1. Nervous System Diseases and Disorders
Chapter 15
Nervous System Diseases and Disorders 1

2. Anatomy and Physiology
Nervous system
Brain, spinal cord, and nerves
Central nervous system (CNS)
Brain
Spinal cord
Peripheral nervous system (PNS)
Autonomic nervous system
Cranial and spinal nerves 2

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

4. Common Signs and Symptoms
Symptoms specific to CNS:
Stiffness in neck, back, or extremities
Inability to move any part of body
Seizures or convulsions
Paralysis
Visual difficulties 4

5. Common Signs and Symptoms
Symptoms specific to CNS: (continued)
Inability to speak
Paralysis
Extreme or prolonged drowsiness
Stupor, unconsciousnes
Amnesia or extreme forgetfulness 5

6. Diagnostic Tests Cerebrospinal fluid
Measurement of intracranial pressure
X-rays of skull and vertebral column
Myelogram
Angiogram
Electroencephalography (EEG)
CT and MRI 6

7. Infectious Diseases Encephalitis
Inflammation of brain tissue caused by bacteria and viruses
Symptoms:
Headache
Elevated temperature
Stiff neck and back
Lethargy
Mental confusion
Coma
Treatment:
Treatment is supportive
Antiviral medication may be effective 7

8. Infectious Diseases Meningitis
Inflammation of meninges or coverings of brain and spinal cord
Causes:
Bacteria
Virus
Fungi
Toxins
E.g., lead, arsenic 8

9. Infectious Diseases Meningitis Symptoms: High fever Severe headaches
Photophobia
Stiffness and resistance in neck (nuchal rigidity)
Drowsiness, stupor, seizures
Coma 9

10. Infectious Diseases Meningitis Diagnosis Treatment
Lumbar puncture to find causative agent
Treatment
Antibiotics for bacterial infection
Antipyretics
Anticonvulsants
Quiet, dark environment 10

11. Infectious Diseases Poliomyelitis
Viral infection affecting brain and spinal cord
Cause:
Virus spread by oropharyngeal secretions and infected feces
Almost eliminated by vaccine in United States 11

12. Infectious Diseases Poliomyelitis Symptoms: Diagnosis Muscle weakness
Neck stiffness
Nausea and vomiting
Muscles atrophy and become paralyzed
Diagnosis
Virus culture from throat, feces, and/or spinal fluid 12

13. Infectious Diseases Poliomyelitis Supportive treatment: Analgesics
Bedrest during acute phase
Long-term physical therapy and braces may be needed
If respiratory system involved, mechanical ventilation may be needed 13

14. Infectious Diseases Tetanus Highly fatal infection of nerve tissue
Cause
Bacteria Clostridium tetani
First symptom:
Jaw stiffness
Commonly called lockjaw 14

15. Infectious Diseases Rabies An often fatal encephalomyelitis
Caused by virus
Primarily affects animals
E.g., dogs, cats, raccoons, squirrels
Transmitted to humans through bite of infected animal 15

16. Infectious Diseases Rabies Symptoms: Fever Pain Paralysis Convulsions
Rage
Spasms and paralysis of muscles for swallowing
Throat spasms leading to hydrophobia 16

17. Infectious Diseases Rabies Symptoms: Treatment: No cure
Inability to swallow
Drooling of frothy saliva
Treatment:
Immediate washing of area with soap and water
Anti-rabies injections
No cure 17

18. Infectious Diseases Shingles
Viral disease caused by herpes zoster (chicken pox virus)
Symptoms
Itchy, painful, red rash and small vesicles on sensory nerve paths
Symptoms last 10 days to several weeks
Diagnosis
Made based on the appearance of lesions
Viral culture test 18

19. Shingles
Photo courtesy Robert A. Silverman, MD, Pediatric Dermatology, Georgetown University 19

20. Infectious Diseases Shingles Treatment:
There is no cure
Treatment is symptomatic
Antivirals
Analgesics
Antipyretics
Antipruritics
Vaccine recommended by CDC for adults over age 60 20

21. Vascular Disorders Cerebrovascular accident (CVA) Also known as stroke
Is due to a poor blood supply to the brain
Causes
Cerebral thrombus
Cerebral embolism
Cerebral hemorrhage 21

22. Vascular Disorders CVA
Symptoms: numerous symptoms depending on the area of the brain affected and the severity of the CVA
Sudden loss of consciousness
Confusion
Poor coordination
Dysphasia
Dysphagia
Hemiparesis 22

