1. The document discusses the classification and clinical features of autonomic nervous system disorders, which can involve the brain, spinal cord, or peripheral nerves.
2. Tests of autonomic function are described, including the Valsalva maneuver, sympathetic skin response test, and tests of cardiovascular, thermoregulatory, and vasomotor responses.
3. Specific conditions discussed include orthostatic hypotension, complex regional pain syndrome, and Horner's syndrome. The pathways involved in Horner's syndrome and sites of potential lesions are outlined.
The document discusses dysautonomia and Postural Orthostatic Tachycardia Syndrome (POTS). It defines POTS as excessive increase in heart rate when upright, and describes its two main forms - neuropathic POTS caused by loss of vasoconstriction and hyperadrenergic POTS with increased norepinephrine. Treatment depends on the form but may include physical countermaneuvers, salt, water, medications and exercise. Postural vasovagal syncope, characterized by fainting, is the most common type of orthostatic intolerance.
Newer antiepileptics and recent advance in management of epilepsyChetan Ganteppanavar
Newer classifications of seizures focus on seizure onset and awareness rather than anatomy. The 2017 ILAE classification introduced terms like "aware" and "impaired awareness" instead of "simple" and "complex partial". It also clarified generalized vs focal onset. Over 15 new antiepileptic drugs have been introduced since 1990 with different mechanisms than older drugs like phenytoin. Newer drugs target sodium channels, calcium channels, GABA, glutamate and potassium channels. Their advantages and disadvantages depend on efficacy, side effects, drug interactions and cost. Management of epilepsy involves choosing appropriate antiepileptic drugs based on seizure type, weighing benefits vs risks, and discontinuing successfully after sufficient seizure freedom.
This document provides information on epilepsy, including definitions of key terms, classification of seizure types, pathophysiology, diagnosis, treatment, and management. It defines epilepsy as a chronic disorder involving recurrent seizures from abnormal neuronal discharge in the brain. Seizures are classified based on origin point and symptoms. Treatment involves identifying and treating underlying causes, avoiding triggers, suppressing seizures with antiepileptic drugs or surgery, and managing related physiological and social issues. Commonly used AEDs are discussed as well as protocols for managing status epilepticus, an emergency condition.
The document discusses various movement disorders, classifying them as either hypokinetic-hypertonic (such as Parkinson's disease) or hyperkinetic-hypotonic (including tremors, chorea, dystonia, tics, myoclonus, and ballism). Parkinson's disease is primarily caused by dopamine loss in the basal ganglia. Its treatment involves levodopa drugs and dopamine agonists. Tremors can be essential, physiological, or pathological, and are treated with beta-blockers or anti-epileptics. Dystonia causes abnormal muscle contractions and is treated with medications, botulinum toxin, or surgery. Chorea involves irregular movements and its causes include Huntington's disease and
This document provides an overview of paraplegia in children, including definitions, causes, classifications, clinical features, investigations, associated conditions, management, and complications. Paraplegia is defined as impairment of motor function in the lower extremities, which can be caused by lesions in the brain, spinal cord, or peripheral nerves. Causes include infection, inflammation, tumors, trauma, vascular issues, and inherited or metabolic conditions. Management involves general care, physiotherapy, symptom treatment, and addressing the underlying cause. Complications can include bedsores, contractures, infections, and blood clots.
Spinal cord injuries can cause partial or complete loss of motor and sensory function below the site of injury. There are several types of spinal cord injuries including complete and incomplete injuries. Risk factors include men, young adults, seniors, and those active in sports. Causes include trauma, bullet wounds, and falls. Symptoms depend on the injury level but may include paralysis, numbness, loss of bowel/bladder control. Diagnostic tests include imaging like CT, MRI to determine injury level and severity. Complications can include autonomic dysreflexia, pressure sores, loss of sexual function. Treatment involves stabilizing the spine, managing complications, and long-term rehabilitation.
Movement disorders are neurological syndromes characterized by either excess or paucity of voluntary movements unrelated to weakness or spasticity. They are divided into hyperkinetic disorders like restless leg syndrome, tremor, dystonia, myoclonus, chorea, and tics, and hypokinetic disorders like Parkinson's disease and Parkinson plus syndromes. Restless leg syndrome causes uncomfortable sensations in the legs relieved by movement, especially at night. Essential tremor is a common postural tremor of the hands that may be accentuated by activity and improved by alcohol. Dystonia causes sustained muscle contractions leading to twisting and repetitive movements or abnormal postures.
