is recovered
- caused by stress or emotional events, migraine headaches
diagnose and treat transient global amnesia?
diagnose - observing s/s on neurologic exam, TIA, CVA, seizure activity
treat - supportive
What is peripheral neuritis/ neuropathy?
- degeneration of the peripheral nerves
- causes r chronic alcohol intoxication, toxicit yfrom arsenic, lead, carbon disulfide, benzene, phosphours, infectious disease includign mumps, pneumonia, diphtheria, metabolic or inflammatory disorders, diabetes, RA, gout, SLE, certain nutritional deficicency diseases
s/s of neuropathy
- s/s r clumsiness and loss of sensation in hands and feet followed by flaccid paralysis and wasting of muscles in those areas, DTR is diminished, tenderness in atrophied muscles, skin may take glossy, red appearance, sweat is decreased, foot drop, pain
diagnose and treat neuroapthy
diagnsoe -history, clinical findings characteristic of motor and sensory involvement, motor and sensory nerve impairment usually detected by EMG, nerve conduction study (NCS)
treat - remove toxic substances, correct vitamin and nutritional deficits, treat underlying disease processes, avoid alc, anticonvulsants, tricyclic antidepressants and getting rest and physical therapy
etiology of encephalitits?
- caused by viruses or the toxins from chickenpox, measles, mumps, result f a bite from an infected mosquito (Eastern equine, Western equine, Venezuelan equine encephalomyelitis, St. Louis encephalitis)
What is gullain-barre syndrome?
- acute, rapidly progressive disease of PNS
- numbness and tingling of feet and hands, increasing muscle pain and tenderness, usually starts in lower extremities, move up body in 24 to 72 hours, respiratory insufficency, difficulty swallowing
- though to be autoimmune, known to follow respiraotry infection or gastroenteritis, demyelination of nerves occurs
diagnose and treat gullain-barre syndrome?
diagnsoe - elevated protein level in CSF, normal leukocytes as is CSF pressure
treat - hospitalization, supportive treatmetn, plasmapheresis washes plasma to remove antibodies, IVIG
What is brain abscess?
- collection of pus, can occur anywhere in brain tissue
- main symtpoms is headache, increased ICP, N&V, visual disturbances, unequal pupil size, seizures, eye look to area of insult, nuchal rigidity
- caused by local infection, secondary to infections elsewhere in body (staphylococci, streptococci, pneumococci, head trauma, craniotomy)
diagnose and treat brain abscess?
diagnose - history of infeciton or isult to CNS, charqcteristic clincal features, increased ICP, EEG, CT (no lumbar puncture), blood cultures
treat - IV antibiotics, mannitol or steroids, surgical drainage
diagnose and treat poliomyeltis?
diagnose - clincal symtpoms, history of possible exposure, isolate poliovrisu from throat washing or feces, positive CSF cultrues
treat - supportive, analgesics, moist heat applications, bed rest, physical therapy, respiratory support w/ mechanical ventilation,
What is post-polio syndrome?
- occur later in life in person who ahve previosly experienced the disease
- functional deterioration of muscles is accompanied by loss of strength
- progressive weakness begins 30 yrs or more after initial attack and involves already affected muscles
- fasciculations and muscular atrphy
types of brain tumors
- gliomas (tumors derived from glial cells)
- meningiomas (tumors arising from the arachnoid membrane)
- embryonal tumors (neoplasms that arise in children)
- all 3 = 75% of all cancerous primary brain tumrsors
- gliomas and mengingiomas increase after 45
- among children udner age 15 brain tumors r most common slid malignancy
how to treat AD?
- no cure
- drug therap to allievate cognitive symtpoms: cholinesterase inhibitors, rivastigmine (thought to prevent breakdwon of acetylcholine), N-methyl-Dasoartate (NMDA) inhiitor, antipsychotic or neuroleptic agents, SSRI antidepressants, risperidone and olanzapine for those who start to have delusion symtpms, mood stabilizers, trazodone for undowning general management of fluuid intake, adequate nutrition, personal hygeine
