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Neuropathology

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Neuropathology

  1. 1. Neurological Disorders Paul Kelner, M.D.
  2. 3. Neurological Disorders <ul><li>Overview and Organization of the Nervous System </li></ul><ul><ul><li>Central Nervous System – brain and spinal cord </li></ul></ul><ul><ul><li>Peripheral nervous system – cranial nerves and spinal nerves </li></ul></ul>
  3. 4. Divisions of the Nervous System
  4. 5. Neurological Disorders: Organization of the Nervous System <ul><li>The Central Nervous System </li></ul><ul><ul><li>The Brain </li></ul></ul><ul><ul><li>The Spinal Cord </li></ul></ul><ul><ul><li>Motor pathways (in spinal cord) - efferent </li></ul></ul><ul><ul><li>Sensory pathways (in spinal cord) - afferent </li></ul></ul>
  5. 6. Central Nervous System
  6. 7. Afferent and Efferent Pathways
  7. 8. Neurological Disorders: Organization of the Nervous System <ul><li>Peripheral Nervous System </li></ul><ul><ul><li>Cranial nerves </li></ul></ul><ul><ul><li>Spinal nerves </li></ul></ul><ul><ul><li>Somatic nerves </li></ul></ul><ul><ul><li>Autonomic nervous system </li></ul></ul><ul><ul><ul><li>Sympathetic </li></ul></ul></ul><ul><ul><ul><li>Parasympathetic </li></ul></ul></ul>
  8. 9. Neurological disorders Cranial Nerves
  9. 10. Cranial Nerves
  10. 12. Cranial Nerves Reviewed
  11. 13. Autonomic Nervous System
  12. 14. Neurological disorders <ul><li>Cells of the Nervous System </li></ul><ul><ul><li>The Neuron </li></ul></ul><ul><ul><li>Neuroglia and Schwann cells </li></ul></ul><ul><li>The Nerve Impulse </li></ul><ul><ul><li>Synapses </li></ul></ul><ul><ul><li>Neurotransmitters </li></ul></ul><ul><li>Myelin Formation: </li></ul><ul><ul><li>Peripheral NS – Schwann cells </li></ul></ul><ul><ul><li>Central NS – Oligodendrocytes </li></ul></ul>
  13. 15. Neuron
  14. 16. Neuroglia
  15. 17. Saltatory Conduction
  16. 18. http://s3.amazonaws.com/ppt-download/nerve-impulse-28770.ppt#256,1,NERVE IMPULSE/ACTION POTENTIAL Web Site with AP transmission animation
  17. 19. The Synapse
  18. 21. The Brain
  19. 22. The Brain (Functional Areas)
  20. 23. Neurological disorders <ul><ul><li>Protective structures </li></ul></ul><ul><ul><ul><li>Cranium </li></ul></ul></ul><ul><ul><ul><li>Meninges </li></ul></ul></ul><ul><ul><ul><li>Cerebrospinal fluid and the ventricular system </li></ul></ul></ul><ul><ul><ul><li>Vertebral column </li></ul></ul></ul><ul><ul><ul><li>Blood supply </li></ul></ul></ul>
  21. 24. Neurological disorders
  22. 25. The Meninges
  23. 26. Cerebral Ventricular System
  24. 27. MRI of Spinal Cord within Vertebrae
  25. 28. Cerebral Blood Supply
  26. 29. Circle of Willis
  27. 30. Pain A Summary of Important Concepts Part II
  28. 31. Pain
  29. 32. Pain (definitions) <ul><li>Pain Threshold – point at which a stimulus is perceived as pain </li></ul><ul><li>Pain Tolerance – amount of pain a person will tolerate before outwardly responding to it </li></ul><ul><li>Nociceptive pain – pain resulting from direct tissue injury </li></ul><ul><li>Non-nociceptive pain – neuropathic pain </li></ul>
  30. 33. Neuropathic (non-nociceptive pain)
  31. 34. Neurological disorders <ul><li>Pain (continued) </li></ul><ul><ul><li>Acute versus chronic pain </li></ul></ul><ul><ul><ul><li>Acute pain is a protective mechanism </li></ul></ul></ul><ul><ul><ul><li>Chronic pain is persistent, lasting > 6 months </li></ul></ul></ul>
