0. Essentials of Human Diseases and Conditions 4th edition
Margaret Schell Frazier
Jeanette Wist Drzymkowski

1. Chapter 13 Neurologic Diseases and Conditions

2. Learning Objectives Name the main components of the nervous system.
List some of the problems to which the nervous system is susceptible.
Describe how data are collected during a neurologic assessment.
Name the common symptoms and signs of a cerebrovascular accident (CVA).

3. Learning Objectives (cont’d.)
Name the three vascular disorders that may cause a CVA.
Define a transient ischemic attack (TIA).
Distinguish between (a) epidural and subdural hematomas and (b) cerebral concussion and cerebral contusion.
Name three mechanisms of spinal injuries.
Name the goals of treatment of spinal cord injuries.

4. Learning Objectives (cont’d.)
Explain the neurologic consequences of the deterioration or rupture of an intervertebral disk.
Describe the symptoms of migraine.
Explain why cephalalgia sometimes is considered a symptom of underlying disease.
Describe first aid for seizures.

5. Learning Objectives (cont’d.)
Explain how the symptoms of Parkinson disease are controlled.
Describe the progression of amyotrophic lateral sclerosis (ALS).
Discuss transient global amnesia.
Distinguish between trigeminal neuralgia and Bell palsy.

6. Learning Objectives (cont’d.)
List the diagnostic tests used for meningitis and explain how the causative organism is identified.
Name the common causes of encephalitis.
Explain the pathologic course of Guillain-Barré syndrome.
Explain what is meant by postpolio syndrome.

7. Chapter 13 Lesson 13.1

8. Orderly Function of the Nervous System
The nervous system is a complex network comprised of:
neurons (nerve cells that make up the brain)
spinal cord
nerves
What structures carry electrical impulses through the body?

9. Orderly Function of the Nervous System (cont’d.)
The nervous system is composed of two divisions:
central nervous system (brain and spinal cord)
peripheral nervous system (nerves that radiate from the spinal cord throughout the body)
What are the functions of each division?

10. Orderly Function of the Nervous System (cont’d.)
Peripheral nervous system is divided into two parts:
sympathetic
parasympathetic
together, these regulate the voluntary (muscle movements) and involuntary (heart rate) functions of the body
The sympathetic and parasympathetic work in tandem with one another to coordinate all of the body’s functions.
What are other examples of voluntary and involuntary functions of the body?

11. The Peripheral Nervous System
Discuss the labeled parts of the peripheral nervous system on the figures.
Note how the peripheral nerves radiate from the spinal cord to the rest of the body; hence the term “peripheral.”

12. Orderly Function of the Nervous System (cont’d.)
The nervous system is susceptible to various problems:
vascular compromise and circulatory deficits
injury
infection
inherited defect
congenital defect
degeneration
tumor
Some of the most common diseases and conditions that affect the nervous system will be explored later in the presentation.
What are some other problems that affect the nervous system?

13. Neurologic Assessment
There is a variety of methods to evaluate neurologic status and cognitive function.
Take thorough medical history, including any medications.
Test mental functions (speech, language, and writing skills).
Test cranial nerve function (sense of smell, vision, taste, hearing, swallowing, etc.).
Test motor function (muscle strength and tone).
Test coordination and balance.
Test sensory function (diminished or abnormal sensation).
These tests are all part of a comprehensive neurologic assessment.
What might a doctor test for sensory function?
What diseases might be present if mental functions appear impaired?

14. 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.
CVA is the number one cause of disability in adults.
The brain tissue in the affected area is starved for blood.
What does the blood have that is essential for the brain’s function?

15. Cerebrovascular Accident (Stroke) (cont’d.)
Note the blockage in the artery and how it starves the remaining section of the brain of blood and oxygen.
Damage in this area can result in the following symptoms described.

16. 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
Different areas of the brain control different functions.
Symptoms vary depending on which area of the brain is affected by the stroke.
What is the worst result of a stroke? (coma or death)

17. 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)
How do strokes occur? can also result from systemic diseases such as diabetes and syphilis.
What lifestyle and hereditary issues can also contribute to being at risk for a stroke?

