Anatomy and Physiology. Neurological Topics. Common Signs and Symptoms

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1 Anatomy and Physiology Neurological Topics HIHIM 409 Nervous system: brain, spinal cord, nerves Central Nervous System (CNS) and Peripheral Nervous System (PNS) CNS: brain and spinal cord PNS: autonomic nervous system, cranial and spinal nerves Learning. ALL RIGHTS RESERVED. 2 Common Signs and Symptoms Common signs and symptoms Headache Nausea and vomiting Weakness Mood swings Fever Common Signs and Symptoms Symptoms specific to CNS Stiffness in neck, back, or extremities Inability to move any part of the body Seizures or convulsion Paralysis Visual difficulties Learning. ALL RIGHTS RESERVED. 3 Learning. ALL RIGHTS RESERVED. 4 Common Signs and Symptoms Symptoms specific to CNS Inability to speak Paralysis Extreme or prolongeddrowsinessdrowsiness Stupor, unconsciousness, amnesia, extreme forgetfulness Common Signs and Symptoms Common diagnostic tests Cerebrospinal fluid Measuring intracranial pressure X rays of skull and vertebralcolumn Myelogram Learning. ALL RIGHTS RESERVED. 5 Learning. ALL RIGHTS RESERVED. 6 1

2 Common Signs and Symptoms Common diagnostic tests Angiogram Electroencephlogram CAT Scan MRI Encephalitis Inflammation of brain tissue caused by bacteria and viruses : Headache, stiff neck and back Fever and lethargy Confusion and even coma Learning. ALL RIGHTS RESERVED. 7 Learning. ALL RIGHTS RESERVED. 8 Encephalitis : Supportive Antiviral medication may be effective Meningitis Inflammation of meninges or coverings of brain and spinal cord Causes: Bacterial and viral Fungi Toxins such as lead and arsenic Learning. ALL RIGHTS RESERVED. 9 Learning. ALL RIGHTS RESERVED. 10 Meningitis High fever Severe headaches Photophobia Meningitis Stiffness and resistance in neck (nuchal rigidity) Drowsiness Stupor Seizures Coma Learning. ALL RIGHTS RESERVED. 11 Learning. ALL RIGHTS RESERVED. 12 2

3 Meningitis Diagnosis: collect spinal fluid to find cause Antibiotics for bacterial infection Antipyretics Anticonvulsants Quiet dark environment Poliomyelitis Viral infection affecting brain and spinal cord Vaccine has eliminated the disease in the United States Virus is spread by oropharyngeal secretions and infected feces Learning. ALL RIGHTS RESERVED. 13 Learning. ALL RIGHTS RESERVED. 14 Poliomyelitis Muscle weakness Neck stiffness Nausea and vomiting Poliomyelitis Diagnosis: clinical examination, throat, feces, and spinal fluid culture : supportive therapy including analgesics and bedrest during acute phase Learning. ALL RIGHTS RESERVED. 15 Learning. ALL RIGHTS RESERVED. 16 Poliomyelitis Long term physical therapy and braces may be needed If respiratory system involved, mechanical ventilation may be needed Tetanus Highly fatal infection of nerve tissue caused by bacteria Clostridium tetani First symptom is stiffness of the jaw, commonly called lockjaw Learning. ALL RIGHTS RESERVED. 17 Learning. ALL RIGHTS RESERVED. 18 3

4 Rabies Caused by virus Primarily affects animals such as dogs, cats, raccoons, squirrels Transmitted to humans through bite of an infected animal Rabies Fever and pain Convulsions and rage Spasms and paralysis of muscles for swallowing Learning. ALL RIGHTS RESERVED. 19 Learning. ALL RIGHTS RESERVED. 20 Rabies Throat spasms leading to hydrophobia Inability to swallow; drooling of frothy saliva Clean infection site and rabies vaccine injections No cure Shingles Viral disease caused by herpes zoster Itching, painful red rash, and small vesicles on sensory nerve paths last ten days to several weeks Learning. ALL RIGHTS RESERVED. 21 Learning. ALL RIGHTS RESERVED. 22 Shingles Diagnosis Appearance of lesions Viral culture test Shingles Antiviral medications Analgesics Antipyretics Antipruritic medications Learning. ALL RIGHTS RESERVED. 23 Learning. ALL RIGHTS RESERVED. 24 4