  32. 35. Neurological disorders <ul><ul><li>Clinical manifestations of pain </li></ul></ul><ul><ul><ul><li>Acute pain </li></ul></ul></ul><ul><ul><ul><ul><li>Somatic pain </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Visceral pain </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Referred pain </li></ul></ul></ul></ul><ul><ul><ul><li>Chronic pain </li></ul></ul></ul><ul><ul><ul><ul><li>Neuropathic pain </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hyperesthesias </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Phantom limb pain </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cancer </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Reflex sympathetic dystrophy(RSD) </li></ul></ul></ul></ul>
  33. 36. Referred Pain
  34. 37. Alterations in Neurological Function Part III
  35. 38. Neurological Disorders <ul><li>Alterations in Cognitive Systems </li></ul><ul><ul><li>Alterations in arousal – Coma </li></ul></ul><ul><ul><ul><li>Structural vs. metabolic vs. psychogenic causes </li></ul></ul></ul><ul><ul><ul><li>Grouped according pathologic process </li></ul></ul></ul><ul><ul><ul><ul><li>Infectious </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Vascular </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Neoplastic </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Traumatic </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Congenital </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Degenerative </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Polygenic </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Metabolic </li></ul></ul></ul></ul>
  36. 39. Coma <ul><li>By definition, coma (decreased arousal) is produced by: </li></ul><ul><ul><li>Bilateral hemispheric damage </li></ul></ul><ul><ul><li>Suppression by hypoxia,hypoglycemia, drugs or toxins </li></ul></ul><ul><ul><li>Brain stem lesion or metabolic derangement that suppresses Reticular Activating System (RAS) </li></ul></ul>
  37. 40. Neurological disorders <ul><li>Coma </li></ul><ul><ul><li>Clinical manifestations </li></ul></ul><ul><ul><ul><li>Level of consciousness </li></ul></ul></ul><ul><ul><ul><li>Pattern of breathing (cheyne-stokes) </li></ul></ul></ul><ul><ul><ul><li>Pupillary changes </li></ul></ul></ul><ul><ul><ul><li>Oculomotor responses (ie. Doll’s eyes) </li></ul></ul></ul><ul><ul><ul><li>Motor responses </li></ul></ul></ul>
  38. 41. Posturing <ul><li>Decorticate </li></ul><ul><ul><li>Flexion of arms, wrists, fingers </li></ul></ul><ul><ul><li>Adduction of upper extremities </li></ul></ul><ul><ul><li>Extension of lower extremities </li></ul></ul><ul><li>Decerebrate </li></ul><ul><ul><li>Extremities in extension </li></ul></ul><ul><ul><li>Pronation of forearms and plantar extension of feet </li></ul></ul>
  39. 42. Decorticate -> <- Decerebrate
  40. 43. Glasgow Coma Scale (GCS)
  41. 44. Neurological disorders <ul><ul><li>Outcomes </li></ul></ul><ul><ul><ul><li>Mortality </li></ul></ul></ul><ul><ul><ul><ul><li>Brain death – brain stem death – no potential for recovery –no control of homeostasis </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cerebral death – death of cerebral hemispheres not including the brain stem – vegetative state </li></ul></ul></ul></ul><ul><ul><ul><li>Morbidity </li></ul></ul></ul><ul><ul><ul><ul><li>Recovery of consciousness </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Residual cognitive dysfunction </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Psychosocial domain </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Vocational domain </li></ul></ul></ul></ul>
  42. 45. Neurological disorders <ul><ul><li>Seizures – a sudden, explosive disorderly discharge of cerebral neurons </li></ul></ul><ul><ul><ul><li>Characterized by sudden, transient alterations in brain function </li></ul></ul></ul><ul><ul><ul><li>Clinical manifestations – Motor, Sensory, Autonomic, Psychic, Level of arousal </li></ul></ul></ul><ul><ul><ul><li>Epilepsy – term applied to seizures in which no underlying cause is found </li></ul></ul></ul><ul><ul><ul><ul><li>General term for primary condition causing seizures </li></ul></ul></ul></ul>
