Recommended
More Related Content
Similar to Common Neurological Disorders for undergraduates( MBBS, NURSING,PHRMA STUDENTS) DR Ganesh.pptx
Similar to Common Neurological Disorders for undergraduates( MBBS, NURSING,PHRMA STUDENTS) DR Ganesh.pptx (20)
More from Dr Ganeshgouda Majigoudra Consultant Neurologist Nanjappa hospitals
More from Dr Ganeshgouda Majigoudra Consultant Neurologist Nanjappa hospitals (13)
Recently uploaded
Recently uploaded (20)
Common Neurological Disorders for undergraduates( MBBS, NURSING,PHRMA STUDENTS) DR Ganesh.pptx
- 1. COMMON NEUROLOGICAL DISORDERS AND MANAGEMENT DR GANESHGOUDA MAJIGOUDRA CONSULTANT NEUROLOGIST NANJAPPA HOSPITALS DAVANAGERE ganeshgoudam4@gmail.com 9380906082
- 5. SYMPTOMS OTHER: Vomiting, altered level of consciousness, memory problems, LOC, behavioral problems ,abnormal movements, falls etc
- 6. COMMON CNS DISORDERS: Stroke Seizures Parkinson's disease Multiple sclerosis Head injury Sleep disorders Meningitis,Enchephelitis Tumors Nutritional deficiency disorders Developmental disorders Dementia Spinal cord infections and inflammation
- 8. NEUROLOGICAL DISEASES - INVESTIGATIONS • ESR, CBC, CRP, • Serum biochemistry, Electrolytes, Toxicology screen • CSF examination and microbiology • CT scan Brain / MRI Brain or spinal cord • EEG - Electroencephalography • Nerve Conduction Studies NCS and EMG – electromyography • Metabolic disease tests – serum aminoacids and urine organic acids • Chromosomal studies (Karyotype), Chromosomal miroarray • Genetic studies – WES - Whole Exome Sequencing (DNA exon analysis) – WGS - Whole Genome Sequencing (DNA total analysis) BIOPSY IF NEEDED
- 9. DISORDERS OF PERIPHERAL NERVES
- 10. NEUROPATHY Mononeuropathy 🞑 damage by trauma eg pressure Diabetics – nerves sensitive to pressure 🞑 damage to blood supply (vasa nervorum) Vasculitic diseases Polyneuropathy 🞑 Multiple peripheral nerves 🞑 Distal, symmetrical pattern 🞑 Lower limbs before upper limbs 🞑 Causes - Inflammatory Metabolic toxic
- 11. Diabetic neuropathy 30 – 40% of diabetic patients will develop significant nerve damage during their lives due to sub- optimal control Small fibre neuropathy Autonomic neuropathy Motor neuropathy Large fibre neuropathy Complications 🞑 ulcers 🞑 Infection
- 12. Diabetic neuropathy Acute painful neuropathies, 🞑 Constant burning, parasthesiae, shooting pains 🞑 Either symmetrical sensory stocking distribution 🞑 Contact discomfort (eg. clothes) 🞑 Insomnia INVESTIGATIONS AND MANAGEMENT
- 13. Nerve compression 🞑 Median nerve compression In carpal tunnel syndrome occurs in up to 10% patients Diagnosis difficult if severe neuropathy involving hands Requires nerve conduction studies Surgical decompression 🞑 Ulnar nerve compression Usually at elbow (groove of medial epicondyle) Pain and paraesthesia along medial aspect of forearm and numbness in little and ring fingers 🞑 Common peroneal nerve neuropathy Nerve runs around head of fibula Presents with foot drop and may have wasting of tibialis anterior (weak foot dorsiflexion, toe extension and foot eversion)
- 14. Guillain-Barre syndrome Acute peripheral neuropathy affecting motor more than sensory nerves Usually follows infection Clinical features 🞑 Symptoms over days/weeks 🞑 Bilateral flaccid weakness 🞑 Loss of tendon reflexes 🞑 May affect muscles of respiration 🞑 Burning pains and numbness INVESTIGATIONS AND MANAGEMENT
