CHAPTER 15 NERVOUS SYSTEM DISEASES AND DISORDERS Anatomy

CHAPTER 15 NERVOUS SYSTEM DISEASES AND DISORDERS

Anatomy and Physiology � Nervous system: brain, spinal cord, nerves � Central Nervous System (CNS) and Peripheral Nervous System (PNS) � CNS: brain and spinal cord � PNS: autonomic nervous system, cranial and spinal nerves 2

Common Signs and Symptoms � Common signs and symptoms �Headache �Nausea and vomiting �Weakness �Mood swings �Fever 3

Common Signs and Symptoms � Symptoms specific to CNS �Stiffness in neck, back, or extremities �Inability to move any part of the body �Seizures or convulsion �Paralysis �Visual difficulties 4

Common Signs and Symptoms � Symptoms specific to CNS �Inability to speak �Paralysis �Extreme or prolonged drowsiness �Stupor, unconsciousness, amnesia, extreme forgetfulness 5

Common Signs and Symptoms � Common diagnostic tests �Cerebrospinal fluid �Measuring intracranial pressure �X-rays of skull and vertebral column �Myelogram 6

Common Signs and Symptoms � Common diagnostic tests �Angiogram �Electroencephlogram �CAT Scan �MRI 7

Infectious Diseases � Encephalitis �Inflammation of brain tissue caused by bacteria and viruses �Symptoms: ○ Headache, stiff neck and back ○ Fever and lethargy ○ Confusion and even coma 8

Infectious Diseases � Encephalitis �Treatment: ○ Supportive ○ Antiviral medication may be effective 9

Infectious Diseases � Meningitis �Inflammation of meninges or coverings of brain and spinal cord �Causes: ○ Bacterial and viral ○ Fungi ○ Toxins such as lead and arsenic 10

Infectious Diseases � Meningitis �Symptoms ○ High fever ○ Severe headaches ○ Photophobia 11

Infectious Diseases � Meningitis �Symptoms ○ Stiffness and resistance in neck (nuchal rigidity) ○ Drowsiness ○ Stupor ○ Seizures ○ Coma 12

Infectious Diseases � Meningitis �Diagnosis: collect spinal fluid to find cause �Treatment ○ Antibiotics for bacterial infection ○ Antipyretics ○ Anticonvulsants ○ Quiet dark environment 13

Infectious Diseases � Poliomyelitis �Viral infection affecting brain and spinal cord �Vaccine has eliminated the disease in the United States �Virus is spread by oropharyngeal secretions and infected feces 14

Infectious Diseases � Poliomyelitis �Symptoms ○ Muscle weakness ○ Neck stiffness ○ Nausea and vomiting 15

Infectious Diseases � Poliomyelitis �Diagnosis: clinical examination, throat, feces, and spinal fluid culture �Treatment: supportive therapy including analgesics and bedrest during acute phase 16

Infectious Diseases � Poliomyelitis �Long-term physical therapy and braces may be needed �If respiratory system involved, mechanical ventilation may be needed 17

Infectious Diseases � Tetanus �Highly fatal infection of nerve tissue caused by bacteria Clostridium tetani �First symptom is stiffness of the jaw, commonly called “lockjaw” 18

Infectious Diseases � Rabies �Caused by virus �Primarily affects animals such as dogs, cats, raccoons, squirrels �Transmitted to humans through bite of an infected animal 19

Infectious Diseases � Rabies �Symptoms ○ Fever and pain ○ Convulsions and rage ○ Spasms and paralysis of muscles for swallowing 20

Infectious Diseases � Rabies �Symptoms ○ Throat spasms leading to hydrophobia ○ Inability to swallow; drooling of frothy saliva �Treatment ○ Clean infection site and rabies vaccine injections �No cure 21

Infectious Diseases � Shingles �Viral disease caused by herpes zoster �Itching, painful red rash, and small vesicles on sensory nerve paths �Symptoms last ten days to several weeks 22

Infectious Diseases � Shingles �Diagnosis ○ Appearance of lesions ○ Viral culture test 23

