Anatomy and Physiology Nervous system: brain, spinal cord, nerves Central Nervous System (CNS) and...

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Anatomy and Physiology

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

Common Signs and Symptoms Common signs and symptoms

HeadacheNausea and vomitingWeaknessMood swingsFever

Common Signs and Symptoms Symptoms specific to CNS

Stiffness in neck, back, or extremitiesInability to move any part of the bodySeizures or convulsionParalysisVisual difficulties

Common Signs and Symptoms Symptoms specific to CNS

Inability to speakParalysisExtreme or prolonged drowsinessStupor, unconsciousness, amnesia, extreme

forgetfulness

Common Signs and Symptoms Common diagnostic tests

Cerebrospinal fluidMeasuring intracranial pressureX-rays of skull and vertebral columnMyelogram

Common Signs and Symptoms Common diagnostic tests

AngiogramElectroencephlogramCAT ScanMRI

Infectious Diseases

EncephalitisInflammation of brain tissue caused by

bacteria and virusesSymptoms:

○ Headache, stiff neck and back○ Fever and lethargy○ Confusion and even coma

Infectious Diseases

EncephalitisTreatment:

○ Supportive○ Antiviral medication may be effective

Infectious Diseases

MeningitisInflammation of meninges or coverings of

brain and spinal cordCauses:

○ Bacterial and viral○ Fungi○ Toxins such as lead and arsenic

Infectious Diseases

MeningitisSymptoms

○ High fever○ Severe headaches○ Photophobia

Infectious Diseases

MeningitisSymptoms

○ Stiffness and resistance in neck (nuchal rigidity)

○ Drowsiness○ Stupor○ Seizures○ Coma

Infectious Diseases

MeningitisDiagnosis: collect spinal fluid to find causeTreatment

○ Antibiotics for bacterial infection○ Antipyretics○ Anticonvulsants○ Quiet dark environment

Infectious Diseases

PoliomyelitisViral infection affecting brain and spinal cordVaccine has eliminated the disease in the

United StatesVirus is spread by oropharyngeal secretions

and infected feces

Infectious Diseases

PoliomyelitisSymptoms

○ Muscle weakness○ Neck stiffness○ Nausea and vomiting

Infectious Diseases

Poliomyelitis Diagnosis: clinical examination, throat,

feces, and spinal fluid cultureTreatment: supportive therapy including

analgesics and bedrest during acute phase

Infectious Diseases

Poliomyelitis Long-term physical therapy and braces may

be neededIf respiratory system involved, mechanical

ventilation may be needed

Infectious Diseases

TetanusHighly fatal infection of nerve tissue caused

by bacteria Clostridium tetaniFirst symptom is stiffness of the jaw,

commonly called “lockjaw”

Infectious Diseases

RabiesCaused by virusPrimarily affects animals such as dogs, cats,

raccoons, squirrels Transmitted to humans through bite of an

infected animal

Infectious Diseases

RabiesSymptoms

○ Fever and pain○ Convulsions and rage○ Spasms and paralysis of muscles for

swallowing

Infectious Diseases

RabiesSymptoms

○ Throat spasms leading to hydrophobia○ Inability to swallow; drooling of frothy saliva

Treatment ○ Clean infection site and rabies vaccine

injectionsNo cure

Infectious Diseases

ShinglesViral disease caused by herpes zosterItching, painful red rash, and small vesicles

on sensory nerve pathsSymptoms last ten days to several weeks

Infectious Diseases

ShinglesDiagnosis

○ Appearance of lesions○ Viral culture test

Infectious Diseases

ShinglesTreatment

○ Antiviral medications○ Analgesics○ Antipyretics○ Antipruritic medications

Transient Ischemic Attacks TIAs or mini-strokes Insufficient blood to brain Symptoms

Weakness of arm and/or legDizzinessSlurred speechMild loss of consciousness

Transient Ischemic Attacks Symptoms last few minutes to an hour Diagnosis is made by angiogram Surgery to improve blood flow

Functional Disorders

Degenerative Disk Disease Headache Epilepsy Bell’s Palsy

Degenerative Disk DiseaseDegeneration or wearing away of the

intervertebral diskWearing away allows vertebrae to bump or

rub against each other

Degenerative Disk DiseaseSymptoms:

○ Difficulty walking○ Radiating pain in back and in one or both legs

Degenerative Disk DiseaseDiagnosis:

