HPEX 353 Chapter 10: Nervous System Diseases and Disorders

What is the Nervous System made up of?

Brain, spinal cord, and nerves

What does the Nervouse System do?

Regulate and coordinates body activities and responses

What are the two divisions of the Nervouse System?

Central nervous system and peripheral nervous system

Central Nervous system (CNS)

•Brain and spinal cord

•Processes and stores sensory information

Peripheral Nervous System (PNS)

•Sympathetic and parasympathetic

•Conduits information to and from the CNS

What are neurons?

•Nerve cells that make up nerves

•They are able to initiate or conduct electrochemical impulses

Three types of neurons

•Sensory/Afferents: transmit impulses to the CNS from:

• Skin, skeletal muscles and joints: somatic

• Internal organs: visceral

•Motor/ Efferent: transmit impulses from the CNS to muscles and glands

•Interneurons: connection between sensory and motor neurons

Responsibility of Brain

•coordinates, controls and regulates multiple life-sustaining tasks (HR, respirations, BP, temperature, sensory information, synthesis of some hormones, coordinates physical movement, etc.)

Responsibility of Spinal Cord

transmits electrochemical messages to and from the brain and processes spinal cord reflexes.

Responsibility of Meninges

•Protective layer that covers brain and spinal cord.

•3 membranes:

• Dura mater

• Arachnoid membrane

• Pia mater (Subarachnoid space: Cerebrospinal Fluid (CSF)

(protection, moving waste products and nutrients) )

What part of the Nervous system is the Automatic Nervous System in?

PNS

Part of Automatic Nervous System

•Sympathetic System: Responsible (in part) for the "fight-or-flight" response during times of stress, ager or fear.

•Parasympathetic System: Responsible for the calm and relaxation of the body in non-stress situations.

Description of Acute & Chronic Headache

**Diffuse pain occurring in any portion of the head

•Unknown etiology (physical or emotional stress?)

•3 types:

• Primary (tension, migraine and cluster)

• Secondary (occur because of some underlying structural problem)

• Other (cranial neuralgias, facial pain and other headaches)

Symptoms of Acute & Chronic Headache

•Dull and aching or acute and pounding

•Intermittent or intense

•Front, sides or back

Medical Dignosis of Acute & Chronic Headache

•History of recurrent headaches

•Quantity, quality and duration

•Neurological testing

Treatment of Acute & Chronic Headache

•Analgesics

•Muscle relaxants and minor tranquilizers may be prescribed

Description of Migraine Headache

**Recurring headache characterized by intense pain often accompanied by nausea and vomiting.

Symptoms of Migraine Headache

•Changes in cerebral blood flow (vasoconstriction/vasodilation)

•Triggers: certain food, hormonal changes, sensory stimuli, changes in weather and some medications

Medical Dignosis of Migraine Headache

•History (recurrence and aura)

Treatment of Migraine Headache

•Specific migraine medication:

•Pain-relieving medications

• Analgesics

• Triptans

• Anti-nausea medication

•Preventive medications (*only if more than four debilitating attacks per month and attacks that last more than 12 hours)

• Beta blockers

• Antidepressants

• Botox

Description of Traumatic Brain Injury

**The brain collides with the inside of the skull (sometimes bruising the brain, tearing nerve fibers and causing bleeding)

•Violent trauma events

•Cerebral concussion= mildest form of TBI

•Cerebral contusion= bruising of the brain

Symptoms of Traumatic Brain Injury

•Brief unconsciousness

•Amnesia

•Headache

•Confusion

•Balance problems

•Blurred vision

•Ringing in the ears

•Mood changes

•Vomiting and Nausea

•Convulsions and Seizures

•Numbness in extremities

•Slurred speech

Medical Diagnosis of Traumatic Brain Injury

•CT and MRIs

•Glasgow Coma scale (3-15, for severity)

Treatment of Traumatic Brain Injury

•Mild TBIs: rest and mild analgesics

•Severe TBIs: Medical Emergency

• Hospitalization

Description of Subdural Hematoma

**Blood collects between the dura mater and the arachnoid membrane. Pressure from the mass of blood can impair brain function.