18. Cerebrovascular Accident (Stroke) (cont’d.)
Treatment
immediate medical intervention within three hours of stroke may limit brain damage. It includes:
immediately chewing an aspirin
anticoagulants (to prevent clotting of blood)
surgery to improve circulation and remove clots
The goal of medical treatment is to restore lost functions and treat underlying disorders.
Which health care professionals might be on the team of treating a patient with a stroke?
Some permanent disability may remain after the initial treatment and recovery.

19. Cerebrovascular Accident (Stroke) (cont’d.)
Prevention
Known risk factors include:
smoking
excesses in diet and alcohol consumption
high blood pressure
diabetes
What risk factors does the patient have no control over?
How would you encourage someone at risk for a stroke to begin making lifestyle changes?

20. 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.
Why are TIAs referred to as “little strokes” or “mini strokes”? (Because they resemble a stroke caused by an embolism.)

21. Transient Ischemic Attack (cont’d.)
Symptoms
sudden weakness or numbness down one side of body (hemiparesis)
dizziness
dysphagia
confusion
Do TIAs cause unconsciousness? (No, they last a few seconds to a few hours and then subside.)
TIAs are signals of an impending stroke.

22. Transient Ischemic Attack (cont’d.)
Diagnosis
history and physical examination
cranial MRI scan
CT scan
EEG
What causes a TIA? (The most immediate cause is a piece of plaque that breaks away from an artery or heart valve and travels to the brain.)
This is known as an embolism or moving clot.
What is plaque and how does it develop?

23. Transient Ischemic Attack (cont’d.)
Treatment
aspirin (as soon as symptoms appear)
anticoagulants
surgery (if needed to increase blood flow to the affected area)
What is the likely prognosis for a patient who has had a TIA? (Prognosis varies according to the extent and duration of the episodes.) Most attacks have minimal effects.
Stress reduction and lifestyle changes should be implemented as a means of reducing risk.
What ways could a person reduce the stress in his or her life?

24. Head Trauma: Epidural and Subdural Hematomas
An epidural hematoma is a mass of blood that forms between the skull and the dura mater, the outermost of the three membrane layers that cover the brain.
A subdural hematoma is a similar mass, but it forms beneath the dura mater.
What is the definition of a hematoma? (A localized swelling filled with blood resulting from a break in a blood vessel.)

25. Epidural and Subdural Hematomas (cont’d.)
Note the location of the mass.
In the epidural hematoma, the mass is located on the outside of the dura mater vs. beneath in the subdural, hence the term “sub.”

26. Epidural and Subdural Hematomas (cont’d.)
Symptoms usually appear within a few hours of head trauma and include:
sudden headache
dilated pupils
nausea and vomiting
increased drowsiness
slight paralysis or weakness affecting one side of the body (hemiparesis)
Pressure on the brain from either of these hematomas can result in impaired functioning or even death.
This condition is considered a neurological emergency.
What are the symptoms of subdural hematoma? (Symptoms of subdural hematoma are similar to epidural hematoma except the onset is slower and may mimic symptoms of TIA or stroke. Double-vision is common with a subdural hematoma.)

27. Epidural and Subdural Hematomas (cont’d.)
Treatment
If consciousness is lost, a craniotomy (burr hole drilled in the skull to relieve pressure) might be necessary.
If patient is conscious, medical attention should be sought immediately.
What is the usual cause? (Head trauma)
What are the symptoms? (Head pain and symptoms following an injury require immediate medical attention.)
When a craniotomy is performed promptly, a complete recovery is possible.
What does loss of consciousness indicate in this situation?

28. 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.
What is an example of violent back and forth motion that could cause a concussion?

29. Cerebral Concussion (cont’d.)
Symptoms
immediate loss of consciousness:
can be followed by a period of amnesia
shallow respiration
slower pulse
muscle tone flacid
Upon gaining consciousness, patient might experience:
headache
nausea/vomiting
blurred vision
sensitivity to light (photophobia)
Unconsciousness may last from a few seconds to several minutes.
Amnesia may last 12 to 24 hours.

30. Cerebral Concussion (cont’d.)
Diagnosis
complete neurological examination
CT scan
Treatment
bed rest
observation for behavioral changes
Many people fully recover from a concussion with no lasting damage.
What are some common reasons why concussions occur?
What are practical ways people could prevent a concussion in normal circumstances?