- 15. NERVE MUSCLE JUNCTION DISORDERS
- 16. Myaesthenia gravis Autoimmune disorder Most patients have antibodies to acetylcholine receptors at neuromuscular junction Incidence 0.4 in 100000) Clinical features 🞑 Fatiguable ptosis 🞑 Diplopia with limitation of eye movements 🞑 Facial weakness 🞑 Dysphagia 🞑 Dysarthria 🞑 Neck and limb muscle weakness 🞑 Can involve respiratory muscles INVESTIGATIONS AND MANAGEMENT
- 17. MUSCLE DISORDERS
- 18. Myopathy Weakness of trunk and proximal limb muscles May be weakness of neck flexion and/or extension and muscles of facial expression Gait waddling
- 19. Inflammatory myopathies Polymyositis 🞑 May occur in association with autoimmune connective tissue disorders Dermatomyositis 🞑 Rash affects face and knuckles 🞑 In minority of cases may have associated malignancy Inclusion body myositis 🞑 Selective involvement of finger flexors and quadriceps
- 21. Muscular dystrophy Dystrophinopathies 🞑 Duchenne muscular dystrophy proximal weakness in early childhood Difficulty rising from squatting position (use hands to ‘climb’ up legs –Gowers’ sign) Pseudohypertrophy of calf Progressive disability 🞑 Becker muscular dystrophy Presents in adolescence or adult life Can have normal lifespan but progressive disability 🞑 Limb-girdle dystrophies
- 24. DISORDERS OF SPINAL CORD
- 25. Spinal root disease (radiculopathy) Cervical radiculopathy 🞑 Prolapse of intervertebral disc may compress cervical nerve as exits 🞑 Neck pain, muscle weakness, loss of tendon reflex, sensory impairment 🞑 Drugs, physiotherapy, may need surgery Prolapsed lumbar intervertebral disc 🞑 S1 root Low back pain and tenderness Pain down leg from buttock to ankle (sciatica) Wasting and weakness of gastrocnemius and soleus) S1 sensory loss Depressed ankle reflex 🞑 L5 root Sciatic pain Foot drop (weakness extensor hallucis longus) L5 dermatomal sensory impairment INVESTIGATIONS AND MANAGEMENT
- 26. Spinal cord disease Inherited 🞑 Hereditary spastic paraplegia Congenital 🞑 Arnold-Chiari (develop syringomyelia) Trauma 🞑 Disc protrusions, vertebral fracture Infection 🞑 Epidural abscess Inflammation 🞑 Post-viral transverse myelitis Neoplasm 🞑 Vetebral metastases, cord tumour Vascular 🞑 Spinal cord infarct, epidural haematoma Metabolic 🞑 Subacute combined degeneration of the cord Degenerative 🞑 Cord – motor neurone disease 🞑 Spine – spondylosis with cord compression
- 27. Spinal dysraphism (spina bifida) Failure of closure of neural tube during development Defect of overlying skin Abnormal development of bony structures Particularly affects lumbosacral region Myelomeningocoele 🞑 Parts of spinal cord in meningeal sac 🞑 Paraplegia and incontinence Spina bifida occulta 🞑 Mildest form 🞑 Failure of fusion of vertebral arches INVESTIGATIONS AND MANAGEMENT
- 28. Spinal dysraphism (spina bifida) Failure of closure of neural tube during development Defect of overlying skin Abnormal development of bony structures Particularly affects lumbosacral region Myelomeningocoele 🞑 Parts of spinal cord in meningeal sac 🞑 Paraplegia and incontinence Spina bifida occulta 🞑 Mildest form 🞑 Failure of fusion of vertebral arches INVESTIGATIONS AND MANAGEMENT
- 30. Multiple sclerosis Most common chronic neurological disorder affecting young people In most typical form is characterised by lesions separated in time and space in central nervous system More common in temperate than tropical climate More common in females (M:F1.5:1) Usual age of presentation is between ages of 20 – 40 Prevalence of 1 in 1000
