Neurological Disorders Dr. Kline FSU-PC

I. Neurological Disorders The normal functioning of the CNS can be affected by a number of disorders, the most common of which are headaches, tumors, vascular problems, infections, epilepsy, head trauma, demyelinating diseases, and metabolic & nutritional diseases. The normal functioning of the CNS can be affected by a number of disorders, the most common of which are headaches, tumors, vascular problems, infections, epilepsy, head trauma, demyelinating diseases, and metabolic & nutritional diseases.

A. Vascular Diseases in the brain: Minor to total reduction in blood flow to the neurons deprives the cells of oxygen & glucose, resulting in interference with cellular metabolism. Minor to total reduction in blood flow to the neurons deprives the cells of oxygen & glucose, resulting in interference with cellular metabolism. Disruption of cellular metabolism, caused by reduced blood flow, lasting longer than 10 min., results in cell death for neurons in that brain region. Disruption of cellular metabolism, caused by reduced blood flow, lasting longer than 10 min., results in cell death for neurons in that brain region. These disorders account for most common causes of death & chronic disability in the Western world. These disorders account for most common causes of death & chronic disability in the Western world.

1. Stroke (Cerebral vascular accident) Results from severe severe interruption of blood flow to the brain (usually affecting arteries). Results from severe severe interruption of blood flow to the brain (usually affecting arteries). The onset of a stroke may span days to years, often with little-to-no warning. The onset of a stroke may span days to years, often with little-to-no warning. A stroke produces an infarct (area of dead or dying tissue resulting from obstruction of blood vessels normally supplying area). A stroke produces an infarct (area of dead or dying tissue resulting from obstruction of blood vessels normally supplying area).

What factors influence the severity of deficits resulting from a stroke? Location of the blockage Location of the blockage Size of the blood vessels Size of the blood vessels --prognosis is better if blockage occurred in small vessels rather than larger vessels. --prognosis is better if blockage occurred in small vessels rather than larger vessels. Relative health of surrounding vessels Relative health of surrounding vessels Age of patient (younger has better chance of recovery) Age of patient (younger has better chance of recovery) How quickly patient is seen following stroke How quickly patient is seen following stroke

2. Cerebral Ischemia- insufficient supply of blood to brain, are like mini-strokes. Decreases in blood flow result of 3 causes: Decreases in blood flow result of 3 causes: A. Thrombosis-a plug or clot in a blood vessel that remains at its point of formation. A. Thrombosis-a plug or clot in a blood vessel that remains at its point of formation. B. Embolism -moving (clot, bubble of air, sack of cells, or fat deposit) from larger vessel into a smaller vessel. B. Embolism -moving (clot, bubble of air, sack of cells, or fat deposit) from larger vessel into a smaller vessel. --often effect middle cerebral artery of left side of brain which is near speech comprehension for many. --often effect middle cerebral artery of left side of brain which is near speech comprehension for many. C. Cerebral arteriosclerosis-thickening & hardening of arteries that reduces blood flow. C. Cerebral arteriosclerosis-thickening & hardening of arteries that reduces blood flow.

3. Migraine Stroke People with classic migraines often experience a transient ischemic attack with some neurological symptoms. These include: People with classic migraines often experience a transient ischemic attack with some neurological symptoms. These include: Impaired sensory functioning (vision) Impaired sensory functioning (vision) Numbness of skin Numbness of skin Difficulties in moving & aphasia (Language Disorder) Difficulties in moving & aphasia (Language Disorder) *Account for a significant proportion of strokes in young people under 40. *Account for a significant proportion of strokes in young people under 40. *Occurs more in females than males. *Occurs more in females than males. *Cause is unknown (may be vasospasm). *Cause is unknown (may be vasospasm).

4. Cerebral Hemorrahage Massive bleeding in the brain. Onset is abrupt & may be quickly fatal. Prognosis often poor. Massive bleeding in the brain. Onset is abrupt & may be quickly fatal. Prognosis often poor. Causes: Causes: Hypertension Hypertension Congenital defects of cerebral arteries Congenital defects of cerebral arteries Leukemia & other blood disorders Leukemia & other blood disorders Toxic chemicals Toxic chemicals

5. Aneurysms Vascular dilations resulting from localized defects in the elasticity of the vessel. Vascular dilations resulting from localized defects in the elasticity of the vessel. The vessels distend like a “balloon” until they are vulnerable to rupture. The vessels distend like a “balloon” until they are vulnerable to rupture. Most common symptom is severe headache, often present for many months to years. Most common symptom is severe headache, often present for many months to years.

