NS Diseases

Cerebrovascular accident (stroke)

neurologic emergency where brain is damaged by sudden disruption of blood flow to part of brain (embolic) or by bleeding inside head (hemorrhagic) 

• Severe headache

• Aphasia: can’t speak

• Dysphasia: partially can’t speak

• Hemiparisis (paralysis on one side)

• Concussion, dizziness, vision issues, balance loss

• Caused by..

1. Occlusion of an artery caused by an atheroma 

2. Sudden obstruction by an embolus

   1. Includes cerebral thrombosis (clot), embolism (moving clot)

3. Cerebral bleeding

• Most often caused by atherosclerosis 

• CVAs caused by embolus/hemorrhage have sudden onset

• CVAs caused by thrombus appear more gradually 

• Cerebral embolism is a blockage caused by foreign object (embolus)

  • Carried in bloodstream until it becomes wedged in blood vessel and obstructs blood flow to brain

• Cerebral hemorrhage is when cerebral artery is not blocked but instead ruptures

  • Floods surrounding tissue with blood  

Left brain damage

• Right side paralysis

• Speech and memory deficits

• Cautious behavior

Right brain damage

• Left side paralysis

• Perceptual and memory deficits

• Impulsive behavior

Transient ischemic attack

Temporary episodes with duration of less than 24 hours of impaired neurological function caused by inadequate flow of blood to part of brain

• “Mini stroke” 

  • Resemble stroke caused by embolism

• Sudden weakness/numbness on one side, dizziness, confusion, loss of balance

• Sudden headache

• Recurring episodes 

• Caused by piece of plaque, formed by atherosclerosis, breaking away from wall of artery and traveling to brain 

  • Embolus or moving clot 

  • Platelet fibrin emboli from arterial ulcer is most common 

• Do not cause permanent brain damage unlike strokes 

Epidural hematomas

Collection or mass of blood that forms between skull and dura mater (outermost of three meningeal layers covering brain) 

• Completely outside brain 

• Appear within few hours

• Sudden headache, dilated pupils, nausea, vomiting, drowsiness

• Deterioration is rapid

Subdural hematoma

Blood collects between dura maters and arachnoid membrane (second meningeal membrane)

• Within the outer layers of brain

• Similar to epidural symptoms 

  • Onset is delayed because of slower accumulation

• Diplopia (double vision) is common 

Hematoma

Causes

• Blood from ruptured vessel seeps into and around meningeal layers

• Head trauma is usual cause of epidural hematoma 

• Sudden acceleration or deceleration injury often causes of subdural 

Cerebral concussion

Bruising of cerebral tissue caused by back-and-forth movements of head

• Headache, nausea, vomiting, vision issues after consciousness regain

• Caused by impact from blunt object

  • Results in disruption of normal electrical brain activity 

  • Brain not permanently injured 

Cerebral contusion

More serious than concussion, bruising of tissue along or just beneath brain surface 

• Symptoms persist longer than 24 hours 

  • Range from temporary consciousness loss to coma

• Caused by blow to the head or blunt trauma 

  • Twisting of two brain hemispheres when it collides with cranial bones may damage structures within brain 

• Often associated with skull fracture 

Depressed skull fracture

 Break or fracture in one of the bones of the cranium 

• Bones pushed below normal surface of skull

• Symptoms depend on fracture site

  • Ex. bone fragment pressing on motor area may cause hemiplegia (paralysis on one side of the body)

• Bleeding from wound, ears, nose, or around the eyes

• Racoon eyes

• Caused by blunt object direct impact 

Paraplegia

Loss of nerve function below waste

Causes

• Trauma to thoracic and lumbar spine from vertebrae fracture

• Dislocation (vertical compression)

Symptoms

• No function below the waste

Quadriplegia

Loss of nerve function in cervical region resulting in paralysis of torso

Causes of quadreplegia

• Trauma to cervical vertebrae

• Anything super high is fatal from hyperextension 

Symptoms

• Paralysis of cervical region, respiratory issues

Degenerative disk disease

Deterioration of intervertebral disks resulting in pain in areas served by spinal nerves below disk space 

