Neurological Disorders Dr. Kline FSU-PC


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Neurological Disorders Dr. Kline FSU-PC

  1. 1. Neurological Disorders Dr. Kline FSU-PC
  2. 2. I. Neurological Disorders <ul><li>The normal functioning of the CNS can be affected by a number of disorders, the most common of which are headaches, tumors, vascular problems, infections, epilepsy, head trauma, demyelinating diseases, and metabolic & nutritional diseases . </li></ul>
  3. 3. A. Vascular Diseases in the brain: <ul><li>Minor to total reduction in blood flow to the neurons deprives the cells of oxygen & glucose, resulting in interference with cellular metabolism . </li></ul><ul><li>Disruption of cellular metabolism, caused by reduced blood flow, lasting longer than 10 min. , results in cell death for neurons in that brain region. </li></ul><ul><li>These disorders account for most common causes of death & chronic disability in the Western world . </li></ul>
  4. 4. 1. Stroke (Cerebral vascular accident) <ul><li>Results from severe severe interruption of blood flow to the brain (usually affecting arteries). </li></ul><ul><li>The onset of a stroke may span days to years, often with little-to-no warning. </li></ul><ul><li>A stroke produces an infarct (area of dead or dying tissue resulting from obstruction of blood vessels normally supplying area). </li></ul>
  5. 5. What factors influence the severity of deficits resulting from a stroke? <ul><li>Location of the blockage </li></ul><ul><li>Size of the blood vessels </li></ul><ul><li>--prognosis is better if blockage occurred in small vessels rather than larger vessels. </li></ul><ul><li>Relative health of surrounding vessels </li></ul><ul><li>Age of patient (younger has better chance of recovery) </li></ul><ul><li>How quickly patient is seen following stroke </li></ul>
  6. 6. 2. Cerebral Ischemia - insufficient supply of blood to brain, are like mini-strokes. <ul><li>Decreases in blood flow result of 3 causes: </li></ul><ul><li>A. Thrombosis -a plug or clot in a blood vessel that remains at its point of formation . </li></ul><ul><li>B. Embolism -moving (clot, bubble of air, sack of cells, or fat deposit) from larger vessel into a smaller vessel. </li></ul><ul><li>--often effect middle cerebral artery of left side of brain which is near speech comprehension for many. </li></ul><ul><li>C. Cerebral arteriosclerosis -thickening & hardening of arteries that reduces blood flow. </li></ul>
  7. 7. 3. Migraine Stroke <ul><li>People with classic migraines often experience a transient ischemic attack with some neurological symptoms. These include: </li></ul><ul><li>Impaired sensory functioning (vision) </li></ul><ul><li>Numbness of skin </li></ul><ul><li>Difficulties in moving & aphasia (Language Disorder) </li></ul><ul><li>*Account for a significant proportion of strokes in young people under 40. </li></ul><ul><li>*Occurs more in females than males. </li></ul><ul><li>*Cause is unknown (may be vasospasm). </li></ul>
  8. 8. 4. Cerebral Hemorrahage <ul><li>Massive bleeding in the brain. Onset is abrupt & may be quickly fatal. Prognosis often poor. </li></ul><ul><li>Causes: </li></ul><ul><li>Hypertension </li></ul><ul><li>Congenital defects of cerebral arteries </li></ul><ul><li>Leukemia & other blood disorders </li></ul><ul><li>Toxic chemicals </li></ul>
  9. 9. 5. Aneurysms <ul><li>Vascular dilations resulting from localized defects in the elasticity of the vessel. </li></ul><ul><li>The vessels distend like a “balloon” until they are vulnerable to rupture. </li></ul><ul><li>Most common symptom is severe headache, often present for many months to years. </li></ul>
  10. 10. Treatment for vascular disorders: <ul><li>Drug therapy (anticoagulants to dissolve clots or prevent clotting) </li></ul><ul><li>Vasodilators to dilate vessels </li></ul><ul><li>Drugs used to treat hypertension </li></ul><ul><li>Salty solutions to reduce edema in brain </li></ul><ul><li>Surgery to repair damaged vessels; total removal of aneurysm. </li></ul>
  11. 11. B. Head Trauma Injuries <ul><li>Brain injury from head trauma is most common form of brain damage in people under 40. </li></ul><ul><li>There are two types of Head Trauma Injuries: </li></ul><ul><li>Open-head & closed-head injuries. </li></ul>
  12. 12. Ways in which Head trauma may damage the brain: <ul><li>1. By directly damaging neurons & support cells (e.g., gunshot wound). </li></ul><ul><li>2. By causing blood flow disruption leading to a stroke (closed-head injury). </li></ul><ul><li>3. By causing bleeding in the brain which causes the brain to swell. </li></ul><ul><li>4. By making the brain vulnerable to infection (open-head injuries). </li></ul>
  13. 13. 1. Open-Head Injuries: <ul><li>Results from injury to brain in which the skull is penetrated either by projectiles (gunshots/missile wounds) or other moving objects. </li></ul><ul><li>Most people with open-head injuries do not lose consciousness & produce distinctive symptoms that may undergo rapid & spontaneous recovery. </li></ul><ul><li>Deficits are specialized & often resemble those of surgical excisions. </li></ul>