○ X-ray○ Myelogram○ CAT or MRI

Degenerative Disk DiseaseTreatment

○ 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 mechanismsTension on facial, neck, and scalp musclesVascular changes in arterial size of vessels

inside head

Headaches Contributing factors

StressToxic fumesNoiseLack of sleepAlcohol consumption

Headaches May be acute or chronicPain may be constant, pressure, throbbing,

stabbing, intermittentTension, cluster, following lumbar puncture,

migraine

HeadachesDiagnosis

○ History and physical examination○ X-ray○ EEG, MRI, and CAT

HeadachesTreatment

○ Analgesics○ Bedrest and muscle massage ○ Muscle relaxants○ Warm baths○ Biofeedback

EpilepsyChronic disease of brainIntermittent episodes of abnormal electrical

activity in brainMost common symptom is seizureConvulsions include petit mal, grand mal

EpilepsyDiagnosis

○ EEG○ CAT scan○ Cerebral angiogram○ Blood tests

EpilepsyTreatment

○ Anticonvulsive medications○ Close monitoring and adjusting of medications

Bell’s PalsyAffects facial nerve (7th cranial), causing

unilateral paralysisAffects individuals 20 to 60 years of age

Bell’s PalsySymptoms

○ Drooping weakness of eye○ Drooling of saliva○ Unable to whistle or smile○ Distorted facial appearance

Bell’s PalsyDiagnosis

○ History and symptomsTreatment

○ Analgesics and anti-inflammatory medication

DementiaLoss of mental ability due to loss of neurons

or brain cellsMost common dementia is senility Most common cause of senile dementia is

Alzheimer's disease

Alzheimer's DiseaseForm of dementiaAffects individuals 70 and olderEarly symptoms

○ Short-term memory loss○ Inability to concentrate○ Slight changes in personality

Alzheimer's DiseaseSymptoms of disease progression

○ Diminished communication skills○ Meaningless words○ Inability to form sentences○ Increased forgetfulness○ Irritability and agitation

Alzheimer's DiseasePositive diagnosis: autopsyInitially may be made by ruling out other

brain diseasesTreatment is supportiveNo cure

Vascular DementiaAtrophy and death of brain cells due to

decreased blood flowAtherosclerotic plaque can cause decreased

blood flow and is common with aging

Vascular DementiaSymptoms

○ Changes in memory, personality, and judgment

○ Irritability, depression, and sleeplessness○ Lacks personal hygiene

Vascular DementiaDiagnosis

○ Blood flow testing and history and physicalTreatment

○ Increasing blood flow to brain○ Carotid endarterectomy

Head Trauma DementiaDeath of brain cells due to head traumaSymptoms

○ Decrease in mental intellect and cognitive function

Head Trauma DementiaDiagnosis

○ History○ Cranial X-rays○ MRI and CT

Treatment○ Correct damage if possible

Substance-Induced DementiaBrain cell death from drug toxicity and toxinsCauses mental impairment and decreased

cognitive ability

Sleep Disorders

InsomniaInability to fall or stay asleepRelated to stress, pain, fear, depression,

caffeine, alcohol, nicotine, and bronchodilators

Treatment○ Identifying and removing cause

Sleep Apnea

Sleep disorder characterized by periods of breathlessness

Sleep Apnea

SymptomsDaytime sleepinessExtreme snoringPersonality changesDepressionImpotence

Sleep Apnea

DiagnosisMonitor affected individual during sleep for

apnea and low blood oxygen levels

Sleep Disorders

Sleep ApneaTreatment

○ Based on cause○ Weight loss○ Surgery to correct nasal obstruction○ Oxygen during sleep○ Medications to stimulate breathing

Tumors

Primary and secondary Benign and malignant Symptoms

HeadacheVomiting and seizuresMood and personality changesVisual disturbance and loss of memory

Tumors

DiagnosisClinical symptomsX-ray, CT, and MRIBiopsy

Treatment: surgery, radiation, and chemotherapy

Trauma

Concussions and ContusionsBlow to head by an object, fall, or other

trauma such as an automobile accidentDisruption of normal electrical activity in

Trauma

Concussions and ContusionsCauses immediate unconsciousnessMay last a few seconds to several hoursConcussion is less serious than a contusion

Trauma

Concussions and ContusionsContusion is bruising of the brain Outcomes:

○ Can lead to a hematoma○ Increased intracranial pressure (ICP)○ Permanent brain damage

Trauma

Concussions and ContusionsDiagnosis

○ History of injury○ Neurologic examination○ Cranial X-ray○ CT and MRI

Trauma

Concussions and ContusionsTreatment

○ Bedrest and direct observation○ Individual should be checked every 2 to 4

hours ○ Monitor changes in consciousness, eye pupil

size, mood, and behavior

Trauma

Concussion and ContusionsTreatment

○ Analgesics, stimulants, and sedatives should not be given to individuals with a head injury

