Nervous system 2 pathologies Flashcards
Raised Intercranial Pressure
Raised intercranial pressure describes an increase in the pressure within the cranial cavity.
Pathophysiology:
Compression of blood vessels leads to reduced oxygen perfusion to the brain
Causes/triggers:
* Tumour (e.g. gliomas or metastases)
* Haemorrhage (e.g. subdural (venous bleed), subarachnoid (arterial bleed)
* Hydrocephalus (excess cerebrospinal fluid)
* Meningitis (meningeal inflammation) – brain swelling
* Encephalitis (inflammation of brain tissue) – brain swelling
* Intracranial abscess
Signs and symptoms:
* Headache (worse on awakening, coughing and moving head)
* Vomiting (often without nausea)
* Visual disturbance (if damage to optic nerve which is vulnerable due to its anatomical course through the cranium)
* Pupil fixed / dilated in one eye
* Impaired mental state: lethargic, irritable
* Altered speech and seizures
* Papilloedema (bulging of the optic disc – seen only with ophthalmoscopy)
* Elevated blood pressure, slow and irregular pulse, slow breathing (Cushing triad)
Hydrocephalus
An abnormal accumulation of cerebrospinal fluid (CSF) occupying the cerebral ventricles and subarachnoid space
Pathophysiology:
* Usually due to impaired absorption but can be due to excessive secretion
* Results in ventricular dilation and subsequently CSF permeates through the ependymal lining into the surrounding white matter
Causes/triggers:
Small children:
* Infection
* Congenital malformation
Older children and adults:
* Tumour
* Traumas
* Meningitis
Signs and symptoms:
* Headache – worse in the morning after waking up (CSF doesn’t drain well whilst lying down)
* Increase in head circumference and dilated scalp veins in infants
* Vomiting (and nausea)
* Blurred or double vision
* Neck pain
Allopathic treatment:
* Diuretics inhibit CSF secretion
* Emergency: (To prevent white matter scarring / brain damage / death)
* Shunt, ventricular drain, lumbar puncture
Other:
* Hydro = head
* Cephalus = brain
Meningitis
Infection or inflammation of the meninges
Causes/triggers:
* Viral meningitis is the most common cause (90%) and is less severe; e.g. herpes simplex
* More severe cases may involve bacterial
* May also be fungal or parasitic micro-organisms
* Affects immune-compromised populations: elderly, HIV, organ transplants, cancer patients
* Can be non-infective e.g. brain tumour
Main signs and symptoms:
* Fever and sudden onset of severe headache
* Marked neck stiffness, photophobia and vomiting
* Petechiae: small purple/red spots on the skin as a result of tiny haemorrhages - non-blanching (bacterial only)
* Kernig’s sign = pain resistance to knee extension when lying with the hips fully flexed
* Brudzinski sign = neck flexion causes flexion of hip and knee
Diagnosis/investigations:
* Lumbar puncture (withdraw CSF between. L4-L5)
* Treatment
* Antibiotics, antivirals and corticosteroids
* Analgesics and antipyretics
* Intravenous fluids
Complications:
* Swelling (and raised ICP)
* Septicaemia
* Seizures
* Can be life-threatening when it leads to raised intracranial pressure – a medical emergency
Concussion
Concussion describes a temporary loss of neuronal function
Pathophysiology:
It is a reversible head injury resulting from a significant blow to the head disrupting neurological function
Main signs and symptoms:
* Vary from mild to severe and depending on area of brain. Could ultimately lead to haemorrhage.