31. Cerebral Contusion
Contusion involves bruising the tissues along or just beneath the surface of the brain.
A contusion is more serious than a concussion.
How does a contusion occur? (Caused by a blow to the head or hitting a hard surface, such as in an automobile accident.)
The twisting of the two brain hemispheres when colliding with cranial bones may cause damage deep within the brain.

32. 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
slight paralysis or weakness affecting one side of the body
drowsiness, lethargy, combative mood
Because permanent damage to the brain could occur from a contusion caused by subdural and epidural hematomas immediate medical attention is needed with this condition.

33. Cerebral Contusion (cont’d.)
Diagnosis
a complete neurological examination
CT scan
Treatment
hospitalization so vital signs can be monitored
Why must vital signs be monitored?
What neurological aspects would be particularly important to assess during the neurological exam?

34. Depressed Skull Fracture
A fractured skull occurs when a break or fracture occurs in one of the bones of the cranium.
When one or more of these skull bones are depressed or torn loose, they are pushed below the normal surface of the skull.
The bones that are depressed and pushed into the brain cause injury.
How is this caused? (Direct impact with a blunt object is the most common cause of depressed fractures.)

35. Depressed Skull Fracture (cont’d.)
Notice the depressed skull fracture and how the bone is broken and pushed into the cerebral tissue.
The comminuted fracture occurs when the bone is pulverized or shattered at the point of fracture.

36. Depressed Skull Fracture (cont’d.)
Symptoms
varies based upon site of fracture
typically not progressive, but static until bone causing pressure is removed
For instance, a depressed fracture that presses on the motor area of the brain might cause paralysis on one side of the body.
Epilepsy is a common complication of depressed skull fractures.
How might a person sustain a depressed skull fracture? (Industrial accident, car accident)

37. Depressed Skull Fracture (cont’d.)
Treatment
focused on relieving intracranial pressure, usually by performing a craniotomy to raise the depressed bone to its original place
head protection worn until the fracture at least partially healed
Prognosis is unpredictable and depends on several factors, such as extent of the injury and other medical conditions.
How would you persuade parents to require their child to wear a bike helmet?

38. Spinal Cord Injuries: Paraplegia and Quadriplegia
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.
Both conditions occur when the spinal cord is injured.
The location of the injury on the spinal cord usually determines the extent of the paralysis.

39. Paraplegia and Quadriplegia (cont’d.)
Symptoms
Paraplegia:
loss of motor and sensory control in lower extremities and trunk
loss of bladder, bowel, and sexual function
Quadriplegia:
loss of motor and sensory control in upper and lower body
low blood pressure (hypotension)
high body temperature (hyperthermia)
slow heart rate (bradycardia)
respiratory problems
Why does damage to the spinal cord lead to some degree of permanent disability? (nerve pathways control many bodily functions and actions)
Spinal cord damage may be only temporary.

40. 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.
hyperflexion of neck
Trauma to the cervical vertebrae (C5 or above) can result in quadriplegia.
hyperextension of spine
Trauma occurring above C3 is usually fatal.
What determines the result of an injury? (The site of the injury, the type of trauma to the spinal cord, and severity of trauma usually determine whether the person will be paraplegic or quadriplegic.)

41. Spinal Injuries (cont’d.)
Notice the location of the various spinal injuries in each diagram and how these correspond to the degree of paralysis.

42. Paraplegia and Quadriplegia (cont’d.)
Diagnosis
complete assessment of neurologic functioning
spinal radiographic films
MRI scans
CT scans
A variety of assessments and scans are needed to determine the extent of the injuries.
What parts of the body could a typical paraplegic have some measure of control over?
What parts of the body could a typical quadriplegic have some measure of control over?

43. Paraplegia and Quadriplegia (cont’d.)
Treatment
Main goals:
restoration of normal alignment and stability of spine
decompression of the spinal cord, nerves, and vertebrae
early rehabilitation
Surgery
Medications
When should treatment begin for a patient rendered a paraplegic or quadriplegic? (The earlier treatment begins, the better the prognosis. Partial or total severing of the spinal cord results in permanent, irreversible damage and paralysis below the point of injury.)