23. Vascular Disorders CVA Diagnosis Treatment:
Physical exam, EEG, CT scan, and MRI
Treatment:
Anticoagulant
Hypertensive medications
Rehabilitation program 23

24. Vascular Disorders CVA Risk factors: Surgical prevention treatment:
Smoking
High-fat diet
Obesity
Lack of exercise
Surgical prevention treatment:
Carotid endarterectomy 24

25. Vascular Disorders Transient ischemic attacks (TIAs)
Also known as mini-strokes
Due to insufficient blood supply to brain
Symptoms:
Weakness of arm and/or leg
Dizziness
Slurred speech
Mild loss of consciousness 25

26. Vascular Disorders TIAs Symptoms last few minutes to 1 hour
Diagnosis by angiogram
Treatment:
Surgery to improve blood flow 26

27. Functional Disorders Degenerative disk disease Headaches Epilepsy
Bell’s palsy
Parkinson’s disease 27

28. Functional Disorders Degenerative disk disease
Degeneration or wearing away of intervertebral disk
Allows vertebrae to bump or rub against each other
Symptoms:
Difficulty walking
Radiating pain in back and in one or both legs
Diagnosis by X-ray, myelogram, CT scan, and MRI 28

29. Functional Disorders Degenerative disk disease Treatment:
Rest back and legs
Back brace
Analgesics
Anti-inflammatories
Exercise to ease pain
Surgery 29

30. Functional Disorders Headaches
One of the most common disorders in humans
Usually a symptom of another disease rather than a disorder in and of itself
Disorders that typically have headaches as a symptom include:
Sinusitis Meningitis
Encephalitis Hypertension
Anemia Constipation
Premenstrual tension Tumors 30

31. Functional Disorders Headaches Caused by two mechanisms:
Tension on facial, neck, and scalp muscles
Vascular changes in arterial size of vessels inside head
Contributing factors:
Stress
Toxic fumes
Noise
Lack of sleep
Alcohol consumption 31

32. Functional Disorders Headaches Headaches may be acute or chronic
Pain may be mild to unbearable and incapacitating
Pain may be constant, pressure, throbbing, stabbing, or intermittent
Types:
Tension
Cluster
Following lumbar puncture
Migraine 32

33. Functional Disorders Headaches Diagnosis: Treatment:
History and physical, X-ray, EEG, MRI, and CT
Treatment:
Lifestyle changes – improved diet, sleep, exercise
Analgesics
Bedrest
Muscle massage
Muscle relaxants
Warm baths
Biofeedback 33

34. Functional Disorders Epilepsy Chronic disease of brain
Intermittent episodes of abnormal electrical activity in brain
Symptoms:
Seizure
Convulsions 34

35. Functional Disorders Epilepsy Common types of seizures
Petit mal
Grand mal
Status epilepticus
Diagnosis by EEG, CT scan, cerebral angiogram, and blood tests
Treatment:
Anticonvulsive medications
Close monitoring and adjusting of medication 35

36. Functional Disorders Bell’s palsy
Affects facial nerve (7th cranial) leading to unilateral (one-sided) paralysis
Affects individuals 20 to 60 years of age
Symptoms:
Drooping weakness of eye and mouth
Inability to close the affected eye
Drooling of saliva 36

37. Functional Disorders Bell’s palsy Symptoms: (continued)
Unable to whistle or smile
Distorted facial appearance
Diagnosis by history and symptoms
Treatment:
Analgesics
Anti-inflammatories 37

38. Functional Disorders Parkinson’s disease
Slow, progressive brain degeneration
Cause is unknown, but may be related to a decrease of brain neurotransmitter – dopamine
Symptoms:
Rigidity and immobility of hand
Very slow speech pattern
Pill-rolling motion of fingers
Expressionless facial appearance 38

39. Functional Disorders Parkinson’s disease Symptoms: (continued)
Abnormal bent-forward posture
Short, fast-running steps with shuffling appearance
Symptomatic treatment:
Dopamine replacement
Physical and psychological therapy 39

40. Dementias Loss of mental ability due to loss of neurons or brain cells
Types of dementia
Senile (old age)
Alzheimer’s disease – the most common type of senile dementia
Senile and Alzheimer’s disease are often used synonymously, but they are not the same.
Vascular
Head trauma
Substance induced 40

41. Dementias Alzheimer’s disease A form of senile dementia
Usually affects individuals age 70 and older
Early symptoms:
Short-term memory loss
Inability to concentrate
Slight changes in personality 41

42. Dementias Alzheimer’s disease Symptoms of disease progression:
Diminished communication skills
Meaningless words
Inability to form sentences
Increased forgetfulness
Irritability and agitation 42