• Natural part of aging

• Radiating pain down nerve path (dermatome)

• Constant back pain 

• Caused by aging

  • Fluid in disk decreases

Herniated and bulging disk

Rupture of nucleus pulposus through annular wall of disk and into the spinal canal

• Intervertebral disks are soft pads of cartilage and gelatinous material located between each of the vertebrae that make up the spine

  • Acts as shock-absorbing cushion for vertebrae and gives back flexibility 

  • Within each disk is gelatinous center called nucleus pulposus

• Severe back pain that worsens with movement 

  • When this pain results from pinching of nerve roots that form sciatic nerve, it is known as sciatica 

• Occurs in lower back between fourth and fifth lumbar vertebrae 

• Caused by trauma, sudden impact, bad posture

Sciatic nerve injury (spinal stenosis)

Pathologic condition caused by trauma to nucleus pulposus inside intervertebral disks

Spinal stenosis: narrowing of spinal canal or nerve root foramen

• Rupture of disks produces sharp pain from sciatic nerve down to leg and foot

• Caused by trauma and aging  

Headache (cephalalgia)

Pain in head that is not confined to any specific nerve distribution area

• General head pain

• Main structure involved

  • Meininges

  • Muscles

  • Nerves around skull

• Pain can be caused by sinus infection, TMJ syndrome, hypertension, stroke 

• Cluster headaches: severe pain behind eyes, abrupt 

• Two causes

  • Strain on facial, neck, scalp muscles called a tension headache

  • Edema within blood vessels of head called vascular headache

    • Changes in arterial size 

Migraine

 Periodic severe headaches

• May have visual auras

  • Zigzag lines, flashing lights, total darkness

• Photophobia is another warning sign

• Become less frequent/intense with age 

• Caused by genetics or cerebral blood flow changes 

  • Or even consuming things like cheese and wine

Epilepsy

Seizure disorder, chronic brain disorder with sudden episodes of abnormal electrical activity in brain 

• Partial seizures 

  • Localized electrical activity, compulsive behavior, conscious 

• Generalized seizures

  • Spread electrical activity 

  • Absence seizures: brief loss of consciousness with blinking off into the distance 

  • Tonic-clonic: muscle spasms, begin with loud cry and loss of consciousness

• Status epilepticus

  • Continuous seizures with no rest

Parkinson disease

Common, slowly progressing neurological disorder with onset of disturbances → “pill rolling” tremor of thumb and forefinger, muscular rigidity, slow movement, postural instability 

• Primary symptom is trembling hands

• Walking with shuffling gait

• Impaired speech and coordination 

• Face takes on expressionless appearance, muffled speech, difficulty swallowing 

• Caused by dopamine deficiency 

• Caused by position ingestion, after encephalitis 

Huntington chorea

Hereditary degenerative disease of cerebral cortex and basal ganglia 

• Chronic chorea (uncontrolled movement), difficulty swallowing, speech difficulties, personality disruption

• Transmitted by autosomal dominant trait 

Amyotrophic lateral sclerosis (Lou Gehrig Disease)

Progressive motor neuron disease that results in muscular atrophy

• Fasciculations (small involuntary muscular contractions)

• Progresses to cause speech, chewing, breathing difficulties

  • Ventilator is needed

• Brain function is not affected

• May be from autosomal inherited traits 

Restless leg syndrome

Neurologic condition with overwhelming urge to move the legs to stop an uncomfortable sensation

• Feelings like itching, burning, pulling sensations in the legs

  • May be felt in arms, hips, face

• Inability to sit for long periods of time interferes with life

• Usually occurs at night 

• May be from anemia

Transient global amnesia

• Usually benign

• 1 to 6 days, temporary 

• Encompasses entire memory of current events (global)