  14. 14. 2. Closed-Head Injuries <ul><li>Caused by a blow to the head (car accident, blunt instrument swung at head). </li></ul><ul><li>Damage may be three-fold : </li></ul><ul><li>A. Damage at site of blow is called a coup . </li></ul><ul><li>B. The brain may shift & hit the opposite side of the skull producing an additional bruise (contusion) known as a countercoup . </li></ul>
  15. 15. Closed-Head Injuries (Contd.) <ul><li>C. The brain may suffer additional damage, resulting from shearing of nerve fibers which produce microscopic lesions. </li></ul><ul><li>Frontal & temporal areas are most likely to be damaged in closed-head injuries. </li></ul><ul><li>These injuries are commonly accompanied by loss of consciousness (from damage to brainstem fibers), edema (swelling), & hemorrhaging. </li></ul><ul><li>Length of coma often is positively correlated with severity of damage. </li></ul>
  16. 16. Behavioral impairments resulting from closed-head injuries: <ul><li>1. Discrete impairment of functions mediated by brain regions that sustained direct impact (coup & countercoup). </li></ul><ul><li>2. Microscopic lesions caused by shearing of neurons results in widespread damage. </li></ul>
  17. 17. Mental recovery from Closed-Head Injury: <ul><li>Most mental recovery occurs rapidly in the first 6-9 months following injury. </li></ul><ul><li>Memory functions recover more slowly than general intellectual functions. Depending on length of coma & amnesia following injury, prognosis may be very good. </li></ul><ul><li>Personality changes may be pronounced; person may be less likely to recover their personality than they are to recover general intellectual functioning. </li></ul>
  18. 18. C. Epilepsy <ul><li>Results from recurrent seizures (disruptions in neural firing) of various types that disturb consciousness. </li></ul><ul><li>Seizures may be classified based on potential cause: </li></ul><ul><li>--- Symptomatic seizures -caused by infection, trauma, tumor, toxic chemical, vascular problem, etc. </li></ul><ul><li>---- Idiopathic seizures - appear spontaneously; with no apparent cause. </li></ul>
  19. 19. Symptoms of Epilepsy <ul><li>1. An aura or warning of a seizure that’s about to occur . </li></ul><ul><li>E.g., may be an odor, noise, or visual image </li></ul><ul><li>2. Loss of consciousness (ranges from complete collapse to staring off into space). </li></ul><ul><li>3. Movements (ranging from minor such as small twitching to large convulsions). </li></ul>
  20. 20. Types of Epilepsy <ul><li>1. Focal seizures- seizures occur in a locus (particular place in brain) & then spread. </li></ul><ul><li>E.g., symptoms may start with twitching in one digit of the hand and quickly spread to the other fingers & arm.) </li></ul><ul><li>2. Complex partial seizures – usually originate in the temporal lobe (sometimes the frontal lobe). </li></ul>
  21. 21. Stages of Complex partial seizures <ul><li>1. Subjective feelings, forced thoughts, alterations in mood, dejavu </li></ul><ul><li>2. Automatisms, which are stereotyped repetitive movements such as lip smacking, chewing, fidgeting. </li></ul><ul><li>3. Postural changes in which person may assume catatonic postures. </li></ul>
  22. 22. 3. Generalized seizures <ul><li>Are bilaterally symmetrical without local onset. </li></ul><ul><li>Grand Mal attack is accompanied by loss of consciousness, stereotyped motor behavior. </li></ul><ul><li>4. Petit mal attack- Brief loss of awareness during which there is little motor activity such as blinking, turning the head, rolling the eyes, etc. </li></ul>
  23. 23. Treating Epilepsy <ul><li>1. Anticonvulsant drugs are used to treat this. </li></ul><ul><li>(E.g., Dilantin, phenobarbital, etc.) </li></ul><ul><li>Mode of action is unknown, may work by stabilizing weak neural membrane in abnormal cells. </li></ul><ul><li>2. Surgery to remove focus of epilepsy if known. </li></ul>
  24. 24. D. Brain Tumors <ul><li>A mass of cells that grow & have no use. </li></ul><ul><li>Brain tumors grow from glia & other support cells, not the neurons themselves. </li></ul><ul><li>Tumor growth varies depending on type of tumor, where its located, & type of cell that it grows from. </li></ul>
  25. 25. Types of Brain Tumors <ul><li>1. Gliomas - tumors that arise from glial cells & infiltrate the brain. May be benign to malignant. </li></ul><ul><li>About 45% of all tumors are gliomas. </li></ul><ul><li>A. Astrocytomas -result from growth of astrocytes. Usually not malignant & may be treated fairly easily. Prognosis is good. </li></ul><ul><li>B. Glioblastomas -highly malignant, rapidly growing. </li></ul>
  26. 26. 2. Meningiomas - attached to meninges. Are encapsulated on outside of brain. Usually benign. <ul><li>3. Metastatic Tumors - a tumor that results in the brain from tumor cells carried from the body elsewhere (breast, liver, lung, etc.). </li></ul>
  27. 27. Treatment for tumors <ul><li>Surgery to remove tumors if operable. </li></ul><ul><li>Radiation to reduce or shrink tumors. </li></ul>