  43. 46. Neurological disorders <ul><ul><li>Conditions associated with seizure disorders </li></ul></ul><ul><ul><ul><li>Any disorder that alters neuronal environment </li></ul></ul></ul><ul><ul><ul><ul><li>Metabolic defects </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Congenital conditions </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Genetic predisposition </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Peri- or post-natal injury </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Infections </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Tumors </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Drugs or alcohol </li></ul></ul></ul></ul>
  44. 47. Neurological disorders <ul><li>Terminology </li></ul><ul><ul><li>Aura </li></ul></ul><ul><ul><li>Prodroma </li></ul></ul><ul><ul><li>Tonic phase </li></ul></ul><ul><ul><li>Clonic phase </li></ul></ul><ul><ul><li>Postictal state </li></ul></ul>
  45. 48. Generalized Seizures <ul><li>Generalized Seizures </li></ul><ul><li>(Produced by the entire brain) Symptoms </li></ul><ul><li>1. &quot;Grand Mal&quot; or Generalized tonic-clonic Unconsciousness, convulsions, muscle rigidity </li></ul><ul><li>2. Absence Brief loss of consciousness </li></ul><ul><li>3. Myoclonic Sporadic (isolated), jerking movements </li></ul><ul><li>4. Clonic Repetitive, jerking movements </li></ul><ul><li>5. Tonic Muscle stiffness, rigidity </li></ul><ul><li>6. Atonic Loss of muscle tone </li></ul>
  46. 49. Partial Seizures <ul><li>Partial Seizures </li></ul><ul><li>(Produced by a small area of the brain) Symptoms </li></ul><ul><li>1. Simple (awareness is retained) </li></ul><ul><li>a. Simple Motor </li></ul><ul><li>b. Simple Sensory </li></ul><ul><li>c. Simple Psychological a. Jerking , muscle rigidity, spasms, head-turning </li></ul><ul><li>b. Unusual sensations affecting either the vision, hearing, smell taste or touch </li></ul><ul><li>c. Memory or emotional disturbances </li></ul><ul><li>2. Complex </li></ul><ul><li>(Impairment of awareness) Automatisms such as lip smacking, chewing, fidgeting, walking and other repetitive, involuntary but coordinated movements </li></ul><ul><li>3. Partial seizure with secondary generalization Symptoms that are initially associated with a preservation of consciousness that then evolves into a loss of consciousness and convulsions. </li></ul>
  47. 50. Neurological disorders <ul><li>Types of seizure disorders </li></ul><ul><ul><li>Generalized seizures </li></ul></ul><ul><ul><li>Partial seizures </li></ul></ul><ul><ul><li>Status epilepticus </li></ul></ul><ul><ul><li>Absence </li></ul></ul><ul><ul><li>Pseudo-seizures </li></ul></ul><ul><li>Treatment of seizure disorders </li></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><li>Patient education </li></ul></ul><ul><ul><li>surgery </li></ul></ul>
  48. 51. Neurological Disorders <ul><ul><li>Data processing defects </li></ul></ul><ul><ul><ul><li>Agnosia – failure to recognize form and nature of objects </li></ul></ul></ul><ul><ul><ul><li>Dysphasia – impairment in understanding or production of language </li></ul></ul></ul><ul><ul><ul><ul><li>Expressive </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Echolalia </li></ul></ul></ul></ul><ul><ul><ul><li>Aphasia – loss of ability to understand or produce language </li></ul></ul></ul>
