Patho-physiology of nervous System Talk 2 Syndromes in neurosciences. Petr Maršálek Dept pathological physiology 1.Med. F. CUNI

Transcription

1 Patho-physiology of nervous System Talk 2 Syndromes in neurosciences Petr Maršálek Dept pathological physiology 1.Med. F. CUNI

2 Talks on NS Talk 1 - Pain and Motor disorders Talk 2 - This - Syndromes in neurosciences Talk 3 - Disorders of special senses Talk 4 - Cognitive functions, dementias, etc. 2 of 23

3 Syndromes Hypoxia of CNS carbon mono-oxide poisoning liquor circulation disorders cerebral oedema intra-cranial hypertension intra-cranial hemorrhage systemic neuro-muscular plate disorders epilepsy migraine sleep/ wake cycle disorders vomiting as a sign of NS 3 of 23

4 Cerebrovascular brain disease. Hypo-perfusion, brain hypoxia 4 of 23

5 Topic signs 5 of 23

6 Concentration 35 ppm (0.0035%) 100 ppm (0.01%) 200 ppm (0.02%) 400 ppm (0.04%) 800 ppm (0.08%) Acute carbon-monooxide poisoning Symptoms Headache and dizziness within six to eight hours of constant exposure Slight headache in two to three hours Slight headache within two to three hours; loss of judgment Frontal headache within one to two hours Dizziness, nausea, and convulsions within 45 min; insensible within 2 hours 1,600 ppm (0.16%) 3,200 ppm (0.32%) 6,400 ppm (0.64%) 12,800 ppm (1.28%) Headache, tachycardia, dizziness, and nausea within 20 min; death in less than 2 hours Headache, dizziness and nausea in five to ten minutes. Death within 30 minutes. Headache and dizziness in one to two minutes. Convulsions, respiratory arrest, and death in less than 20 minutes. Unconsciousness after 2-3 breaths. Death in less than three minutes. 6 of 23

7 Acute CO poisoning blood gases affinity to Hb 7 of 23

8 Blood gases 8 of 23

9 9 of 23

10 10 of 23

11 11 of 23

12 Intracranial hypertension, subjective and objective signs 12 of 23

13 Obstructive hydrocephalus 13 of 23

14 Angiografic findings in intra-cranial expansions (Bartko, 1985) 14 of 23

15 Intracranial hemorrhage 15 of 23

16 Q 22 Glasgow coma scale Eyes Verbal Motor Glasgow Coma Scale Opens eyes in Opens eyes Does not Opens eyes response to in response open eyes spontaneously painful stimuli to voice N/A Makes no sounds Makes no movements Incomprehensible sounds Extension to painful stimuli (decerebrate response) Utters inappropriate words Abnormal flexion to painful stimuli (decorticate response) Confused, disoriented Flexion / Withdrawal to painful stimuli Oriented, converses normally Localizes painful stimuli N/A N/A Obeys commands The scale comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person). 16 of 23

17 Disorders of Neuromuscular transmission 17 of 23

18 Disorders of Neuromuscular transmission 18 of 23

19 Artificial ventilation/ Iron lung Ventilation can be delivered via: Hand-controlled ventilation such as: Bag-Valve-Mask Resuscitator Continuousflow or Anaesthesia (or T-piece) bag A mechanical ventilator. Iron lung is a historical type of mechanical ventilator 19 of 23

20 Demyelination sclerosis multiplex 20 of 23

21 Normal findings: EEG waves: Alpha waves, 8-13 Hz, parieto-occipital region, marked in closed eyes Beta waves, Hz, frontal region Gamma waves, Hz, are not regularly used due to interference with electric power net. Delta waves, < 4 Hz, e.g in synchronous phase of sleep. Theta waves, 4-7 Hz, e.g in synchronous phase of sleep. 21 of 23

22 Epilepsy: Cortico- Thalamic and Thalamo-cortical feedback system modulating sensory inputs 22 of 23

23 Migraine phosphenes 23 of 23

24 Migraine - scotomas 24 of 23

25 Q 24/1 Sleep/ wake cycle 25 of 23

26 Sleep/ wake cycle + narkolepsy and reticular formation effects 26 of 23

27 Vomiting center/ causes of vomiting 27 of 23

28 Causes of vomiting 1 Intracranial hypertension - irritation 2 Drugs nicotine, apomorphine, etc 3 Kinetosis 4 Radiation diesease 5 Pregnancy 6 Psychogenic 7 Pharyngeal irritation 8 Local gastric irritation food poisoning 9 Peritoneal irritation, ileus 10 Other internal organs heart etc 28 of 23

29 Autonomous nervous system disorders. 29 of 23

30 30 of 23