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Nervous System(CNS)


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Nervous system for Medical Transcriptionist

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Nervous System(CNS)

  1. 1. Nervous system(CNS) Is the chief controlling & co-ordinating system of the body. It controls the voluntary & involuntary activities of the body & adjust the individual to given surroundings. Nerves are the protoplasmic extension of the nerve(neuron) form the neural pathways called the nerves. Impulses are given out to brain & goes out the whole body is called as efferent pathway & impulses going from body to brain are the afferent pathway. Parts of the nervous system Central nervous system Peripheral nervous system brain Spinal cord 12 cranial nerve 31 spinal nerve Autonomic nervous system sympathetic parasympathetic
  2. 2. Face & scalp sensation, taste 7.Facial Eye mov. & face & scalp sensation 6. Abducens Sensation over face , scalp 5.Trigeminal Opthalmic Mandibular maxillary -----,,------- 4.Trochlear Eye mov. 3.Occulomotor Vision 2. Optic Smell 1.Olfactory Function Cranial nerve Tongue movement 12. Hypoglossal Neck and back muscle 11. Accessory Throat, voice box, larynx, chest abdomen viscera 10. Vagus Tongue & throat sensation 9. Glossopharyngeal Hearing and balance 8. Vestibulocochlear nerve
  3. 3. There are 3 types of nervous tissue in the N.S Neuron or excitable cell Non-excitable cell or neuralgia Structure of Neuron and pathway
  4. 4. There are 3 types of nervous tissue in the N.S Neuron or excitable cell Non-excitable cell or neuraglia Structure of Neuron and pathway
  5. 5. <ul><li>Neuralgia cells are of three type: </li></ul><ul><li>Astrocytes:cells are responsible for transporting water & salts between capillaries & nerve cells </li></ul><ul><li>Microglia:small in size & have many branches, responsible for phagocytosis </li></ul><ul><li>Oligodendraglial cells have few dendrites and produce myelin sheath </li></ul><ul><li>Abbreviations </li></ul><ul><li>AFP: alpha feto protein </li></ul><ul><li>ALS: amyotropic lateral sclerosis </li></ul><ul><li>CVE: cerbero vascular episode </li></ul><ul><li>EEG: electro encephalogram </li></ul><ul><li>ICP: intracranial pressure </li></ul><ul><li>LP: lumbar puncture </li></ul><ul><li>MS: multiple sclerosis </li></ul><ul><li>RIND:reversible ischemic neurological deficit </li></ul><ul><li>TENS:transcutaneous electrical nerve through skin stimulation </li></ul><ul><li>TIA:transient ischemic attack </li></ul>
  6. 6. <ul><li>Blood brain barrier: a barrier exist at the capillary level between the blood and nerve cell. </li></ul>Ganglion:any nervous tissue outside the nervous system is called a ganglion
  7. 7. Autonomic nervous system (controls the involuntary activities like sweating, salivation, peristalsis Sympathetic nervous system Widespread & diffused activity to combat acute emergencies. Arises from thoracolumbar outflow, as it arises from T1-L2 segments of Spinal cord.There are two types of fibre Medullated & Non-medullated Neurotansmitter is nor-adrenaline, exception are the cholinergic Sympathetic nerves supplying the sweat & skeletal muscles Parasympathetic N.S It combats chronic emergencies It is the craniosacral outflow which contains CN 3,7,9,10 & sacral S1, S2 segments.It releases neurotransmitter like acetylcholine
  8. 8. Brain Cerebrum (two hemispheres) Made up of white & grey matter Spaces within the tissue are the VENTRICLES which contain CSF Below it lies the Thalamus & Hypothalamus Covering are Duramatter, arachnoid & piamatter Cerebellum Located beneath the posterior part of Cerebrum, co-ordinates Voluntary mov. Maintains balance Posture & Muscular tone Brainstem Midbrain Pons means bridge. It contains nerve tract that Connects Cerebrum & Cerebellum with Rest of brain Medulla oblongata Located at the base Of brain, it connects Spinal cord with Rest of the brain. It continues below As spinal cord Frontal Parietal Occipital Temporal
  9. 9. Symptoms ataxia Order Tax/o Syncopal Cut short Syncop/o Neurasthenia Strength Sthenia Apraxia Action Praxia Hemiplegia Paralysis Plegia Aphasia Speech Phasia Hemiparesis Slight weakness Paresis Dyslexia Word Lex/o Epilepsy/narcolepsy Seizure Lepsy Hyperkinesis Movement Kinesis Bradykinesia Movement Kinesia Anesthesia Nervous sensation Esthesia Comatose Deep sleep Comat/o Causalgia Burning Caus/0 Neuralgia Pain Algia Analgesia Sensitivity to pain algesia Terminology Meaning Suffix