○ Medications may mask the symptoms and make assessment difficult

Trauma

Skull FractureGreatest danger is brain tissue damage

from bony fragments Potential of cutting brain, severing a vessel,

and causing a hematomaBrain damage may be temporary or

permanent

Trauma

Skull FractureFracture near base of skull may injure

respiratory center and impair breathingInfection of brain tissue may be a problem

Trauma

Skull FractureTreatment

○ Dependent on type and position of fracture○ Craniotomy may be necessary to relieve ICP○ Protective headgear may be necessary until

fracture is healed

Trauma

Epidural and Subdural HematomaBlood vessels rupture and hemorrhageBlood seeps between bony skull and outer

meninges Pushes dura mater away from inner bony

Trauma

Epidural and Subdural HematomaEpidural Hematoma symptoms

○ Headache○ Dilated pupils○ Nausea, vomiting, and dizziness

Trauma

Epidural and Subdural HematomaSubdural Hematoma

○ Usually the result of head hitting a stationary object

Blood collects between the dura mater and arachnoid layer

Trauma

Epidural and Subdural HematomaSubdural Hematoma

○ Develops slowly over period of daysSymptoms

○ Hemiparesis○ Nausea, vomiting, dizziness○ Convulsions and loss of consciousness

Trauma

Epidural and Subdural HematomaDiagnosis

○ Clinical history○ Cranial X-ray, CT or MRI

Treatment○ Decrease intracranial pressure○ Craniotomy called “bur holes”

Spinal Cord Injury—Quadriplegia and Paraplegia

Injury to spinal cordResults in varying degrees of loss of

movementResults in varying degrees of loss of feeling

below the area of injury

QuadriplegiaLoss of movement and feeling in the trunk

and all four extremities Loss of bowel, bladder, and sexual function

ParaplegiaLoss of movement and feeling in trunk and

both legsLoss of bladder, bowel, and sexual function

Emergency treatmentImmediate treatment is necessaryDo not move the victim unless surroundings

are unsafeMaintain position of spine with special

collars and backboards

DiagnosisHistory of injuryNeurologic examSpinal X-rays, MRI, and CAT scan

TreatmentRealignment and stabilization of the bony

spinal column Decompression or release of pressure on

spinal cordPrevent further injury

Rare Diseases

Amyotrophic Lateral Sclerosis (ALS)“Lou Gehrig’s” diseaseDestructive disease of motor or movement

neurons

Rare Diseases

Amyotrophic Lateral Sclerosis (ALS)Atrophy of muscles leading to progressive

loss of movement of hands, arms, and legsTreatment is supportive No cure

Rare Diseases

Guillian-Barré SyndromeAcute, progressive disease affecting the

spinal nervesBegins 10 to 21 days after febrile illness

Rare Diseases

Guillian-Barré SyndromeEarly symptoms include nausea, fever, and

malaiseWithin 24 to 72 hours paresthesia, muscle

weakness, and paralysis usually begins

Rare Diseases

Guillian-Barré SyndromeSymptoms may progress for several days to

weeksOnce progression ceases, recovery beginsTreatment is supportiveRecovery is usually complete

Rare Diseases

Huntington’s ChoreaInherited diseaseAppears during middle ageProgressive degenerative disease of brain

Rare Diseases

Huntington’s ChoreaLoss of muscle control and choreaLeads to mental deteriorationPersonality change, moody behavior, loss of

memory, dementiaTreatment is supportiveNo cure

Rare Diseases

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

Rare Diseases

Multiple Sclerosis (MS)Symptoms:

○ Muscle weakness and lack of coordination○ Paresthesia○ Speech difficulty○ Loss of bladder function○ Visual disturbance especially diplopia

Rare Diseases

Multiple SclerosisAffects adults between ages 20 and 40Periods of remission and exacerbationTreatment

○ Physical therapy○ Muscle relaxants in order to maintain muscle

tone and reduce spastic movement

Rare Diseases

Parkinson’s DiseaseSlow, progressive brain degenerationDevelops between ages 50 and 60

Rare Diseases

Parkinson’s Disease Classic symptoms

Rigidity and immobility of handVery slow speech pattern“Pill rolling” motion of fingersExpressionless facial appearance

Rare Diseases

Parkinson’s DiseaseSymptomsAbnormal “bent forward” postureShort, fast-running steps, shuffling

appearance

Rare Diseases

Parkinson’s DiseaseTreatment

○ Symptomatic○ Dopamine replacement○ Physical and psychological therapy

Anatomy and Physiology Nervous system: brain, spinal cord, nerves Central Nervous System (CNS) and...

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