diseases

Meningitis

  • Meningitis is an inflammation of the meninges surrounding the brain and spinal cord.

  • Causes of Meningitis:

    • Primarily caused by viral infections.
    • Can also be caused by bacterial and fungal infections.

  • Mortality Rates:

    • Bacterial meningitis: mortality rate ranges from 70% to 100% if left untreated.
    • Viral meningitis: generally considered a benign disease.
    • Fungal meningitis: rare, often occurs due to a fungus spreading through the blood to the spinal cord.

  • Risk Factors:

    • Higher risk in individuals with weakened immune systems (e.g., those with HIV or cancer).
    • Fungal meningitis can affect anyone.

  • Symptoms of Meningitis:

    • High fever
    • Chills
    • Headache
    • Vomiting
    • Positive Brudzinski's sign:
    • Demonstrated by hip and knee flexing when the head and neck of a dorsal recumbent person are raised.
    • Positive Kernig's sign:
    • Demonstrated by pain and resistance when the knee is straightened after being flexed at the thigh and knee.

  • Diagnosis:

    • For bacterial and fungal meningitis: confirmed via lumbar puncture, showing:
    • Elevated cerebrospinal fluid (CSF) pressure
    • Cloudiness due to excess white cells
    • Identification of the causative organism through culturing.
    • For viral meningitis: can use nasopharyngeal swabs, rectal swabs, stool samples, CSF, and blood serum for laboratory testing.

  • Common Causes:

    • Bacterial meningitis can result from infections of the ears, sinuses, lungs, pneumonia, or brain abscesses.
    • Significant viral cause in the U.S. is a group of viruses known as enteroviruses.
    • Most common fungal cause, especially in immunocompromised individuals, is Cryptococcus.
    • In some cases, the cause may remain unknown.

  • Treatment:

    • Bacterial meningitis: includes antibiotics.
    • Medications to reduce cerebral edema, pain relievers, and anticonvulsants may also be used.
    • Isolation could be indicated in certain bacterial meningitis cases.

Multiple Sclerosis (MS)

  • Definition & Overview:

    • Multiple sclerosis is a demyelinating disease of the nervous system
    • Primarily affects young adults, diagnosed typically between ages 20-40.

  • Prevalence:

    • More than a million individuals in the U.S. are affected by MS or related disorders.

  • Economic Impact:

    • Significant financial burden due to many sufferers being unable to work.

  • Symptoms:

    • Symptoms vary based on nerve damage site, may include:
    • Paralysis
    • Numbness
    • Double vision
    • Gait issues (foot dragging)
    • Loss of balance
    • Weakness
    • Tremors
    • Speech and hearing difficulties
    • Bowel and bladder dysfunctions
    • Pins and needles sensations.

  • Disease Course:

    • Patients may experience remissions after episodes.
    • Most have a pattern of remissions and exacerbations, leading to progressive deterioration.

  • Pathophysiology:

    • The disease destroys myelin sheaths, creating patches replaced by scar tissue, which disrupts nerve impulse transmission.
    • Research indicates it might stem from:
    • Reactivated dormant viruses.
    • An autoimmune response.
    • Environmental and genetic factors.

  • Treatment:

    • For acute exacerbations, IV ACTH may be utilized.
    • Preventive medications include:
    • Injectables: Avonex, Xtavia, Betaseron.
    • Oral medications: Ocrelizumab, Mayzent.
    • Infusion medications: Briumvi, Novantrone.
    • Medications for emotional fluctuations and muscle spasticity as needed.

  • Rehabilitation:

    • Physical and occupational therapy aids in:
    • Optimizing strength
    • Relieving muscle stiffness
    • Enhancing balance and endurance
    • Functional adaptation in home/work environments.

Neuralgia

  • Definition:
    • General term describing nerve pain, classified by affected body area.
  • Characteristics:
    • Causes severe pain along the nerve course.
    • Resulting from:
    • Pressure on nerve trunks.
    • Faulty nerve nutrition, toxins, inflammation, or root ganglia changes.
  • Management:
    • Treatments include:
    • Pain medications
    • Physical therapy
    • Application of heat/cold
    • Rest and stretching exercises.

Paralysis

  • Definition:

    • Temporary or permanent loss of voluntary function in a portion of the body.

  • Mechanism:

    • Depends on integrity of motor neurons (upper motor neurons in the brain and lower motor neurons in the spinal cord).

  • Classification of Paralysis:

    • Two broad types:
    • Spastic Paralysis: caused by upper motor neuron damage.
    • Flaccid Paralysis: caused by lower motor neuron damage.