  10. 10. Investigations <ul><li>CSF Analysis: Cell & bacterial counts along with cultures of samples of CSF are done when diseases of the meninges or brain is suspected. </li></ul><ul><li>Cerebral Angiography: Contrast medium is injected into an artery and x-ray are taken of blood system of the brain. </li></ul><ul><li>CT Scan: study the bony & nervous tissue </li></ul><ul><li>Myelography: Contrast medium is injected into the subarachnoid space through lumbar puncture and x-rays are taken of the spinal cord. </li></ul><ul><li>Echo encephalography: Ultrasonic waves are beamed through the brain tissue and echoes coming from the brain structure are recorded. </li></ul><ul><li>MRI of the brain: to study tumors of brain </li></ul><ul><li>Radioactive studies: Brain scan: radioactive chemicals are given intravenously and travel to the brain. Special scanner machine then record the passage and absorption of the chemicals into the brain tissue. </li></ul><ul><li>Positron Emission Tomography(PET scan): An isotope that give particles called as positrons is injected i.v combined with glucose, the uptake is recorded on a television </li></ul><ul><li>Electroencephalogram(EEG): recording of electrical activities of the brain. It is used to demonstrate seizure, brain tumors. </li></ul><ul><li>Lumbar puncture(spinal): CSF is withdrawn between two lumbar vertera(L3 & 4).A device to measure the pressure i.e Intracranial pressure. </li></ul><ul><li>Stereotactic radiosurgery(gamma knife):radioactive beam is focused on the brain tissue to be irradiated </li></ul>
  11. 11. Diseases <ul><li>Spina bifida:congenital defect in the spinal column. types are occulta & cystica. There is protusion of meninges(meningocele) or protusion of the meninges and spinal cord(meningomyelocele). Pt. has hydrocepahalus, paraplegia & lack of control over bladder & rectum, Rx is surgery. </li></ul><ul><li>Hydrocephalus: abnormal collection of CSF in the brain & spinal cord, leading to enlarged head & small face.Rx a catheter is placed from the ventricles of the brain into the peritoneal space, so that the CSF drains out.(ventriculo-peritoneal shunt) </li></ul><ul><li>Alzheimer’s disease: deterioration of mental capacity(dementia). Pt. complains of loss of memory, impairment of judgment anxiety, depression & emotional disturbance </li></ul><ul><li>Amyotropic lateral sclerosis(ALS)(Lou Gehrig’s disease):degeneration of motor neurons in spinal cord & brain. Pt has weakness of skeletal muscles, difficulty in swallowing, talking & dypnoea leading to quadriplegia. </li></ul><ul><li>Epilepsy:sudden excessive discharge of electrical activity within brain, cause is brain tumors, meningitis, vascular disease. Types are the Tonic-Clonic Seizures(Grand mal seizures) and the absence seizures(petit mal seizures). </li></ul><ul><li>Huntington’s chorea; degenerative disorder of cerebrum leading to bizarre, involuntary, dance like movements, Rx is symptomatic </li></ul><ul><li>Multiple Sclerosis(MS): destruction of myelin sheath on neurons, pt has paresthesia, muscle weakness, unsteady gait & paralysis,Rx immunosuppressive </li></ul><ul><li>Myasthenia gravis: neuromuscular disorder characterized by relapsing weakness of skeletal muscle due to antibodies blocking the acetylcholine receptor.immunosupp. </li></ul><ul><li>Palsy: Paralysis(complete loss of motor function) cerebral palsy due to damage to cerebrum, bells palsy due to palsy of facial nerve </li></ul>
  12. 12. <ul><li>Parkinson’s disease: degeneration of nerves in the brain, occurring in old age leading to tremors, weakness & slowness of movement. it is due to deficiency of dopamine. </li></ul><ul><li>Tourette syndrome: neurological disorder marked by involuntary, spasmodic, twitching movements, rx with haloperidol </li></ul><ul><li>Meningitis: inflammation of meningitis, caused by meningococcal or streptococcal bacterial or viral infection, pt. has headache, photophobia (sensitivity to light) and stiff neck. Rx is antibiotics. </li></ul><ul><li>Shingles; viral disease affecting the peripheral nerve. Blisters & pain spread in a band like pattern over the skin along the distribution of the peripheral nerves. It is caused by HSV, the same virus causing chicken-pox. </li></ul><ul><li>Brain Tumors: abnormal growth of