SBI241 Week 4 - Nervous System Disorders

What are the two main divisions of the Nervous System?

Central Nervous System (CNS) and Peripheral Nervous System (PNS)

What does the Central Nervous System consist of?

Brain and Spinal Cord

What are the two divisions of the Autonomic Nervous System?

Sympathetic Nervous System (SNS) and Parasympathetic Nervous System (PNS)

What is the function of the Somatic Nervous System?

Voluntary control of skeletal muscles and transmission of sensory information

What is the general function of the Autonomic Nervous System?

To control involuntary functions, such as heart rate, digestion, and breathing

What neurotransmitter is primarily used by the sympathetic nervous system in stressful situations?

Noradrenaline (norepinephrine)

What neurotransmitter is primarily used by the parasympathetic nervous system?

Acetylcholine

What are the two main types of Cholinergic receptors?

Muscarinic and Nicotinic

What are the two main types of Adrenergic receptors?

Alpha (α) and Beta (β)

What is the definition of Pain according to the notes?

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

What are nociceptors?

Sensory receptors that detect painful stimuli

Where are nociceptors NOT found?

Brain and Spinal Cord

Name three types of stimuli that can activate nociceptors:

Thermal (Heat), Mechanical (Damage, Infection, Inflammation), and Chemical (Histamine, Kinins, Prostaglandins)

What are the two types of first-order neurons that transmit pain signals?

Aδ (A delta) fibers and C fibers

Describe the sensation of 'First Pain'

Sharp, localized, and well-defined

Describe the sensation of 'Second Pain'

Dull, aching, throbbing, and poorly localized

What neurotransmitter is associated with the fast-sharp pain pathway?

Glutamate

What neurotransmitter is associated with the slow-chronic pain pathway?

Substance P

What is the role of the Gate Control Theory of Pain?

It suggests that certain nerve fibers can block or modulate pain signals

What is referred pain?

Pain perceived at a location other than the site of the painful stimulus

What are Endorphins, Encephalins, and Dynophines?

Endogenous opioid peptides that act as natural pain relievers

Provide three key drug groups used in pain management:

Opioid analgesics, Non-steroidal anti-inflammatory drugs, Adjuvant analgesic medications

What is a common adverse effect of opioid analgesics on the PNS?

Constipation

What is the most common non-opioid analgesic?

Paracetamol (acetaminophen)

What does CVA stand for?

Cerebrovascular Accident

What are the two main types of stroke?

Ischemic and Hemorrhagic

What is the primary cause of Ischemic Stroke?

Thrombosis or Embolism leading to arterial occlusion

What is the primary cause of Hemorrhagic Stroke?

Rupture of an aneurysm or small vessel disease

Name three risk factors for stroke.

Hypertension, Atrial Fibrillation, and Hyperlipidemia

What does FAST stand for in relation to stroke symptoms?

Face, Arms, Speech, Time

What is one potential sign of increased intracranial pressure (ICP)?

All of the above

What is a Transient Ischemic Attack (TIA)?

A temporary disruption of blood flow to the brain, often called a "mini-stroke"

What is one strategy for the treatment of Ischemic Stroke?

Thrombolytic therapy (tPA)

What is one intervention for the long-term non-pharmacological management of stroke?

Carotid endarterectomy, thrombectomy, dietary plan, smoking cessation and reducing alcohol intake, regular monitoring of blood pressure and blood sugar levels

What is a Stroke?

A sudden interruption of blood flow to the brain, resulting in cell death and loss of brain function

What are the two main causes of a stroke?

Ischemia (lack of blood flow) and Hemorrhage (bleeding)

What are the two types of Ischaemic stroke?

Thrombotic and Embolic

What are the two types of Haemorrhagic stroke?

Intracerebral hemorrhage (ICH) and Subarachnoid hemorrhage (SAH)

What two conditions, when experienced together, significantly increase the likelihood of stroke and death from stroke?

Hypertension and Diabetes

Is stroke only a disease of old age?

No, stroke can occur at any age, including in children and young adults

What are uncontrollable risk factors for stroke?

Age, sex, ethnicity, and family history

What are controllable risk factors for stroke?

Hypertension, high cholesterol, diabetes, smoking, and physical inactivity

Besides the other risk factors, what other two conditions can increase the risk of stroke?

Transient ischaemic attack (TIA), Atrial fibrillation and carotid artery disease

What happens during an ischaemic stroke?

A blockage in a blood vessel supplying the brain cuts off oxygen and nutrients, causing cell death

What is a common cause for an ischaemic stroke?

A high cholesterol level causing a ‘furring’ of the arteries with fatty deposits

What happens during a haemorrhagic stroke?

A blood vessel in or around the brain bursts, causing bleeding and increased pressure in the skull, resulting in compression and eventual ischaemia to brain tissue

What is a common cause of haemorrhagic stroke?

Hypertension (high blood pressure) or rupture of an aneurysm

Besides the FAST acronym, what are other signs and symptoms of stroke?

Sudden confusion, trouble speaking or understanding speech, vision changes, severe headache, dizziness, loss of balance or coordination, weakness or numbness in face, arm, or leg

How do clinical manifestations of stroke vary?

Depending on the location and severity of brain damage, symptoms can include weakness, numbness, vision changes, speech difficulties, cognitive impairments, and more

If the area of damage from a stroke is unilateral, what side of the body will symptoms be seen?

Symptoms will typically only be seen on the contralateral (opposite) side of the body

What are the effects of damage to the left side of the brain due to stroke?

Language and speech difficulties (aphasia), right-sided weakness or paralysis

What are the effects of damage to the right side of the brain due to stroke?

Spatial difficulties, left-sided weakness or paralysis, difficulty with judgment and impulse control

What are the manifestations of stroke in Intracerebral Haemorrhage (ICH)?