Paraplegia is a spinal cord injury that paralyzes the lower limbs, caused by damage to the spinal cord and nervous system. It affects movement in the trunk, legs, and pelvic region. Causes include spinal fractures, tumors, infections, and trauma. Paraplegia is categorized as complete or incomplete based on the extent of movement loss. Complications include pressure sores, urinary issues, muscle tightness, osteoporosis, and respiratory problems. Physiotherapy focuses on prevention of complications, strengthening, stretching, mobility training, and achieving independence through exercise and assistive devices.
The document discusses dysautonomia and Postural Orthostatic Tachycardia Syndrome (POTS). It defines POTS as excessive increase in heart rate when upright, and describes its two main forms - neuropathic POTS caused by loss of vasoconstriction and hyperadrenergic POTS with increased norepinephrine. Treatment depends on the form but may include physical countermaneuvers, salt, water, medications and exercise. Postural vasovagal syncope, characterized by fainting, is the most common type of orthostatic intolerance.
Newer antiepileptics and recent advance in management of epilepsyChetan Ganteppanavar
Newer classifications of seizures focus on seizure onset and awareness rather than anatomy. The 2017 ILAE classification introduced terms like "aware" and "impaired awareness" instead of "simple" and "complex partial". It also clarified generalized vs focal onset. Over 15 new antiepileptic drugs have been introduced since 1990 with different mechanisms than older drugs like phenytoin. Newer drugs target sodium channels, calcium channels, GABA, glutamate and potassium channels. Their advantages and disadvantages depend on efficacy, side effects, drug interactions and cost. Management of epilepsy involves choosing appropriate antiepileptic drugs based on seizure type, weighing benefits vs risks, and discontinuing successfully after sufficient seizure freedom.
This document provides information on epilepsy, including definitions of key terms, classification of seizure types, pathophysiology, diagnosis, treatment, and management. It defines epilepsy as a chronic disorder involving recurrent seizures from abnormal neuronal discharge in the brain. Seizures are classified based on origin point and symptoms. Treatment involves identifying and treating underlying causes, avoiding triggers, suppressing seizures with antiepileptic drugs or surgery, and managing related physiological and social issues. Commonly used AEDs are discussed as well as protocols for managing status epilepticus, an emergency condition.
The document discusses various movement disorders, classifying them as either hypokinetic-hypertonic (such as Parkinson's disease) or hyperkinetic-hypotonic (including tremors, chorea, dystonia, tics, myoclonus, and ballism). Parkinson's disease is primarily caused by dopamine loss in the basal ganglia. Its treatment involves levodopa drugs and dopamine agonists. Tremors can be essential, physiological, or pathological, and are treated with beta-blockers or anti-epileptics. Dystonia causes abnormal muscle contractions and is treated with medications, botulinum toxin, or surgery. Chorea involves irregular movements and its causes include Huntington's disease and
This document provides an overview of paraplegia in children, including definitions, causes, classifications, clinical features, investigations, associated conditions, management, and complications. Paraplegia is defined as impairment of motor function in the lower extremities, which can be caused by lesions in the brain, spinal cord, or peripheral nerves. Causes include infection, inflammation, tumors, trauma, vascular issues, and inherited or metabolic conditions. Management involves general care, physiotherapy, symptom treatment, and addressing the underlying cause. Complications can include bedsores, contractures, infections, and blood clots.
Spinal cord injuries can cause partial or complete loss of motor and sensory function below the site of injury. There are several types of spinal cord injuries including complete and incomplete injuries. Risk factors include men, young adults, seniors, and those active in sports. Causes include trauma, bullet wounds, and falls. Symptoms depend on the injury level but may include paralysis, numbness, loss of bowel/bladder control. Diagnostic tests include imaging like CT, MRI to determine injury level and severity. Complications can include autonomic dysreflexia, pressure sores, loss of sexual function. Treatment involves stabilizing the spine, managing complications, and long-term rehabilitation.
Movement disorders are neurological syndromes characterized by either excess or paucity of voluntary movements unrelated to weakness or spasticity. They are divided into hyperkinetic disorders like restless leg syndrome, tremor, dystonia, myoclonus, chorea, and tics, and hypokinetic disorders like Parkinson's disease and Parkinson plus syndromes. Restless leg syndrome causes uncomfortable sensations in the legs relieved by movement, especially at night. Essential tremor is a common postural tremor of the hands that may be accentuated by activity and improved by alcohol. Dystonia causes sustained muscle contractions leading to twisting and repetitive movements or abnormal postures.
