1. Chapter 15 Nervous System Diseases and Disorders

2. 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

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

4. 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

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

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

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

8. 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

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

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

11. Infectious Diseases Meningitis Symptoms High fever Severe headaches
Photophobia

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

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

14. 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

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

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

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

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

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

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

21. 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

22. 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

23. Infectious Diseases Shingles Diagnosis Appearance of lesions
Viral culture test

24. Infectious Diseases Shingles Treatment Antiviral medications
Analgesics
Antipyretics
Antipruritic medications

25. 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

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

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

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

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

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

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

32. 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

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

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

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

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

37. 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

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

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

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

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

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

43. 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

44. 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

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

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

47. 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

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

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

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

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

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

53. 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

54. Sleep Apnea
Sleep disorder characterized by periods of breathlessness

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

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

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

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

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

60. 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

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

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

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

64. 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

65. 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

66. 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

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

68. 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

69. 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

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

71. 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

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

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

74. 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

75. 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

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

77. 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

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

79. 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

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

81. 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

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

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

84. 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

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

86. 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

87. 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

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

89. 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

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

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

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

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