Treatment for vascular disorders: Drug therapy (anticoagulants to dissolve clots or prevent clotting) Drug therapy (anticoagulants to dissolve clots or prevent clotting) Vasodilators to dilate vessels Vasodilators to dilate vessels Drugs used to treat hypertension Drugs used to treat hypertension Salty solutions to reduce edema in brain Salty solutions to reduce edema in brain Surgery to repair damaged vessels; total removal of aneurysm. Surgery to repair damaged vessels; total removal of aneurysm.

B. Head Trauma Injuries Brain injury from head trauma is most common form of brain damage in people under 40. Brain injury from head trauma is most common form of brain damage in people under 40. There are two types of Head Trauma Injuries: There are two types of Head Trauma Injuries: Open-head & closed-head injuries. Open-head & closed-head injuries.

Ways in which Head trauma may damage the brain: 1. By directly damaging neurons & support cells (e.g., gunshot wound). 1. By directly damaging neurons & support cells (e.g., gunshot wound). 2. By causing blood flow disruption leading to a stroke (closed-head injury). 2. By causing blood flow disruption leading to a stroke (closed-head injury). 3. By causing bleeding in the brain which causes the brain to swell. 3. By causing bleeding in the brain which causes the brain to swell. 4. By making the brain vulnerable to infection (open- head injuries). 4. By making the brain vulnerable to infection (open- head injuries).

1. Open-Head Injuries: Results from injury to brain in which the skull is penetrated either by projectiles (gunshots/missile wounds) or other moving objects. Results from injury to brain in which the skull is penetrated either by projectiles (gunshots/missile wounds) or other moving objects. Most people with open-head injuries do not lose consciousness & produce distinctive symptoms that may undergo rapid & spontaneous recovery. Most people with open-head injuries do not lose consciousness & produce distinctive symptoms that may undergo rapid & spontaneous recovery. Deficits are specialized & often resemble those of surgical excisions. Deficits are specialized & often resemble those of surgical excisions.

2. Closed-Head Injuries Caused by a blow to the head (car accident, blunt instrument swung at head). Caused by a blow to the head (car accident, blunt instrument swung at head). Damage may be three-fold: A. Damage at site of blow is called a coup. A. Damage at site of blow is called a coup. B. The brain may shift & hit the opposite side of the skull producing an additional bruise (contusion) known as a countercoup. B. The brain may shift & hit the opposite side of the skull producing an additional bruise (contusion) known as a countercoup.

Closed-Head Injuries (Contd.) C. The brain may suffer additional damage, resulting from shearing of nerve fibers which produce microscopic lesions. C. The brain may suffer additional damage, resulting from shearing of nerve fibers which produce microscopic lesions. Frontal & temporal areas are most likely to be damaged in closed-head injuries. Frontal & temporal areas are most likely to be damaged in closed-head injuries. These injuries are commonly accompanied by loss of consciousness (from damage to brainstem fibers), edema (swelling), & hemorrhaging. These injuries are commonly accompanied by loss of consciousness (from damage to brainstem fibers), edema (swelling), & hemorrhaging. Length of coma often is positively correlated with severity of damage. Length of coma often is positively correlated with severity of damage.

Behavioral impairments resulting from closed-head injuries: 1. Discrete impairment of functions mediated by brain regions that sustained direct impact (coup & countercoup). 1. Discrete impairment of functions mediated by brain regions that sustained direct impact (coup & countercoup). 2. Microscopic lesions caused by shearing of neurons results in widespread damage. 2. Microscopic lesions caused by shearing of neurons results in widespread damage.

Mental recovery from Closed-Head Injury: Most mental recovery occurs rapidly in the first 6-9 months following injury. Most mental recovery occurs rapidly in the first 6-9 months following injury. Memory functions recover more slowly than general intellectual functions. Depending on length of coma & amnesia following injury, prognosis may be very good. Memory functions recover more slowly than general intellectual functions. Depending on length of coma & amnesia following injury, prognosis may be very good. Personality changes may be pronounced; person may be less likely to recover their personality than they are to recover general intellectual functioning. Personality changes may be pronounced; person may be less likely to recover their personality than they are to recover general intellectual functioning.