Sudden severe headache, vomiting, altered mental status, hemiparesis, and increased blood pressure

What are the causes of Intracerebral haemorrhage (ICH)?

Hypertension, cerebral amyloid angiopathy, anticoagulant use, vascular malformations, and trauma

What happens during a subarachnoid haemorrhage?

Blood escapes from defective or injured vasculature into the subarachnoid space (CSF)

What are the early signs of increased Intracranial Pressure (ICP)?

Headache, vomiting, altered mental status, confusion, and decreased level of consciousness

What are the late signs of increased Intracranial Pressure (ICP)?

Cushing's triad (bradycardia, hypertension, and irregular respirations)

What is the ABCD2 score used for?

To assess the risk of stroke after a Transient Ischemic Attack (TIA)

What consists of care and acute management of stroke?

Rapid assessment, stabilization, thrombolysis (if eligible), supportive care, and early rehabilitation

What are the main types of treatment for stroke?

Supportive care (maintaining cerebral perfusion), Thrombolysis and Aspirin (for Ischaemic strokes), and treating raised intracranial pressure (ICP) and stopping bleeding (for SAH)

What non-pharmacological methods are used to treat strokes?

Physical therapy, occupational therapy, speech therapy, rehabilitation, Carotid endarterectomy or Thrombectomy

Which allied health professionals will be involved in the rehabilitation of patients post-acute stroke?

Physiotherapist, occupational therapist, speech pathologist, dietitian, social worker and psychologist

What is the role of pain as a mechanism?

To alert the body to potential or actual tissue damage, prompting withdrawal or protective responses

How did ancient Greeks view pain?

The ancient Greeks conceived of pain as an emotion, a punishment from the gods, or a sign of weakness

What are the symptoms of pain?

Increased heart rate, blood pressure, ventilation, nausea and vomiting, as well as sweating, especially acute surgical pain

What are the pain receptors in the skin and other tissues?

Nociceptors

What is the neurotransmitter used in Fast-sharp pain pathway?

Glutamate

What is the neurotransmitter used in Slow-chronic pain pathway?

Substance P

What are the two ascending pathways?

Spinothalamic tract and spinomesencephalic tract (or spinoreticular tract)

What is the description of Acute pain?

A sudden onset pain that is usually short-term, sharp, and localized, often caused by tissue damage or injury

What is the description of Chronic pain?

A persistent pain that lasts beyond the normal healing time, often becoming a long-term condition lasting 3 months or more

What is the description of Superficial pain?

A sharp, well-localized pain originating from the skin or mucous membranes

What is the description of Deep pain?

A dull, aching, or throbbing pain originating from deep tissues such as muscles, joints, or organs

What substances are involved in Analgesia System?

Endorphins, enkephalins, and dynorphins (endogenous opioids), as well as serotonin, norepinephrine, and GABA

What is phantom limb pain?

Pain felt in a limb that is no longer present, often experienced by amputees

What is neuropathic pain?

Pain caused by nerve damage or dysfunction, often described as burning, shooting, or stabbing

What are some methods to assess pain?

Verbal rating scales (e.g., mild, moderate, severe), numerical rating scales (e.g., 0-10), and visual analog scales

Name a multidimensional pain assessment tool

McGill Pain Questionnaire (MPQ)

What are the general principles of pain management?

Use a multimodal approach, tailor treatment to individual needs, and regularly assess and adjust treatment

What are some Opioid analgesics?

Morphine, oxycodone, hydrocodone, fentanyl, and codeine

What are the effects of Opioids in the CNS?

Analgesia, sedation, and respiratory depression

What are the effects of Opioids in the PNS?

Analgesic and anti-inflammatory effects, Decreased gut motility, Spasms of sphincter muscles, Suppression of some spinal reflexes, Release of histamine, miosis (pupil constriction)

What are some non-opioid analgesics?

Acetaminophen, ibuprofen, aspirin, and naproxen

What are common adverse drug reactions to non-opioid analgesics?

Gastrointestinal issues (e.g., bleeding, ulcers) for NSAIDs, liver damage for acetaminophen, renal damage, allergic reactions

What are adjuvant analgesics?

Tricyclic antidepressants, Corticosteroids, Psychoactive drugs, Bisphosphonates and Clonidine

What are some non-pharmacological analgesic techniques?

Heat or cold therapy, massage, and relaxation techniques

What are the two structural classifications of the nervous system?

Central Nervous System (CNS) and Peripheral Nervous System (PNS)

What are the components of the Central Nervous System?

Brain and Spinal Cord (Cervical, Thoracic, Lumbar, Sacral)

What are the two functional classifications of the nervous system?

Somatic Nervous System (SNS) and Autonomic Nervous System (ANS)

What type of control does the Somatic Nervous System have?

Voluntary control over skeletal muscles

What are the effectors of the Somatic Nervous System?

Skeletal Muscles

What type of control does the Autonomic Nervous System have?

Involuntary control over smooth muscles, cardiac muscles, and glands

What are the effectors of the Autonomic Nervous System?

Smooth Muscle, Cardiac Muscle, and Glands

What part of the brain controls and integrates the Autonomic Nervous System?

Hypothalamus and brainstem

What are the two major divisions of the Autonomic Nervous System?

Sympathetic Nervous System (SNS) and Parasympathetic Nervous System (PNS)

What effect does the parasympathetic system have on the pupil?

Constriction (miosis)

What effect does the sympathetic system have on the pupil?

Dilation (mydriasis)

What effect does the parasympathetic system have on salivary flow?

Increased salivary flow (stimulates watery secretion)

What effect does the sympathetic system have on salivary flow?

Decreased salivary flow or thickens salivary secretions

What effect does the sympathetic system have on the heart?

Increased heart rate and contractility