DIsorders of the Nervous System: Outcome

Transcription

1 DIsorders of the Nervous System: Outcome Station 1: Headache Types of headaches 1. Tension Headache: Most common causes of headache, Is not due to any underlying nervous system disease. 2. Migraine Headache: Symptoms Intense, throbbing or pounding pain on the side of the head in the area of the temple, forehead, eye or back of the head. Most also have symptoms which can be associated with effects on the nervous system. o Nausea and Vomiting o Pallor and cold sensitivity o Photophobia and phonophobia are the term for sensitivity to light and sound. o Migraine Aura and Premonitory Symptoms: They include: Seeing lights - flashing, brightly colored lights in the middle of the field of vision and move outward, often in a zigzag pattern. A scotoma is a hole in the field of vision, also called a blind spot. o Vague symptoms that may precede an attack include general fatigue and sleepiness, irritability, depression or euphoria, and cravings for sweet or salty food. Migraine headache treatment varies somewhat from treatment of most other types of headaches. There are some natural treatments such as avoiding triggers and exercise. Some people will benefit from over-the-counter pain medications such as ibuprofen or Tylenol, especially in combination with caffeine, as in some drugs like Excedrin. The Specific drugs are used to treat migraines that stop or prevent the headache.

2 DIsorders of the Nervous System: Outcome Cluster Headache Rare Called "cluster" headaches because they tend to occur in clusters Some treatments and medications are used to try to treat the symptoms of an attack once it starts. Most slow acting medications like ibuprofen and others do not work because they take time to take effect. In some cases surgical treatment or injection of nerves at base of brain are used. 4. Brain Tumor Headache: Most headaches are not caused by a tumor. A tumor in or around the brain is a potential cause of headache. Injury to the brain does not cause pain; the headache is caused by irritation of the membranes surrounding the brain, the meninges (particularly the dura mater), which is highly sensitive. Irritation of the dura caused by direct involvement by the growing tumor or by pressure that stretch the dura due to the tumor mass. Therefore, headache is more common with tumors that are either close to these membranes or which are large enough to cause an increase in pressure in the head. for a brain tumor headache is no different than other headaches. They are often treated with simple analgesic medications like ibuprofen or acetaminophen. However, treatment of the underlying tumor may also be warranted.

3 DIsorders of the Nervous System: Outcome Station 2: VASCULAR DISORDERS 1. Cerebral Aneurysm and Subarachnoid Hemorrhage: bleeding around the brain typically due to rupture of a cerebral artery. Description: A cerebral aneurysm is a bulging of an artery that supplies blood to the brain. The aneurysms can enlarge over time and may rupture. If they rupture then bleeding occurs around the brain, called subarachnoid hemorrhage because it occurs in the space under the arachnoid membrane, which covers the brain and spine. Subarachnoid hemorrhage occurs suddenly and causes a severe headache and can cause significant neurological injury or death. The cause of a cerebral aneurysm in most patients is not known. They generally occur sporadically and develop during a persons life. They are more common with older age May be an association with high blood pressure and/or smoking. There are some familial conditions, which can increase the risk for the development of aneurysms. Traditionally treatment is surgical, by exposing the aneurysm and placing a clip across the opening into the aneurysm from the blood vessel. This clip closes the opening, or neck, and prevents further ruptures. More recently, another technique has been introduced. Endovascular coiling involves navigating a small catheter into the aneurysm (inserted into a blood vessel in the leg) and filling the aneurysm from the inside with small metallic coils.

4 DIsorders of the Nervous System: Outcome Stroke The term stroke refers to any new neurological symptoms with a sudden onset. TERMS USED: Ischemia: Ischemia is the lack of adequate blood flow to support the normal functioning of a tissue such as the brain. Infarction: An infarction is the death of tissue due to inadequate blood flow (ischemia) to the tissue. Cause Of Strokes Most commonly due to a blood clot in an artery that supplies the brain. The most common cause is carotid stenosis. o The carotid artery supplies the head and neck. o Atherosclerosis causes narrowing of the artery, particularly in patients with high blood pressure, high cholesterol levels, and diabetes mellitus. o Smoking, obesity and a sedentary lifestyle also contribute o The narrowing of the carotid and the atherosclerotic plaque in the artery can lead to clot formation. o Clots break free lodging into a smaller artery in the head. o If this blockage is severe and is not quickly reversed, permanent damage (infarction) to the brain supplied by that artery will occur. Symptoms Ischemic (disruption of blood flow) stroke in the region of the middle brain typically causes weakness of the opposite side of the body (hemiparesis). If ischemia involves the dominant hemisphere (usually the left side) then language can be affected as well. In the case of very large infarctions the brain can swell, leading to intracranial pressure, which can lead to coma or death. Ischemia in different parts of brain create different symptoms o Infarction of the brain stem can cause coma and death The treatment of ischemic stroke varies from patient to patient. In general, patients are observed with supportive measures in the hospital and are often given medications, which help prevent further clotting of the blood to prevent further ischemic events.

