HOSA PATHO: Nervous system

10%

CVA/cerebrovascular accident (stroke)

• caused by an obstruction of disruption in the blood flow/blood supply to the brain. Sometimes referred to as a brain attack. Can be caused by an embolism or a hemorrhage.

• symptoms reflect the impacted region.

• common symptoms: sudden severe headache, aphasia, dysphagia, difficulty understanding, paralysis of the face, hemiparesis, and sudden vision loss or confusion.

• occlusion of artery, embolism, cerebral thrombosis.

• MRI, CT, and electroenchaplography

• immediate medical intervention; heparin meds.

Transient ischemic attack

• temporary episodes that last less than 24 hours of impaired neurologic function caused by obstruction in blood flow to a portion of the brain

• numbness, weakness, confusion, difficulty seeing through one eye

• atherosclerotic plaque becomes an embolus and obstructs blood supply to the brain

• Cranial MRI and CT

• Heparin (anticoagulant)

Head trauma

TBI: traumatic brain injury

• concussions, contusions, and countrecoup injuries.

• common among athletes

Epidural and subdural hematomas

• epidural hematoma: collection of blood that forms between the skull and the dura

• sub-dural hematoma: collection of blood that pools between the dura matter and the arachnoid membrane (second meningeal membrane).

• dilated pupils, headaches, nausea

• blood vessels rupture; blood seeps into layers of the meninges, trauma

• cranial radiography, CT

• craniotomy + burr hole/trephination release pressure

Cerebral concussion

• brusing of the cerebral tissue caused by back and forth movements of the head (acceleration/deceleration and blunt force).

• loss of consciousness, confusion, shallow respirations, and sensitivity to light, double vision

• blunt force/Mild TBI

• CT indicates damage

• bed rest and required medication

Cerebral contusion/countrecoup insult

• brusing of the tissue along or just below the surface of the brain

• temporary loss of consciousness to coma.

• blow to the head/ttrauma/TBI

• CT and cranial radiography

• hospitalization

Depressed skull fracture

• break or fracture of the bones of the cranium causing depression into the tissues/below the normal surface of the skull.

• Seizures are a common complications

• bruising behind the ear- battle sign

• Bruising under the eyes- racoon eyes

• direct impact on the skull by blunt force/object

• cranial radiography and CT scan

• relieve intracranial pressure

paraplegia, quadriplegia/tetraplegia

• paraplegia: loss of nerve function in the areas below the waist (paralysis of the lower trunk and legs)

• quadraplegia/tetraplegia: loss of nerve function in the cervical region resulting in paralysis of the arms, handsome trunk, and legs.

• incontinence, paralysis of lower extremeties, hypotension, bradycardia, loss of seual function

• spinal cord injuries, vertebral fractures and dislocation

• spinal radiography, MRI, CT

• spinal realignment, decompression, etc

• Corticosteroid-use post op

• paraplegia

• loss of nerve function in the areas below the waist (paralysis of the lower trunk and legs)

• quadraplegia/tetraplegia

• loss of nerve function in the cervical region resulting in paralysis of the arms, handsome trunk, and legs.

Degenerative disk disease

degeneration or deterioration of an intervertebral disk ; natural part of aging.

pain radiates via dermatomes, burning sensation, severe back pain, and intractable

spinal stenosis, lack of lubricating fluid between disks, and inflammation

MRI, CT, and electromyography

NSAIDs and TCNS (trans cutaneous nerve stimulation)

Herniated and bulging disk

known as ruptured or slipped disk

rupture of nucleus pusposus through the annular wall of the disk and into the spinal canal

sciatica pain from nerve; pinching pain, sharp pain, radiating pain can be uni or bi lateral)

accumulated trauma or poor posture

MRI, CT, myelography

variable and usually surgical intervention

Sciatic never injury (spinal stenosis)

• pathologic condition

• trauma, degeneration, or rupture of the interveretbral disk, leading to spinal stenosis or sciatic nerve injury (compression on the spinal cord and spinal nerve roots)

