1. Nervous System Neurological Testing, Diseases, and Disorders

2. 29-2 Neurologic Testing Typical neurologic examination Typical neurologic examination State of consciousness State of consciousness Reflex activity Reflex activity Speech patterns Speech patterns Motor patterns Motor patterns

3. 29-3 Neurologic Testing: Diagnostic Procedures Lumbar puncture Lumbar puncture Magnetic resonance imaging (MRI) Magnetic resonance imaging (MRI) Positron emission tomography (PET) scan Positron emission tomography (PET) scan Cerebral angiography Cerebral angiography Computerized tomography (CT) scan Computerized tomography (CT) scan Electroencephalogra m (EEG) Electroencephalogra m (EEG) X-ray X-ray

4. 29-4 Neurologic Testing – Cranial Nerve Tests Olfactory nerves (Cranial nerve I) Olfactory nerves (Cranial nerve I) Have patient smell various substances Have patient smell various substances Cranial nerves III, IV, and VI Cranial nerves III, IV, and VI Have patient track movement of finger Have patient track movement of finger Cranial nerve V Cranial nerve V Have patient clench teeth, feel jaw muscles Have patient clench teeth, feel jaw muscles

5. 29-5 Cranial nerve VII Cranial nerve VII Check patient’s facial expression Check patient’s facial expression Cranial nerve XII Cranial nerve XII Have patient extend his tongue and move it from side to side Have patient extend his tongue and move it from side to side Neurologic Testing – Cranial Nerve Tests (cont.)

6. Neurologic Testing- Cranial Nerve Tests (cont) 29-6

7. 29-7 Neurologic Testing: Reflex Testing Areflexia Areflexia Absence of a reflex Absence of a reflex Hyporeflexia Hyporeflexia Decreased reflex Decreased reflex Hyperreflexia Hyperreflexia Stronger-than-normal reflex Stronger-than-normal reflex

8. 29-8 Biceps reflex Biceps reflex Absence indicates spinal cord damage in the cervical region Absence indicates spinal cord damage in the cervical region Knee reflex Knee reflex Absence may indicate damage to lumbar or femoral nerves Absence may indicate damage to lumbar or femoral nerves Abdominal reflexes Abdominal reflexes Used to evaluate damage to thoracic spinal nerves Used to evaluate damage to thoracic spinal nerves Neurologic Testing: Reflex Testing

9. 29-9 Common Diseases and Disorders Disease/DisorderDescription Alzheimer’s disease Progressive, degenerative disease of the brain Amyotrophic lateral sclerosis (ALS) Lou Gehrig’s disease Degeneration of neurons in the spinal cord and brain Bell’s palsyWeak or paralyzed facial muscles

10. 29-10 Common Diseases and Disorders (cont.) Disease/DisorderDescription Brain tumors and cancers Abnormal growths Can be primary or secondary tumors Most common – gliomas Epilepsy and seizures Occurs as a result of bursts of electrical signals that disrupt normal brain functioning Guillain-Barré Syndrome Body’s immune system attacks the PNS

11. 29-11 Disease/DisorderDescription Headaches Tension Migraines Cluster Episodic or chronic With aura/without aura Form of migraines; occurs in groups MeningitisInflammation of meninges Multiple sclerosis (MS) Chronic disease of CNS Myelin is destroyed Common Diseases and Disorders (cont.)

12. 29-12 Disease/DisorderDescription NeuralgiasDisorders causing nerve pain Parkinson’s disease Progressive and degenerative motor system disorder SciaticaDamage to sciatic nerve StrokeBrain cells die because of an inadequate blood flow; “brain attack” Common Diseases and Disorders (cont.)

13. Diseases/disorders Traumatic disorders – caused by injury: Traumatic disorders – caused by injury: Concussion. Concussion. Brain contusion. Brain contusion. Congenital disorders – present at birth: Congenital disorders – present at birth: Spina bifida. Spina bifida. Hydrocephalus. Hydrocephalus. Cerebral palsy. Cerebral palsy. Cerebrovascular accident (CVA). Cerebrovascular accident (CVA). Encephalitis. Encephalitis. Epilepsy. Epilepsy. Meningitis. Meningitis. Multiple sclerosis (MS) Multiple sclerosis (MS) Neuralgia. Neuralgia. Paralysis. Paralysis. Parkinson’s disease. Parkinson’s disease. Dementia. Dementia. Alzheimer’s disease. Alzheimer’s disease.