44. Chapter 13 Lesson 13.2

45. Intervertebral Disk Disorders: Degenerative Disk Disease
Intervertebral disks are located between the vertebrae.
The degeneration is usually the result of constant wearing on the disk through misalignment.
A constant rubbing on the disk results in inflammation and gradual destruction of the disk.
The inflammation eventually involves the spinal nerve roots and causes scarring.

46. 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
How does degenerative disk disease differ from injury to the spinal cord through trauma?
Why might there be a loss of motor function in the legs?

47. Degenerative Disk Disease (cont’d.)
Diagnosis
Various imaging:
MRI scan
myelogram with contrast
rarely CT scan
Why might more than one imaging technique be used to diagnosis a disk disorder?

48. 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
What are transcutaneous electrical nerve stimulation (TENS) units?

49. 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.
What is a herniated disk called? (also known as a ruptured or slipped disk)
What are intervertebral disks?

50. Herniated and Bulging Disk (cont’d.)
Notice how in both diagrams the bulging disk (B) and herniated disk (C) are pressing against the spinal cord, which results in pain.
How does the herniated disk differ from the bulging disk? (It has pushed out of the annulus.)

51. 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.
What is sciatica?
Most herniated disks occur in the lower back.
What would cause the pain to radiate to other parts of the body?

52. Herniated and Bulging Disk (cont’d.)
Causes
sudden impact
improper body mechanics when lifting
poor posture
aging (can cause disk to degenerate)
How are herniated disks diagnosed? (Physical examination along with CT and MRI scans may be used in diagnosis.)

53. 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
Many herniated disks resolve with rest.
When surgical intervention is necessary, the outcome is usually favorable.
What constitutes good body mechanics when lifting a heavy object?

54. Sciatic Nerve Injury – Spinal Stenosis
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.
Spinal stenosis, a narrowing of the spinal canal, is often termed sciatica because of the compression on the spinal cord and spinal cord roots.

55. Sciatic Nerve Injury – Spinal Stenosis (cont’d.)
Note the location of the vertebrae and the associated pain in the sciatic nerve.
The pain then radiates through the buttocks and leg.
What is a common name for the coccyx? (tailbone)

56. Sciatic Nerve Injury – Spinal Stenosis (cont’d.)
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
What contributes to spinal stenosis? (Trauma to the sciatic nerve may result from a fall, poor body mechanics, or other injury.)
Aging process and arthritis can cause a narrowing of the spinal canal.

57. Sciatic Nerve Injury – Spinal Stenosis (cont’d.)
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)
A physical examination and a series of images may be taken (radiographic, MRI, CT) to diagnose the condition.
What are the “core” muscles, and why are they important?
What purpose do narcotics serve in the treatment of pain?

58. Functional Disorders – Headache
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.
Headaches may be chronic or acute and are located in the frontal, temporal (side), or occipital (back) regions of the head.
While there are many environmental causes of headaches, there are only two physiologic causes.
What are environmental factors that might also cause headache?

59. 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.
Brain tissues themselves never ache because they do not contain sensory nerves.
Headaches are also called cephalalgia.
Under what circumstances do you get headaches?

60. Functional Disorders – Headache (cont’d.)
Treatment
If no underlying cause is found, the typical treatment includes:
analgesics
muscle relaxants
minor tranquilizers
muscle massage
warm bath
Physical examination and imaging scans are often needed to diagnose the cause of the headache.
Most headaches subside in a reasonable amount of time.
Stress reduction and relaxation techniques may also help.
What are ways to reduce stress and possibly the frequency of headaches?

61. Migraine
periodic severe headaches that may completely incapacitate the individual and are almost always accompanied by other symptoms
The nature of the attack varies by person but may be preceded by a period of abnormal fatigue or irritation.
Susceptibility to migraines tends to run in families, leading to a strong suspicion of inherited or genetic links to this disorder.
In some cases, foods (aged cheese, chocolate, and red wine) can be linked to an attack.

62. Migraine (cont’d.) Symptoms bilateral throbbing pain nausea vomiting
visual auras (zigzagging lines, flashing lights)
high sensitivity to light
Headaches may begin in adolescence or early adulthood and become less frequent with age.
Migraines affect women twice as often as men.
Why might women be more susceptible to migraines than men?

63. 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
An EEG, CT scan, or MRI may be used to diagnose and rule out any organic conditions.
Prognosis is good when drug therapy and rest are applied.
What psychosocial factors might “trigger” an attack?