5 DIsorders of the Nervous System: Outcome Station 3: Types of Spinal Disorders Degenerative Spinal Disease: Degenerative spinal disease is related to chronic wear and tear on the spine due to aging and physical activity. It can lead to a number of different spine disorders. Herniated Disc o Cervical Herniated Disc o Thoracic Herniated Disc o Lumbar Herniated Disc Spinal Stenosis o Cervical Stenosis o Lumbar Stenosis o Foraminal Stenosis Spinal Instability Spine Trauma: Physical trauma is a potential cause of injury to the spine and spinal cord. Spinal Tumors: Like the brain, the spinal cord can develop both benign and malignant tumors in or around it. Spinal Dysraphism - Neural tube defect o The developing nervous system forms from a sheet of cells in the embryo, which fold on themselves to form a tube, the neural tube. o Normally, this tube closes off completely. o However, in some cases the closure and normal development of the neural tube does not proceed correctly. o In general, the malformations can vary from mild to very severe and life threatening. o Most common form is Spina Bifida

6 DIsorders of the Nervous System: Outcome Station 4: NEURON DISORDERS Multiple Sclerosis (MS) A disease of the central nervous system related to something termed "demyelination". In MS, the myelin sheath around some axons in the central nervous system becomes damaged. This damage makes conduction along these axons faulty, slowing or stopping completely, leading to symptoms. Areas of demyelination, called MS plaques, are patchy and can occur almost anywhere in the brain or spinal cord. The specific symptoms that occur depend on the specific location of the demyelination within the nervous system. Types of Possible MS Symptoms Sensory: Including numbness, tingling, and pain. Motor: Including weakness in one or more limbs, spasticity and muscle spasm, tremors, facial paralysis, etc. Coordination and Balance: Including lack of fine motor or gross motor coordination, clumsiness, loss of balance and falls, difficulty walking, etc. Vision: Blurred or double vision, blindness, loss of vision in part of the visual field, etc. Speech: Such as slurred speech. Non-Specific Symptoms: Various other symptoms are possible such as fatigue (quite common), heat sensitivity, dizziness, impaired thinking, etc.

7 Parkinson's Disease DIsorders of the Nervous System: Outcome Is considered a motor system disease because its primary manifestations affect motor control, at least initially. It is generally a disorder of older age, occurring most frequently after 50 years of age. Although it is not a "common" disease, it probably affects about 1 and a half million Americans currently with about 50,000 new cases diagnosed annually. It is a progressive degenerating disease that leads to loss of neurons in the brain, in particular locations. The initial causes of Parkinson's Disease are poorly understood, What it causes to occur in the brains of patients is well described. o For unknown reasons, abnormal clumps of protein build up in certain neurons (nerve cells) in the brain. These clumps are called Lewy Bodies. o As the disease progresses, neurons in certain parts of the brain die. o One of the most pronounced areas of damage in this disease is in a group of cells (nucleus) in the brain called the substantia nigra. o These cells normally use dopamine as their neurotransmitter and are part of the basal ganglia, a collection of nuclei important for control and coordination of initiation of motor functions. o The death of these dopamine-secreting cells in the brain lead to imbalance and dysfunction of the basal ganglia, affecting motor system control. T o This imbalance is progressive and explains the motor symptoms (tremor, rigidity, etc.) that are common in patients with Parkinson's disease. Symptoms of Parkinson's, including tremor, rigidity, slowed movement and others.