  49. 52. Neurological disorders <ul><ul><li>Dementia </li></ul></ul><ul><ul><ul><li>Progressive failure of multiple cerebral functions </li></ul></ul></ul><ul><ul><ul><li>Syndrome with many causes </li></ul></ul></ul><ul><ul><ul><li>Loss of intellect with impaired mental abilities </li></ul></ul></ul><ul><ul><ul><ul><li>Disoriented </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Memory problems (recent and remote) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Language problems </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Attentional focus </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Alterations in behaviors </li></ul></ul></ul></ul>
  50. 53. Neurological Disorders <ul><ul><ul><li>Evaluation of cause </li></ul></ul></ul><ul><ul><ul><ul><li>Neuropsychological testing </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Laboratory and diagnostic testing </li></ul></ul></ul></ul><ul><ul><ul><li>Treat underlying cause </li></ul></ul></ul><ul><ul><ul><ul><li>Infections </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Nutritional issues </li></ul></ul></ul></ul><ul><ul><ul><li>Progressive dementias </li></ul></ul></ul><ul><ul><ul><ul><li>Goal is to maintain current function and prevent continued deterioration </li></ul></ul></ul></ul>
  51. 54. Neurological disorders <ul><ul><li>Alzheimer disease (AD) </li></ul></ul><ul><ul><ul><li>Most common cause of severe cognitive dysfunction in older persons </li></ul></ul></ul><ul><ul><ul><ul><li>Familial, early-onset – occurs in persons before age 65 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Familial, late-onset – known as FAD </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Non-hereditary, late-onset AD – occurs in 70% of cases </li></ul></ul></ul></ul><ul><ul><ul><li>Exact cause is not known – several theories </li></ul></ul></ul><ul><ul><ul><ul><li>Loss of neurotransmitter stimulation by choline acetyltransferase </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Mutations in genes that code amyloid proteins </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Alterations in apolipoprotein E (binds beta amyloid) </li></ul></ul></ul></ul><ul><ul><ul><li>Neurofibrillary tangle </li></ul></ul></ul><ul><ul><ul><li>Senile plaques – diagnostic of Alzheimer’s Disease </li></ul></ul></ul><ul><ul><ul><li>Diagnosis </li></ul></ul></ul><ul><ul><ul><li>Treatment </li></ul></ul></ul>
  52. 55. Alzheimer’s Atrophy
  53. 56. Pet Scan and AD
  54. 57. Alzheimer’s Disease Microscopic Pathology
  55. 58. Neurological disorders: Trauma and Bleeds <ul><li>Hematomas </li></ul><ul><ul><li>Extradural hematomas </li></ul></ul><ul><ul><li>Subdural hematomas </li></ul></ul><ul><ul><li>Subarachnoid hemorrhage </li></ul></ul><ul><ul><li>Intracerebral hemorrhage </li></ul></ul>
  56. 59. Epidural Hematoma
  57. 60. Subdural Hematoma
  58. 61. Subarachnoid Hemorrhage
  59. 62. Intracerebral Hemorrhage
  60. 63. Neurological disorders <ul><li>Cerebrovascular accidents (Stroke) </li></ul><ul><ul><li>Occurs in 600,000 persons per year </li></ul></ul><ul><ul><li>Third leading cause of death in US </li></ul></ul><ul><ul><li>Most common in persons > 65 years </li></ul></ul><ul><ul><li>More common in women </li></ul></ul><ul><ul><li>More common in African-Americans and Asians </li></ul></ul><ul><ul><li>Heredity component </li></ul></ul>
  61. 64. CVA on CT
  62. 65. Neurological disorders <ul><li>Risk factors for CVA </li></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>Smoking </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Insulin resistance </li></ul></ul><ul><ul><li>Polycythemia and thrombocythemia </li></ul></ul><ul><ul><li>Elevated lipoprotein-a </li></ul></ul><ul><ul><li>Impaired cardiac function </li></ul></ul><ul><ul><li>Hyperhomocysteinemia </li></ul></ul><ul><ul><li>Atrial fibrillation </li></ul></ul><ul><ul><li>Estrogen deficiency </li></ul></ul>
  63. 66. Carotid Artery Disease
  64. 67. Carotid Artery Disease