  • Forms of Paralysis:

    • Hemiplegia
    • Paraplegia
    • Quadriplegia

  • Prevention of Brain and Spinal Cord Damage:

    • Stroke risks can be minimized by:
    • Proper exercise
    • Healthy blood pressure and cholesterol levels
    • Avoiding smoking
    • Stress reduction.
Hemiplegia
  • Definition:
    • Unilateral paralysis caused by brain damage (either side).
  • Characteristics:
    • Right brain damage → left body paralysis; left brain damage → right body paralysis.
    • May include:
    • Weakness or paralysis in arm, leg, face, tongue.
    • Sudden (stroke or injury) or gradual onset (tumor or disease).
    • Symptoms may include difficulty understanding language and problems with eating.
  • Causes:
    • May be due to:
    • Cerebrovascular accidents (CVA/stroke)
    • Tumors
    • CNS infections
    • Trauma.
  • Treatment Approaches:
    • Early treatment focuses on preventing further involvement and complications
    • Later treatment involves:
    • Physical therapy
    • Occupational therapy
    • Speech therapy
    • Modifications for independence.
Paraplegia
  • Definition:
    • Loss of motor or sensory function in lower extremities, resulting from trauma.
  • Statistics:
    • About 40% of the 18,000 annual spinal cord injuries lead to paraplegia.
    • Majority of cases occur in males (75-79%) aged 16 to 30 from accidents, sports, and violence.
  • Onset:
    • Immediate paralysis associated with a spinal cord injury.
    • May involve loss of bladder, bowel, and sexual functions.
  • Causes:
    • Trauma from accidents or congenital conditions like spina bifida or cerebral palsy.
  • Treatment Initiatives:
    • Immediate care at the accident scene.
    • Stabilization of the spine, removal of bone fragments, and drainage of urine via a catheter.
    • Continued care for skin maintenance, nutrition, and infection control.
  • Rehabilitation Programs:
    • Promote recovery and activity.
    • Patients require psychological support.
Quadriplegia
  • Definition:
    • Comprehensive paralysis affecting all body systems (arms, legs, below the injury level).
  • Statistics:
    • Approximately 140,000 people living with quadriplegia in the U.S.
  • Injury Types:
    • Usually results from trauma.
  • Symptoms:
    • Flaccid or spastic paralysis with sensory loss below injury.
    • Injuries above C5 significantly affect major body systems:
    • Low blood pressure
    • Slow heart rate
    • Respiratory difficulties requiring support.
  • Treatment Protocols:
    • Patient immobilization and alignment at the accident scene.
    • Hospitalization for further stabilization and surgery for spinal repairs.
    • Continuous challenges to maintain essential functions and emotional support are critical.

Parkinson's Disease

  • Overview:
    • A common, progressive neurological disorder affecting about 1% of the population aged 60+ (approximately 90,000 new cases annually in the U.S.).
    • More prevalent in males.
  • Symptoms:
    • Muscle rigidity, tremors (notably, pill rolling), high-pitched voice, and a mask-like expression.
    • Progresses to characterized gait, drooling, and increased muscle tension.
  • Cause of Illness:
    • Etiology is unknown, most commonly linked to dopamine deficiency affecting brain cell function.
    • Factors may include genetic predisposition, environmental exposure, and toxins.
  • Treatment Options:
    • Levodopa and Carbidopa are used to manage symptoms until high dosages become problematic.
    • Surgical procedures such as:
    • Deep brain stimulation (DBS) – involves implantation of electrodes monitored with external devices.
    • Thalamotomy and pallidotomy – aimed at specific symptomatic relief.
  • Impact of Notable Individuals:
    • Advocates like Michael J. Fox have raised awareness and urgency for research efforts to find cures.

Reye's Syndrome

  • Definition & Characteristics:
    • Acute illness in childhood characterized by:
    • Fatty infiltration of the liver
    • Increased intracranial pressure (ICP)
    • Damaging effects also seen in kidneys and possibly heart muscles.
  • Epidemiology:
    • Occurs in children from infancy to adolescence, with a higher frequency in whites.
    • Mortality rates have decreased from 90% to 20% with early and effective treatment.
  • Symptoms Severity Stages:
    • Initial: vomiting, lethargy, liver dysfunction.
    • Advanced: hyperventilation, delirium, seizures leading to respiratory arrest.
  • Associations:
    • Often follows acute viral infections, notably due to aspirin consumption; hence, aspirin is contraindicated in children.
  • Management Strategies:
    • Focused on reducing ICP and managing associated symptoms.
    • Medical intervention may involve aggressive treatment options.

Sciatica

  • Definition:
    • Term referring to leg pain along the sciatic nerve, primarily unilateral.
  • Symptoms:
    • Sharp pain radiating from buttocks down the thigh to the lower leg, aggravated by movement.
    • Pain may worsen at night or with certain atmospheric changes.
  • Causes:
    • Nerve irritation or damage results from spinal stenosis or herniated discs, strenuous activities, or pelvic tumors.
  • Management Approaches:
    • Maintenance of activities as tolerated, applying heat or cold, medications, and physical therapy.
    • Chronic cases may necessitate surgical intervention if conservative treatment fails.

Spinal Cord Defects

  • Overview:
    • Result from improper tissue closure during early pregnancy months, commonly in lumbosacral area.
  • Prevalence:
    • Approximately 7 cases per 10,000 live births in the U.S.
  • Types of defects:
    • Spina Bifida Occulta:
    • Incomplete closure of vertebrae without protrusion; usually asymptomatic.
    • Meningocele:
    • Protruding sac containing meninges and cerebrospinal fluid (CSF).
    • Myelomeningocele:
    • Protruding sac containing meninges, CSF, and part of the spinal cord, leading to varying neurological deficits.
  • Etiology:
    • Condition arises from failure of the neural tube closure, ideally before 23rd gestational day.
    • Folic acid deficiency is a major contributing factor; prenatal vitamins are crucial in prevention.
  • Treatment & Prognosis:
    • Depend on defect extent; oculta may not require treatment, while meningocele and myelomeningocele need surgical intervention.
    • Hydrocephalus might necessitate shunt installation.