Infectious Diseases � Shingles �Treatment ○ Antiviral medications ○ Analgesics ○ Antipyretics ○ Antipruritic medications 24

Transient Ischemic Attacks � TIAs or mini-strokes � Insufficient blood to brain � Symptoms �Weakness of arm and/or leg �Dizziness �Slurred speech �Mild loss of consciousness 25

Transient Ischemic Attacks � Symptoms last few minutes to an hour � Diagnosis is made by angiogram � Surgery to improve blood flow 26

Functional Disorders � Degenerative Disk Disease � Headache � Epilepsy � Bell’s Palsy 27

Functional Disorders � Degenerative Disk Disease �Degeneration or wearing away of the intervertebral disk �Wearing away allows vertebrae to bump or rub against each other 28

Functional Disorders � Degenerative Disk Disease �Symptoms: ○ Difficulty walking ○ Radiating pain in back and in one or both legs 29

Functional Disorders � Degenerative Disk Disease �Diagnosis: ○ X-ray ○ Myelogram ○ CAT or MRI 30

Functional Disorders � Degenerative Disk Disease �Treatment ○ Rest back and legs ○ Back brace ○ Analgesics and anti-inflammatory drugs ○ Exercise to ease pain ○ Surgery 31

Functional Disorders � Headaches - one of the most common disorders in humans � Caused by two mechanisms �Tension on facial, neck, and scalp muscles �Vascular changes in arterial size of vessels inside head 32

Functional Disorders � Headaches � Contributing factors �Stress �Toxic fumes �Noise �Lack of sleep �Alcohol consumption 33

Functional Disorders � Headaches �May be acute or chronic �Pain may be constant, pressure, throbbing, stabbing, intermittent �Tension, cluster, following lumbar puncture, migraine 34

Functional Disorders � Headaches �Diagnosis ○ History and physical examination ○ X-ray ○ EEG, MRI, and CAT 35

Functional Disorders � Headaches �Treatment ○ Analgesics ○ Bedrest and muscle massage ○ Muscle relaxants ○ Warm baths ○ Biofeedback 36

Functional Disorders � Epilepsy �Chronic disease of brain �Intermittent episodes of abnormal electrical activity in brain �Most common symptom is seizure �Convulsions include petit mal, grand mal 37

Functional Disorders � Epilepsy �Diagnosis ○ EEG ○ CAT scan ○ Cerebral angiogram ○ Blood tests 38

Functional Disorders � Epilepsy �Treatment ○ Anticonvulsive medications ○ Close monitoring and adjusting of medications 39

Functional Disorders � Bell’s Palsy �Affects facial nerve (7 th cranial), causing unilateral paralysis �Affects individuals 20 to 60 years of age 40

Functional Disorders � Bell’s Palsy �Symptoms ○ Drooping weakness of eye ○ Drooling of saliva ○ Unable to whistle or smile ○ Distorted facial appearance 41

Functional Disorders � Bell’s Palsy �Diagnosis ○ History and symptoms �Treatment ○ Analgesics and anti-inflammatory medication 42

Functional Disorders � Dementia �Loss of mental ability due to loss of neurons or brain cells �Most common dementia is senility �Most common cause of senile dementia is Alzheimer's disease 43

Functional Disorders � Alzheimer's Disease �Form of dementia �Affects individuals 70 and older �Early symptoms ○ Short-term memory loss ○ Inability to concentrate ○ Slight changes in personality 44

Functional Disorders � Alzheimer's Disease �Symptoms of disease progression ○ Diminished communication skills ○ Meaningless words ○ Inability to form sentences ○ Increased forgetfulness ○ Irritability and agitation 45

Functional Disorders � Alzheimer's Disease �Positive diagnosis: autopsy �Initially may be made by ruling out other brain diseases �Treatment is supportive �No cure 46

Functional Disorders � Vascular Dementia �Atrophy and death of brain cells due to decreased blood flow �Atherosclerotic plaque can cause decreased blood flow and is common with aging 47