•From severe head injury (ruptured of vessels)

Symptoms of Subdural Hematoma

•Difficulty walking

•Headache

•Confusion

•Slurred speech and vision

•Hemiparesis

Medical Diagnosis of Subdural Hematoma

•Medical history

•CT scans and MRI

Treatment of Subdural Hematoma

**Medical emergency

•Craniotomy

Description of Transient Ischemic Attacks (TIAs)

**Temporary episodes of impaired neurological activity resulting from insufficient blood flow to a part of the brain.

•Temporary obstruction of cerebral arterioles by small emboli or by ischemia of a small portion of the brain region.

Symptoms of Transient Ischemic Attacks (TIAs)

**portion of the brain affected

• Confusion

• Mental weakness

• Weakness in extremities

• Diplopia

• Speech deficits

*Normally, no unconsciusness

Medical Diagnosis of Transient Ischemic Attacks (TIAs)

•Physical exam

•Neurological exam

•Carotid ultrasound

•Cranial CT scans & MRI

Treatment of Transient Ischemic Attacks (TIAs)

**portion of the brain affected

•Antiplatelet agents

•Anticoagulant agents

•Surgery

Description of Cerebrovascular Accident (CVA) I

**Sudden impairment of consciousness and subsequent paralysis.

•Stroke or brain attack

•Etiology: hypertension, smoking, lack of exercise, high-fat diet, diabetes, etc.

•Two types:

•Ischemic stroke: Interruption of blood flow in a cerebral vessel (i.e. emboli, thrombus)

•Hemorrhagic stroke: Rupture of a blood vessel (i.e. hypertension, aneurysm, head injury)

Symptoms of Cerebrovascular Accident (CVA) I

•Face droop

•Arms raise

•Speech slurred

•Dizziness

•Unconsciousness

•Bradycardia

•Hemiparesis

•Cheyne-stokes respiration

•Dysphasia

•Numbness

•Diplopia

Medical Diagnosis of Cerebrovascular Accident (CVA) I

•Medical history

•Neurological examination

•Angiogram

•Transcranial Doppler (TCD)

Treatment of Cerebrovascular Accident (CVA) I

**Depend on the origin, time and type

•Anticoagulants

•Antiplatelet agents

•Surgery

•Physical rehabilitation

Description of Cerebral Aneurysm

** Abnormal focal dilation of an artery in the brain that results from a weakening of the intima layer of a blood vessel.

•The artery walls become thin and deteriorate and can rupture without warning

•Risk factors: congenital, smoking, hypertension, high cholesterol, alcohol and drugs

•Most common in women over 40

Symptoms of Cerebral Aneurysm

•Severe headache

•Dilated pupils

•Blurred vision

•Neck pain

•Nausea

•Photosensitivity

Medical Diagnosis of Cerebral Aneurysm

•CT scan

•Lumbar puncture to detect blood in the CSF

•Cerebral angiography

Treatment of Cerebral Aneurysm

•Surgery

Description of Epilepsy

** Chronic brain disorder characterized by recurring attacks of abnormal sensory, motor and psychological activity.

•Disruption of the normal electrical activity pattern within the brain (neurons discharge in a random, intense manner)

•Idiopathic/Birth trauma/ Congenital malformations/ Fever/ CVA/ CNS infections

Symptoms of Epilepsy

•Uncontrollable twitch of fingers/hand/mouth

•Dizziness

•Loss of consciousness

•Intense rigidity of the body

•Chewing of the tongue

•Cyanosis

Medical Diagnosis of Epilepsy

•Medical history

• head trauma? infections? family history?

•Electroencephalogram

•Cranial CT and MRI

Treatment of Epilepsy

•Anticonvulsant drugs

•Neurosurgery (severe cases

Description of Meningitis

** Inflammation of the meninges

•The majority are viral infections (enteroviruses) but bacterial and fungal are also possible.