• lower back pain that radiates down the leg

• pain of sciatic nerve

• pain in claves increasing with standing and physical activity

• trauma, gunshot, or stab wounds

• spinal radiography, MRI, CT, and EMG

• oral corticosteroids and antiinflammatory medication

Headache

cephalgia

Cluster headaches

associated with Horner syndrome and more common in men

cephalalgia (headache)

It involves pain anywhere within the cranial cavity varying in intensity from mild to severe, may be chronic or acute, and may occur as a result of a disease process or be totally benign. The majority of headaches are transient and produce mild pain that is relieved by a mild analgesic.

tension headache

s a dull, bilateral, or diffuse headache that is often described as a pressure or squeezing sensation of mild to moderate intensity. This type of headache has no accompanying migraine features (such as nausea), and its pain does not prohibit activity, characteristics that do not match this patient's symptoms. Headache triggered by stress is often mistaken as tension-type headache, even though stress is one of the most commonly reported migraine triggers. Up to 75% of patients with migraine report neck pain that precedes or occurs during the attack, and this scenario is frequently mistaken for tension-type headache/mild migraine/cervicogenic (neck related) migrane

ascular headache

Pain arises from the vascular system--cluster or migraine headaches due to inappropriate vasoconstriction of the arteries

Migraine

• severe headaches that are almost always accompanied by other symptoms; nausea, vomiting, and sensitivity to light and sound

• Experiences visual ayras (flashing lights, areas of total darkness, and zigzagging lines)

• generally unknown; change in cerebral blood flow

• medical history, CT, EEG

• analegesics

Epilespy

seizure disorder, chronic brain disorder, characterized by sudden episodes of abnormal intense electrical activity in the brain, which results in seizure activity.

30 types of epilepsy

• idopathic, caused by cerebral palsy, CVA, and diabetes

• MRI and EEG and medical history.

• Anticonvulsant drugs

partial epilepsy

part of the brain has abnormal electrical activity

general epilepsy

diffuse electrical abnormalities within the brain and include absence (perit mal) and tonic-clonic (grand mal) attacks

perit mal epilepsy

brief change in level of consciousness, blank staring with loss of awareness.

tonic-cloic/grand mal epilepsy attack/episode

loud cry then fall to unconsciousness

Parkinson disease

slowly progressive neurologic disorder characterized by the onset of recognizable distrubances. Pill rolling tremor of the thumb and forefingers, muscular rigiditym slowness of movement, and postural instability.

insidious onset: trembeling hands, jaws, afcem legs, and stiff limbs and trunk.

Peculiar shuffling gait (the head is bowed, the body is flexed forward, and the knees are slightly bent)

usually over 60

deficiency in dompamine

characteristic medical history and dopamine levels

cannot be cured; DBS deep brain stimulation

Huntington chorea /huntington disease

hereditary disease of the cerebral cortex and basal ganglia resulting in the progressive atrophy of the brain

arms and face are first impacted d

tounge smaking

speech difficulty

autosomal dominant trait

Amytrophic Lateral sclerosis/ Lou Gehrig disease

• progressive motor neuron destruction that results I muscular atrophy

• fasculations (small involuntary muscular contractions), atrophy, and weakness. Dysphagia and apashia.

• impacts men more than women

• EMG and muscle biopsy

• no cure

Restless leg syndrome

• overwhelming urge to move the legs. itching, burning, jittery, creepy-crawly pulling,, tugging, painful sensation in the legs,

• have periodic limb disorder during sleep

• unknown (40-50)

• medical history

• /blood tests show low blood iron levels

• could be secondary to parkinson’s disease and thyroid disease

• Regular exercise and stretching

Transient global amnesia

• benign. total loss of recent memory (the learning process is completely blocked)

• confusion, maybe a headache

• unknown cause

• symptomatic analysis

• supportive treatment

Peripheral neuritis/neuropathy

• degenration of the peripheral nerves.

• insidious onset; risk factors include alcohol intoxication and severe infection.

• tenderness, deep tendon reflexs are diminished, loss of sensation in hands and feet

• atrophied muscles

• chronic alcohol intoxication and severe infections, diabetes, lupus, and pneumonia are also possible causes.

• motor and sensory impairment: EMG

• anticonvulsants

Trigeminal neuralgia (Tic Douloureux)

• pain of the area innervated by the cranial nerve V (5), the trigeminal nerve.