C. Epilepsy Results from recurrent seizures (disruptions in neural firing) of various types that disturb consciousness. Results from recurrent seizures (disruptions in neural firing) of various types that disturb consciousness. Seizures may be classified based on potential cause: Seizures may be classified based on potential cause: ---Symptomatic seizures-caused by infection, trauma, tumor, toxic chemical, vascular problem, etc. ---Symptomatic seizures-caused by infection, trauma, tumor, toxic chemical, vascular problem, etc. ----Idiopathic seizures- appear spontaneously; with no apparent cause. ----Idiopathic seizures- appear spontaneously; with no apparent cause.

Symptoms of Epilepsy 1. An aura or warning of a seizure that’s about to occur. 1. An aura or warning of a seizure that’s about to occur. E.g., may be an odor, noise, or visual image E.g., may be an odor, noise, or visual image 2. Loss of consciousness (ranges from complete collapse to staring off into space). 2. Loss of consciousness (ranges from complete collapse to staring off into space). 3. Movements (ranging from minor such as small twitching to large convulsions). 3. Movements (ranging from minor such as small twitching to large convulsions).

Types of Epilepsy 1. Focal seizures- seizures occur in a locus (particular place in brain) & then spread. 1. Focal seizures- seizures occur in a locus (particular place in brain) & then spread. E.g., symptoms may start with twitching in one digit of the hand and quickly spread to the other fingers & arm.) E.g., symptoms may start with twitching in one digit of the hand and quickly spread to the other fingers & arm.) 2. Complex partial seizures – usually originate in the temporal lobe (sometimes the frontal lobe).

Stages of Complex partial seizures 1. Subjective feelings, forced thoughts, alterations in mood, dejavu 1. Subjective feelings, forced thoughts, alterations in mood, dejavu 2. Automatisms, which are stereotyped repetitive movements such as lip smacking, chewing, fidgeting. 2. Automatisms, which are stereotyped repetitive movements such as lip smacking, chewing, fidgeting. 3. Postural changes in which person may assume catatonic postures. 3. Postural changes in which person may assume catatonic postures.

3. Generalized seizures Are bilaterally symmetrical without local onset. Are bilaterally symmetrical without local onset. Grand Mal attack is accompanied by loss of consciousness, stereotyped motor behavior. Grand Mal attack is accompanied by loss of consciousness, stereotyped motor behavior. 4. Petit mal attack- Brief loss of awareness during which there is little motor activity such as blinking, turning the head, rolling the eyes, etc. 4. Petit mal attack- Brief loss of awareness during which there is little motor activity such as blinking, turning the head, rolling the eyes, etc.

Treating Epilepsy 1. Anticonvulsant drugs are used to treat this. 1. Anticonvulsant drugs are used to treat this. (E.g., Dilantin, phenobarbital, etc.) (E.g., Dilantin, phenobarbital, etc.) Mode of action is unknown, may work by stabilizing weak neural membrane in abnormal cells. Mode of action is unknown, may work by stabilizing weak neural membrane in abnormal cells. 2. Surgery to remove focus of epilepsy if known. 2. Surgery to remove focus of epilepsy if known.

D. Brain Tumors A mass of cells that grow & have no use. A mass of cells that grow & have no use. Brain tumors grow from glia & other support cells, not the neurons themselves. Brain tumors grow from glia & other support cells, not the neurons themselves. Tumor growth varies depending on type of tumor, where its located, & type of cell that it grows from. Tumor growth varies depending on type of tumor, where its located, & type of cell that it grows from.

Types of Brain Tumors 1. Gliomas- tumors that arise from glial cells & infiltrate the brain. May be benign to malignant. 1. Gliomas- tumors that arise from glial cells & infiltrate the brain. May be benign to malignant. About 45% of all tumors are gliomas. About 45% of all tumors are gliomas. A. Astrocytomas-result from growth of astrocytes. Usually not malignant & may be treated fairly easily. Prognosis is good. A. Astrocytomas-result from growth of astrocytes. Usually not malignant & may be treated fairly easily. Prognosis is good. B. Glioblastomas-highly malignant, rapidly growing. B. Glioblastomas-highly malignant, rapidly growing.

2. Meningiomas- attached to meninges. Are encapsulated on outside of brain. Usually benign. 3. Metastatic Tumors- a tumor that results in the brain from tumor cells carried from the body elsewhere (breast, liver, lung, etc.). 3. Metastatic Tumors- a tumor that results in the brain from tumor cells carried from the body elsewhere (breast, liver, lung, etc.).

Treatment for tumors Surgery to remove tumors if operable. Surgery to remove tumors if operable. Radiation to reduce or shrink tumors. Radiation to reduce or shrink tumors.