  • Amnesia manifests as a total loss of recent memory 

• Triggered stress, confusion

• Person has recall of personal identity and memory of past years

• Memory returns in 12 hours 

• Normal neurological function 

Peripheral neuritis/neuropathy

Degeneration of peripheral nerves 

• Affect distal muscles of extremities

• Clumsiness, loss of sensation in hands and feet 

• Deep tendon reflexes become diminished and tenderness is notes

• Skin becomes glossy and red

• Caused by chronic alcoholism, exposure to chemicals, infectious disease

• Leads to muscle weakness and sensory loss

Trigeminal neuralgia

Pain of the area innervated by the cranial nerve five (trigeminal nerve)

• Pain radiates along distribution of cranial nerve V and can affect any of the branches

  • Usually affects second and third branches 

• When ophthalmic branch is affected, pain is experienced in eye and forehead

• Maxillary branch involved nose, upper lip, cheek

• Mandibular branch involves lower lip, outer tongue, and cheek closest to ear

• More than one branch can be involved

  • Pain is always unilateral

  • Doesn’t cross midline, only one side of face was involved 

• Poor sleep and malnourished 

• Related to compression of nerve root by tumor or vascular lesion 

Bell palsy

Disorder of facial nerve 7 (CN VII) that causes sudden weakness or paralysis of face muscles

• Pain behind ear, followed by inability to open eye

• Drooping of mouth and drooling

• First noticed in the morning

• Unable to smile and facial expression is distorted

• Caused by blockage of impulses from facial nerve 7 caused by compression in the bony canal 

Meningitis

Inflammation of meninges (membranous coverings of brain and spinal cord)

• Early symptoms include vomiting and headache that increases in intensity with head movement

• Positive signs

  • Kernig’s sign: resistance to leg extension

  • Brudzinski’s sign: hips flex with neck flex, increased tendon reflex, photophobia

• Caused by bacterial/viral infections

  • Haemophilus influenzae, neisseria meningitis, streptococcus

Encephalitis

Inflammation of the brain tissue 

• Sudden onset 

• Stiffness of neck and back, muscular weakness, visual disturbances, lethargy

  • Mental confusion

• Leads to cerebral edema and cell destruction

• Caused by viruses or toxins

  • Chickenpox, measles, mumps

• Result from bite from an infected mosquito

Guillain-barre syndrome

Acute, rapidly progressive disease of the PNS

• Numbness and tingling of feed

• Increasing muscle pain and tenderness

• Weakness starts in lower extremities and moves up in 24-72 hours

• Cause is thought to have an autoimmune basis

  • Follows respiratory infection or gastroenteritis in 10-21 days 

Brain abscess

Collection of pus anywhere in the brain tissue

• Primary symptom is a headache

• Eyes look toward area of insult (toward side of head where abscess is located)

• Neck stiffness

• Caused by local infection or secondary to other infections

  • Staphylococci, streptococci, pneumococci

• Any occurrence that breaches integrity of CNS (trauma and wound) may be portal of entry 

Poliomyelitis and post-polio syndrome

• Poliovirus enters body through nose and throat

  • Crosses into gastrointestinal tract and reproduces in lymphoid tissue

• Travels through bloodstream and moves to CNS

  • Assaults motor neurons of spinal cord

• Transmitted from person to person

Poliomyelitis

Viral infection of anterior horn cells of gray matter of the spinal cord, causes selective destruction of motor neurons 

• Low grade fever

• Discharge from nose

• Malaise

• Followed by muscle weakness, stiff neck, nausea, muscle atrophy

• Involves muscles supplied by supplied by spinal nerves → spinal poliomyelitis 

Post-polio syndrome

Late-life functional deterioration in previously affected muscles

• Weakness and atrophy in muscles 

Intracranial Tumors (Brain Tumors)

• Primary: originates in brain 

• Secondary: metastasized from other areas 

  • Headache, seizures, nausea, cognitive dysfunction, muscle weakness

• Symptoms cerebellar tumors

  • Eye movement and loss of balance

• Symptoms glioblastoma: aggressive tumor 

  • Nausea, vomit, seizure

• 75% of all primary cancer from gliomas, meningioma, embryonal