5 Transient Ischemic Attacks TIAs or mini strokes Insufficient blood to brain Symptoms Weakness of arm and/or leg Dizziness Slurred speech Mild loss of consciousness Transient Ischemic Attacks Symptoms last few minutes to an hour Diagnosis is made by angiogram Surgery to improve blood flow Learning. ALL RIGHTS RESERVED. 25 Learning. ALL RIGHTS RESERVED. 26 Degenerative Disk Disease Headache Epilepsy Bell s Palsy Degenerative Disk Disease Degeneration or wearing away of the intervertebral disk Wearing away allows vertebrae to bump or rub against each other Learning. ALL RIGHTS RESERVED. 27 Learning. ALL RIGHTS RESERVED. 28 Degenerative Disk Disease : Difficulty walking Radiating pain in back and in one or both legs Degenerative Disk Disease Diagnosis: X ray Myelogram CAT or MRI Learning. ALL RIGHTS RESERVED. 29 Learning. ALL RIGHTS RESERVED. 30 5

6 Degenerative Disk Disease Rest back and legs Back brace Analgesics and anti inflammatory drugs Exercise to ease pain Surgery Headaches one of the most common disorders in humans Caused by two mechanisms Tension on facial, neck, and scalp muscles Vascular changes in arterial size of vessels inside head Learning. ALL RIGHTS RESERVED. 31 Learning. ALL RIGHTS RESERVED. 32 Headaches Contributing factors Stress Toxic fumes Noise Lack of sleep Alcohol consumption Headaches May be acute or chronic Pain may be constant, pressure, throbbing, stabbing, intermittent Tension, cluster, following lumbar puncture, migraine Learning. ALL RIGHTS RESERVED. 33 Learning. ALL RIGHTS RESERVED. 34 Headaches Diagnosis History and physical examination X ray EEG, MRI, and CAT Headaches Analgesics Bedrestandmuscle massage Muscle relaxants Warm baths Biofeedback Learning. ALL RIGHTS RESERVED. 35 Learning. ALL RIGHTS RESERVED. 36 6

7 Epilepsy Chronic disease of brain Intermittent episodes of abnormal electrical activity in brain Most common symptom is seizure Convulsions include petit mal, grand mal Epilepsy Diagnosis EEG CAT scan Cerebral angiogram Blood tests Learning. ALL RIGHTS RESERVED. 37 Learning. ALL RIGHTS RESERVED. 38 Epilepsy Anticonvulsive medications Close monitoring and adjusting of medications Bell s Palsy Affects facial nerve (7 th cranial), causing unilateral paralysis Affects individuals 20 to 60 years of age Learning. ALL RIGHTS RESERVED. 39 Learning. ALL RIGHTS RESERVED. 40 Bell s Palsy Drooping weakness of eye Drooling of saliva Unable to whistle or smile Distorted facial appearance Bell s Palsy Diagnosis History and symptoms Analgesics and anti inflammatory medication Learning. ALL RIGHTS RESERVED. 41 Learning. ALL RIGHTS RESERVED. 42 7

8 Dementia Loss of mental ability due to loss of neurons or brain cells Most common dementiais is senility Most common cause of senile dementia is Alzheimer's disease Alzheimer's Disease Form of dementia Affects individuals 70 and older Early symptoms Short term memory loss Inability to concentrate Slight changes in personality Learning. ALL RIGHTS RESERVED. 43 Learning. ALL RIGHTS RESERVED. 44 Alzheimer's Disease of disease progression Diminished communication skills Meaningless words Inability to form sentences Increased forgetfulness Irritability and agitation Alzheimer's Disease Positive diagnosis: autopsy Initially may be made by ruling out other brain diseases is supportive No cure Learning. ALL RIGHTS RESERVED. 45 Learning. ALL RIGHTS RESERVED. 46 Vascular Dementia Atrophy and death of brain cells due to decreased blood flow Atherosclerotic plaque can cause decreased blood flow and is common with aging Vascular Dementia Changes in memory, personality, and judgment Irritability, depression, and sleeplessness Lacks personal hygiene Learning. ALL RIGHTS RESERVED. 47 Learning. ALL RIGHTS RESERVED. 48 8