- 31. Multiple sclerosis Pathophysiology 🞑 Affects white matter of brain and spinal cord 🞑 Inflammatory cells present and myelin damaged 🞑 Foci of inflammation and demyelination known as plaques 🞑 Initially inflammation and oedema, followed by loss of myelin and then gliosis (scar tissue) 🞑 Leads to reduction in conduction velocity 🞑 Thought that environmental agent (eg. virus) triggers condition in genetically susceptible individual
- 32. Multiple sclerosis Presentation 🞑 Visual disturbance Optic neuritis caused by inflammatory demyelination of one optic nerve Pain around one eye especially on eye movement Blurred vision which may progress to monocular blindness over days or weeks Loss of colour vision 🞑 Limb weakness and sensory disturbance Lesion in spinal cord or cerebral hemispheres May have tingling sensation down back +/or limbs on neck flexion Symptoms may be worse after hot bath
- 34. Multiple sclerosis Management 🞑 If relapse severe enough to limit function – treat with steroids 🞑 Symptom control Spasticity, fatigue, bladder disturbance, depression, pain 🞑 Disease modifying therapy Interferon beta and glatiramer acetate
- 35. Parkinson’s disease Degenerative condition affecting extrapyramidal pathways (neurotransmitter dopamine) Affects dopaminergic neurones in substantia nigra of midbrain projecting to striatum of basal ganglia Symptoms occur when 60-80% nigrostriate neurones lost Mean age of onset 60 years Positive family history Clinical triad: 🞑 Akinesia 🞑 Rigidity 🞑 Tremor
- 36. Parkinson’s disease Gait 🞑 Flexed/stooped posture 🞑 Difficulty defending balance 🞑 Difficulty initiating walking (‘freezing’) 🞑 Steps small and shuffling 🞑 Festinant 🞑 Normal arm swing lost 🞑 Risk of falls
- 37. Parkinson’s disease Treatment 🞑 Medical Levodopa (often in combination with DOPAdecarboxylase inhibitor) Dopamine receptor agonists Selegiline (monoamine oxidase inhibitor type B) Entacapone (catechol-O- methyltransferase inhibitor) Amantadine 🞑 Surgical Stereotactic thalamotomy (severe tremor) Pallidotomy (drug-induced dyskinesias)
- 38. Other movement disorders Chorea 🞑 Randomly distributed, irregular timed muscle jerks Athetosis 🞑 Inability to sustain body part in one position (eg fingers) Tremor Dystonia Tics Drug-induced Restless legs syndrome Stiff person syndrome
- 39. Stroke Third most common cause of death in developed world (annual incidence 2 per 1000 population) Rapidly developing symptoms or signs If resolve within 24 hours – transient ischaemic attack
- 42. Stroke Treatment 🞑 If no haemorrhage start aspirin 🞑 Clopidogrel can be used in patients intolerant of aspirin 🞑 Thrombolysis iv tissue plasminogen activator (alteplase/tenecteplase) Within 4.5 hours of stroke onset Prevention 🞑 Modify risk factors Smoking Diet (inc lower cholesterol) Blood pressure Diabetic control
- 43. Stroke Complications 🞑 Pneumonia 🞑 Deep venous thrombosis and pulmonary embolism 🞑 Myocardial infarction 🞑 10% of patients with cerebral infarction die in first 30 days post- stroke 🞑 50% remain dependent 🞑 Long-term disability Pressure sores, seizures, falls, spasticity, depression