Functional Disorders � Vascular Dementia �Symptoms ○ Changes in memory, personality, and judgment ○ Irritability, depression, and sleeplessness ○ Lacks personal hygiene 48

Functional Disorders � Vascular Dementia �Diagnosis ○ Blood flow testing and history and physical �Treatment ○ Increasing blood flow to brain ○ Carotid endarterectomy 49

Functional Disorders � Head Trauma Dementia �Death of brain cells due to head trauma �Symptoms ○ Decrease in mental intellect and cognitive function 50

Functional Disorders � Head Trauma Dementia �Diagnosis ○ History ○ Cranial X-rays ○ MRI and CT �Treatment ○ Correct damage if possible 51

Functional Disorders � Substance-Induced Dementia �Brain cell death from drug toxicity and toxins �Causes mental impairment and decreased cognitive ability 52

Sleep Disorders � Insomnia �Inability to fall or stay asleep �Related to stress, pain, fear, depression, caffeine, alcohol, nicotine, and bronchodilators �Treatment ○ Identifying and removing cause 53

Sleep Apnea � Sleep disorder characterized by periods of breathlessness 54

Sleep Apnea � Symptoms �Daytime sleepiness �Extreme snoring �Personality changes �Depression �Impotence 55

Sleep Apnea � Diagnosis �Monitor affected individual during sleep for apnea and low blood oxygen levels 56

Sleep Disorders � Sleep Apnea �Treatment ○ Based on cause ○ Weight loss ○ Surgery to correct nasal obstruction ○ Oxygen during sleep ○ Medications to stimulate breathing 57

Tumors � Primary and secondary � Benign and malignant � Symptoms �Headache �Vomiting and seizures �Mood and personality changes �Visual disturbance and loss of memory 58

Tumors � Diagnosis �Clinical symptoms �X-ray, CT, and MRI �Biopsy � Treatment: surgery, radiation, and chemotherapy 59

Trauma � Concussions and Contusions �Blow to head by an object, fall, or other trauma such as an automobile accident �Disruption of normal electrical activity in brain 60

Trauma � Concussions and Contusions �Causes immediate unconsciousness �May last a few seconds to several hours �Concussion is less serious than a contusion 61

Trauma � Concussions and Contusions �Contusion is bruising of the brain �Outcomes: ○ Can lead to a hematoma ○ Increased intracranial pressure (ICP) ○ Permanent brain damage 62

Trauma � Concussions and Contusions �Diagnosis ○ History of injury ○ Neurologic examination ○ Cranial X-ray ○ CT and MRI 63

Trauma � Concussions and Contusions �Treatment ○ Bedrest and direct observation ○ Individual should be checked every 2 to 4 hours ○ Monitor changes in consciousness, eye pupil size, mood, and behavior 64

Trauma � Concussion and Contusions �Treatment ○ Analgesics, stimulants, and sedatives should not be given to individuals with a head injury ○ Medications may mask the symptoms and make assessment difficult 65

Trauma � Skull Fracture �Greatest danger is brain tissue damage from bony fragments �Potential of cutting brain, severing a vessel, and causing a hematoma �Brain damage may be temporary or permanent 66

Trauma � Skull Fracture �Fracture near base of skull may injure respiratory center and impair breathing �Infection of brain tissue may be a problem 67

Trauma � Skull Fracture �Treatment ○ Dependent on type and position of fracture ○ Craniotomy may be necessary to relieve ICP ○ Protective headgear may be necessary until fracture is healed 68

Trauma � Epidural and Subdural Hematoma �Blood vessels rupture and hemorrhage �Blood seeps between bony skull and outer meninges �Pushes dura mater away from inner bony skull 69

Trauma � Epidural and Subdural Hematoma �Epidural Hematoma symptoms ○ Headache ○ Dilated pupils ○ Nausea, vomiting, and dizziness 70

Trauma � Epidural and Subdural Hematoma �Subdural Hematoma ○ Usually the result of head hitting a stationary object �Blood collects between the dura mater and arachnoid layer 71

