chapter 6 neurologic system

alzheimer disease AD

progressive neurodegenerative disease of brain

60-80% all cases of dementia

cortical degeneration in frontal lobes

atrophy in all areas of cortex

two forms of AD

familial

sporadic

two categories of genes have a direct link to AD development

risk genes

deterministic genes

cause of AD

unknown

AD common risk factors

advanced age over 80

genetic factors- APOE epsilon 4 allele

down syndrome

exposure to aluminum

traumatic brain injury

cardiovascular disease

diabetes

dyslipidemia

early changes AD

memory loss that affects job skills

difficulty performing familiar tasks

difficulty learning and retaining new information

inability to concentrate

deterioration in personal hygiene and appearance

AD signs as disease progresses

degenerative disorder of frontal lobe

difficulty with abstract thinking and activities that require judgment

progressive difficulty in communicating

severe deterioration of memory, language and motor function

repetitive actions

restlessness, wandering

irritability, depression, mood swings, paranoia, hostility, combativeness

nocturnal awakenings

disorientation

preclinical ad

before memory loss and confusion about time and place develop

mild cognitive impairment MCI due to AD

mild changes in memory and thinking ability

small personality changes and forgetfulness

decrease in ability to plan and organize

dementia due to AD

thinking impairment

memory impairment

behavioral changes that impair ability to function in daily life occur

severe impairment in cognitive function and inability to perform self-care activities

treating AD

no cure

cholinesterase inhibitors

memantine

monoclonal antibody type agents mAbs

cholinesterase inhibitorys AD

donepezil, rivastigmine, galantamine

prevent breakdown of acetylcholine and keep its levels high

memantine

uncompetitive low-to-moderate affinity N-methyl-D-aspartate receptor antagonist

regulates activity of glutamate which is involved in info processing storing and retrieval

monoclonal antibody type agents mAbs

aducanumab

lecanemab

immuse response againts beta-amyloid proteins

common signs of dementia

amnesia

anomia forgetting names of people and objects

apathy

apraxia- inability to perform simple actions

agnosia- inability to recognize familiar objects and their purpose

tests for AD

PET scan

CT scan

MRI

EEG

CSF

cerebral blood flow studies

blood biomarkers

PET scan AD

positron-emission tomography scan measures metabolic activity of cerebral cortex and may help confirm early diagnosis

CT scan AD

computed tomography scan may show more brain atrophy than what occurs in normal aging

MRI

magnetic resonance imaging evals condition of brain and rules out intracranial lesions as source of dementia

EEG

evaluates brain electrical activity and may show brain wave slowing late in disease

helps to differentiate tumors, abscesses, and other intracranial lesions that might cause symptoms

CSF analysis AD

shows beta-amyloid and tau proteins

helps determine whether signs and symptoms stem from a chronic neurologic infection

cerebral blood flow studies may detect abnormalities in

blood flow to brain

potential diagnostic tools under investigation include blood biomarkers that show

level of beta-amyloid and tau protein accumulation and biomarkers that show injured or actually degenerating nerve cells

amyotrophic lateral sclerosis

aka Lou Gehrig disease

progressive neurodegenerative disease that affects motor nerve cells of brain and spinal cord

motor neurons eventually die and voluntary muscle movement is impacted

two types of als

sporadic

familial

familial als

disease is inherited

als causes

gene mutation

chemical imbalance from higher levels of glutamate

accumulation of abnormal forms of proteins which destroy nerve cells

autoimmune disorders

precipitating factors for acute deterioration in als

trauma

viral infection

physical exhaustion

als signs and symptoms

muscle weakness

difficulty walking, clumsiness, muscle twitching, muscle spasms

impaired speech

difficulty chewing and swallowing

difficulty breathing

choking

excessive drooling

depression

inappropriate laughing

crying spells

treating als

no cure

drug therapy

stem cell

tests to diagnose als

electromyography

muscle biopsy

csf analysis

neurologic examination

bell palsy

aka acute peripheral facial paresis

facial nerve disorder

inflammation of cranial nerve VII on one side of face in absence of stroke or other disease