43. Dementias Alzheimer’s disease Diagnosis Treatment
Positive only by autopsy
Initially, diagnosis may be made by ruling out other brain diseases
Treatment
Supportive, no known cure
Focused on safety, maintaining nutrition, hydration, personal hygiene
Emotional support for family and caregivers 43

44. Dementias Vascular dementia
Atrophy and death of brain cells due to decreased blood flow
Atherosclerotic plaque can cause decreased blood flow
Common with aging 44

45. Dementias Vascular dementia Symptoms:
Changes in memory, personality, and judgment
Irritability
Depression
Sleeplessness
Lack of personal hygiene 45

46. Dementias Vascular dementia Diagnosis: Treatment:
History and physical, blood flow testing
Treatment:
Increasing blood flow to brain
Carotid endarterectomy 46

47. Dementias Head trauma dementia Death of brain cells due to head trauma
Symptoms:
Decrease in mental intellect and cognitive function
Loss of ability to reason, remember, or show appropriate emotions
Changes in personality 47

48. Dementias Head trauma dementia Diagnosis: Treatment: Prevention:
History, cranial X-rays, CT scan, and MRI
Treatment:
Correct damage, if possible
Therapy and rehabilitation
Prevention:
Is often easy to prevent with proper use of protective equipment 48

49. Dementias Substance-induced dementia
Brain cell death from drug toxicity and toxins
Toxic substances include:
Alcohol Cocaine
Heroine Lead
Mercury Paint fumes and thinner
Insecticides
Symptoms:
Mental impairment
Decreased cognitive ability 49

50. Sleep Disorders Insomnia The most common form of sleep disorder
Inability to fall or stay asleep
Cause:
Stress, pain, fear, depression, caffeine, alcohol, nicotine, and bronchodilators
Treatment:
Identifying and removing cause 50

51. Sleep Disorders Sleep apnea Characterized by periods of breathlessness
Cause:
More common in men
Obesity
Hypertension
Airway obstruction
Alcohol ingestion
Cigarette smoking 51

52. Sleep Disorders Sleep apnea Symptoms: Diagnosis: Daytime sleepiness
Extreme snoring
Changes in personality
Depression
Impotence
Diagnosis:
Monitoring affected individual during sleep for apnea and low blood oxygen levels 52

53. Sleep Disorders Sleep apnea Treatment: Prevention: Based on cause
Weight loss
Surgery to correct nasal obstruction
Oxygen during sleep
Medications to stimulate breathing
Prevention:
Most cases can be prevented by maintaining a healthy weight, avoiding alcohol, not smoking, and avoiding environmental smoke 53

54. Tumors Brain tumor Classified as primary and secondary
Primary tumors are called brain tumors
Secondary tumors are named after the organ of origin
Cause:
Unknown
Symptoms:
Headache
Vomiting
Seizures
Changes in mood and personality
Visual disturbance
Loss of memory 54

55. Tumors Diagnosis: Treatment: Clinical symptoms X-ray CT scan MRI
Biopsy
Treatment:
Surgery
Radiation
Chemotherapy 55

56. Trauma Concussions and contusions
Concussion less serious than contusion
Contusion is a physical bruising of the brain tissue
Cause
Blow to head by object, fall, or other trauma
E.g., automobile accident
Symptoms:
Disruption of normal electrical activity in brain – unconsciousness
Unconsciousness may last a few seconds to several hours
Headache
Blurred vision 56

57. Trauma Concussions and contusions Symptoms: (continued)
Irritability
Draw up knees and begin vomiting
Contusions can lead to:
Hematoma
Increased intracranial pressure (ICP)
Permanent brain damage
Coup and contrecoup contusions 57

58. Coup and Contrecoup 58

59. Trauma Concussions and contusions Diagnosis: Treatment:
History of injury, neurologic examination, cranial X-ray, CT scan, and MRI
Treatment:
Bedrest
Direct observation
Individual should be checked every 2 to 4 hours
Monitoring of changes in consciousness, eye pupil size, mood, and behavior
Analgesics, stimulants, and sedatives should not be given
Medications may mask symptoms and make assessment difficult 59

60. Trauma Skull fracture A break in a cranial (skull bone)
Greatest danger:
Brain tissue damage from bony fragments
Potential of cutting brain, severing vessels, causing hematoma
Brain damage may be temporary or permanent 60