9 Vascular Dementia Diagnosis Blood flow testing and history and physical Increasing blood flow to brain Carotid endarterectomy Head Dementia Death of brain cells due to head trauma Decrease in mental intellect andcognitive function Learning. ALL RIGHTS RESERVED. 49 Learning. ALL RIGHTS RESERVED. 50 Head Dementia Diagnosis History Cranial X rays MRI and CT Correct damage if possible Substance Induced Dementia Brain cell death from drug toxicity and toxins Causes mental impairment and decreased cognitive ability Learning. ALL RIGHTS RESERVED. 51 Learning. ALL RIGHTS RESERVED. 52 Sleep Disorders Insomnia Inability to fall or stay asleep Related to stress, pain, fear, depression, caffeine, alcohol, nicotine, and bronchodilators Identifying and removing cause Sleep Apnea Sleep disorder characterized by periods of breathlessness Learning. ALL RIGHTS RESERVED. 53 Learning. ALL RIGHTS RESERVED. 54 9

10 Symptoms Daytime sleepiness Extreme snoring Personality changes Depression Impotence Sleep Apnea Sleep Apnea Diagnosis Monitor affected individual during sleep for apnea and low blood oxygen levels Learning. ALL RIGHTS RESERVED. 55 Learning. ALL RIGHTS RESERVED. 56 Sleep Apnea Based on cause Sleep Disorders Weight loss Surgery to correct nasal obstruction Oxygen during sleep Medications to stimulate breathing Tumors Primary and secondary Benign and malignant Symptoms Headache Vomiting and seizures Mood and personality changes Visual disturbance and loss of memory Learning. ALL RIGHTS RESERVED. 57 Learning. ALL RIGHTS RESERVED. 58 Tumors Diagnosis Clinical symptoms X ray, CT, and MRI Biopsy Treatment: surgery, radiation, and chemotherapy Concussions and Contusions Blow to head by an object, fall, or other trauma such as an automobile accident Disruptionof of normalelectricalactivity activity in brain Learning. ALL RIGHTS RESERVED. 59 Learning. ALL RIGHTS RESERVED

11 Concussions and Contusions Causes immediate unconsciousness May last a few seconds to several hours Concussionis is less serious than a contusion Concussions and Contusions Contusion is bruising of the brain Outcomes: Canlead to a hematoma Increased intracranial pressure (ICP) Permanent brain damage Learning. ALL RIGHTS RESERVED. 61 Learning. ALL RIGHTS RESERVED. 62 Concussions and Contusions Diagnosis History of injury Neurologic examination Cranial X ray CT and MRI Concussions and Contusions Bedrest and direct observation Individual should be checked every 2 to 4 hours Monitor changes in consciousness, eye pupil size, mood, and behavior Learning. ALL RIGHTS RESERVED. 63 Learning. ALL RIGHTS RESERVED. 64 Concussion and Contusions Analgesics, stimulants, and sedatives should not be given to individuals with a head injury Medications may mask the symptoms and make assessment difficult Skull Fracture Greatest danger is brain tissue damage from bony fragments Potential of cutting brain, severing a vessel, and causing a hematoma Brain damage may be temporary or permanent Learning. ALL RIGHTS RESERVED. 65 Learning. ALL RIGHTS RESERVED

12 Skull Fracture Fracture near base of skull may injure respiratory center and impair breathing Infection of brain tissue may be a problem Skull Fracture Dependent on type and position of fracture Craniotomymay may be necessary to relieve ICP Protective headgear may be necessary until fracture is healed Learning. ALL RIGHTS RESERVED. 67 Learning. ALL RIGHTS RESERVED. 68 Epidural and Subdural Hematoma Blood vessels rupture and hemorrhage Blood seeps between bony skull and outer meninges Pushes dura mater away from inner bony skull Epidural and Subdural Hematoma Epidural Hematoma symptoms Headache Dilated pupils Nausea, vomiting, and dizziness Learning. ALL RIGHTS RESERVED. 69 Learning. ALL RIGHTS RESERVED. 70 Epidural and Subdural Hematoma Subdural Hematoma Usually the result of head hitting a stationary object Blood collects betweenthe the dura mater and arachnoid layer Epidural and Subdural Hematoma Subdural Hematoma Develops slowly over period of days Hemiparesis Nausea, vomiting, dizziness Convulsions and loss of consciousness Learning. ALL RIGHTS RESERVED. 71 Learning. ALL RIGHTS RESERVED