cause of bell palsy

unknown

risk factors bell palsy

being in third trimester of pregnancy

early postpartum

older adults

people w diabetes or hypothyroidism

persons with tick bite

etiology of bell palsy

unknown

suggestion of acute demyelination of nerves s

strongest supported cause of als

reactivation of herpes simplex virus isoform HSV1

reactivation of herpes zoster virus HZV

has been linked to lyme disease

signs and symptoms als

rapid onset of facial weakness on one side

pain around and behind ear

recent viral illness or tick bite

numbness of face, tongue, and ear

ringing in ear

headache

hearing deficit in ear on affected side

drooping of mouth

inability to close eyelid on affected side

tests for als

MRI
CT

blood tests

bell palsy is considered

benign

most recover 3 weeks to 6 months

epilepsy

aka seizure disorder

neurologic disorder where brain activity is abnormal causing seizures

epilepsy is diagnosed if a patient has

two unprovoked seizures occurring more than 24 hours apart

a single unprovoked seizure if recurrence risk is high

diagnosis of an epilepsy syndrome

seizures

paroxysmal events associated with abnormal electrical discharges of neurons in brain

discharge may trigger a convulsive movement, an interruption of sensation, an alteration in consciousness, or combination of these

epilepsy causes

no known cause

seizures are caused by abnormal brain activity

in about 50% cases

epilepsy has no known causes

possible causes of epilepsy

genetic influences

perinatal injuries

metabolic abnormalities

brain conditions

infections

traumatic brain injury

ingestion of toxins

status epilepticus

continuous seizure state that must be interrupted by emergency measures

4 phases of emergency treatment for status epilepticus

stabilization phase

initial therapy phase

second therapy phase

third therapy phase

types of seizures

partial seizures

Jacksonian seizure

sensory seizure

complex partial seizure

secondarily generalized seizure

generalized seizures

absence seizure

myoclonic seizure

generalized tonic-clonic seizure

akinetic seizure

treating epilepsy

drug therapy

surgery

tests for epilepsy

EEG

CT scan

MRI

serum glucose studies

calcium studies

skull xrays

lumbar puncture

brain scan

guillain-barre syndrome

GBS aka acute inflammatory demyelinating polyneuropathy AIDP

rapidly progressing acute autoimmune process occurring every few days to weeks following a viral or bacterial infection

GBS 3 phases

acute phase- first definitive symptom develops and ends 1-3 weeks later when no further deterioration is noted

plateau phase lasts several days to 2 weeks

recovery phase- remyelination and axonal process regrowth, can last 4 months to 3 years

cause of GBS

unknown

thought to be cell-mediated, immunologic attack on peripheral nerves in response to a virus or other cause of cell injury

signs and symptoms of GBS

tingling and numbness

muscle weakness

immobility

paralysis

muscle stiffness and pain

sensory loss

loss of position sense

diminished or absent deep tendon reflexes

tests to diagnose GBS

csf analysis

electromyography

electrophysiologic testing

treating gbs

endotracheal intubation

tracheotomy

most recover spontaneously

meningitis

brain and spinal cord meninges become inflamed

blood flow to brain is reduced

origin of meningeal inflammation may be

bacterial

viral

protozoal

fungal

most common causes of meningitis

bacerial

viral

risk factors for meningitis

malnourishment

immunosuppression

cns trauma

signs and symptoms of viral meningitis

drowsiness

confusion

stupor

slight neck or spine stiffness

headache

nausea

vomiting

signs and symptoms of meningitis

headache

stiff neck and back

malaise

photophobia

chills

fever

vomiting

twitching

seizures

confusion or delirium

fretfulness

bulging of fontanels

refusal to eat

signs of meningitis

Brudzinski sign

Kernig sign

tests to diagnose meningitis

lumbar puncture

CT scan

MRI

EEG

chest xrays

sinus and skull xrays

WBC count

CT scan

blood cultures

treating meningitis

prevention and vaccinations

MCV4 vaccine

MPSV4 vaccine

serogroup B meningococcal vaccines

antibiotics

bed rest

hypothermia

fluid therapy

migraine

episodic neurologic disorder characterized by a headache lasting 4 to 72 hours

people who menstruate may experience migraines

more frequently before and during menstruation or report a decrease during pregnancy and menopause