the brain tissue & meninges, arise from the neurons & meninges(meningioma) astrocytes(glioblastoma multiforme).They cause cerebral edema & hydrocephalus. </li></ul><ul><li>Cerebral Concussion: brief loss of consciousness after injury, recovery less than 24 hrs. </li></ul><ul><li>Cerebral contusion:bruising of brain tissue as a result of direct trauma, neurological deficit persist beyond 24 hrs, it is associated with fracture of skull, subdural & epidural hematoma leading to permanent injury or epilepsy. </li></ul><ul><li>CVE: disruption of normal blood supply to the brain, also called as stroke or cerebral infarct. There are three types of stroke 1.Thrombotic: blood clot in the arteries, leading to occlusion of blood supply, before total occlusion occurs a patient may experience symptoms that point to gradual occlusion of the blood vessels.These short episode of neurological dysfunction are called as TIA. 2.Embolic a clot travelling from other area gets into the cerebral supply.3.Haemorrhagic: bursting of the cerebral artery. </li></ul>
  13. 13. <ul><li>General Anesthetics </li></ul><ul><li>desflurane </li></ul><ul><li>enflurane </li></ul><ul><li>etomidate </li></ul><ul><li>FENTANYL </li></ul><ul><li>HALOTHANE </li></ul><ul><li>ISOFLURANE </li></ul><ul><li>KETAMINE </li></ul><ul><li>methohexital </li></ul><ul><li>methoxyflurane </li></ul><ul><li>MIDAZOLAM </li></ul><ul><li>MORPHINE </li></ul><ul><li>NITROUS OXIDE (N20) </li></ul><ul><li>PROPOFOL </li></ul><ul><li>SEVOFLURANE </li></ul><ul><li>sufentanil </li></ul><ul><li>THIOPENTAL </li></ul><ul><li>Local Anesthetics </li></ul><ul><li>BENZOCAINE </li></ul><ul><li>BUPIVACAINE </li></ul><ul><li>cocaine </li></ul><ul><li>LIDOCAINE </li></ul><ul><li>prilocaine </li></ul><ul><li>PROCAINE </li></ul><ul><li>ROPIVACAINE </li></ul><ul><li>tetracaine </li></ul>
  14. 14. <ul><li>Opioid Analgesics, Agonist-antagonists </li></ul><ul><li>Agonists </li></ul><ul><li>CODEINE </li></ul><ul><li>diphenoxylate </li></ul><ul><li>fentanyl </li></ul><ul><li>heroin </li></ul><ul><li>HYDROCODONE </li></ul><ul><li>l-alpha-acetyl-methadol </li></ul><ul><li>levomethadyl acetate </li></ul><ul><li>loperamide </li></ul><ul><li>MEPERIDINE </li></ul><ul><li>METHADONE </li></ul><ul><li>MORPHINE </li></ul><ul><li>OXYCODONE </li></ul><ul><li>d-propoxyphene </li></ul><ul><li>combinations - opioids plus acetaminophen and ASA </li></ul><ul><li>TRAMADOL </li></ul><ul><li>Agonist/Antagonists and Antagonists </li></ul><ul><li>BUPRENORPHINE </li></ul><ul><li>butorphanol </li></ul><ul><li>nalbuphine </li></ul><ul><li>nalorphine </li></ul><ul><li>NALOXONE </li></ul><ul><li>NALTREXONE </li></ul><ul><li>nalmefene </li></ul><ul><li>pentazocine </li></ul>Antitussives, Expectorants and Mucolytics (0.5) CODEINE DEXTROMETHORPHAN HYDROCODONE
  15. 15. <ul><li>Drugs Used in the Treatment </li></ul><ul><li>of Motor Disorders </li></ul><ul><li>AMANTADINE </li></ul><ul><li>BACLOFEN </li></ul><ul><li>BENZODIAZEPINES </li></ul><ul><li>BENZTROPINE </li></ul><ul><li>BROMOCRIPTINE </li></ul><ul><li>CARBIDOPA </li></ul><ul><li>cyclobenzaprine </li></ul><ul><li>DANTROLENE </li></ul><ul><li>DOPAMINE </li></ul><ul><li>ENTACAPONE </li></ul><ul><li>haloperidol </li></ul><ul><li>L-DOPA </li></ul><ul><li>pergolide </li></ul><ul><li>PRAMIPREXOLE </li></ul><ul><li>ropinerole </li></ul><ul><li>SELEGILINE (deprenyl) trihexyphenidyl </li></ul><ul><li>Antiepileptics </li></ul><ul><li>acetazolamide </li></ul><ul><li>CARBAMAZEPINE </li></ul><ul><li>clonazepam </li></ul><ul><li>DIAZEPAM </li></ul><ul><li>ETHOSUXIMIDE </li></ul><ul><li>felbamate </li></ul><ul><li>GABAPENTIN </li></ul><ul><li>Lamotrigine </li></ul><ul><li>LORAZEPAM </li></ul><ul><li>PHENOBARBITAL </li></ul><ul><li>PHENYTOIN </li></ul><ul><li>primidone </li></ul><ul><li>TIAGABINE </li></ul><ul><li>topiramate </li></ul><ul><li>VALPROIC ACID </li></ul><ul><li>vigabatrin </li></ul>
  16. 16. <ul><li>Antiepileptics </li></ul><ul><li>acetazolamide </li></ul><ul><li>CARBAMAZEPINE </li></ul><ul><li>clonazepam </li></ul><ul><li>DIAZEPAM </li></ul><ul><li>ETHOSUXIMIDE </li></ul><ul><li>felbamate </li></ul><ul><li>GABAPENTIN </li></ul><ul><li>Lamotrigine </li></ul><ul><li>LORAZEPAM </li></ul><ul><li>PHENOBARBITAL </li></ul><ul><li>PHENYTOIN </li></ul><ul><li>primidone </li></ul><ul><li>TIAGABINE </li></ul><ul><li>topiramate </li></ul><ul><li>VALPROIC ACID </li></ul><ul><li>vigabatrin </li></ul>