  65. 68. Neurological disorder <ul><ul><li>Thrombotic strokes </li></ul></ul><ul><ul><ul><li>Due to arterial occlusion caused by thrombi </li></ul></ul></ul><ul><ul><ul><li>Classified secondary to clinical manifestations </li></ul></ul></ul><ul><ul><ul><ul><li>Transient ischemic attacks (TIA) </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Caused by thromboembolic particles </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Abrupt onset of symptoms </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Strokes-in-evolution (Sometimes called RIND –reversible ischemic neurologic deficit) </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Intermittent progression of neuro deficits over hours to days </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Completed strokes </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Maximum amount of destruction has occurred </li></ul></ul></ul></ul></ul>
  66. 69. Neurological disorders <ul><li>Embolic strokes </li></ul><ul><ul><li>Fragment of clot breaks off from thrombi outside of brain </li></ul></ul><ul><ul><li>Most common from heart, aorta, carotid artery or thorax </li></ul></ul><ul><ul><li>Risk factors  atrial fibrillation, MI, endocarditis, valve replacements </li></ul></ul><ul><ul><li>Tumors, fat and air can also cause strokes </li></ul></ul><ul><li>Hemorrhagic strokes </li></ul><ul><ul><li>Third most common cause of CVA </li></ul></ul><ul><ul><li>Risk factors </li></ul></ul><ul><ul><ul><li>Hypertension </li></ul></ul></ul><ul><ul><ul><li>Aneurysms </li></ul></ul></ul><ul><ul><ul><li>Bleeding disorders </li></ul></ul></ul><ul><ul><ul><li>Tumors </li></ul></ul></ul><ul><ul><ul><li>Trauma </li></ul></ul></ul><ul><ul><ul><li>Drug use </li></ul></ul></ul>
  67. 70. Neurological disorders <ul><li>Symptoms of CVA </li></ul><ul><ul><li>Depend upon which artery is obstructed </li></ul></ul><ul><ul><ul><li>Weakness </li></ul></ul></ul><ul><ul><ul><li>Facial drooping </li></ul></ul></ul><ul><ul><ul><li>Loss of or trouble with speech </li></ul></ul></ul><ul><ul><ul><li>Loss of function of limbs – hemiparesis </li></ul></ul></ul><ul><ul><ul><li>Loss of or changes in vision </li></ul></ul></ul><ul><ul><ul><li>Headache </li></ul></ul></ul><ul><ul><ul><li>Inability to recognize objects or persons </li></ul></ul></ul><ul><ul><ul><li>Changes in level of consciousness </li></ul></ul></ul>
  68. 71. Neurological disorders <ul><li>Treatment of CVA </li></ul><ul><ul><li>“ Time is Brain”  treatment within 6 hours of onset of symptoms </li></ul></ul><ul><ul><li>Interventional and drug therapy </li></ul></ul><ul><ul><ul><li>Clot busters – thrombolytics – TPA </li></ul></ul></ul><ul><ul><ul><li>Improve blood flow - vasodilators </li></ul></ul></ul><ul><ul><ul><li>Stenting of vessels </li></ul></ul></ul><ul><ul><ul><li>Prevention of thrombus – anti-platelet drugs </li></ul></ul></ul><ul><ul><li>Physical, emotional and mental rehabilitation </li></ul></ul><ul><ul><li>Education of patient and family </li></ul></ul>
  69. 72. Aneurysms <ul><li>Many etiologies (can be inherited) </li></ul><ul><li>Dilation or outpouching of vessels </li></ul><ul><li>Usually go undiagnosed until they bleed </li></ul><ul><li>Treated surgically </li></ul>
  70. 73. Aneurysm
  71. 74. Aneurysm Clip
  72. 75. Neurological disorders <ul><li>Headaches – Most common neurological disorder </li></ul><ul><ul><li>Can be a symptom of serious illness </li></ul></ul><ul><ul><li>Can be a symptom of being a nursing student </li></ul></ul><ul><li>Migraines - Benign recurring headache provoked by a trigger </li></ul><ul><ul><li>Affects 11 million person in the U.S. </li></ul></ul><ul><ul><li>Prevalent in women ages 15-55 years and can occur in children </li></ul></ul><ul><ul><li>Auras can occur </li></ul></ul><ul><ul><li>Most common is migraine without aura </li></ul></ul>