64. 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
Epilepsy takes many forms – there are more than 30 types of seizures known.
It is possible for a person to have more than one type.
What is a seizure?

65. Epilepsy (cont’d.) Symptoms
partial seizure can involve motor movement, such as:
rhythmic twitching
compulsive lip smacking
picking at clothing
sensory auras
amnesia of the attack
Partial seizures do not involve the entire brain but arise from a localized area in the brain.
There is no loss of consciousness with partial seizures.

66. 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
tonic-clonic attacks (also called grand mal): severe form of epilepsy characterized by seizures involving spasms and loss of consciousness
Generalized seizures can cause a diffuse electrical abnormality in the brain.
Tonic-clonic seizures may begin with a loud cry, followed by falling to the ground, and loss of consciousness.
What should you do if you encountered someone who was having a seizure?
Seizures usually subside in 1 to 2 minutes.
Status epilepticus occurs when one seizure follows another with no recovery of consciousness between attacks. This is a medical emergency.

67. Epilepsy (cont’d.) Causes
pathologic conditions associated with seizure include:
scar tissue on the cerebral cortex from infection or trauma
tumor of the cerebral cortex
cerebral edema
stroke
birth trauma (cerebral palsy)
drug toxicity (alcoholism)
Not all seizures imply epilepsy.
Classification of epilepsy is based on the location of abnormal activity and its duration.
An EEG, MRI, and CT scan may be used in diagnosis.

68. Epilepsy (cont’d.) Treatment anticonvulsive medications
surgical intervention (rare) to remove a lesion in the brain
Drug therapy is often sufficient to control seizure activity.
Status epilepticus is a life-threatening event and needs immediate medical attention.

69. Epilepsy (cont’d.) First aid for seizures Do: Don’t: Cushion head.
Loosen tight neckwear.
Turn person to the side.
Look for identification.
Don’t:
Put anything in mouth.
Hold person down.
Why shouldn’t anything be put into the mouth of a person who is having a seizure?
What should be done if a seizure lasts more than five minutes, or the person is having a difficult time recovering? (Call for medical help.)

70. 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
Dopamine is a neurotransmitter manufactured in the midbrain.

71. 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
Mean onset is 60 years of age.
Afflicts more men than women.
Diagnosis is made after careful neurologic examination.
Decreased dopamine levels may be noted in the urine.

72. Parkinson Disease (cont’d.)
Treatment
no cure known; managing symptoms only:
physical therapy
drug therapy
levodopa and carbidopa (drugs the body converts to dopamine)
antidepressants
anticholinergics (for tremor and rigidity)
What advantages might physical therapy provide?
Would it be important for family members to participate in physical therapy? Why or why not?

73. 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
A cerebral CT scan can show brain atrophy.
DNA analysis can detect a defective gene.
History of progressive chorea and dementia are risk factors.
Other definitive diagnoses do not exist.

74. 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)
Typically the arms and face are first affected by lack of muscle control.
Other symptoms may be subtle.
The onset of symptoms typically begins in early middle age.

75. 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.
What should a family be told about the progressive nature of Huntington Chorea at the time of diagnosis?
If you were a patient with HC, how much would you want to know?

76. Amyotrophic Lateral Sclerosis
also known as Lou Gehrig disease, a progressive motor neuron disease that results in motor atrophy
The cause of ALS is not known, but inherited traits are suspected.
Who was Lou Gehrig?

77. 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
swallowing
chewing
breathing
Functioning of the mind is not affected.
Affects slightly more men than women.
Onset usually occurs after the age of 50 to 60 years.

78. 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.
Death usually occurs within six to 10 years.
What happens if pulmonary function ceases?

79. 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
Although frightening, it is usually a benign event.
Amnesia may last from one to 12 hours and cover the entire memory for that duration of time, resulting in total loss of recent memory.

80. 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
Memory loss may include the preceding three to five years.
The person may be able to perform routine tasks with out a problem.
Neurologic signs are typically normal.

81. 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.
The individual will probably never regain memory of the events that occurred during the episode or the hours or days that immediately preceded the episode.
Why might stress “trigger” such a loss of memory?