14. Spina Bifida Opening in the spinal column Opening in the spinal column At delivery, spinal cord and nerves are exposed causing nerve damage At delivery, spinal cord and nerves are exposed causing nerve damage Results in paralysis Results in paralysis

15. Cerebral Palsy Caused by brain damage at birth Caused by brain damage at birth Lack of oxygen, birth injuries, infection, etc. Lack of oxygen, birth injuries, infection, etc. Symptoms: Symptoms: Tense muscles leading to Tense muscles leading to contractures contractures Tremors Tremors Mental retardation Mental retardation Treatment: Treatment: Therapy, anticonvulsants, braces, surgery Therapy, anticonvulsants, braces, surgery

16. Cerebrovascular accident (CVA) a.k.a. stroke a.k.a. stroke Blood flow to the brain is impaired resulting in brain tissue damage Blood flow to the brain is impaired resulting in brain tissue damage Causes Causes Cerebral hemorrhage Cerebral hemorrhage Aneurysm Aneurysm Weak blood vessels Weak blood vessels Blood clot Blood clot Treatment depends on cause Treatment depends on cause

17. Encephalitis Inflammation of the brain resulting in weakness, visual disturbances, vomiting, stiff neck and back, coma Inflammation of the brain resulting in weakness, visual disturbances, vomiting, stiff neck and back, coma Caused Caused Virus Virus Chemical Chemical Bacteria Bacteria Treatment is supportive including medications and monitoring Treatment is supportive including medications and monitoring

18. Epilepsy Seizure syndrome Seizure syndrome Disorder associated with abnormal electrical impulses in the neurons of the brain Disorder associated with abnormal electrical impulses in the neurons of the brain Causes Causes Trauma Trauma Toxins Toxins Idiopathic (spontaneous) Idiopathic (spontaneous) Treated with medications Treated with medications

19. Hydrocephalus Excessive accumulation of cerebrospinal fluid in the ventricles Excessive accumulation of cerebrospinal fluid in the ventricles Symptoms include abnormally large head, prominent forehead, irritability, retardation Symptoms include abnormally large head, prominent forehead, irritability, retardation Treated with Treated with surgical shunt between ventricles

20. Meningitis Inflammation of the meninges of the brain and/or spinal cord Inflammation of the meninges of the brain and/or spinal cord Caused by bacteria or virus Caused by bacteria or virus High fever, headaches, back and neck pain, n/v, delirium, convulsions and death High fever, headaches, back and neck pain, n/v, delirium, convulsions and death Treatment includes medications and anticonvulsants Treatment includes medications and anticonvulsants

21. Multiple sclerosis Chronic, progressive disabling condition resulting from degeneration of the myelin sheath Chronic, progressive disabling condition resulting from degeneration of the myelin sheath Occurs between 20 and 40 y.o. Occurs between 20 and 40 y.o. Cause is unknown Cause is unknown Progresses at different rates depending on the person Progresses at different rates depending on the person No cure No cure

22. Neuralgia Nerve pain Nerve pain Caused by inflammation, pressure, toxins and other disease Caused by inflammation, pressure, toxins and other disease Treatment directed at eliminating the cause of the pain Treatment directed at eliminating the cause of the pain

23. Paralysis Usually results from brain or spinal cord injury Usually results from brain or spinal cord injury Hemiplegia Hemiplegia Paralysis on one side Paralysis on one side Quadriplegia Quadriplegia Paralysis of the arms, legs, and body below the spinal cord injury Paralysis of the arms, legs, and body below the spinal cord injury No cure, treatment is supportive No cure, treatment is supportive

25. Parkinson’s disease Chronic, progressive degeneration of brain cells usually in people over 50 y.o. Chronic, progressive degeneration of brain cells usually in people over 50 y.o. Tremors, stiffness, muscular rigidity, forward leaning position, shuffling gait, mood swings, etc. Tremors, stiffness, muscular rigidity, forward leaning position, shuffling gait, mood swings, etc. Treatment is supportive and symptomatic Treatment is supportive and symptomatic

26. Shingles Herpes zoster Herpes zoster Inflammation of nerve cells caused by herpes virus Inflammation of nerve cells caused by herpes virus Same virus that causes chicken pox Same virus that causes chicken pox Occurs in thoracic area on one side of the body and follow path of affected nerves Occurs in thoracic area on one side of the body and follow path of affected nerves Itching, fever, increased skin sensitivity Itching, fever, increased skin sensitivity Treatment is to relieve pain and itching until inflammation subsides Treatment is to relieve pain and itching until inflammation subsides

27. Dementia General term defining a loss in at least two areas of complex behavior such as language, memory, visual/spatial abilities or judgment General term defining a loss in at least two areas of complex behavior such as language, memory, visual/spatial abilities or judgment Does not mean that everyone that is forgetful has dementia Does not mean that everyone that is forgetful has dementia

28. Alzheimer’s disease Progressive disease where initial symptom is usually a problem with remembering recently learning information Progressive disease where initial symptom is usually a problem with remembering recently learning information Nerve endings in the cortex of the brain degenerate and block signals Nerve endings in the cortex of the brain degenerate and block signals Cause is unknown and has 3 stages: Cause is unknown and has 3 stages: 1 st stage lasts 2-4 years and involves short-term memory loss, anxiety and poor judgment 1 st stage lasts 2-4 years and involves short-term memory loss, anxiety and poor judgment 2 nd stage lasts 2-10 years and increases memory loss, difficulty recognizing people, motor problems, loss of social skills 2 nd stage lasts 2-10 years and increases memory loss, difficulty recognizing people, motor problems, loss of social skills 3 rd stage lasts 1-3 years and includes inability to recognize self, weight loss, seizures, mood swings, and aphasia (loss of speech). 3 rd stage lasts 1-3 years and includes inability to recognize self, weight loss, seizures, mood swings, and aphasia (loss of speech).