  73. 76. Tension Vs. Migraine Headaches <ul><li>Symptom A </li></ul><ul><li>Tension B </li></ul><ul><li>Migraine </li></ul><ul><li>Intensity, Duration and Quality of Pain </li></ul><ul><li>Mild or moderate pain intensity √ √ </li></ul><ul><li>Severe √ </li></ul><ul><li>Duration of headache </li></ul><ul><li>30 min – 7 days </li></ul><ul><li>4-72 hours √ </li></ul><ul><li>√ </li></ul><ul><li>Intense pounding, throbbing and/or debilitating √ </li></ul>
  74. 77. Symptom A Tension B Migraine Intensity, Duration and Quality of Pain Mild or moderate pain intensity √ √ Severe   √ Duration of headache             30 min – 7 days             4-72 hours √   √ Intense pounding, throbbing and/or debilitating   √ Distracting but not debilitating √   Steady ache √   Location of Pain One side of head   √ Both sides of head √ √ Associated Symptoms Nausea/vomiting   √ Sensitivity to light and/or sounds   √ Aura before onset of headache such as visual symptoms   √
  75. 78. Neurological disorders <ul><li>Basis of migraines is multifactorial </li></ul><ul><ul><li>Serotonin </li></ul></ul><ul><ul><li>Vasoactive substances </li></ul></ul><ul><ul><li>Inflammatory processes </li></ul></ul><ul><li>Treatment of migraine </li></ul><ul><ul><li>Avoidance of triggers </li></ul></ul><ul><ul><li>Rest or sleep in a dark, quiet room </li></ul></ul><ul><ul><li>Compresses, cold or warm </li></ul></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><ul><li>Serotonin antagonists (Imitrex) </li></ul></ul></ul><ul><ul><ul><li>Beta or calcium channel blockers </li></ul></ul></ul><ul><ul><ul><li>Aspirin, caffeine, NSAIDS </li></ul></ul></ul><ul><ul><ul><li>Magnesium supplements </li></ul></ul></ul>
  76. 79. Migraine On MRI
  77. 80. Neurological disorders <ul><li>Meningitis – infection & inflammation of meninges </li></ul><ul><ul><li>Caused by bacteria, viruses, fungi, parasites or toxins </li></ul></ul><ul><ul><li>Acute, subacute or chronic </li></ul></ul><ul><ul><ul><li>Bacterial vs. aseptic meningitis </li></ul></ul></ul><ul><ul><li>Symptoms </li></ul></ul><ul><ul><ul><li>Fever, chills, petechial rash </li></ul></ul></ul><ul><ul><ul><li>Headache, photophobia, otophobia, neck stiffness </li></ul></ul></ul><ul><ul><ul><li>Nuchal rigidity, decrease consciousness, seizures, hemiparesis, hemiplegia </li></ul></ul></ul>
  78. 81. Meningitis
  79. 82. Neurological disorders <ul><ul><li>Treatment </li></ul></ul><ul><ul><ul><li>Supportive measures - Quiet, dark room </li></ul></ul></ul><ul><ul><ul><li>Antibiotics or anti-viral medications </li></ul></ul></ul><ul><ul><ul><li>Vaccinations are available for bacterial form </li></ul></ul></ul><ul><ul><ul><li>Chemoprophylaxis for exposed persons </li></ul></ul></ul>
  80. 83. Neurological disorders <ul><li>Parkinson’s disease </li></ul><ul><ul><li>Common degenerative disease of basal ganglia involving the dopamine-secreting cells </li></ul></ul><ul><ul><li>Onset after age 40, most common in men </li></ul></ul><ul><ul><li>Primary vs. secondary </li></ul></ul>
  81. 84. Degeneration of the Substantia Nigra NORMAL Parkinson’s Disease
  82. 85. Neurological disorders <ul><ul><li>Symptoms </li></ul></ul><ul><ul><ul><li>Resting tremor </li></ul></ul></ul><ul><ul><ul><li>Rigidity </li></ul></ul></ul><ul><ul><ul><li>Akinesia – hypokinesia and bradykinesia </li></ul></ul></ul><ul><ul><ul><li>Stooped posture </li></ul></ul></ul><ul><ul><ul><li>Shuffling gait, equilibrium disorders </li></ul></ul></ul><ul><ul><ul><li>Orthostatic hypotension, gastric/urinary retention and constipation </li></ul></ul></ul><ul><ul><ul><li>Depression </li></ul></ul></ul>