- 44. Subarachnoid haemorrhage Causes 🞑 Rupture of aneurysm 🞑 Arteriovenous malformation 🞑 Trauma 🞑 Blood vessels weakened by infection (v rare) Features 🞑 Sudden severe headache with photophobia, vomiting, neck stiffness Management 🞑 30-40% die within few days of onset 🞑 Signif risk of rebleeding in 6 weeks after onset 🞑 Nimodipine 🞑 Aneurysm clipped or coiled
- 45. Intracerebral haemorrhage 10% of all strokes Large haematomas have poor prognosis (>50% mortality) – risk of hydrocephalus and coning Causes 🞑 Hypertension 🞑 Bleeding into tumours 🞑 Trauma 🞑 Blood disorders 🞑 Blood vessel disorders INVESTIGATIONS AND MANAGEMENT
- 46. Epilepsy 1% of population suffer from epilepsy Definition 🞑 ‘ paroxysmal disorder in which cerebral cortical neuronal discharges result in intermittent, stereotyped attacks of altered consciousness, motor or sensory function, behaviour or emotion’ Classification 🞑 Partial (simple or complex) 🞑 Generalised (absence, myoclonic, tonic-clonic, tonic, atonic)
- 47. Convulsions
- 48. Partial seizures/focal seizures Simple partial seizure/Focal aware 🞑 Arise in one cortical area (most commonly temporal lobes) 🞑 Usually brief 🞑 Discharge remains localised (eg focal motor, sensory or psychic symptoms) 🞑 No loss of awareness Complex partial seizure/focal impaired aware 🞑 Impairment of awareness during attack 🞑 Frequently altered or ‘autonomic’ behaviour 🞑 Reactive automatisms – may be able to do simple task Partial onset with secondary generalisation/ focal to BL 🞑 Epileptic discharge spreads to both cerebral hemispheres
- 49. Generalised seizures Absence Myoclonic Clonic Tonic Tonic-clonic Atonic
- 50. Tonic-clonic seizures May have prodrome or no warning Tonic phase – rigidity Often cyanosed Clonic phase – jerking (about 2 mins) May be incontinent or bite cheek/tongue Post-ictal confusion and tiredness INVESTIGATIONS AND MANAGEMENT
- 51. Conditions that mimic epilepsy Syncope 🞑 Lasts <30 secs, pale, little/no confusion after event Cardiac 🞑 arrhythmia, outflow obstruction Transient ischaemic attacks 🞑 Usually last longer, rarely LOC Metabolic disturbance Non-epileptic attacks
- 52. Headache and facial pain Headache 🞑 Primary (uncertain cause) Migraine Cluster headache Tension-type 🞑 Secondary (known cause) Raised ICP Idiopathic intracranial hypertension Meningeal irritation Giant cell arteritis Metabolic disturbances Facial pain 🞑 Trigeminal neualgia 🞑 Post-herpetic neuralgia
- 53. Migraine Unilateral headache Associated with nausea, vomiting, visual disturbance Typical onset teens and twenties Aura may be phase of vasoconstriction Then vasodilatation of extracerebral vessels may cause headache Treatment 🞑 simple analgesia initially 🞑 triptan (5HT1 R agonist) 🞑 Prophylactic agents Propranolol Flunarazine INVESTIGATIONS AND MANAGEMENT
- 54. Other headaches Cluster headache 🞑 Unilateral headache 🞑 Severe attacks pain around one eye 🞑 Lasts 20 – 120 mins 🞑 Usually recurs several times a day 🞑 Pattern continues for days, weeks or months 🞑 Then symptom-free for weeks-months 🞑 Treatment Steroids initially, then verapamil Tension-type headache/ chronic daily headache 🞑 May be due to neck muscle contraction 🞑 Amitriptyline may help
- 55. Facial pain Trigeminal neuralgia 🞑 Compression of trigeminal sensory root 🞑 Unilateral facial pain with trigger areas 🞑 Treat with carbamazepine initially 🞑 May require surgery Post-herpetic neuralgia 🞑 Post-shingles of a branch of trigeminal nerve 🞑 Persistent facial pain after rash healed 🞑 May respond to amitriptyline, carbamazepine INVESTIGATIONS AND MANAGEMENT
