Chapter 11 Neuro Part II

Neural Function

Overview

  • Introduction to neural function and its significance in the human body.

Learning Objectives

  • Normal Neural Anatomy and Physiology: Understanding the structure and function of the nervous system.

  • Congenital Neurologic Disorders: Discussion and comparison of disorders from birth.

  • Traumatic Neurologic Disorders: Comparing various traumatic disorders affecting the nervous system.

  • Infectious Neurologic Disorders: Understanding infections that impact neurological function.

  • Vascular Neurologic Disorders: Describe and compare disorders related to vascular issues affecting the nervous system.

  • Headache Disorders: An overview of different types of headaches and their characteristics.

  • Types of Seizure Disorders: Comparison of various seizure types.

  • Chronic Degenerative Neurologic Disorders: An exploration into progressive disorders.

  • Types of Dementia: Comparing and contrasting different forms of dementia.

  • Cancers of the Nervous System: Discussion on oncological disorders within the nervous system.

Infectious Neurologic Disorders

Meningitis

  • Description: Inflammation/infection of the meninges and subarachnoid space, potentially affecting CSF.

  • Causes: Bacterial (Group B Streptococcus, Neisseria meningitidis) and viral (Enterovirus, HIV) infections, and tumors.

  • Inflammatory Response: Triggers swelling of the meninges and increased intracranial pressure (ICP).

  • Risk Factors: Young age under 25 years, communal living, pregnancy, working with animals and immunodeficiency.

Meningitis Complications and Treatment

  • Severity: Can be self-limiting (viral) or life-threatening (bacterial).

  • Complications: Include permanent neurologic damage, seizures, and possible death.

  • Manifestations: Fever, headaches, stiff neck, and irritability in children.

  • Diagnosis: Health and Physical (H&P) examination, lumbar puncture, polymerase chain reaction test.

  • Treatment: Antibiotics for bacterial meningitis, antivirals, hydration, corticosteroids, and vaccinations for prevention.

Encephalitis

Overview

  • Description: Inflammation/infection of the brain, causing neurological deficits.

  • Causes: Viral (Coxsackievirus, Herpes virus) and some bacterial infections.

  • Diagnostic Procedures: Similar to meningitis; includes MRI and lumbar puncture for CSF analysis.

  • Infection triggers inflammation which will cause vasodilation, increase capillary permeability and will cause nerve cell degeneration and brain destruction.

  • S/S: flulike, headache, neck rigidity, agitation, bulging fontanelle

  • Treatment: Rest, increase liquids, respiratory supports, reorientation and emotional support, analgesis and antipyretics, corticosteroids, antiseizure/sedatives, speech therapy

  • Prevent: vaccine, protective clothing, mosquito repellant and eliminating water sources around the home


Zika Virus Disease

  • Caused by flavivirus

  • transmitted by mosquitos, mother to fetus and blood transfusion

  • Manifestations: fluelike symptoms, rash, conjunctivies, muscoskelatal pain and headache

Traumatic Brain Injury (TBI)

Overview

  • Causes: Sudden impacts from falls, motor vehicle accidents, or sports injuries.

  • Risk Groups: High-risk populations include children, adolescents, and older adults.

TBI Complications and Manifestations

  • Severity: Ranges from mild concussions to severe traumatic injuries.

  • Consequences: Cognitive deficits, scientific, language changes, and potential death.

  • Diagnosis: Includes physical exams, CT scans, and continuous observation.

  • Treatment: Rest, analgesics, and potentially surgery.

  • Can cause change in thinking, sensation, language and emotion

    • can cause migraines, alzheimer, parkinsons, neurologic dysfunction and cognitive deficits

  • Concussion: A mild traumatic brain injury that can result from a blow to the head, leading to symptoms such as confusion, headache, dizziness, and temporary loss of consciousness.

  • Cerebral Contusion: A bruise on the brain caused by a direct impact, which may lead to swelling, bleeding, and potentially more severe symptoms such as memory loss, difficulty concentrating, and changes in personality.

  • Manifestations: not being able to recall event, seizures, asymmetric face features, fractures/bruises, scalp wound.

  • Prevention: seat belt, helmet and safety seats, supervision of children

Increased Intracranial Pressure (ICP)

Defintion: Increased Intracranial Pressure (ICP) refers to a rise in pressure within the skull that can lead to serious complications, including brain damage and impaired neurological function.

Causes and Symptoms

  • Causes: Tumors, trauma, or cerebral edema leading to increased ICP.

  • Symptoms: Decent consciousness level, bradycardia, and headache.

  • Compensatory Mechanisms:

    • Autoregulation: blood vessels dilate to increase blood flow and constrict if ICP increases

    • Cushing’s Reflex: hypothalamus increase sympathetic stimulation when MAP drops below ICP and causes vasoconstriction, increases CO

Treatment

  • Diagnosis: H/P, Head CT/MRI and ICP monitoring

  • Treatment: removal of tumor, respiratory support, semi fowler position, draining excess CSF, stool softeners, antiulcers

Herniation:

Definition: increased ICP and displacement of brain tissue

  • Transtentorial: herniation occurs when the temporal lobe is displaced downward through the tentorial notch, potentially compressing the brainstem and leading to severe neurological deficits.

  • Uncalherniation: a type of transtentorial herniation where the uncus of the temporal lobe is displaced downward, often leading to compression of the brainstem and midbrain.

  • Cerebral/Tonsillar herniation: occurs when there is a shift of brain tissue due to increased intracranial pressure, which can lead to significant complications, including loss of consciousness and respiratory failure.

Hematoma

  • Epidural Hematoma: bleeding in dura and skull due to arterial tear

    • Neurologic dysfunction, loss of consciousness, short period of alertness and loss of consciousness again

  • Subdural Hematomas: between dura and arachinoid due to a venous tear

    • happens within 24hrs of injury

    • high mortality

    • ICP increases after a week


Cerebrovascular Disorders

Transient Ischemic Attack (TIA)

  • Definition: Temporary episodes of cerebral ischemia without lasting damage.

  • Symptoms: Similar to strokes; weakness, speech issues, and sensory changes.

  • Management: Risk factor modification, antiplatelet agents, and lifestyle changes.

Cerebrovascular Accident (CVA)

  • Definition: Permanent ischemic damage due to cerebral blood supply interruption.

  • Types: Ischemic strokes (most common) and hemorrhagic strokes (most fatal).

  • Diagnosis and Treatment: Focus on prompt assessment and treatment for minimizing damage.

Headache Disorders

Overview

  • Definition: Pain experienced in the head region; can vary in intensity and duration.

  • Types: Primary headaches (no underlying causes) vs. secondary headaches (due to causes like infections or trauma).

  • Symptoms and Treatment: Includes avoiding triggers, medications, and potential therapies.

Conclusion

  • Importance of recognizing and understanding various neurologic disorders for effective management and treatment.


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