Paraplegia is a spinal cord injury that paralyzes the lower limbs, caused by damage to the spinal cord and nervous system. It affects movement in the trunk, legs, and pelvic region. Causes include spinal fractures, tumors, infections, and trauma. Paraplegia is categorized as complete or incomplete based on the extent of movement loss. Complications include pressure sores, urinary issues, muscle tightness, osteoporosis, and respiratory problems. Physiotherapy focuses on prevention of complications, strengthening, stretching, mobility training, and achieving independence through exercise and assistive devices.
1) The document discusses carotid sinus syncope, which is caused by pressure on the carotid sinus leading to drops in heart rate or blood pressure and resulting in fainting.
2) It describes testing a 54-year-old man for carotid sinus hypersensitivity by applying pressure to his carotid arteries and monitoring his heart rate and blood pressure.
3) Carotid sinus hypersensitivity is diagnosed if pressure causes a heart rate pause of over 3 seconds or lowers blood pressure by at least 50 mm Hg, and permanent pacing is recommended for recurrent syncope caused by carotid sinus stimulation.
1. Peripheral neuropathies can involve sensory nerves, motor nerves, or both and may affect a single nerve, multiple contiguous nerves, or multiple non-contiguous nerves.
2. Common causes of peripheral neuropathy include diabetes, paraproteinemia, alcohol misuse, renal failure, and HIV infection.
3. Mononeuropathy involves a single nerve and implies a local compressive, traumatic, or vascular process. Mononeuropathy multiplex damages multiple non-contiguous nerves simultaneously through ischemia or microangiopathy.
4. Polyneuropathy presents as symmetrical distal sensory and motor deficits in a stocking-glove pattern and can be caused by diabetes, alcoholism, and vitamin B12 deficiency.
This document discusses the evaluation of syncope in adults. Syncope is defined as a brief, self-limited loss of consciousness due to decreased blood flow to the brain. The causes of syncope can be categorized as neurally-mediated, orthostatic, cardiac, or structural/cardiopulmonary. A thorough history, physical exam, and diagnostic testing are needed to determine the underlying cause and guide treatment. The history provides clues to distinguish syncope from other conditions and identify risk factors, while the physical exam focuses on vital signs and signs of end-organ damage or dysfunction.
This document discusses spinal cord injuries, their classification and effects. It describes the following types of spinal cord injury: concussion, contusion, compression, laceration, hemorrhage and transection. Complete transection results in loss of all sensations and motor functions below the level of injury, causing tetraplegia or paraplegia. Incomplete injuries can cause central cord syndrome, anterior cord syndrome, posterior cord syndrome or Brown-Sequard syndrome. Brown-Sequard syndrome is caused by incomplete transection on one side and results in ipsilateral sensory and motor loss and contralateral loss of pain and temperature sensation.
This document provides an overview of syncope, including its definition, causes, evaluation, and treatment. Syncope is defined as a brief loss of consciousness due to decreased blood flow to the brain. Evaluation involves taking a thorough history and physical exam, with ECG, carotid sinus massage, tilt table testing, and monitoring tests used as indicated. Causes include reflex or neurally-mediated syncope, orthostatic hypotension, cardiac arrhythmias, and structural heart issues. Treatment focuses on managing the underlying cause, lifestyle modifications, and medications depending on the type of syncope. Syncope can be serious if cardiac in origin, so risk stratification helps determine need for further testing and guide management.
Syncope is a transient loss of consciousness due to transient global cerebral hypoperfusion. It is characterized by rapid onset, short duration, and spontaneous recovery. The most common causes are reflex-mediated syncope and orthostatic hypotension, which account for one-third of syncopal episodes. Evaluation involves detailed history taking and physical examination, including orthostatic vital signs and carotid sinus massage. Tilt table testing can be used to confirm neurogenic causes when initial evaluation is insufficient.
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury.
Syncope is defined as a brief, self-limited loss of consciousness due to reduced cerebral blood flow. It is characterized by rapid onset, short duration, and spontaneous recovery. The document discusses the various causes of syncope including neurally-mediated (vasovagal), orthostatic, cardiac, and others. It outlines the evaluation process including history, physical exam, ECG, and cardiac monitoring. Further tests like tilt table testing and electrophysiology studies may be used depending on the suspected cause to determine the etiology and appropriate treatment. The history is critical to differentiate syncope from other mimics and identify high-risk patients who require more extensive cardiac evaluation and monitoring.
