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

Common Signs and Symptoms Headache Nausea and vomiting Weakness Mood swings Fever

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

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

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

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

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

Infectious Diseases Encephalitis Treatment: Supportive Antiviral medication may be effective

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

Infectious Diseases Meningitis Symptoms High fever Severe headaches Photophobia

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

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

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

Infectious Diseases Poliomyelitis Symptoms Muscle weakness Neck stiffness Nausea and vomiting

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

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

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

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

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

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

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

Infectious Diseases Shingles Diagnosis Appearance of lesions Viral culture test

Infectious Diseases Shingles Treatment Antiviral medications Analgesics Antipyretics Antipruritic medications

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

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

Functional Disorders Degenerative Disk Disease Headache Epilepsy Bell’s Palsy

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

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

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

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

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

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

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

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

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

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

Functional Disorders Epilepsy Diagnosis EEG CAT scan Cerebral angiogram Blood tests

Functional Disorders Epilepsy Treatment Anticonvulsive medications Close monitoring and adjusting of medications

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sleep Apnea Sleep disorder characterized by periods of breathlessness

Sleep Apnea Symptoms Daytime sleepiness Extreme snoring Personality changes Depression Impotence

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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