82. Chapter 13 Lesson 13.3

83. Peripheral Nerve Disorders: Peripheral Neuritis
degeneration of the peripheral nerves that extend to the extremities, leading to muscle weakness and sensory loss
Onset is sudden and progressive.

84. 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
How much alcohol usage is considered “safe” when it comes to general health guidelines?
Peripheral neuritis is common with diabetes.
What is diabetes?

85. 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
Atrophied muscles show diminished deep tendon reflexes and tenderness.
If leg and/or foot are affected, foot drop may be experienced as a symptom. What is foot drop?

86. 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
Control of underlying causes may provide substantial relief of symptoms.
How might proper nutrition help this condition?

87. Trigeminal Neuralgia (Tic Douloureux)
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.
The excruciating pain that typically results from this condition can be debilitating.

88. Trigeminal Neuralgia (Tic Douloureux) (cont’d.)
The diagram shows the trigeminal nerve and its branches.
Note the coverage of the nerve and how large an area of the face may be affected.

89. Trigeminal Neuralgia (Tic Douloureux) (cont’d.)
Symptoms
sudden onset of excruciating pain that may affect one or more nerve branches
ophthalmic branch: causes pain in the eye and forehead
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
The pain is always unilateral and does not cross the midline of the face.
What kinds of daily activities might “trigger” pain from this condition?

90. Trigeminal Neuralgia (Tic Douloureux) (cont’d.)
Treatment
analgesics for pain
surgical intervention might be necessary to dissect nerve roots.
cessation of smoking (if applicable)
Episodes may last from months to years and then subside.
Infection of a sinus or tooth must first be ruled out during the diagnosis.

91. 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
The seventh cranial nerve is responsible for this condition.

92. 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
This disorder is often first noticed in the morning, having developed overnight.
Condition is usually unilateral.
May be transient or permanent.
Occurs between the ages of 20 and 60 years of age in men and women alike.

93. 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
Complete recovery is possible if disease is treated early.
Recovery is often spontaneous, especially in younger individuals.

94. Trigeminal Neuralgia and Bell Palsy – Compare/Contrast
Similarities
both caused by disorder of facial nerve
sudden onset
unilateral
Differences
Trigeminal
extreme pain
no motor function impairment
prognosis varies
Bell Palsy
sudden paralysis
motor function impaired
prognosis is good if treated early
Which disorder would be most difficult to live with?

95. Infectious Disorders – Meningitis
inflammation of the meninges, the membranous coverings of the brain, and the spinal cord
The infection can originate directly from the brain, spinal cord, or sinuses.

96. Infectious Disorders – Meningitis (cont’d.)
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
Drowsiness can progress to coma.
Seizure may be present.
Early symptoms may not appear severe enough to warrant treatment.
Which of these symptoms are not typically present with influenza?

97. Infectious Disorders – Meningitis (cont’d.)
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
What does the presence of elevated levels of white blood cells, protein, and glucose, indicate the body is attempting to do?

98. Infectious Disorders – Meningitis (cont’d.)
Treatment
aggressive antibiotic therapy
anticonvulsive drugs to control seizure activity
aspirin or acetaminophen for headache
dark and quiet environment
Bacterial forms of meningitis respond well to antibiotics; viral strains usually run their course and patient recovers.
What are common preventative practices to avoid infections, including meningitis?

99. 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.
How is West Nile encephalitis contracted?

100. 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
Symptoms may have a sudden or gradual onset.

101. Encephalitis (cont’d.)
Diagnosis
blood tests
cerebrospinal fluid sample
EEG
How is a diagnosis determined?
How is cerebral fluid obtained?
Blood and cerebrospinal fluid will reveal the presence of the virus.
The EEG will also show abnormalities.

102. Encephalitis (cont’d.)
Treatment
antiviral agents effective against herpes simplex encephalitis.
otherwise:
mild analgesics for pain
anticonvulsive
antibiotics for any present infection
Most viral forms run their course.
Residual damage to the brain may result.
What measures could be taken to avoid contracting encephalitis through mosquito contact?

103. 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.
This condition destroys or removes the myelin sheath that surrounds the nerve.

104. Guillain-Barré Syndrome (cont’d.)
Symptoms
tingling and numbness of feet and hands at onset of disease
followed by:
increasing muscle pain and tenderness
progressive muscle weakness
paralysis
difficulty swallowing
Muscle pain, weakness, and paralysis move quickly up the body in 24 to 72 hours.