This document summarizes several chronic neurological disorders including seizure disorder, dementia, Parkinson's disease, cerebral palsy, hydrocephalus, multiple sclerosis, spinal cord injury, Guillain-Barré syndrome, and Bell's palsy. It describes the key characteristics, causes, symptoms, diagnoses, and treatment approaches for each condition.
This document discusses various movement disorders including Parkinsonism, Parkinson's disease, atypical Parkinsonisms, secondary Parkinsonism, hyperkinetic movement disorders such as tremor, chorea and athetosis, hemiballismus, myoclonus, and dystonia. It describes the characteristic symptoms and common causes of each disorder. Parkinsonism involves bradykinesia, rigidity, and/or tremor due to basal ganglia damage. Parkinson's disease is the most common cause and involves degeneration of dopaminergic neurons in the substantia nigra. Hyperkinetic disorders include tremors, chorea/athetosis, hemiballismus, myoclonus, and dyst
This document discusses seizure disorders and epilepsy. It begins by differentiating between types of seizures, such as partial and generalized seizures. Diagnostic tests for seizures are outlined, along with the assessment and management of seizures. Various anti-seizure medications are discussed, along with goals of drug therapy and patient education. Nursing priorities for patients with seizures include maintaining a patent airway, providing oxygenation, obtaining vascular access, using seizure precautions, administering appropriate medications, and assessing therapeutic drug levels.
Syncope is defined as a transient loss of consciousness and postural tone due to decreased cerebral blood flow. The main causes of true syncope include orthostatic, cardiac, neurally-mediated, and situational. Neurally-mediated syncope accounts for around 66% of cases and includes vasovagal syncope and carotid sinus syndrome. Treatment depends on the underlying cause but may include lifestyle modifications, medication, pacing, or ablation. Diagnostic tests for evaluating syncope include cardiac monitoring, tilt table testing, electrophysiological study, and implantable loop recorder.
This document provides an outline on syncope (transient loss of consciousness). It defines syncope, describes the mechanisms, classifications, clinical features, diagnosis and treatment. Key points include:
- Syncope is caused by transient global hypoperfusion of the brain due to low cardiac output or systemic vascular resistance.
- Causes are classified as cardiac (e.g. arrhythmias, structural issues), non-cardiac (e.g. neurological, metabolic), or unknown.
- Common causes include vasovagal, orthostatic hypotension, arrhythmias, and carotid sinus hypersensitivity.
- Evaluation involves history, physical exam, ECG and sometimes tilt table testing or cardiac
Syncope is a common medical problem that causes a brief loss of consciousness. It affects 15-39% of the general population annually. The main causes are vasovagal, orthostatic hypotension, cardiac issues, and unknown. Evaluation involves ruling out other conditions through history, exam, ECG and basic tests. If no cause is found, tilt table testing may be used. Treatment focuses on addressing the underlying cause, with beta-blockers and volume expanders sometimes used for vasovagal syncope. Prognosis depends on any cardiac issues found.
The document discusses stroke, including its causes, risk factors, symptoms, classifications, assessments, and rehabilitation management. Some key points:
- Stroke is caused by an abnormality in cerebral circulation, cutting off blood flow to the brain.
- Risk factors include smoking, obesity, lack of exercise, infection, and psychological stress.
- Symptoms can include weakness, numbness, difficulty speaking, and headaches.
- Assessments include patient history, observations of impairments, range of motion, motor function, and imaging tests.
- Rehabilitation in the acute stage focuses on positioning, respiratory/circulation exercises, and prevention of pressure sores and deconditioning. Later stages address flexibility,
This document discusses the diagnosis, evaluation, and management of toxic neuropathies. Regarding diagnosis, it is important to obtain a thorough occupational and environmental history to identify potential toxic exposures. Quantitative sensory testing, nerve conduction studies, electromyography, and laboratory tests can help diagnose neuropathy. For management, the key is removing the patient from the toxic exposure. Supportive care includes lifestyle modifications. Treatment options discussed include non-pharmacological approaches as well as medications like antidepressants and anticonvulsants. Alpha-lipoic acid, evening primrose oil, and vitamin E may also help treat symptoms.
