nero part 2

Amyotrophic Lateral Sclerosis (Lou Gehrigs D)

Weakness/wasting of muscles under voluntary control (No sensory/cognitive changes) and is neurologically degenerative, rapidly progressive and fatal

in Lou Gehrigs D

motor neuron degeneration and corticospinal sclerosis (in lateral columns of the spinal cord) cause muscle atrophy

Amyotrophy

no muscle nutrition or progressive muscle wasting/atrophy

early stages of Amyotrophic Lateral Sclerosis (Lou Gehrigs D)

surviving motor neurons sprout new branches to reinnervate affected muscle fibers but if > 1/2 motor neurons are affected reinnervation fails and weakness is evident. Initially muscles are weak but progress to flaccid/spastic paralysis

Amyotrophic Lateral Sclerosis (Lou Gehrigs D) symptoms

trouble with swallowing, communication, respiration and managing secretions

Amyotrophic Lateral Sclerosis fatality

Death occurs 2-5 years after manifestation. Usually due to respiratory failure

Decorticate

Hemispheric damage above the midbrain

Decerebrate

Severe damage to the diencephalon or midbrain

Spinal Cord Injuries can cause (5)

Loss of voluntary control, flaccid paralysis, dec muscle tone, muscle atrophy and dec reflexes

Bleeds are caused by

injury (sudden changes in motion tear blood vessels), brain isnt anchored to the skull (floating) or aneurysm/artery bursts (last stage of chronic HTN)

bleeds can cause

shifted/distorted brain, herniated brain tissue (pushed out of normal space) or compressed blood vessels (ischemia)

Bleeds within brain

Hemorrhagic Stroke from arterial aneurysms bursting

Epidural bleeds

Between skull/dura and mostly ARTERIAL

Subdural bleeds

Between dura/arachnoid and mostly VENOUS

Subarachnoid and intracerebral bleeds

Between pia mater/brain (into CSF) or brain tissue. Venous or arterial

Bleed Symptoms

changes in consciousness, Glasgow Coma Scale and Brain stem function (Pupillary response and corneal reflex)

Change in level of consciousness (bleeds) cause

Delirium, Lethargic, Obtunded (dulled), Stuperous and Comatose

Cerebrovascular Accident (stroke) in the elderly

main cause of disability and 1/5 cause death

Signs of stroke

Numbness/weakness on one side, trouble speaking/understanding, trouble walking, visual disturbances and severe headaches (hemorrhagic stroke)

Risk factors for cva (stroke)

Htn, A fib, smoking, high cholesterol and sedentary lifestyle

Meningitis

subarachnoid space infection (mostly bacterial) causing a stiff neck and cerebral dysfunction

Encephalitis

inflamed brain (mostly viral)

Brain Abscess

Infections from neighboring structures (teeth, sinuses, ears) or penetrating wounds thats mostly bacterial or necrotizing

delirium

Abrupt onset causing altered levels of consciousness. mostly physiologic causes and reversible

Dementia

Progressive failure of cerebral functions causing irreversible confused states and declined intellectual ability

neuropathological hallmarks of Alzheimers D

Amyloid rich senile plaques, neurofibrillary tangles and neuronal degeneration. begins years before symptoms

Early Symptoms of Alzheimers

AD begins very slowly. starts with difficulty solving simple math problems and remembering recent events/activities and names of people/things

mild forgetfulness

most people with this dont have AD

Middle Stages of AD

Forgetfulness interferes with daily activities. Patients have trouble thinking clearly, recognizing familiar people/places and forget how to do simple tasks

in middle stages of AD

patients have trouble speaking/understanding and reading/writing

late stages of AD

patients become anxious/aggressive and wander away from the home requiring total care

Parkinson’s Disease

motor system disorder from a loss of dopamine producing brain cells

primary symptoms of PD (4)

Tremor, rigidity (stiff limbs/trunk), bradykinesia (slowness of movement) and postural instability (impaired balance and coordination)

as symptoms worsen in PD

patients have trouble walking, talking and completing simple tasks

PD symptoms

Depression, sleep disruptions, urinary problems, constipation and difficulty swallowing, chewing and speaking

Multiple Sclerosis

Degeneration of myelin (preserved axons)

Autoimmune process in Multiple Sclerosis

CD4 cells, chemotaxis and an infiltration of monocytes and macrophages cross the blood brain barrier. T cells become autoreactive to a single myelin protein

Multiple Sclerosis symptoms

worse with stress. Paresthesias (numbness/tingling), strange sensation of tightness, banding, constriction, imbalance, ataxia (lack of coordination) and visual changes (blurring/double vision)

Myasthenia Gravis

chronic. Immune system produces antibodies that attack the neuromuscular junction/postsynaptic membrane destroying ACh receptors on muscle cells

Myasthenia Gravis causes

skeletal muscle weakness/fatigue. if it involves bulbar or respiratory muscles it can be life threatening

bulbar muscles

head/neck muscles that control swallowing, speaking and chewing

Myasthenia Gravis symptoms

weakness in extremities, drooping eyelids, slurred speech and difficulty making facial expressions

Primary headaches

migraines, tension headaches and cluster headaches

headache Red flag symptoms

Abrupt thunderclap (vascular hemorrhage), worse at night or with cough/valsalva (elevated ICP) or with fever (infection)

Migraine

unilateral. can cause photosensitivity, severe pain and visual aura

Tension headache

dull/moderate pain

Cluster headaches

unilateral severe periorbital (around the eyes) pain that occurs in clusters. can be chronic or episodic

Cluster periods

headaches followed by short/long remission periods

Cluster headaches symptoms

red watery eyes and forehead sweating

Glasgow Coma Scale

Eye opening and Verbal/motor response