105. Guillain-Barré Syndrome (cont’d.)
Treatment
hospitalization required for observation
blood plasma washed to remove antibodies (called plasmapheresis) and speed recovery
Diagnosis is confirmed by finding elevated protein in the cerebrospinal fluid, which peaks in four to six weeks after onset.
Prognosis varies but recovery is usually complete.

106. 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
Examples of secondary sources of the infection could include sinusitis and dental abscess.

107. 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
visual disturbances
unequal pupil size (anisocoria)
seizures
How is the diagnosis made?
History of infection, especially of the sinuses, or an injury to the central nervous system along with stated symptoms may indicate the presence of an abscess.
An EEG and CT scans are used to confirm diagnosis.

108. Brain Abscess (cont’d.)
Treatment
intravenous antibiotics
mannitol or steroids to reduce cerebral edema
surgical drainage of abscess to relieve pressure
Prognosis varies depending on the location, size, and cause, of the abscess.
When intracranial pressure cannot be controlled, death may result.
Lumbar puncture is not an option because intracranial pressure may cause brain stem to herniate, which may lead to death.

109. Poliomyelitis and Postpolio Syndrome
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.
How long is the incubation period? (seven to 21 days.)
Who is the well-known researcher who developed a polio vaccine years ago? (Jonas Salk)
Due to an effective vaccine, polio is very rare in the Western world.

110. Poliomyelitis and Postpolio Syndrome (cont’d.)
Symptoms
low-grade fever
profuse discharge from nose
malaise
these symptoms are followed by:
muscle weakness
stiff neck
nausea and vomiting
atrophy of muscles
muscle and joint deterioration
Poliomyelitis that involves the muscles supplied by spinal nerves is termed spinal.
Poliomyelitis that involves the muscles supplied by cranial nerves is termed bulbar.
Poliovirus is transmitted from person to person from airborne saliva particles.
Why is polio vaccine still administered to children if the disease is under control?

111. Poliomyelitis and Postpolio Syndrome (cont’d.)
Treatment
analgesics
moist heat
bed rest
physical therapy
leg braces
mechanical ventilation
There are two polio vaccines currently licensed in the U.S.
Prognosis is fair and depends on which muscles are involved.
Prognosis for postpolio syndrome is good.
What would you tell parents who are reluctant to have their child exposed to an almost nonexistent disease?

112. Intracranial Tumors (Brain Tumors)
These tumors can be primary (originate in the brain itself) or secondary (cancer that has metastasized from another area of the body).
Secondary tumors may have originated from the lung, liver, kidney, or skin.
Tumors are named according to the tissues from which they originate.
For children under 15, brain tumors are the most common solid malignancy.
Brain tumors are more common in industrialized countries and among whites.

113. Intracranial Tumors (Brain Tumors) (cont’d.)
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)
Compression of brain tissue causes progressive neurologic deficits, expansion of the brain, and increased intracranial pressure.
Symptoms of early tumors are somewhat vague.
What would you recommend to help someone cope with the news of having a brain tumor?

114. Intracranial Tumors (Brain Tumors) (cont’d.)
Diagnosis
detailed history
neurologic examination
diagnostic imaging studies
cranial MRI (preferred option)
functional MRI
tissue sample (from surgery or biopsy)
Diagnosis of brain tumors is complicated because benign and malignant tumors have similar symptoms.
Why is a surgical procedure on a tumor located deeper in the brain more dangerous than one closer to the surface?

115. Intracranial Tumors (Brain Tumors) (cont’d.)
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
What does radiotherapy attempt to do to tumor cells?
How does chemotherapy work to destroy cancer cells?

116. Intracranial Tumors (Brain Tumors) (cont’d.)
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
whole brain radiation therapy
Patients with secondary metastasis will undergo these treatments to improve the quality of life and reduce the likelihood of death by neurologic causes.
What are some examples of “quality of life issues”?
Long-term complications of surgery, radiation, and chemotherapy, may cause problems later, especially for children.

117. Intracranial Tumors (Brain Tumors) (cont’d.)
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.
What type of community resources would help an individual with a brain tumor and his or her family?