The document discusses spinal cord injuries, including the anatomy of the spinal cord and vertebral column, common mechanisms of injury, types of spinal cord injuries, assessment findings, emergency management, pharmacological interventions like methylprednisolone, and stabilization techniques such as cervical traction. Nursing considerations are also addressed, including monitoring for complications and implementing appropriate nursing diagnoses and interventions.
Basal ganglia and cerebellum are involved in movement disorders. Hypokinetic disorders involve slow movements while hyperkinetic disorders involve involuntary movements. Examples include Parkinson's disease, Huntington's disease, Tourette's syndrome, dystonia, chorea, athetosis, ballismus, myoclonus, tics and ataxia. Treatment depends on the specific disorder but may include drugs to replenish dopamine, reduce metabolism of dopamine, use of dopamine agonists or Ach receptor antagonists.
The document provides an overview of the anatomy and functional organization of the spinal cord. It describes:
1) The spinal cord extends from the medulla to the L1 vertebra and has cervical and lumbar enlargements. It is protected by vertebrae, discs, meninges, cerebrospinal fluid, and ligaments.
2) The spinal cord has 31 pairs of spinal nerves that contain both motor and sensory fibers. Each spinal segment innervates a specific dermatome and myotome.
3) Major ascending and descending tracts in the spinal cord include the corticospinal, spinothalamic, and dorsal column tracts which are involved in motor function and different types of
Dysautonomia refers to a malfunction of the autonomic nervous system that controls involuntary body functions like heart rate, blood pressure, digestion, and sweating. The document discusses the anatomy and functions of the autonomic nervous system and its divisions. It then defines dysautonomia and lists various causes like diabetes, multiple sclerosis, and injuries. Common symptoms involve fatigue, dizziness, digestive issues, urinary problems, and temperature regulation difficulties. Tests of autonomic function are described that measure responses like heart rate and blood pressure during maneuvers to identify autonomic dysfunction.
This document discusses disorders of the autonomic nervous system. It begins by describing the anatomy and neurotransmitters of the sympathetic and parasympathetic nervous systems. It then discusses various tests used to evaluate autonomic function, including heart rate variation with deep breathing, the Valsalva maneuver, sudomotor function tests, and orthostatic blood pressure recordings. The document concludes by describing specific autonomic disorders like Parkinson's disease, spinal cord lesions, autoimmune autonomic neuropathy, and postural orthostatic tachycardia syndrome.
1) The document discusses carotid sinus syncope, which is caused by pressure on the carotid sinus leading to drops in heart rate or blood pressure and resulting in fainting.
2) It describes testing a 54-year-old man for carotid sinus hypersensitivity by applying pressure to his carotid arteries and monitoring his heart rate and blood pressure.
3) Carotid sinus hypersensitivity is diagnosed if pressure causes a heart rate pause of over 3 seconds or lowers blood pressure by at least 50 mm Hg, and permanent pacing is recommended for recurrent syncope caused by carotid sinus stimulation.
1. Peripheral neuropathies can involve sensory nerves, motor nerves, or both and may affect a single nerve, multiple contiguous nerves, or multiple non-contiguous nerves.
2. Common causes of peripheral neuropathy include diabetes, paraproteinemia, alcohol misuse, renal failure, and HIV infection.
3. Mononeuropathy involves a single nerve and implies a local compressive, traumatic, or vascular process. Mononeuropathy multiplex damages multiple non-contiguous nerves simultaneously through ischemia or microangiopathy.
4. Polyneuropathy presents as symmetrical distal sensory and motor deficits in a stocking-glove pattern and can be caused by diabetes, alcoholism, and vitamin B12 deficiency.
This document discusses the evaluation of syncope in adults. Syncope is defined as a brief, self-limited loss of consciousness due to decreased blood flow to the brain. The causes of syncope can be categorized as neurally-mediated, orthostatic, cardiac, or structural/cardiopulmonary. A thorough history, physical exam, and diagnostic testing are needed to determine the underlying cause and guide treatment. The history provides clues to distinguish syncope from other conditions and identify risk factors, while the physical exam focuses on vital signs and signs of end-organ damage or dysfunction.