•Acute bacterial meningitis (i.e. Streptococcus pneumoniae) is a medical emergency

•Infants and older adults at highest risk

•Etiology: from ear or sinus infection or skull fracture

Symptoms of Meningitis

•Headache

•Fever

•Vomiting

•Nuchal rigidity

•Drowsiness

•Seizure

•Purple rash

Medical Dignosis of Meningitis

•Medical history

•Physical examination

•Blood/urine/throat cultures

•Lumbar puncture to assess CSF

• Bacteria and elevated leukocytes

Treatment of Meningitis

•Antibiotics (ASAP)

•Corticosteroids

**For viral infections: fluids, rest and over-the-counter mediation to reduce aches and fever

Description of Alzheimer Disease

** Progressive, chronic, ultimately fatal, brain syndrome associated with the death of neurons in the cerebral cortex

•Acetylcholine production is reduced, resulting in progressive memory impairment

•Unknown etiology (hereditary? autoimmune? head trauma?)

Symptoms of Alzheimer Disease

•Memory loss (progressive)

•Depression

•Agitation and irritability

•Emotionally detachment

•Sleep disturbances

•Deterioration of intellectual ability

•Deterioration of physical ability

Medical Dignosis of Alzheimer Disease

•Mental and functional health

•Cranial CT and MIR

•PET scan

Depression scale

Treatment of Alzheimer Disease

•Cholinesterase inhibitors

•Memantine

Description of Parkinson Disease

**Chronic brain disease characterized by progressive muscle rigidity and involuntary tremors.

•Unknown etiology (loss of synthesis of dopamine) (environmental? genetic?)

Symptoms of Parkinson Disease

•Bradikinesia

•Rigid extremities

•Tremors

•Balance difficulties

•Shuffling walk

•Muffled speech

•Stress

•Fatigue

•Anxiety

Medical Diagnosis of Parkinson Disease

•Physical examination

•Neurological exam

Treatment of Parkinson Disease

•Levodopa (dopamine replacement)

•Anticholinergics

•Physical therapy

•Psychological support

•Invasive techniques

•Deep brain stimulation

Description of Multiple Sclerosis

**Chronic, progressive and irreversible autoimmune disease characterized by the destruction of myelin

•Early adulthood (more women than men)

•Etiology: not fully understood (auto-immune). Vit D?

Symptoms of Multiple Sclerosis

**come and go, triggered by inc. body temperature

•Change of vision (first symptom)

•Transient motor and sensory disturbances

•Muscle weakness

•Paralysis

•Incontinence

•Fatigue

•Balance problems

•Numbness

Medical Dignosis of Multiple Sclerosis

Difficult to diagnose

• Neurological examination

• Eye examination

• CFS analysis

• Cranial CT and MRI

Treatment of Multiple Sclerosis

**Not specific

•Interferon beta products

•Corticosteroids

•Rehabilitation

•Physiological therapy

Muscle relaxants

Description of Amyotrophic Lateral Sclerosis (ALS)

**Progressive muscular atrophy and weakness associated with the neurodegeneration of nerve cells in the brain and spinal cord (Lou Gehrig disease)

•Most common between 50-60 y and more often in men

•Etiology: unknown (genetic?)

•High levels of glutamate damage the nerve cells

Symptoms of Amyotrophic Lateral Sclerosis (ALS)

•Involuntary muscle contraction

•Muscular atrophy

•Weakness

•Twitching

•Speech problems

•Paralysis

Medical Dignosis of Amyotrophic Lateral Sclerosis (ALS)

**Difficult

•Electromyography

MRI

Treatment of Amyotrophic Lateral Sclerosis (ALS)

**Not specific

•Emotional and physical support

•Antiglutamate drug (Rilutek)

*Slow progression

Description of Cerebral Palsy

Permanent, symmetrical paralysis resulting from defects of the brain (trauma during or after birth) or from developmental defects

•Most cases, prenatal causes (80%):

•Maternal rubella

•Maternal diabetes

•Anoxia

•Preeclampsia

Medical Diagnosis of Cerebral Palsy

•Medical history

•Neurological assessment

•CT, MRI and ultrasound

Treatment of Cerebral Palsy

•Physical therapy

•Speech therapy

•Stem cell therapy