  83. 86. Neurological disorders <ul><li>Treatment </li></ul><ul><ul><li>Administration of dopaminergic drugs -> L-Dopa </li></ul></ul><ul><ul><li>Antihistamines, amantadine reduce akinesia </li></ul></ul><ul><ul><li>Drugs lose effects over time </li></ul></ul><ul><ul><li>Stem cell research </li></ul></ul><ul><li>Slow, progressive disease </li></ul><ul><ul><li>Total loss of function </li></ul></ul><ul><ul><li>Death is commonly due to pneumonia </li></ul></ul>
  84. 87. Neurological disorders <ul><li>Multiple sclerosis (MS) </li></ul><ul><ul><li>Common immune disorder involving CNS </li></ul></ul><ul><ul><li>Demyelinating disorder </li></ul></ul><ul><ul><ul><li>Onset between 20 and 50 years </li></ul></ul></ul><ul><ul><ul><li>Females affected twice as often as males </li></ul></ul></ul><ul><ul><ul><li>Most prevalent in northern countries </li></ul></ul></ul><ul><ul><ul><li>Genetic susceptibility </li></ul></ul></ul><ul><ul><li>Previous viral insult in a genetically susceptible person  T cells reactive to myelin </li></ul></ul><ul><ul><ul><li>Destruction of myelin leads to slowing and eventual blockage of conduction </li></ul></ul></ul>
  85. 88. MS on MRI
  86. 89. Neurological disorders <ul><li>MS (continued) </li></ul><ul><ul><li>Different types of MS </li></ul></ul><ul><ul><ul><li>Mixed, spinal, cerebellar, amaurotic forms </li></ul></ul></ul><ul><ul><ul><li>Different clinical courses </li></ul></ul></ul><ul><ul><ul><ul><li>Relapsing-remitting </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Primary progressive </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Secondary progressive </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Progressive relapsing </li></ul></ul></ul></ul>
  87. 90. Neurological disorders <ul><li>MS (continued) </li></ul><ul><ul><li>Symptoms </li></ul></ul><ul><ul><ul><li>Optic neuritis </li></ul></ul></ul><ul><ul><ul><li>Visual changes </li></ul></ul></ul><ul><ul><ul><li>Dizziness </li></ul></ul></ul><ul><ul><ul><li>Nystagmus </li></ul></ul></ul><ul><ul><ul><li>Weakness </li></ul></ul></ul><ul><ul><ul><li>Numbness, tingling </li></ul></ul></ul><ul><ul><ul><li>Ataxia, tremor </li></ul></ul></ul><ul><ul><ul><li>Bladder and bowel changes </li></ul></ul></ul>
  88. 91. Neurological disorder <ul><li>MS (continued) </li></ul><ul><ul><li>Diagnosis with CT scan or MRI </li></ul></ul><ul><ul><li>CSF exam </li></ul></ul><ul><ul><li>Treatment </li></ul></ul><ul><ul><ul><li>Acute management of exacerbations </li></ul></ul></ul><ul><ul><ul><li>Reducing frequency of relapses or disease progression </li></ul></ul></ul><ul><ul><ul><ul><li>Steroids </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Interferon </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Immunosuppressive agents </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Symptom management </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Physical and occupational therapy </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Patient education </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Support of patient and family </li></ul></ul></ul></ul>
  89. 92. Intracranial Neoplasms <ul><li>50 – 60% of all adult intracranial neoplasms are malignant gliomas and/or astrocytomas </li></ul><ul><li>Approximately 25% of patients with primary tumors outside of the CNS will develop intracranial metastases. Most of these develop secondary to lung cancer. </li></ul>
  90. 93. Glioblastoma on MRI
  91. 94. Glioblastoma on MRI GLIOBLASTOMA
  92. 95. Cerebral Edema
  93. 96. Elevated Intracranial Pressure (ICP) <ul><li>Medical Emergency </li></ul><ul><li>Symptoms include headache, vomiting and changes in LOC </li></ul><ul><li>Medically treated with mannitol and other agents </li></ul><ul><li>Definitive treatment involves correction of underlying pathology </li></ul><ul><li>Complications include herniation </li></ul>

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