* Loss of consciousness, memory loss of events surrounding the injury, headache, disorientation
Allopathic treatment:
* Emergency: Rest, if consciousness was lost avoid any vigorous activity for three months
* Homeopathy (i.e. arnica)
Cerebral Contusion
A type of traumatic brain injury that causes bruising of the brain with ruptured blood vessels and oedema
Causes/triggers:
* Usually caused by a blunt blow to the head
Main signs and symptoms:
* Mild to severe symptoms
* Headache, confusion, sleepiness, dizziness, loss of consciousness, nausea, vomiting, seizures, difficulty with coordination and movement
* Impaired memory, vision, speech, hearing
Allopathic treatment:
* Medical emergency
Alternative treatment:
* Homeopathy (arnica and others in high potency)
Coup and Contrecoup injury
A coup / contrecoup injury is a term applied to traumatic head injuries and most often cerebral contusions
Causes/triggers:
It refers to the common pattern of injury, as summarized below:
* Coup: Injury to the site of primary impact\
- Contrecoup: Damage to the brain at a site contra-lateral to the site of trauma.
The skull acts to stop acceleration of the brain away from the site of impact, causing damage on the opposite side
Headaches
A common type of head pain with many causes
Causes / triggers:
* Dehydration
* Cervicogenic (from the neck)
* TMJ (structural problems)
* Tension headaches
* Congested sinuses
* Hypoglycaemia
* Migraines and cluster headaches
* Medication induced; i.e. paracetamol
* Intra-cranial: e.g. brain tumour, haemorrhage, etc.
* Organ referral
Interpreting headaches: You must identify / distinguish between headache causes – ask a series of open questions
Complications:
Headache red flags (potentially more serious cause)
* First onset of headache over 50 yrs of age
* Thunderclap headache – subarachnoid haemorrhage
* Signs of meningitis – headache, neck stiffness, non-blanching rash, positive Kernig/ Brudzinski sign
* Signs of increased intracranial pressure – worsening morning headaches, uneven pupils, double vision, tunnel vision, papilloedema, vomiting and no nausea
Other:
* A new onset of a worsening headache that is of high pain intensity and associated with pupil dilation, is a concerning presentation
Cervicogenic Headaches
A moderate - severe non throbbing headache in occipital to frontal/ temporal region
Causes/triggers:
Aggravated by;
* Neck movement
* Sustained postures
Relived by:
* Stretching and supporting neck
* Massage
Main signs and symptoms:
* Non throbbing
* Usually starts in neck, moves forward to temporal/frontal area
* Tender / reproduced when palpating upper cervical spine)
* Reduced neck ROM (+/- neck discomfort)
Other:
* Duration; one hour to weeks
Tension headaches
Mild to moderate diffuse (bilateral) muscular dull headache
Causes/triggers:
Aggravated by;
* Stress
* Muscle tension
Relived by:
* Rest
* Massage
* Relaxation
Main signs and symptoms:
* Dull headache
* Diffuse bilateral muscular pain (across forehead)
* Occasionally decreased appetite
* Photophobia
Other:
* Duration; hours to days
Migraine Headache
A neurological condition that results in recurrent moderate - severe retro-orbital, frontal throbbing / pulsating headaches
Pathophysiology:
Hypothesised that a complex series of intracranial vascular changes occur, including initial vasoconstriction (aura) and subsequent vasodilation (headache). Induced by cerebral depolarization (this secretes vasodilators and pain mediators)
Causes/triggers:
* More common in women, usually beginning in childhood
* Strong links with family history (genetics)
* Low levels of serotonin
* Food allergies, food additives (tyramine, nitrates, MSG, aspartame), histamine, alcohol
* Emotions (stress), hormonal changes, poor sleep
Aggravated by:
* Exertion, certain foods (dairy, caffeine), stress, noise
Relieved by:
* Being in a dark room, rest, sleep
Main signs and symptoms:
* Aura (15%) occurs hours to days before headache: Unusual vision changes, olfactory and sensory experiences (tingling) preceding the headache
* Unilateral, pulsing headache with a moderate – sever intensity, worsened by movements
* Associated with photophobia and phonophobia
