1. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Vascular Disorders: Cerebrovascular Accident (Stroke)  A cerebrovascular accident (CVA) occurs when the brain is damaged by a sudden disruption in the flow of blood to a part of the brain or by bleeding inside the head.

2. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cerebrovascular Accident (Stroke) (cont’d.)  Common symptoms include sudden:  severe headache  partial or total loss of the ability to articulate ideas or comprehend spoken or written language (aphasia)  weakness (hemiparesis), numbness, or paralysis (hemiplegia), confusion, or impaired consciousness  loss or blurring of vision, double vision (diplopia)  dizziness, loss of balance or coordination

3. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cerebrovascular Accident (Stroke) (cont’d.)  Causes  a CVA is usually a result of one of three types of vascular disorders:  blood clot (cerebral thrombosis)  cerebral hemorrhage  cerebral embolism  artery blockage (atherosclerosis) or hypertension (high blood pressure)

4. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cerebrovascular Accident (Stroke) (cont’d.)  Treatment  immediate medical intervention within three hours of stroke may limit brain damage. It includes: immediately chewing an aspirin immediately chewing an aspirin anticoagulants (to prevent clotting of blood) anticoagulants (to prevent clotting of blood) surgery to improve circulation and remove clots surgery to improve circulation and remove clots

5. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cerebrovascular Accident (Stroke) (cont’d.)  Prevention  Known risk factors include: smoking smoking excesses in diet and alcohol consumption excesses in diet and alcohol consumption high blood pressure high blood pressure diabetes diabetes

6. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Transient Ischemic Attack  Transient ischemic attacks (TIAs) are temporary episodes of impaired neurologic functioning caused by an inadequate flow of blood to a portion of the brain.

7. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Transient Ischemic Attack (cont’d.)  Symptoms  sudden weakness or numbness down one side of body (hemiparesis)  dizziness  dysphagia  confusion

8. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Transient Ischemic Attack (cont’d.)  Diagnosis  history and physical examination  cranial MRI scan  CT scan  EEG

9. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Transient Ischemic Attack (cont’d.)  Treatment  aspirin (as soon as symptoms appear)  anticoagulants  surgery (if needed to increase blood flow to the affected area)

10. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cerebral Concussion  A concussion is bruising of the cerebral tissue that is caused by violent back and forth movement of the head.  Blunt force trauma may also cause this condition.  A concussion causes a disruption of normal electrical activity in the brain, but the brain itself usually is not injured.

11. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cerebral Concussion (cont’d.)  Symptoms  immediate loss of consciousness: can be followed by a period of amnesia can be followed by a period of amnesia shallow respiration shallow respiration slower pulse slower pulse muscle tone flacid muscle tone flacid  Upon gaining consciousness, patient might experience: headache headache nausea/vomiting nausea/vomiting blurred vision blurred vision sensitivity to light (photophobia) sensitivity to light (photophobia)

12. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cerebral Concussion (cont’d.)  Diagnosis  complete neurological examination  CT scan  Treatment  bed rest  observation for behavioral changes

13. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cerebral Contusion  Contusion involves bruising the tissues along or just beneath the surface of the brain.  A contusion is more serious than a concussion.

14. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cerebral Contusion (cont’d.)  Symptoms  vary according to site and extent of injury and persist more than 24 hours  range from temporary consciousness to coma  when conscious: severe headache severe headache slight paralysis or weakness affecting one side of the body slight paralysis or weakness affecting one side of the body drowsiness, lethargy, combative mood drowsiness, lethargy, combative mood

15. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Cerebral Contusion (cont’d.)  Diagnosis  a complete neurological examination  CT scan  Treatment  hospitalization so vital signs can be monitored

16. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Paraplegia is the loss of nerve function below the waist and results in paralysis of the lower trunk and legs.  Quadriplegia is the loss of nerve function below the cervical region, resulting in paralysis of arms, hands, trunk, and legs. Spinal Cord Injuries: Paraplegia and Quadriplegia

17. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Paraplegia and Quadriplegia (cont’d.)  Symptoms  Paraplegia: loss of motor and sensory control in lower extremities and trunk loss of motor and sensory control in lower extremities and trunk loss of bladder, bowel, and sexual function loss of bladder, bowel, and sexual function  Quadriplegia: loss of motor and sensory control in upper and lower body loss of motor and sensory control in upper and lower body low blood pressure (hypotension) low blood pressure (hypotension) high body temperature (hyperthermia) high body temperature (hyperthermia) slow heart rate (bradycardia) slow heart rate (bradycardia) respiratory problems respiratory problems

18. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Paraplegia and Quadriplegia (cont’d.)  Causes  compression of vertebrae Trauma to the thoracic and lumbar regions of the spine (T1 and below) usually results in paraplegia. Trauma to the thoracic and lumbar regions of the spine (T1 and below) usually results in paraplegia.  hyperflexion of neck Trauma to the cervical vertebrae (C5 or above) can result in quadriplegia. Trauma to the cervical vertebrae (C5 or above) can result in quadriplegia.  hyperextension of spine Trauma occurring above C3 is usually fatal. Trauma occurring above C3 is usually fatal.

19. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Paraplegia and Quadriplegia (cont’d.)  Diagnosis  complete assessment of neurologic functioning  spinal radiographic films  MRI scans  CT scans

20. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Paraplegia and Quadriplegia (cont’d.)  Treatment  Main goals: restoration of normal alignment and stability of spine restoration of normal alignment and stability of spine decompression of the spinal cord, nerves, and vertebrae decompression of the spinal cord, nerves, and vertebrae early rehabilitation early rehabilitation  Surgery  Medications

21. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Intervertebral disks are located between the vertebrae.  The degeneration is usually the result of constant wearing on the disk through misalignment. Intervertebral Disk Disorders: Degenerative Disk Disease

22. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Degenerative Disk Disease (cont’d.)  Symptoms  pain that radiates down the nerve path  burning  can include loss of motor function in the legs  numbness and associated weakness of the legs

23. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Degenerative Disk Disease (cont’d.)  Diagnosis  Various imaging: MRI scan MRI scan myelogram with contrast myelogram with contrast rarely CT scan rarely CT scan

24. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Degenerative Disk Disease (cont’d.)  Treatment  resting back and lower extremities  bracing back  analgesics, NSAIDs  surgical intervention might be necessary (spinal fusion, freeing trapped nerves).  severe cases: electrical stimulation of the skin to relieve pain or a continuous flow of morphine

25. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Herniated and Bulging Disk  A herniated disk is a rupture of the nucleus pulposus, an elastic pulpy mass lying in the center of each intervertebral cartilage, which is housed in a circular wall structure (annulus).  When the nucleus pulposus extends into the inner annulus only, it is considered a bulging disk.  When the nucleus pulposus extends through the inner and outer annulus, it is considered a herniated disk.

26. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Herniated and Bulging Disk (cont’d.)

27. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Herniated and Bulging Disk (cont’d.)  Symptoms  Patient experiences severe back pain.  Pain may radiate from back to buttocks, thigh, and leg.  Possible disability can occur if disk pinches or pushes against spinal nerves.

28. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Herniated and Bulging Disk (cont’d.)  Causes  sudden impact  improper body mechanics when lifting  poor posture  aging (can cause disk to degenerate)

29. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Herniated and Bulging Disk (cont’d.)  Treatment (conservative)  bed rest for 24 to 48 hours  hot and cold packs  muscle relaxants  analgesics  back brace  Treatment (advanced)  Surgical excision of the herniated disk or related procedures to relieve the pressure against the spinal cord

30. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Spinal stenosis is brought about by trauma, degeneration, or rupture of the nucleus pulposus within intervertebral disks L4 through S1 (lower back).  The degeneration or rupture exerts pressure directly on the sciatic nerve, sending impulses down into the leg. Sciatic Nerve Injury – Spinal Stenosis

31. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Sciatic Nerve Injury – Spinal Stenosis (cont’d.)

32. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Symptoms  sharp, radiating pain from the sciatic nerve down the leg and to the foot  numbness  pain in lower back, buttocks, thighs, or calves  inability to sit or stand Sciatic Nerve Injury – Spinal Stenosis (cont’d.)

33. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Treatment  bed rest for 24 to 48 hours  back brace  strengthening core muscles (after inflammation subsides)  medications (analgesics, muscle relaxants, anti- inflammatories, and, in some cases, narcotics)  physical therapy  surgical intervention (partial or complete removal might be necessary in some cases) Sciatic Nerve Injury – Spinal Stenosis (cont’d.)

34. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  A pain located in the head that is not confined to any one specific nerve area  Two physiologic causes:  Tension headache results from strain on facial, neck, and scalp muscles.  Vascular headache is brought on when excess fluid in the blood vessels of the head causes the vessels to change in size. Functional Disorders – Headache

35. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Functional Disorders – Headache (cont’d.)  Symptoms  Pain may vary from dull to severe, be constant or intermittent, and have a throbbing, pressure, or penetrating sensation.  This may signal an underlying disorder or disease (hypertension, stroke, brain tumor, or encephalitis) but in most cases does not.

36. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Functional Disorders – Headache (cont’d.)  Treatment  If no underlying cause is found, the typical treatment includes: analgesics analgesics muscle relaxants muscle relaxants minor tranquilizers minor tranquilizers muscle massage muscle massage warm bath warm bath

37. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Migraine  periodic severe headaches that may completely incapacitate the individual and are almost always accompanied by other symptoms

38. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Migraine (cont’d.)  Symptoms  bilateral throbbing pain  nausea  vomiting  visual auras (zigzagging lines, flashing lights)  high sensitivity to light

39. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Migraine (cont’d.)  Treatment  bed rest in a quiet, dark room  analgesics  drug therapy (vasoconstrictors) to constrict blood vessels  antiemetics (to control vomiting)  relaxation therapy  biofeedback

40. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Epilepsy  a chronic brain disorder characterized by sudden episodes of abnormal intense electrical activity in the brain, which results in seizures  Epileptic seizures are classified as either:  partial  generalized

41. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Epilepsy (cont’d.)  Symptoms  partial seizure can involve motor movement, such as: rhythmic twitching rhythmic twitching compulsive lip smacking compulsive lip smacking picking at clothing picking at clothing sensory auras sensory auras amnesia of the attack amnesia of the attack

42. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Epilepsy (cont’d.)  Symptoms (cont’d.)  generalized seizures include: absence attacks (also called petit mal): characterized by frequent but transient lapses of consciousness and only rare spasms absence attacks (also called petit mal): characterized by frequent but transient lapses of consciousness and only rare spasms tonic-clonic attacks (also called grand mal): severe form of epilepsy characterized by seizures involving spasms and loss of consciousness tonic-clonic attacks (also called grand mal): severe form of epilepsy characterized by seizures involving spasms and loss of consciousness

43. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Epilepsy (cont’d.)  Causes  pathologic conditions associated with seizure include: scar tissue on the cerebral cortex from infection or trauma scar tissue on the cerebral cortex from infection or trauma tumor of the cerebral cortex tumor of the cerebral cortex cerebral edema cerebral edema stroke stroke birth trauma (cerebral palsy) birth trauma (cerebral palsy) drug toxicity (alcoholism) drug toxicity (alcoholism)

44. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Epilepsy (cont’d.)  Treatment  anticonvulsive medications  surgical intervention (rare) to remove a lesion in the brain

45. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Epilepsy (cont’d.)  First aid for seizures  Do: Cushion head. Cushion head. Loosen tight neckwear. Loosen tight neckwear. Turn person to the side. Turn person to the side. Look for identification. Look for identification.  Don’t: Put anything in mouth. Put anything in mouth. Hold person down. Hold person down.

46. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Parkinson Disease  a slowly progressive neurologic disorder that is linked to decreased dopamine production in the brain and is characterized by tremor, weakness of resting muscles, and a shuffling gait

47. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Parkinson Disease (cont’d.)  Symptoms  stooped posture  shuffling gait  head bowed, body flexed forward, prone to falling  “pill-rolling” (tremor of the thumb and forefinger)  expressionless facial features  muffled speech  difficulty swallowing

48. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Parkinson Disease (cont’d.)  Treatment  no cure known; managing symptoms only: physical therapy physical therapy drug therapy drug therapy  levodopa and carbidopa (drugs the body converts to dopamine)  antidepressants  anticholinergics (for tremor and rigidity)

49. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Huntington Chorea  a hereditary degenerative disease of the cerebral cortex and basal ganglia (mass of gray matter at the base of the cerebral hemisphere), which causes progressive atrophy of the brain

50. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Huntington Chorea (cont’d.)  Symptoms  loss of musculoskeletal control (mild fidgeting to lip smacking)  speech difficulties  deterioration of emotional state (personality changes, moody behavior, loss of memory, paranoia, dementia)

51. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Huntington Chorea (cont’d.)  Treatment  Since no cure is known, treatment focuses on symptom control of erratic movement and agitation through drug therapy.  Eventually, residential care could be necessary.

52. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Amyotrophic Lateral Sclerosis  also known as Lou Gehrig disease, a progressive motor neuron disease that results in motor atrophy

53. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Amyotrophic Lateral Sclerosis (cont’d.)  Symptoms  initially, small, involuntary contractions (fasciculations) of the forearms and hands  as disease progresses, muscle atrophy sets in and creates difficulties with: speech speech swallowing swallowing chewing chewing breathing breathing

54. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Amyotrophic Lateral Sclerosis (cont’d.)  Treatment  Since no cure is known, treatment is directed at controlling symptoms through drug therapy, maintaining pulmonary function, and providing supportive services.

55. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Transient Global Amnesia  a temporary amnesia of short duration (several hours) that is marked by sudden onset, loss of recent memories, and an inability to form new memories

56. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Transient Global Amnesia (cont’d.)  Symptoms  sudden onset of memory loss (includes current and recent events but not self-identity)  confusion  repetitive questioning (Where am I?, etc)  no recollection of events of past few hours or possibly days when amnesia period ends

57. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Transient Global Amnesia (cont’d.)  Cause is uncertain.  Suspected links:  stress or emotional events  swimming or immersion in cold water  previous migraine headache  Prognosis is good; recurrence very unlikely.

58. Chapter 13 Lesson 13.3

59. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  degeneration of the peripheral nerves that extend to the extremities, leading to muscle weakness and sensory loss Peripheral Nerve Disorders: Peripheral Neuritis

60. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Peripheral Neuritis (cont’d.)  Can be caused by:  chronic alcohol use  infectious diseases (mumps, pneumonia, diphtheria)  toxicity from various substances (arsenic, lead, etc.)  metabolic or inflammatory diseases (diabetes, rheumatoid arthritis, gout, lupus)  nutritional deficiency diseases

61. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Peripheral Neuritis (cont’d.)  Symptoms  clumsiness  loss of sensation in hands and feet  wasting of muscle tone  glossy or red appearance to skin  decreased sweating  possible foot drop

62. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Peripheral Neuritis (cont’d.)  Treatment  eliminate exposure to toxic substances  correct any nutritional deficiencies  control underlying diseases  stop alcohol consumption (if applicable)  physical therapy  analgesics

63. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Pain originates from fifth cranial nerve, also called the trigeminal nerve.  Most cases have no identified cause, but occasionally the condition is related to tumor, compression of a nerve, multiple sclerosis, or shingles. Trigeminal Neuralgia (Tic Douloureux)

64. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Trigeminal Neuralgia (Tic Douloureux) (cont’d.)

65. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Symptoms  sudden onset of excruciating pain that may affect one or more nerve branches ophthalmic branch: causes pain in the eye and forehead ophthalmic branch: causes pain in the eye and forehead maxillary branch: involves the nose, upper lip, and cheek maxillary branch: involves the nose, upper lip, and cheek mandibular branch: affects lower lip and outer portion of the tongue and cheek near the ear mandibular branch: affects lower lip and outer portion of the tongue and cheek near the ear Trigeminal Neuralgia (Tic Douloureux) (cont’d.)

66. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Treatment  analgesics for pain  surgical intervention might be necessary to dissect nerve roots.  cessation of smoking (if applicable) Trigeminal Neuralgia (Tic Douloureux) (cont’d.)

67. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Bell Palsy  disorder of the facial nerve that causes a sudden onset of weakness or paralysis of facial muscles  can result from blockage of impulses from the facial nerve caused by compression of the nerve

68. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Bell Palsy (cont’d.)  Symptoms (usually unilateral)  pain or drawing sensation behind the ear  inability to open or close the eye  drooping of mouth  drooling of saliva  distorted facial expression

69. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Bell Palsy (cont’d.)  Treatment  warm, moist gentle heat  massage  facial exercises  prednisone (synthetic steroid) to reduce edema of facial nerve  analgesics  electrotherapy to stimulate nerves and prevent atrophy of muscles

70. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Trigeminal Neuralgia and Bell Palsy – Compare/Contrast Similarities  both caused by disorder of facial nerve  sudden onset  unilateral  Bell Palsy  sudden paralysis  motor function impaired  prognosis is good if treated early Differences Trigeminal extreme pain no motor function impairment prognosis varies

71. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  inflammation of the meninges, the membranous coverings of the brain, and the spinal cord Infectious Disorders – Meningitis

72. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Symptoms  vomiting  headache that increases in intensity with movement or shaking of head  neck stiffness (nuchal rigidity)  drowsiness  irritability  high sensitivity to light (photophobia)  hypersensitivity of the skin Infectious Disorders – Meningitis (cont’d.)

73. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Diagnosis  includes a lumbar puncture to determine if cerebrospinal fluid (CSF) has increased levels of white blood cells, protein, and glucose  if so, resulting growth of microbes in cultured CSF confirms diagnosis Infectious Disorders – Meningitis (cont’d.)

74. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Treatment  aggressive antibiotic therapy  anticonvulsive drugs to control seizure activity  aspirin or acetaminophen for headache  dark and quiet environment Infectious Disorders – Meningitis (cont’d.)

75. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Encephalitis  Encephalitis is an inflammation of the brain that leads to cerebral edema and subsequent cell destruction.  Most cases are the result of a bite from an infected mosquito.  Can also be caused by viruses or the toxins from chickenpox, measles, or mumps.

76. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Encephalitis (cont’d.)  Symptoms  headache  elevated body temperature  neck and back stiffness  muscular weakness  restlessness  visual disturbances  lethargy  mental confusion that may progress to disorientation and even to coma

77. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Encephalitis (cont’d.)  Diagnosis  blood tests  cerebrospinal fluid sample  EEG

78. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Encephalitis (cont’d.)  Treatment  antiviral agents effective against herpes simplex encephalitis.  otherwise: mild analgesics for pain mild analgesics for pain anticonvulsive anticonvulsive antibiotics for any present infection antibiotics for any present infection

79. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Guillain-Barré Syndrome  An acute, rapidly progressive disease of the spinal nerves  This condition is thought to have an autoimmune basis and has been known to follow a respiratory infection or gastroenteritis.

80. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Guillain-Barré Syndrome (cont’d.)  Symptoms  tingling and numbness of feet and hands at onset of disease  followed by: increasing muscle pain and tenderness increasing muscle pain and tenderness progressive muscle weakness progressive muscle weakness paralysis paralysis difficulty swallowing difficulty swallowing

81. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Guillain-Barré Syndrome (cont’d.)  Treatment  hospitalization required for observation  blood plasma washed to remove antibodies (called plasmapheresis) and speed recovery

82. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Brain Abscess  a collection of pus anywhere in the brain tissue  can be caused by a local infection or secondary infections elsewhere in the body

83. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Brain Abscess (cont’d.)  Symptoms  headache (prime symptom)  other symptoms depend on location and extent of abscess, amount of cranial pressure, and can include: nausea and vomiting nausea and vomiting visual disturbances visual disturbances unequal pupil size (anisocoria) unequal pupil size (anisocoria) seizures seizures

84. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Brain Abscess (cont’d.)  Treatment  intravenous antibiotics  mannitol or steroids to reduce cerebral edema  surgical drainage of abscess to relieve pressure

85. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Poliomyelitis is a viral infection of the gray matter of the spinal cord that causes a selective destruction of the motor neurons.  Postpolio syndrome is a condition affecting poliomyelitis patients several decades after the initial attack, characterized by fatigue, muscular deterioration, pain in the joints, and respiratory problems. Poliomyelitis and Postpolio Syndrome

86. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Symptoms  low-grade fever  profuse discharge from nose  malaise  these symptoms are followed by: muscle weakness muscle weakness stiff neck stiff neck nausea and vomiting nausea and vomiting atrophy of muscles atrophy of muscles muscle and joint deterioration muscle and joint deterioration Poliomyelitis and Postpolio Syndrome (cont’d.)

87. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Treatment  analgesics  moist heat  bed rest  physical therapy  leg braces  mechanical ventilation Poliomyelitis and Postpolio Syndrome (cont’d.)

88. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  These tumors can be primary (originate in the brain itself) or secondary (cancer that has metastasized from another area of the body). Intracranial Tumors (Brain Tumors)

89. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Symptoms result from a displacement and compression of normal brain tissue by the tumor and include:  headache (usually dull, constant, and worse at night or in the morning)  seizures  nausea and vomiting  loss of consciousness  cognitive dysfunction (memory problems and personality changes) Intracranial Tumors (Brain Tumors) (cont’d.)

90. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Diagnosis  detailed history  neurologic examination  diagnostic imaging studies cranial MRI (preferred option) cranial MRI (preferred option) functional MRI functional MRI  tissue sample (from surgery or biopsy) Intracranial Tumors (Brain Tumors) (cont’d.)

91. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Treatment – primary tumors  benign and malignant tumors often treated similarly  surgery  radiotherapy  chemotherapy  anticonvulsants to treat seizures  corticosteroids to help decrease intracranial pressure  anticoagulants to prevent blood clotting Intracranial Tumors (Brain Tumors) (cont’d.)

92. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Treatment – secondary tumors  focuses on relief of neurological symptoms and long-term tumor control  patients with solitary brain lesions and no other sites of metastasis undergo: surgery surgery whole brain radiation therapy whole brain radiation therapy Intracranial Tumors (Brain Tumors) (cont’d.)

93. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.  Prognosis  The five-year survival rate for all types of brain tumors combined is 32%, which is among the lowest for all types of cancer. Intracranial Tumors (Brain Tumors) (cont’d.)