neurology

The nervous system 2

Central nervous system

Peripheral nervous system

Central nervous systems

1. Spinal cord

2. Brain stem

3. Brain

The body’s master control unit

Peripheral Nervous System

Links brain and central nervous system to the exterior

Peripheral nervous system can be broken down to the

The autonomic nervous system and the somatic nervous system

Autonomic nervous system

Regulates involuntary bodily processes

1. Sympathetic ns

2. Parasympathetic

Sympathetic nervous system

Prepare the body for action and stress. This is called fight or flight. It’s going to accelerate our body

Sympathetic, nervous system catecholamines

• epinephrine

• Norepinephrine

• Dopamine

Sympathetic nervous System catecholamines attach to what

Adrenergic receptors

1. Alpha 1 and 2

2. Beta 1,2,3

The sympathetic Nervous system also has

Antagonist, we are going to block

Example for Sympathetic nervous system

1. If you take a medication that blocks your alpha or your beta, then that’s gonna cause your nervous system to decrease your heart rate and your blood pressure Which is equal to activating the parasympathetic nervous system

Parasympathetic nervous system

Calm the body and helps the body to conserve energy

Rest and digest

Parasympathetic nervous system meds

1. Acetylcholine neuron transmitters for the parasympathetic nervous system that attach to the cholinergic receptors

1. cholinergic receptors Types

Muscerinic

Nicotinic

Digestion and urination

The somatic nervous system

Voluntary movement

In the nervous system, we have two cells

• neurons

• Glia cell

Neurons and glia cells

The recover axon

Glia cells

Will make myelin

Myelin and axon

We will be the white matter Of the central nervous system

Myelin

Help increase speed of impulse transmission

Example, if the Milan is not intact, then our impulse transmission is going to be slower

Neuron - cell body

Will make the gray matter of the Brain and whole central nervous system

Nerve impulse

Is an action potential

The basics of Cell firing

1. Resting membrane potential cell

2. Then a stimulus comes and depolarizes because sodium channels are openSo sodium is entering the cell

3. Up to the point that we have a threshold and whenever you have a threshold, you’ll have an action potential

4. The potassium channels will open potassium will diffuse out of the cell, causing repolarization

Meniniges

The layers protecting the central nervous system

Meniniges Layers

1. Dura mater

2. Arachnoid mater

3. Pia Mater

Dura mater and arachnoid mater what space do you have

Subdural space

Arachnoid mater and Pia mater what space do you have b

Subarachnoid space

Dura mater

• two layers of Venus sinuses between them

• Venus drainage

Arachnoid mater

• lies just beneath the dural matter

• waterproof

Pia mater

• Liz is right on the surface of the brain

• Holds the cerebral arteries in place

Subarachnoid space

You have cerebral spinal fluid

Cerebrospinal fluid CSF

• clear fluid similar to blood plasma

Cerebrospinal fluid CSF Production

600ml

Cerebrospinal fluid CSF Reabsorption

Into the Venous circulation through the arachnoid villi

Cerebrospinal fluid is located where

Inside of the 4 ventricles that’s where is circulates It goes through the central canal to go down to the spinal cord

What happened if we don’t have that communication within the ventricles?

Increase intracranial pressure because you were gonna have a buildup of fluid

Pain terms - Gate control theory

A search that non-painful input closes the gates to painful input, which prevents Pain sensation from traveling to the central nervous system

Example: You hit your elbow and then you begin to rub your elbow with your other hand and that is like preventing in sensation of pain because now your brain is feeling that comfort instead

Pain terms: Pain threshold

Lowest intensity of pain that a person can recognize

Pain terms: Pain tolerance

Greatest intensity of pain that a person can endure

Paint terms: nocieptive pain

Tissue injury, pain: visceral, somatic, or referred : Throbbing, pulsing, stabbing or aching pain

Somatic

Skin joints, and muscles pain

Visceral

Internal organs and lining of cavity pain

Referred

Perceived at a different location

Acute pain

Warning signals

Chronic pain

More than six months

Pain terms neuropathic pain

A damage nerve that can be chronic pain: Central pain or peripheral pain; Tingling, Numbing, or burning

What is the most common type of pain?

Headaches

Headache – migraine

Pain last from 4 to 72 hours in women usually - Genetics

Migraine manifestation

• unilateral pain

• Throbbing

• Worsen by movement and noise

• Nausea

• Vomiting

• Photophobia - fear of light

• Phonophobia - fear of sound

Migraine triggers

• Altered sleep patterns

• Skipping meals

• Over exertion

• Weather changes

• Hormonal changes

• Excessive afferent stimulation

• Chemicals- alcohol or nitrates

Migraine phases

1. Premonito4y - A few days before the migraine starts, you feel like it’s coming

2. Aura - What you feel right before the migraine comes

3. Headache-

4. Recovery

Headaches – cluster

More in males between 20 and 50

Headache last for a minute to hours

Example- You have it every day for two weeks and then it doesn’t show up again for another four months

Cluster manifestation

• Stabbing pain in eye

• ptosis is of the ipsilateral eye - there’s a drop in your eye and it’s in the same side as the pain

• Red eye

• Stuffy nose

Cluster headache activation

Trigeminal

Cluster headache treatment

Oxygen therapy- But nothing really works even that doesn’t really work

Tension type headaches

Most common

Can last several days at least 15 days per month for at least three months

Tension type headaches, manifestations

Sensation of a tight band or pressure around the head with gradual onset of pain

Plegia

Stroke or paralysis

Paralysis

Loss of movement

Paresis

Weakness

Hemi

Both limbs on one side

Di or para

Both upper limbs or both lower limbs

Quadri or tetra

All four limbs

Myasthenia graves

Type two hyper sensitivity - autoimmune

Myasthenia graves receptors stuff

1. We have a nerve ending that releases ACH acetylcholine

2. Our muscles have ACH receptors

3. But there are antibodies to the ACH receptors, which causes the binding of the new transmitters to be inhibited or decreased

