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  1. 1. The Spectrum of Brain Disorders Neil Porter, MD Assistant Professor Department of Neurology University of Maryland
  2. 2. Case 1 – Phineas Gage
  3. 3. Phineas Gage ♦ Railroad foreman in 1848 ♦ Involved in an accident whereby a 3-foot tamping iron was blown though his skull, landing 25 yards away.
  4. 4. Phineas Gage – Reconstruction
  5. 5. Phineas Gage ♦ Gage had no weakness but underwent a personality change from solid and dependable to “fitful, irreverent and grossly profane”
  6. 6. Reconstruction of Gage Injury The rod apparently injured both frontal lobes.
  7. 7. Conclusion ♦ The brain is an amazing and complex instrument that is not well understood.
  8. 8. Goals and Objectives ♦ Goal: To gain an appreciation of the range of disorders affecting the human brain ♦ Objectives – To become familiar with categories of brain disorders – To become familiar with features of these various disorders – To learn about some specific examples of disorders in each category
  9. 9. Definitions
  10. 10. Neurology ♦ The study of the human nervous system within medicine. ♦ Nervous System – Brain – Spinal Cord – Nerves
  11. 11. Neurologist ♦ A doctor trained in Neurology.
  12. 12. Tools of the Neurologist ♦ History ♦ Physical Exam ♦ “Laboratory Tests”
  13. 13. Categories of Brain Disorders ♦ Circulation problems (Strokes) ♦ Infections/Inflammatory conditions ♦ Tumors ♦ Seizures/epilepsy ♦ Trauma ♦ Chemical disorders ♦ Developmental disorders ♦ Degenerative disorders
  14. 14. Organization of the Talk ♦For each category – Features of each disorder – Types of disorders within each category – Case (example)
  15. 15. Circulation problems (Strokes) ♦ People with strokes suddenly lose function such as walking, lifting or speaking due to poor circulation or bleeding into the brain.
  16. 16. Circulation problem: Types ♦ Stroke (poor circulation to part of the brain) – Blood clot – Bleed ♦ Poor circulation in general due to heart attack or cardiac arrest
  17. 17. Circulation (Stroke): Case One of my high school teachers suffered a stroke months ago, being left with right- sided weakness and loss of speech. He is slowly getting better with therapy.
  18. 18. Infections/Inflammation: Features People with brain infections generally have fever, headache and confusion.
  19. 19. Infections/Inflammation: Types ♦ Infections – Meningitis (infected spinal fluid) – Encephalitis (infected brain) – Abscess (infected pocket within the brain) ♦ Inflammation (auto-immune) – Lupus
  20. 20. Infections/Inflammation: Case A healthy 25 year-old engineer lost his ability to read over a period of months. He was found to have encephalitis, and over a treatment period of 2 years finally returned to normal.
  21. 21. Tumor Features Tumor patients usually have worsening headaches, and possible weakness or numbness. Alternatively patients may come in with a seizure.
  22. 22. Tumor Types ♦ “Primary” – start in the brain – On the surface of the brain (meningiomas) – Inside the brain (gliomas) (like Kennedy) ♦ “Secondary” – travel to the brain – Metastatic cancer
  23. 23. Tumor: Case ♦ Teddy Kennedy recently had a seizure. He was found to have a large brain tumor. He has received surgery and possible radiation and remains in the Senate.
  24. 24. Seizures/epilepsy: Features ♦ Epilepsy is the tendency to have seizures (uncontrolled electrical brain activity). People with epilepsy may suddenly have staring spells or shaking spells or they may just “fall out.”
  25. 25. Seizures/epilepsy: Types ♦ Focal seizures (involve part of the brain) ♦ Generalized seizures (involve the whole brain)
  26. 26. Seizures/epilepsy: Case ♦ A young girl started doing poorly in school. Her teacher noted increased staring spells and less participation in class. She was found to have seizures and did fine after starting treatment.
  27. 27. Generalized seizure on EEG
  28. 28. Trauma: Features ♦ People in accidents may have sudden problems (coma, confusion, amnesia) due to injury to their brains.
  29. 29. Trauma: Types ♦ Concussion (brain shock) ♦ Contusion (brain bruise) ♦ Bleed
  30. 30. Trauma: Case ♦ A 19 year-old girl was admitted to Shock- Trauma after being involved in a car accident. She was in a coma for 3 weeks and then woke up after going to a rehab center. She is now home and back to work.
  31. 31. Chemical (metabolic): Features ♦ Chemical disturbances generally affect people’s thinking, leading to confusion or sleepiness within a short period of time.
  32. 32. Chemical (metabolic): Types ♦ Salt imbalance (electrolyte imbalance) ♦ Hormone problems (glandular) ♦ Nutrition problems ♦ Medications ♦ Drug intoxications ♦ Poisoning
  33. 33. Chemical (metabolic): Case A 60 year-old man with longstanding alcohol abuse is brought to the emergency room because he is agitated, confused and feeling that bugs are crawling on him.
  34. 34. Developmental Disorders: Features ♦ Children who are born with strokes, genetic conditions, or infections can have problems with their development.
  35. 35. Developmental Disorder: Types ♦ Cerebral Palsy ♦ Mental retardation ♦ Autism
  36. 36. Developmental Disorder: Case ♦ A 4 year-old boy had problems getting along with others at pre-school. He made poor eye contact and began getting upset when anyone disturbed the layout of his bedroom.
  37. 37. Degenerative Disorders: Features ♦ Degenerative conditions generally involve the slow loss of skills such as thinking, walking over years
  38. 38. Degenerative Disorders: Types ♦ Alzheimer’s Disease ♦ Parkinson’s Disease ♦ Lou Gehrig’s Disease
  39. 39. Degenerative Disorder: Case My father did masonry, tailoring, etc., until he began losing his memory at 66. He was eventually diagnosed with Alzheimer’s Disease. He slowly lost the ability to work, drive, and even talk, despite treatment.
  40. 40. Summary ♦ The brain is a wonderful organ! ♦ The brain is a complex organ! ♦ The brain is understandable. ♦ The brain is not well understood!
  41. 41. Questions and Comments?