• transient, excruciating pain ALWAYS UNILATERAL

• mandibular and maxillary pain

• pain stimulated by thermal or mechanical stimulation

• unknown cause; tumor or vascular lesion

• abrupt and excruciating pain on one side of the face

• analgesics

Bells palsy

disorder of facial nerve CN VII (7) that causes suddenly onset of weakness or paralysis of facial muscles.

drooping o mouth or salivation diminisged taste perception

20-60 years

lyme disease and blockage of nerve CN VII

charcateristic history and differential diagnosis

facial exercises and warm applicants

Meningitis

inflammation of the meninges (membrane covering the spinal cord and the brain)

vomiting, headache that increases in intensity with movemetbtm

POSITIVE Kernig sign (resistance to leg extension after flexing the thigh on the body)

Brudsinki sign (neck flexion causing flexion of the hips from the supine position)

bacterial or viral : haemophilus influenza, beisseria menigitidis, and streptococcus pneumoniae

CSF analysis

IV antibitoics NSAIDs

Kernig sign

resistance to leg extension after flexing the thigh on the body

Brudsinki sign

neck flexion causing flexion of the hips from the supine position

encephalitis

inflammation for brain tissue

stiffness of neck and back muscle weakness

West Nile viral encephalitis

caused by cerebral edema, viruses, and exposure to certain toxins

treated with antivirals

diagnosed via elevate CSF and MRI to look for HSV encephalitis

Guillain-Barre-Syndrome

acute, rapidly progressing disease of the peripheral nervous system

numbness and tingling of the feet

progressive muscle weakness

paralysis

demyeliniation do the nerves, follows respiratory infection and gastroenteritis in 10-21 days.

elevated protein levels in CSf due to demyelination

IV immune globulin

Brain abscess

• colelction of pus anywhere in the brain tissue

• IV antibitoics and steroids

Poliomyelitis and post-polio syndrome

• viral infections of the anterior horn cells of the gray matter of the spinal cordm causes selective destruction of the motor neurons.

• low-grade fever, profuse discharge, and malaise.

• spinal poliomyelitis; involves muscles supplied by the spinal nerves

• bulbar poliomyelitis: inolves muscles supplied by the cranial nerves

• patient reports progressive muscle weakness, nausea, vomiting, and glaccid paralysis of the muscles involved.

• Poliovirus

• CSf possible for poliovirus

• supportive treatment and analgeiscs

• sabin and salk preventative vaccines

Intracranial tumors/brain tumors

• both benign and malignant, are space-occupying lesions that cause increased ICP and localized dysfunction related to their location, S&S - increased ICP, morning headaches, vomiting, seizure

Arteriovenous malformations

• these form during fetal development/congenital disease

• abnormal connection between capillaries and arteries (capillaries are lacking)

• results int he appearance of a tangled mass of arteries and veins

• region specific headache

• usually develop in the brain

• symptoms are similar to those of a stroke

• (nausea, stiffness, lethargy, and generalized weakness)

• mortality rate of 10%

Cerebral aneurysms

asymptomati; therefore, can go unnoticed.

• MOST COMMONLY OCCUR NEAR THE BASE OF THE BRAIN IN THE CIRCLE OF WILLS

• treatment —> surgical repair of the vessel

Chiari malformation

occurs when the brain tissue is pressed down into the spinal cord

caused by an abnormally shaped or snaller-than-normal skull

Chaiari malformation type 1 (I)

involves the smallest amount of brain tissue in the spinal cord.

chiariri malformation type 2 (II)

involves more brain tissue displacement than type 1

• seen with nyelmenigolce (both spinal canal, nerves, and CSF protrude through sac) and spina bifida.

chiariri malformation type 3 (III)

congenital and the rareest form. A portion of the brain stem/cerebellum extends out from the skill through the abnormal opening. Has the worst outcome; high rate of mortality.

severe headache upon sneezing, cough/contusive headaches

Basilar skull fracture

• raccoon eyes, buildup of CSF, often via motor vehicle accident, battle sign + raccoon eyes (manifestations of a basilar skull fracture)