- 56. Neurological infections Bacterial 🞑 Meningitis Neisseria meningitidis, Streptococcus 🞑 Brain abscess May complicate otitis media Raised intracranial pressure, focal signs, seizures 🞑 Parameningeal infections Pus in epidural space 🞑 Tuberculosis 🞑 Syphilis 🞑 Lyme disease 🞑 Leprosy
- 57. Neurological infections Viral infections 🞑 Viral meningitis Mumps, enterovirus 🞑 Viral encephalitis Commonest cause Herpes simplex Headache, fever, reduced LOC, may have seizures 🞑 Herpes zoster Dormant in dorsal root ganglion after chickenpox May reactivate as shingles Pain and itching of single or adjacent dermatomes, following by vesicular rash 🞑 Retroviral infections Meningitic illness may occur at seroconversion Slowly progressive dementia Risks of immunocompromise (infection, tumour) INVESTIGATIONS AND MANAGEMENT
- 58. Head injury Damage at impact 🞑 Contusion and laceration 🞑 Diffuse axonal injury Secondary complications 🞑 Haematoma 🞑 Cerebral oedema 🞑 Cerebral ischaemia 🞑 Coning 🞑 Infection 🞑 Post-traumatic epilepsy INVESTIGATIONS AND MANAGEMENT
- 59. Brain tumour Intracranial neoplasms: 🞑 Benign Usually extra-axial (eg. Meninges, cranial nerves) Compress brain 🞑 Malignant Usually intra-axial (ie. brain parenchyma) Primary (>50% adult intracranial neoplasms) gliomas Secondary (15-20% adult intracranial neoplasms) metastases
- 60. Glioma
- 61. Brain tumour - management Surgery 🞑 Benign tumours Complete excision may be possible -cure 🞑 Malignant Histology Symptomatic Radiotherapy 🞑 Gliomas – direct towards tumour 🞑 Metastases – whole-brain radiation Drug treatment 🞑 Anti-convulsants 🞑 Dexamethasone 🞑 Chemotherapy
- 62. Congenital disorders Cerebral palsy Spinal dysraphism Infantile hydrocephalus Cerebral structural disorders Intrauterine infection
- 63. Cerebral palsy Pre- or peri-natal insult 🞑 Fetal hypoxia or infection 🞑 Prematurity 🞑 Traumatic delivery Clinical features: 🞑 Spastic diplegia May have shortening and deformity of legs 🞑 Spastic hemiplegia Associated with hemisensory deficits, learning difficulties and epilepsy 🞑 Athetoid cerebral palsy Movement disorder develops in early childhood. Usually normal cognitive function
- 64. Developmental delay / Intellectual handicap • Cerebral Palsy • Delayed development • Intellectual handicap INVESTIGATIONS AND MANAGEMENT
- 65. Neurogenetics Huntington’s disease Wilson’s disease Friedreich’s ataxia Hereditary spastic paraplegia Leber’s hereditary optic atrophy Hereditary spinal muscular atrophies Hereditary motor and sensory neuropathy (HMSN) Muscular dystrophies INVESTIGATIONS AND MANAGEMENT
- 66. NEWER DRUGS APPROVED OMAVELOXOLONE -- FA NUSINERSIN-- SMA GOLODIRSEN &VILTOLARSEN --DMD
- 67. Dementia Inherited 🞑 FamilialAlzheimer’s disease, Huntington’s disease Trauma Infection 🞑 Syphilis,AIDS-related, Inflammation 🞑 Multiple sclerosis Neoplasm 🞑 Frontal tumours Vascular 🞑 Multi-infarct dementia Metabolic 🞑 hypothyroidism Drugs/toxins 🞑 Barbiturates, alcohol Degenerative 🞑 Alzheimer’s disease, Prion disease INVESTIGATIONS AND MANAGEMENT
- 68. Neurorehabilitation Aim ‘to restore patients to maximum capability and independence within limits set by their disability and their needs’ Multidisciplinary teams 🞑 Physiotherapy 🞑 Occupational therapy 🞑 Speech therapy 🞑 Neuropsychology 🞑 Social work