   • gradual destruction

Myasthenia gravis manifestation

• The blockage of receptors causes no contraction in the muscle, which makes weakness

• Progressive weakness

• Ptosis

• Diplopia - seeing double

• Dysphagia - difficulty swallowing

Myasthenia gravisis diaghram

• due to the muscles not being able to contract, you can have diaphragmatic involvement

• Creating difficulty breathing

Myasthenia gravis Evaluation

• tension test

Tensilon test

Give them a medication and it improves the Tessalon very fast

• anti acetylcholinesterase inhibitors

Acetylocholinesterase

1. Nerve ending that releases acetylcholine binds the the acetylcholine receptor on the muscle or post synaptic cell

2. Then it gets degraded or destroyed by acetylcholinesterase

3. We end up with choline that gets reabsorbed into nerve terminal and acetate that degrades

• anti acetylcholinesterase inhibitors

1. With these inhibitors were just gonna have access ACH and we will still have muscle contraction

Myasthenia gravis Treatment

• anticholinesterase inhibitors

• Corticosteroids

Myasthenia crisis

Tensilon improves them

Cholinergic crisis

• caused by too much anticholinesterase drug toxicity- too much ACH

• They will get worse with Tensilon test

Cholinergic crisis manifestations

• high GI and GU

• Low cardiovascular and respiratory

Extra parasympathetic response

MS is

A demyelination disorder in the central nervous system

Gillian barre syndrome

Demyelination’s disorder in peripheral nervous systems

Guillain barre syndrome movement

Ascending motor paralysis

• Starts from the bottom up distal extremities are first affected

• Also affect our diaphragm and give us problems breathing

Guillain barre syndrome trigger

• infection - respiratory or GI - campylobacter jejuni enteritis

• Surgery

• Vaccinations

G-B manifestations

• muscle weakness

• Ascending paralysis

• Respiratory arrest

• Symmetrical ascending

• Paresthesias in the feet

The person can recover from this

G-B treatment

• supportive care

• Ventilator support

• Plasmapheresis

• Intravenous immune global in administration

Parkinson’s disease

Chronic and progressive

Degenerative

Debilitating

Parkinson’s disease what’s happening

• lack of dopamine Due to basal ganglia and substantial nigra neurological disease

• More common in males

Parkinson’s disease

Normal amount of Acetylocholine and low dopamine imbalance creates all these problems

Parkinson’s has something called

Levy bodies

What happens when you have an imbalance

Impairment of extrapyramidal tracts controlling movements

Parkinson’s manifestation

• tremors at rest

• Rigidity

• Bradykinesia / akinesia - move slowly

• Postural changes

  TRAP

• pill rolling

• dementia

• Depression

• Shuffling steps

Parkinson treatment

• dopamine replacement

• Reduce ACH - anti cholinergic drugs

• Deep brain stimulation

This treats the symptoms this is not a cure

Amyotrophic lateral sclerosis ALS - Lou Gehrig disease

• neural degenerative disorder that involves upper and lower motor neurons

• Not century and autonomic symptoms

Amyotrophic lateral sclerosis ALS - Lou Gehrig disease Manifestation

• excessive glutamate

• Muscle weakness in any or all

• No inflammation

• Normal intectual and sensory function

• More males

Use computer to speak

Amyotrophic lateral sclerosis ALS - Lou Gehrig disease Death

2 to 5 years after onset symptoms

Amyotrophic lateral sclerosis ALS - Lou Gehrig disease Treatment

• Little treatment available

• Antiglutamate

• Rehabilitation to prevent complications

• Psychological support

Multiple sclerosis - MS

Demyelination- autoimmune - inflammatory destruction of CNS myelin

Scarred myelin Because the nervous system goes little by little it takes long

MS patho

1. You have a blood brain barrier

2. immune cell stay in theblood vessels

3. Sometimes the tea helper cells will leave the blood Brain barrier And go to the brain and find the myelin

4. They will mark the Myelin and triggered the inflammatory response. - attracting T cytotoxic cells, B cells, macrophages, and natural killer cells

5. B cells will make antibodies against myelin

Myelin is

White mater

MS goes through what

Destruction and recovery but another T cell will come and have neuro inflammation at the end it will stop repairing itself

MS clinical manifestations

• crisis and remission

• Mild symptoms to serious

• Parenthesis

• Weakness

• Impaired gait

• Numbness of extremities and difficulty walking

• Optic nerve involvement

• Loss of eye movement- 3,4,6 cranial nerve

• Stalling difficulty

• Cerebellum system - motor movement and balance

MS evaluation

• lesions in white mater CNS

• Ct scan

• elevated IgG= CSF

MS treatment

Want them to stay in remission

• immunosuppresors

• Avoid extreme temperatures

• Plasma exchange

Spinal cord injury

Men are effected 16 to 30

7,800 to 10,000

Common in car accidents and motorcycle crashes, gunshots, stab wounds, and elderly falls

Spinal shock / neurogenic shock

Complete loss of all reflex, motor, sensory and automatic activity below of lesion

• The muscles become paralyzed and flaccid and reflexes are absent. Loss of bladder and rectal control: bladder and bowel distention