13 Epidural and Subdural Hematoma Diagnosis Clinical history Cranial X ray, CT or MRI Decrease intracranial pressure Craniotomy called bur holes Spinal Cord Injury Quadriplegia and Paraplegia Injury to spinal cord Results in varying degrees of loss of movement Results in varying degrees of loss of feeling below the area of injury Learning. ALL RIGHTS RESERVED. 73 Learning. ALL RIGHTS RESERVED. 74 Spinal Cord Injury Quadriplegia and Paraplegia Quadriplegia Loss of movement and feeling in the trunk and all four extremities Lossof of bowel, bladder, and sexual function Spinal Cord Injury Quadriplegia and Paraplegia Paraplegia Loss of movement and feeling in trunk and both legs Lossof of bladder, bowel, and sexual function Learning. ALL RIGHTS RESERVED. 75 Learning. ALL RIGHTS RESERVED. 76 Spinal Cord Injury Quadriplegia and Paraplegia Emergency treatment Immediate treatment is necessary Do not move the victim unless surroundings are unsafe Maintain position of spine with special collars and backboards Spinal Cord Injury Quadriplegia and Paraplegia Diagnosis History of injury Neurologic exam Spinal X rays, MRI, and CAT scan Learning. ALL RIGHTS RESERVED. 77 Learning. ALL RIGHTS RESERVED

14 Spinal Cord Injury Quadriplegia and Paraplegia Treatment Realignment and stabilization of the bony spinal column Decompression or release of pressure on spinal cord Prevent further injury Amyotrophic Lateral Sclerosis (ALS) Lou Gehrig s disease Destructive disease of motor or movement neurons Learning. ALL RIGHTS RESERVED. 79 Learning. ALL RIGHTS RESERVED. 80 Amyotrophic Lateral Sclerosis (ALS) Atrophy of muscles leading to progressive loss of movement of hands, arms, and legs is supportive No cure Guillian Barré Syndrome Acute, progressive disease affecting the spinal nerves Begins 10 to 21 days after febrile illness Learning. ALL RIGHTS RESERVED. 81 Learning. ALL RIGHTS RESERVED. 82 Guillian Barré Syndrome Early symptoms include nausea, fever, and malaise Within 24 to 72 hours paresthesia, muscle weakness, and paralysis usually begins Guillian Barré Syndrome may progress for several days to weeks Once progression ceases, recovery begins is supportive Recovery is usually complete Learning. ALL RIGHTS RESERVED. 83 Learning. ALL RIGHTS RESERVED

15 Huntington s Chorea Inherited disease Appears during middle age Progressive degenerativediseasedisease of brain Huntington s Chorea Loss of muscle control and chorea Leads to mental deterioration Personality change, moody behavior, loss of memory, dementia is supportive No cure Learning. ALL RIGHTS RESERVED. 85 Learning. ALL RIGHTS RESERVED. 86 Multiple Sclerosis (MS) Causes: Demyelination of the nerves of the CNS Allows information to leak from the nerve pathway Leads to poor or absent nerve transmission Multiple Sclerosis (MS) : Muscle weakness and lack of coordination Paresthesia Speech difficulty Loss of bladder function Visual disturbance especially diplopia Learning. ALL RIGHTS RESERVED. 87 Learning. ALL RIGHTS RESERVED. 88 Multiple Sclerosis Affects adults between ages 20 and 40 Periods of remission and exacerbation Physical therapy Muscle relaxants in order to maintain muscle tone and reduce spastic movement Parkinson s Disease Slow, progressive brain degeneration Develops between ages 50 and 60 Learning. ALL RIGHTS RESERVED. 89 Learning. ALL RIGHTS RESERVED

16 Parkinson s Disease Classic symptoms Rigidity and immobility of hand Very slow speech pattern Pill rolling motion of fingers Expressionless facial appearance Parkinson s Disease Abnormal bent forward posture Short, fast running steps, shuffling appearance Learning. ALL RIGHTS RESERVED. 91 Learning. ALL RIGHTS RESERVED. 92 Parkinson s Disease Symptomatic Dopamine replacement Physical and psychological therapy Learning. ALL RIGHTS RESERVED