* Nausea and vomiting (in up to 60%)
Allopathic treatment:
* Analgesics (i.e. ibuprofen, 5-HT agonists)
Alternative treatment:
* Avoid allergens / food intolerances, low GL diet, avoid amine-containing foods (vasodilators) (tyramine, histamine); add magnesium + B6 (e.g. feverfew),
* Acupuncture
* Osteopathy
* Homeopathy
Other:
* Duration; 4 – 72 hours (usually <24 hrs)
Brain tumour
A tumour / growth in the brain. It can be benign or malignant
Causes/triggers:
* Primary tumours – Mostly gliomas (originating from glial cells, most common type is astrocytoma)
* Often secondary malignant tumours (metastatic) but can be primary (originate from the brain)
Main signs and symptoms:
* Morning headaches, increasing in frequency
* Nausea and vomiting
* Uneven pupils and double vision
* Papilloedema
Complications:
Brain tumour
A tumour / growth in the brain. It can be benign or malignant
Causes/triggers:
* Primary tumours – Mostly gliomas (originating from glial cells, most common type is astrocytoma)
* Often secondary malignant tumours (metastatic) but can be primary (originate from the brain)
Main signs and symptoms:
* Morning headaches, increasing in frequency
* Nausea and vomiting
* Uneven pupils and double vision
* Papilloedema
Complications:
Even benign tumours can be life-threatening as they increase intracranial pressure
Epilepsy
Sudden, hyper-excitable and uncontrolled neuronal activity in the brain. It is a symptom of a disease
Causes/triggers:
* Idiopathic, brain tumours, cerebral infarction or haemorrhage
* Congenital malformation, head trauma (loss of consciousness)
* CNS infections (i.e. meningitis), degenerative brain disease, some drugs, chemical imbalances (i.e. hypoglycaemia / calcaemia)
Triggers
* Hypoglycaemia, fever (febrile seizures), sleep deprivation, dehydration, stress, flickering lights, drugs and alcohol (alters brain chemistry), pesticides (inhibit GABA)
Main signs and symptoms:
Two types of seizures = Petit mal seizures (non-convulsive) and Gran mal seizures (convulsive)
Grand mal siezures: A tonic-clonic seizure
- Tonic phase: contraction of all body muscles (causing patient to fall if sitting or standing)
- Clonic phase; rapid contraction and relaxation of muscles causing convulsions
- Ranges from exaggerated twitches to violent shaking
* Usually lasts around a minute
* Followed by physical and nervous exhaustion
Petit mal seizures: Absence seizure
* Lasts 10-30 seconds
* Seen mainly in children
* Abnormal neuronal activity in brain
* Usually no lingering confusion
* Can be idiopathic or due to birth trauma, brain injury or family history
Allopathic treatment:
* Anti-epileptic drugs – anti convulsants such as gabapentin, sodium valproate (adverse effects)
* Emergency care
Alternative treatment:
* Dietary and supplements; EFAs, ketogenic diet, magnesium
* Smoking cessation, Sleep hygiene, stress management
* Acupuncture
* Homeopathy
Spina Bifida
Incomplete closure of the embryonic neural tube resulting in failure of the spinal column to fully enclose the spinal cord
Pathophysiology:
* Most commonly occurs at the lumbosacral junction (L5/S1)
Causes/triggers:
Risk factors:
* Lack of folate (vitamin B9) during and before pregnancy
* Sodium valproate linked
Main signs and symptoms:
Divided into 2 types:
* Spina bifida ‘occulta’ (overlying skin intact, sometimes with overlying thick course hair))
* Spina Bifida ‘cyctica’ (visible cystic mass)
Complications:
* Meningitis
* Hydrocephalus
* Decreased bowel and bladder function
Other:
Spina = spine, bifida = split
Herniated disc
The nucleus pulposus of the disc leaks through the annulus fibrosus, often compressing on spinal nerves
Pathophysiology:
* Commonly occurs in low lumbar spine (l4/5/S1)
* The classic mechanism of injury is combined lumbar spine flexion and rotation (bending and twisting)
Causes/triggers:
* Most commonly occurs between 3-40 years (when discs are most hydrated)
Main signs and symptoms:
* Radiating pain (sharp and linear)
* Positive straight leg raise test
* Oain aggravated by coughing / sneezing
Allopathic treatment:
* Manual therapy, muscle strengthening
* Anti-inflammatory diet and supplements
* Homeopathy
* Herbs
* Acupuncture