migraine phases

premonitory phase'/prodome

migraine aura

headache phase

recovery phase/postdrome

diagnosis of migraines

made from medical history and physical exams

EEG and imaging

management of migraines

avoiding triggers

use pharmacologic management

using transcutaneous electrical stimulation devices providing trigeminal nerve stimulation

multiple sclerosis

MS

results from progressive demyelination of white matter of brain and spinal cord leading to widespread neurologic dysfunction

causes of MS

unknown

autoimmune disorder in which antibodies destroy myelin sheaths around sensory and motor neurons

trigger for development of antibodies is unknown

genes may be a part

signs and symptoms of MS depend on four factors

extent of myelin destruction

site of myelin destruction

extent of remyelination

adequacy of subsequent restored synaptic transmission

treating MS

no cure

drugs

bed rest

massage

prevention of fatigue and rpessure ulcers

tests to diagnose MS

MRI

CSF analysis

evoked potential tests

myasthenia gravis

autoimmune disease which produces sporadic progressive weakness and abnormal fatigue of voluntary skeletal muscles

causes of myasthenia gravis

unknown

commonly accompanies autoimmune disorders and disorders of thymus

signs and symptoms of myasthenia gravis

extreme muscle weakness

fatigue

ptosis

diplopia

difficulty chewing and swallowing

sleepy masklike expression

drooping jaw

bobbing head

arm or hand muscle weakness

two crises of myasthenia gravis

myasthenic crisis

cholinergic crisis

test used to differentiate two types of crises

edrophonium test

treating myasthenia gravis

anticholinesterase drugs

plasmapheresis

thymectomy

endotracheal intubation and mechanical ventilation

tests to diagnose myasthenia gravis

edrophonium test

electromyography

nerve conduction studies

chest xray or CT scan

parkinson disease PD

progressive muscle rigidity

loss of muscle movement

involuntary tremors

causes of pd

unknown

genetic and environmental factors

signs of pd

muscle rigidity

akinesia

pill-roll tremor

high-pitched monotone voice

drooling

dysarthria

dysphagia

fatigue

muscle cramps

oily skin

increased perspiration

insomnia

mood changes

treating pd

drugs

physical therapy

stereotactic neurosurgery

pd

urinalysis

CT scan

MRI

stroke

cerebrovascular accident cva or cerebral infarct

sudden impairment of cerebral circulation in one or more of blood vesels supplying brain

stroke can be due to either of two processes

ischemic stroke

hemorrhagic stroke

transient ischemic attack tia

caused by a temporary interruption of blood flow

patient recovers circulation and has no neurological deficit

factors that increase risk of stroke

history of TIA

atherosclerosis

hypertension

arrhythmias esp atrial fibrillation

carotid artery stenosis

rheumatic heart disease

diabetes mellitus

orthostatic hypotension

cardiac enlargement

high serum triglyceride levels

lack of exercise

hormonal contraceptive use

drug misuse

smoking

family history of cerebrovascular disease

sickle cell disease

top 3 causes of stroke

thrombosis

embolism

hemorrhage

most common artery affected by either ischemic or hemorrhagic stroke

middle cerebral artery

tests to diagnose stroke

CT scan

cerebral angiography

digital subtraction angiography

PET scan

single-photon emission computed tomography

MRI

magnetic resonance angiography

transcranial Doppler studies

cerebral blood flow studies

ophthalmoscopy

EEG

treating stroke

physical rehabilitation

dietary and drug regimens

surgery