This document discusses spinal cord injuries, their classification and effects. It describes the following types of spinal cord injury: concussion, contusion, compression, laceration, hemorrhage and transection. Complete transection results in loss of all sensations and motor functions below the level of injury, causing tetraplegia or paraplegia. Incomplete injuries can cause central cord syndrome, anterior cord syndrome, posterior cord syndrome or Brown-Sequard syndrome. Brown-Sequard syndrome is caused by incomplete transection on one side and results in ipsilateral sensory and motor loss and contralateral loss of pain and temperature sensation.
This document provides an overview of syncope, including its definition, causes, evaluation, and treatment. Syncope is defined as a brief loss of consciousness due to decreased blood flow to the brain. Evaluation involves taking a thorough history and physical exam, with ECG, carotid sinus massage, tilt table testing, and monitoring tests used as indicated. Causes include reflex or neurally-mediated syncope, orthostatic hypotension, cardiac arrhythmias, and structural heart issues. Treatment focuses on managing the underlying cause, lifestyle modifications, and medications depending on the type of syncope. Syncope can be serious if cardiac in origin, so risk stratification helps determine need for further testing and guide management.
Syncope is a transient loss of consciousness due to transient global cerebral hypoperfusion. It is characterized by rapid onset, short duration, and spontaneous recovery. The most common causes are reflex-mediated syncope and orthostatic hypotension, which account for one-third of syncopal episodes. Evaluation involves detailed history taking and physical examination, including orthostatic vital signs and carotid sinus massage. Tilt table testing can be used to confirm neurogenic causes when initial evaluation is insufficient.
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury.
Syncope is defined as a brief, self-limited loss of consciousness due to reduced cerebral blood flow. It is characterized by rapid onset, short duration, and spontaneous recovery. The document discusses the various causes of syncope including neurally-mediated (vasovagal), orthostatic, cardiac, and others. It outlines the evaluation process including history, physical exam, ECG, and cardiac monitoring. Further tests like tilt table testing and electrophysiology studies may be used depending on the suspected cause to determine the etiology and appropriate treatment. The history is critical to differentiate syncope from other mimics and identify high-risk patients who require more extensive cardiac evaluation and monitoring.
This document summarizes several chronic neurological disorders including seizure disorder, dementia, Parkinson's disease, cerebral palsy, hydrocephalus, multiple sclerosis, spinal cord injury, Guillain-Barré syndrome, and Bell's palsy. It describes the key characteristics, causes, symptoms, diagnoses, and treatment approaches for each condition.
This document discusses various movement disorders including Parkinsonism, Parkinson's disease, atypical Parkinsonisms, secondary Parkinsonism, hyperkinetic movement disorders such as tremor, chorea and athetosis, hemiballismus, myoclonus, and dystonia. It describes the characteristic symptoms and common causes of each disorder. Parkinsonism involves bradykinesia, rigidity, and/or tremor due to basal ganglia damage. Parkinson's disease is the most common cause and involves degeneration of dopaminergic neurons in the substantia nigra. Hyperkinetic disorders include tremors, chorea/athetosis, hemiballismus, myoclonus, and dyst
This document discusses seizure disorders and epilepsy. It begins by differentiating between types of seizures, such as partial and generalized seizures. Diagnostic tests for seizures are outlined, along with the assessment and management of seizures. Various anti-seizure medications are discussed, along with goals of drug therapy and patient education. Nursing priorities for patients with seizures include maintaining a patent airway, providing oxygenation, obtaining vascular access, using seizure precautions, administering appropriate medications, and assessing therapeutic drug levels.
Syncope is defined as a transient loss of consciousness and postural tone due to decreased cerebral blood flow. The main causes of true syncope include orthostatic, cardiac, neurally-mediated, and situational. Neurally-mediated syncope accounts for around 66% of cases and includes vasovagal syncope and carotid sinus syndrome. Treatment depends on the underlying cause but may include lifestyle modifications, medication, pacing, or ablation. Diagnostic tests for evaluating syncope include cardiac monitoring, tilt table testing, electrophysiological study, and implantable loop recorder.
This document provides an outline on syncope (transient loss of consciousness). It defines syncope, describes the mechanisms, classifications, clinical features, diagnosis and treatment. Key points include:
- Syncope is caused by transient global hypoperfusion of the brain due to low cardiac output or systemic vascular resistance.
- Causes are classified as cardiac (e.g. arrhythmias, structural issues), non-cardiac (e.g. neurological, metabolic), or unknown.
- Common causes include vasovagal, orthostatic hypotension, arrhythmias, and carotid sinus hypersensitivity.