Trauma � Epidural and Subdural Hematoma �Subdural Hematoma ○ Develops slowly over period of days �Symptoms ○ Hemiparesis ○ Nausea, vomiting, dizziness ○ Convulsions and loss of consciousness 72

Trauma � Epidural and Subdural Hematoma �Diagnosis ○ Clinical history ○ Cranial X-ray, CT or MRI �Treatment ○ Decrease intracranial pressure ○ Craniotomy called “bur holes” 73

Spinal Cord Injury—Quadriplegia and Paraplegia � Injury to spinal cord �Results in varying degrees of loss of movement �Results in varying degrees of loss of feeling below the area of injury 74

Spinal Cord Injury—Quadriplegia and Paraplegia � Quadriplegia �Loss of movement and feeling in the trunk and all four extremities �Loss of bowel, bladder, and sexual function 75

Spinal Cord Injury—Quadriplegia and Paraplegia �Loss of movement and feeling in trunk and both legs �Loss of bladder, bowel, and sexual function 76

Spinal Cord Injury—Quadriplegia and Paraplegia � Emergency treatment �Immediate treatment is necessary �Do not move the victim unless surroundings are unsafe �Maintain position of spine with special collars and backboards 77

Spinal Cord Injury—Quadriplegia and Paraplegia � Diagnosis �History of injury �Neurologic exam �Spinal X-rays, MRI, and CAT scan 78

Spinal Cord Injury—Quadriplegia and Paraplegia � Treatment �Realignment and stabilization of the bony spinal column �Decompression or release of pressure on spinal cord �Prevent further injury 79

Rare Diseases � Amyotrophic Lateral Sclerosis (ALS) �“Lou Gehrig’s” disease �Destructive disease of motor or movement neurons 80

Rare Diseases � Amyotrophic Lateral Sclerosis (ALS) �Atrophy of muscles leading to progressive loss of movement of hands, arms, and legs �Treatment is supportive �No cure 81

Rare Diseases � Guillian-Barré Syndrome �Acute, progressive disease affecting the spinal nerves �Begins 10 to 21 days after febrile illness 82

Rare Diseases � Guillian-Barré Syndrome �Early symptoms include nausea, fever, and malaise �Within 24 to 72 hours paresthesia, muscle weakness, and paralysis usually begins 83

Rare Diseases � Guillian-Barré Syndrome �Symptoms may progress for several days to weeks �Once progression ceases, recovery begins �Treatment is supportive �Recovery is usually complete 84

Rare Diseases � Huntington’s Chorea �Inherited disease �Appears during middle age �Progressive degenerative disease of brain 85

Rare Diseases � Huntington’s Chorea �Loss of muscle control and chorea �Leads to mental deterioration �Personality change, moody behavior, loss of memory, dementia �Treatment is supportive �No cure 86

Rare Diseases � Multiple Sclerosis (MS) �Causes: ○ Demyelination of the nerves of the CNS ○ Allows information to “leak” from the nerve pathway ○ Leads to poor or absent nerve transmission 87

Rare Diseases � Multiple Sclerosis (MS) �Symptoms: ○ Muscle weakness and lack of coordination ○ Paresthesia ○ Speech difficulty ○ Loss of bladder function ○ Visual disturbance especially diplopia 88

Rare Diseases � Multiple Sclerosis �Affects adults between ages 20 and 40 �Periods of remission and exacerbation �Treatment ○ Physical therapy ○ Muscle relaxants in order to maintain muscle tone and reduce spastic movement 89

Rare Diseases � Parkinson’s Disease �Slow, progressive brain degeneration �Develops between ages 50 and 60 90

Rare Diseases � Parkinson’s Disease � Classic symptoms �Rigidity and immobility of hand �Very slow speech pattern �“Pill rolling” motion of fingers �Expressionless facial appearance 91

Rare Diseases � Parkinson’s Disease �Symptoms �Abnormal “bent forward” posture �Short, fast-running steps, shuffling appearance 92

Rare Diseases � Parkinson’s Disease �Treatment ○ Symptomatic ○ Dopamine replacement ○ Physical and psychological therapy 93