Anatomy and physiology of nervous system Katrin Gross-Paju

Basis for understanding nervous system diseases Neurological symptoms=location of brain damage How do you determine the cause/disease? Course Acute onset Progressive Investigations Visualisation Anatomy Modern possibilties Neurophysiology Genetic studies Treatments

Diagnostic process – what brain region? Symptoms Signs

Brain and skull

Motor functions Voluntary movements Damage Weakness Total weakness - paralysis Very mild weakness - paresis

Movement coordination Too little movements Parkinson´ disease Too many movements involuntary Taalamus Nucl caudatus Globus pallidus Putamen Subst nigra Nucl ruber

Cerebellum: balance and coordination Balance and coordination problems

Dominant hemisphere – speech problems

Autonomous nervous system

Autonomous nervous system: III VII, IX X S2 S4

Tilt test Vähemalt 5 min enne testi algust lamada. Vaikne ruum. Sümptomite tekkimisel pt lastakse algasendisse. Vererõhku mõõdetakse lamades ja 1 minut peale püstitõusmist või vertikaliseerimist. 60-80 kraadise nurga alla. 1minutiga enamasti patsientidel kel ortostaasi talumatsu, tekib OH, aga edasine jälgimine aitab selgitada seisundi tõsidust – vererõhu edasist langust Kui koos OH-ga esineb reflektoorne tahhükardia, siis ei saa välistada et OH on tekkinud sekundaarselt hüpovoleemia tõttu. Kui tahhükardiat ei ole, siis autonoomne häire

Postural ortostatic tachycardia syndrome

complaints

Paradoxical drop of blood pressure

Clinical symptoms Older age Falls Dizzeness when standing

Methods of investigation

Complaints, signs, disease history

Disease by history Headache

Computed tomography - CT X-ray Emergency situation

CT brain

Traumatic brain injury

Stroke – intracerebral hemorrhage BROTT ET AL 1997 Yu Yl et al. Stroke 1992 Poungvarin N et al. NEJM 1987 Mendelow AD et al. Lancet 2005, MAYER ET AL 2005

Stroke – ischaemic stroke ND 24.01 2007 30.01 2007

Magnet-resonance tomography Magnetic field 1,5 T 3 T

Normal brain

Acute stroke Flairis nähtamatu

Diagnosis: demyelinating disease KT-s nähtamatu

Prognosis: Demyelinating diseases

EEG

Epilepsy

SPE(C)T – dopamine transporter Diseases affecting dopamine transport

Impact of a neurological disease

Extensive brain damage – PML JC virus induced brain damage in HIV

treatments Disease course modifying treatments (cure) Symptom control Limited to autoimmune diseases Symptom control Parkinson`s disease Genetic diseases Exact cause – no treatment