61. Trauma Skull fracture Symptoms: Treatment:
Variety of symptoms depending on location of fracture
Fracture near base of skull may cause impaired breathing
Hemiparesis
Seizures
Infection
Treatment:
Dependent on type and position of fracture
Craniotomy may be necessary to relieve ICP
Protective headgear may be necessary until fracture healed 61

62. Trauma Epidural and subdural hematomas
Epidural hematoma is a collection of blood between the bony skull and dura mater (outer meninges)
Subdural hematoma is a collection of blood between the dura mater (outer layer) and the arachnoid (middle layer)
Subdural hematoma occurs twice as often as epidural 62

63. Trauma Epidural hematoma Cause: Symptoms:
Usually the result of a fight or accident
Blood vessels rupture and hemorrhage or seep blood usually rapidly over a period of hours
Symptoms:
Usually occur within a few hours
Headache
Dilated pupils
Nausea
Vomiting 63

64. Trauma Epidural hematoma Subdural hematoma Symptoms: (continued)
Dizziness
As the hematoma grows:
Loss of consciousness
Increase in ICP
Subdural hematoma
Cause:
Usually result of head hitting stationary object
As is seen with falls when the head hits the floor 64

65. Trauma Subdural hematoma Cause: (continued) Symptoms:
Blood vessels rupture and seep blood slowly, usually over a period of days
Symptoms:
Hemiparesis
Nausea and vomiting
Dizziness
Convulsions
Loss of consciousness 65

66. Trauma Epidural and subdural hematoma Diagnosis: Treatment:
Cerebral hematoma is made by
Clinical history
Cranial X-ray
CT or MRI
Treatment:
Goal is to decrease ICP
Pressure can be relieved by
Special craniotomy called burr holes
Electrical cauterization 66

67. Trauma Spinal cord injury
Usually results when bony spinal column is injured or fractured
The cord can be injured at any level
Neck area is most vulnerable
Cause:
Automobile accidents – leading cause
Gunshot and knife wounds
Falls and sports injuries 67

68. Trauma Spinal cord injury Symptoms: Varying degrees of injury
Injury to C1-C3 is usually fatal
Quadriplegia
Loss of movement and feeling in trunk and all four extremities
Loss of bowel, bladder, and sexual function
If severe, respiratory ventilation
Paraplegia
Loss of movement and feeling in trunk and both legs 68

69. Trauma Spinal cord injury Diagnosis: Emergency treatment: Treatment:
History of injury, neurologic exam, spinal X-rays, CT scan, and MRI
Emergency treatment:
Immediate treatment necessary
Do not move individual unless surroundings unsafe
Maintain position of spine with special collars and backboards
Treatment:
Realignment and stabilization of bony spinal column
Decompression or release of pressure on spinal cord
Prevent further injury 69

70. Rare Diseases Amyotrophic lateral sclerosis (ALS)
Also known as Lou Gehrig’s disease
Destructive disease of motor or movement neurons
Atrophy of muscles leading to progressive loss of movement of hands, arms, and legs
Supportive treatment
No cure 70

71. Rare Diseases Guillain-Barré syndrome
Acute, progressive disease affecting spinal nerves
Begins 10 to 21 days after febrile illness
Early symptoms:
Nausea
Fever
Malaise 71

72. Rare Diseases Guillain-Barré syndrome
Within 24 to 72 hours, paresthesia, muscle weakness, and paralysis usually begin
Symptoms may progress for several days to weeks
Once progression ceases, recovery begins
Supportive treatment
Recovery usually complete 72

73. Rare Diseases Huntington’s chorea Inherited disease
Appears during middle age
Progressive degenerative disease of brain
Leads to mental deterioration 73

74. Rare Diseases Huntington’s chorea Symptoms: Supportive treatment
Loss of muscle control and chorea
Changes in personality mood, and behavior
Loss of memory and dementia
Supportive treatment
No cure 74

75. Rare Diseases Multiple sclerosis (MS) Causes: Symptoms:
Demyelination of CNS nerves
Allows information to leak from nerve pathway
Leads to poor or absent nerve transmission
Symptoms:
Muscle weakness and lack of coordination
Paresthesia
Speech difficulty
Loss of bladder function
Visual disturbance, especially diplopia 75

76. Rare Diseases Multiple sclerosis Affects adults between ages 20 and 40
Periods of remission and exacerbation
Treatment:
Physical therapy
Muscle relaxants to maintain muscle tone and reduce spastic movement 76

77. Effects of Aging
Decreased nervous system activity in brain and spinal cord
Loss of short-term memory
Loss of visual acuity and peripheral vision
Altered sleep patterns 77