MT M 4.6 Nervous System conditions and procedures

Question 1

Disorders of the nervous system

Answer 1

Disorders of the nervous system occur when there is damage to the brain, spinal cord, or nerves. Physical examination of a patient with a neurological complaint involves a detailed history of the complaint, assessment of the patient’s mental status and memory, cranial nerve testing, muscle tone and gait observation, reflexes, sensation, and coordination.

Question 2

Dementia

Answer 2

Dementia is a progressive deterioration of a patient’s cognitive abilities and memories that then impairs the performance of activities of daily living (ADLs), thinking, reasoning, and remembering.
These causes of dementia are not reversible, and there is no cure. The strongest risk factor for dementia is advancing age, and the frequency of dementia increases with each decade of life.
The progression of some dementias may be slowed with medications called cholinesterase inhibitors.

Question 3

Alzheimer’s dementia (AD)

Answer 3

One of the most common causes of dementia.

Four were identified.

Question 4

vascular dementia,

Answer 4

One of the most common causes of dementia.

Four were identified.

Question 5

frontotemporal dementia

Answer 5

One of the most common causes of dementia.

Four were identified.

Question 6

Parkinson’s disease

Answer 6

One of the most common causes of dementia.

Four were identified.

Question 7

mini-mental state examination

Answer 7

The mini-mental state examination (MMSE) is a screening tool used to help with the diagnosis of dementia, and it assesses the patient’s memory, orientation, language comprehension, naming, and copying.

Question 8

Brain Tumors

Answer 8

Tumors that develop in the brain either arise from the brain tissue itself or metastasize to the brain from other primary tumors. Primary brain tumors can either be benign or malignant. The symptoms of a brain tumor include progression of a neurological deficit, seizures, or nonspecific neurological symptoms such as headache dementia, personality change, or gait disorder. Figure 4.9A shows an illustration of a brain tumor, specifically a glioma, which is a tumor that is made of neurological tissue.

Question 9

positron emission tomography scan

Answer 9

a positron emission tomography scan (PET) showing a brain tumor in the frontal lobe.

Question 10

Brain tumor imaging

Answer 10

Brain tumors can be seen on images of the brain with a CT scan, PET scan, or MRI.

Question 11

neuroma

Brain tumors

Answer 11

A neuroma is a tumor of nerve cells and nerve fibers

Question 12

astrocytoma

Brain tumors

Answer 12

An astrocytoma is a tumor of the brain that is made up of astrocytes. Astrocytomas are the most common primary metastatic brain tumors, and they carry a poor prognosis, as they are difficult to surgically remove and respond poorly to radiation.

Question 13

oligodendroglioma

Brain tumors

Answer 13

Another malignant tumor of the nervous system is an oligodendroglioma, which is located in the central nervous system. However, these tumors are more easily removed via surgery and respond better to chemotherapy.

Question 14

Cerebrovascular accidents (CVA)

Answer 14

Cerebrovascular accidents (CVA) occur when blood flow to the brain is disrupted. The term CVA refers to conditions such as strokes or aneurysms.

Question 14

meningioma

Answer 14

A meningioma is a benign tumor of the meninges and can be cured by surgical removal.

Question 14

Strokes

Answer 14

Strokes can be hemorrhagic or ischemic.
Hemorrhagic strokes occur when a blood vessel in the brain ruptures,
Ischemic strokes occur when blood clots block the flow of blood to the brain, and these blood clots are either an embolism or a thrombosis.

Question 15

embolism

Answer 15

An embolism (Figure 4.10C) is a clot that travels to the brain from another area of the body

Question 16

thrombosis

Answer 16

a thrombosis (Figure 4.10B) is a clot that develops in the cerebral artery.

Question 17

aneurysm

Answer 17

An aneurysm is a weakness in the blood vessel wall that is at risk for hemorrhage.

Question 18

symptoms and damage to the brain depends upon where the injury is and the size of the hemorrhage or infarct

Answer 18

An infarct is an area of tissue damage or death due to a lack of blood supply. The saying “time is brain” is appropriate for these patients, as the longer the blood supply to the brain tissue is blocked, the more permanent the injury to the brain and the resulting symptoms. The goal for treatment is to reestablish blood flow to the brain as quickly as possible either by stopping the hemorrhage, removing the blood clot, or relieving the compression of the artery. CVAs are critical conditions requiring rapid medical support and intervention and can lead to permanent neurological damage or even death.

Question 19

seizure

Answer 19

A seizure is an episode where there is sudden, abnormal, and excessive activity of the central nervous system leading to changes in attention and/or behavior that the patient is unable to control.

Question 20

Epilepsy

Answer 20

Epilepsy is a chronic disorder of the brain where the patient experiences recurrent seizures

Question 21

Multiple sclerosis (MS)

Answer 21

Multiple sclerosis (MS) is a chronic disease of the central nervous system that is commonly caused by the immune system. It is characterized by inflammation, demyelination, and then scarring of the nerves. The damage to the myelin sheath is called a plaque, and these plaques develop in the neurons of the brain and spinal cord. This causes tremors and spasms, muscle weakness in the limbs, incoordination, paresthesia, and visual and speech disturbances. MS symptoms can range from mild to severely debilitating, and they can be progressive or relapsing and remitting. Figure 4.11 shows the extensive symptoms that may be experienced by a patient with multiple sclerosis.

Question 22

Treatments for MS

Answer 22

Treatments for MS include oral steroid medication for acute attacks or worsening symptoms. Disease-modifying agents that act on the immune system are used to prevent the progression of the disease.

Question 23

Parkinson’s disease

Answer 23

Parkinson’s disease is a disorder where the nerve cells that control movement begin to deteriorate. This decreases the amount of dopamine, which is a neurotransmitter that carries nerve impulses from one neuron to another, in the brain

Question 24

Symptoms of Parkinson’s disease

Answer 24

Symptoms of Parkinson’s disease include tremor of the extremities at rest, bradykinesia, akinesia, rigid limbs, shuffling gait, and a stooped posture. The tremor typically starts on one side of the body and then progresses to the other side. Parkinson’s disease is also associated with depression, cognitive impairment or dementia, and sleep dysfunction.

Question 25

Medications to increase the amount of dopamine

Parkinson’s disease

Answer 25

Medications to increase the amount of dopamine are used to help control the tremors and other physical symptoms of the disease.

Question 26

Deep brain stimulation

Parkinson’s disease

Answer 26

Deep brain stimulation is a surgical procedure used to treat the symptoms of Parkinson’s disease when medications are no longer effective. It is a surgically planted device that delivers electronic stimulation of the areas of the brain that control movement. This stimulation interferes with and blocks the abnormal signals that are sent in Parkinson’s disease.