8 DIsorders of the Nervous System: Outcome Amyotrophic Lateral Sclerosis Amyotrophic lateral sclerosis (ALS) Is a rare but devastating disease of the central nervous system. It affects primarily the motor control portions of the brain and spinal cord, leading to relatively rapid paralysis of the body. Commonly known as Lou Gehrigs Disease because the famous baseball star suffered from ALS and eventually died due to complications of the disease. Cause are not well understood Some cases appear to run in families, known as familial ALS, suggesting that genetics may play at least a partial role in the disease. o In these families, mutations in a gene called SOD1 have been found. This gene is normally important for preventing free radical damage to cells in the body. How this mutation leads specifically to ALS and damage to motor neurons in the nervous system is not understood. Several other factors have been investigated but none have lead to definitive answers. o For example, it has been hypothesized that autoimmunity and/or environmental exposure to toxins or infectious agents may lead to the disease. o None of these has been confirmed.

9 DIsorders of the Nervous System: Outcome Station 5: CNS Infection An infection is a disease caused by the invasion of a diseasecausing micro-organism or virus. The growth of the bacteria, virus or other invading organism in the human tissues causes damage and inflammation by a variety of mechanisms. Meningitis: One of the most common forms of infection It is characterized by infection of the membranes covering the brain and spinal cord, the meninges, Types of Meningitis o Spinal Meningitis o Bacterial Meningitis o Viral Meningitis o Fungal Meningitis Meningitis Symptoms Headache Fever Neck pain and/or Sensitivity to light (photophobia) Nausea and vomiting Change in Mental Status. Other meningitis symptoms Seizures, bulging fontanel (soft spot on the skull of children), hydrocephalus is common with fungal forms of meningitis.

10 DIsorders of the Nervous System: Outcome Encephalitis: An inflammation of the brain usually by infection by a virus. There are many viruses that can infect the brain. Some common types include; o Herpes viruses o Arboviruses (transmitted by mosquitoes, ticks and other insects; examples include eastern and western equine virus, St. Louis virus and West Nile virus) o Rabies o Varicella-zoster (a herpes virus that causes chicken pox and shingles) o Epstein-barr virus o Measles virus. Many types of viral brain infection have very mild, flu-like symptoms such as headache, irritability, lethargy, and fever along with other general flu-like symptoms such as general body aches and pains. More serious infections can cause seizures, personality changes, confusion, hallucinations, stupor or coma, paralysis, and tremors. The distribution of these symptoms depends on the areas of brain involved and the type of virus implicated. In mild cases patients are generally instructed to rest, eat well and drink plenty of fluids and to treat symptoms (such as using Tylenol and other medications for headache and fever). In more serious cases patients may be hospitalized. Anti-inflammatory drugs may be used to help reduce brain swelling. In the case of herpes viruses (including herpes and varicella-zoster) some antiviral medications may be useful in limiting the severity of disease.

11 DIsorders of the Nervous System: Outcome Brain abscesses A bacterial brain infection that cause destructive lesions within the brain. An abscess is a general term for a walled off area of infection which includes the surrounding ring of tissue containing a liquefied center filled with bacteria, white blood cells and fluid. (Commonly known as puss.) An abscess can occur if bacteria are introduced into the brain. The brain is usually sterile Bacteria can be introduced by: o Sinusitis or Mastoiditis (infection of the mastoid air cells behind the ear) can lead to infiltration of the brain and a resulting abscess. o Other infections from the head (such as oral infections) can also seed the brain occasionally. o Distant Infections - For example, patients with bacterial endocarditis (infection of the heart valves) can have pieces of infectious material end up in the brain. o Intravenous drug users can often introduce bacteria into their bloodstream, which can lead to abscesses in various parts of the body. o Penetrating Injury or Surgery - Anything that directly deposits bacteria into the brain tissue can cause a resulting abscess. For example, a penetrating traumatic injury (knife, gunshot wound, etc.) that penetrates the skull into the brain. Symptoms Headache, fever, seizures, nausea and vomiting. As it grows, damaging the brain tissue and causing swelling of the surrounding brain, it can weakness, numbness, language difficulties, visual symptoms, etc. Large abscesses can increase intracranial pressure and can lead to coma. If not treated, brain abscess can often be fatal. Intravenous antibiotics. However, because systemically administered antibiotics generally do not get into the abscess cavity, most brain abscesses require surgical drainage. The abscess is opened surgically and the infectious material is removed and washed out.