Comprehensive Notes on CNS Problems: MS and SCI

Key Concepts in Care of Patients with CNS Issues

• Primary Concepts:
  • Immunity
  • Mobility
  • Sensory Perception
• Exemplars:
  • Multiple Sclerosis (MS) as Immunity Exemplar
  • Spinal Cord Injury (SCI) as Mobility Exemplar
• Interrelated Concepts:
  • Comfort
  • Cognition
  • Sexuality

Multiple Sclerosis (MS)

• Definition:
  • Chronic disease marked by demyelination and axonal nerve damage.
• Types of MS:
  • Relapsing-Remitting: Episodes of symptoms followed by recovery.
  • Primary Progressive: Gradual worsening of function from onset.
  • Secondary Progressive: Initially relapsing-remitting, then progressive worsening.
  • Progressive-Relapsing: Progressive disease with acute relapses.

Etiology of MS

• Factors Influencing MS:
  • Immune System Dysfunction
  • Genetic Predisposition: Higher risk with first-degree relatives.
  • Environmental Factors: Such as infections, vitamin D deficiency.

Clinical Assessment for MS

• Assessment Types:
  • Physical, Psychosocial, Laboratory assessments.
  • Important to differentiate MS from conditions like ALS.
  • MRI: Diagnostic imaging for MS.

Common Physical Symptoms of MS

• Symptoms Include:
  • Fatigue, stiffness, spasms, and tremors.
  • Visual disturbances: blurred vision, diplopia, nystagmus.
  • Sensory issues: numbness, tingling.
  • Bowel and bladder dysfunction.

Psychosocial Considerations

• Emotional aspects such as depression and coping skills should be assessed regularly.
• Secondary Depression: Common in MS patients.

Laboratory Assessments

• Key Indicators:
  • No single lab test for diagnosis.
  • CSF Analysis: Elevated protein, increased WBC, and elevated Immunoglobulin G.
  • MRI with Contrast: Identifies plaques.

Management of MS

• Goals of Management:
  • Modify disease effects, prevent exacerbations, manage symptoms, maintain quality of life.
• Drug Therapy:
  • Interferons: Reduce severity and frequency of relapses.
  • Steroids: Especially for acute exacerbations.
  • Fingolimod (Gilenya): First oral immunomodulator.
  • Complementary Approaches: Massage, Yoga, and Herbal therapies.

Spinal Cord Injury (SCI)

• Definition:
  • Damage to neural elements of the spinal cord leading to loss of function below the injury level.
• Types of Injuries:
  • Complete SCI: Total loss of function below the injury site.
  • Incomplete SCI: Some function remains below the injury level.

Mechanisms of SCI

• Causes:
  • Hyperflexion, hyperextension, axial loading, and penetration injuries.

Assessment of SCI

• Initial Assessment Includes:
  • Airway, Breathing, Circulation checks.
  • Monitoring for signs of hemorrhage and consciousness using the Glasgow Coma Scale.
• Types of Paralysis:
  • Tetraplegia: Loss of function in all four limbs.
  • Paraplegia: Loss of function in the lower limbs.

Spinal Shock

• Characteristics:
  • Flaccid paralysis and loss of reflex actions below the injury.
  • Return of reflexes indicates reversal of shock.

Autonomic Dysreflexia

• Common in patients with SCI above T6.
• Symptoms:
  • Severe hypertension, bradycardia, and severe headache.
  • Triggered by bladder distension or noxious stimuli.
• Management:
  • Elevate the head, remove triggers, monitor vital signs.

Management of SCI

• Goals of Treatment:
  • Ensure airway integrity, prevent secondary injury, and manage mobility.
• Surgical Interventions:
  • May include decompression and stabilization surgeries.
• Drug Therapy:
  • Corticosteroids like Methylprednisolone to reduce inflammation.