- Evaluation involves history, physical exam, ECG and sometimes tilt table testing or cardiac
Syncope is a common medical problem that causes a brief loss of consciousness. It affects 15-39% of the general population annually. The main causes are vasovagal, orthostatic hypotension, cardiac issues, and unknown. Evaluation involves ruling out other conditions through history, exam, ECG and basic tests. If no cause is found, tilt table testing may be used. Treatment focuses on addressing the underlying cause, with beta-blockers and volume expanders sometimes used for vasovagal syncope. Prognosis depends on any cardiac issues found.
The document discusses stroke, including its causes, risk factors, symptoms, classifications, assessments, and rehabilitation management. Some key points:
- Stroke is caused by an abnormality in cerebral circulation, cutting off blood flow to the brain.
- Risk factors include smoking, obesity, lack of exercise, infection, and psychological stress.
- Symptoms can include weakness, numbness, difficulty speaking, and headaches.
- Assessments include patient history, observations of impairments, range of motion, motor function, and imaging tests.
- Rehabilitation in the acute stage focuses on positioning, respiratory/circulation exercises, and prevention of pressure sores and deconditioning. Later stages address flexibility,
This document discusses the diagnosis, evaluation, and management of toxic neuropathies. Regarding diagnosis, it is important to obtain a thorough occupational and environmental history to identify potential toxic exposures. Quantitative sensory testing, nerve conduction studies, electromyography, and laboratory tests can help diagnose neuropathy. For management, the key is removing the patient from the toxic exposure. Supportive care includes lifestyle modifications. Treatment options discussed include non-pharmacological approaches as well as medications like antidepressants and anticonvulsants. Alpha-lipoic acid, evening primrose oil, and vitamin E may also help treat symptoms.
The document discusses spinal cord injuries, including the anatomy of the spinal cord and vertebral column, common mechanisms of injury, types of spinal cord injuries, assessment findings, emergency management, pharmacological interventions like methylprednisolone, and stabilization techniques such as cervical traction. Nursing considerations are also addressed, including monitoring for complications and implementing appropriate nursing diagnoses and interventions.
Basal ganglia and cerebellum are involved in movement disorders. Hypokinetic disorders involve slow movements while hyperkinetic disorders involve involuntary movements. Examples include Parkinson's disease, Huntington's disease, Tourette's syndrome, dystonia, chorea, athetosis, ballismus, myoclonus, tics and ataxia. Treatment depends on the specific disorder but may include drugs to replenish dopamine, reduce metabolism of dopamine, use of dopamine agonists or Ach receptor antagonists.
The document provides an overview of the anatomy and functional organization of the spinal cord. It describes:
1) The spinal cord extends from the medulla to the L1 vertebra and has cervical and lumbar enlargements. It is protected by vertebrae, discs, meninges, cerebrospinal fluid, and ligaments.
2) The spinal cord has 31 pairs of spinal nerves that contain both motor and sensory fibers. Each spinal segment innervates a specific dermatome and myotome.
3) Major ascending and descending tracts in the spinal cord include the corticospinal, spinothalamic, and dorsal column tracts which are involved in motor function and different types of
Dysautonomia refers to a malfunction of the autonomic nervous system that controls involuntary body functions like heart rate, blood pressure, digestion, and sweating. The document discusses the anatomy and functions of the autonomic nervous system and its divisions. It then defines dysautonomia and lists various causes like diabetes, multiple sclerosis, and injuries. Common symptoms involve fatigue, dizziness, digestive issues, urinary problems, and temperature regulation difficulties. Tests of autonomic function are described that measure responses like heart rate and blood pressure during maneuvers to identify autonomic dysfunction.
This document discusses disorders of the autonomic nervous system. It begins by describing the anatomy and neurotransmitters of the sympathetic and parasympathetic nervous systems. It then discusses various tests used to evaluate autonomic function, including heart rate variation with deep breathing, the Valsalva maneuver, sudomotor function tests, and orthostatic blood pressure recordings. The document concludes by describing specific autonomic disorders like Parkinson's disease, spinal cord lesions, autoimmune autonomic neuropathy, and postural orthostatic tachycardia syndrome.
Final [CH13] NOTES ppt, Neurological Problems.pptTristanBabaylan1
This document provides an overview of rapid neurologic assessment techniques including the Glasgow Coma Scale and assessment of level of consciousness. It also discusses conditions such as migraines, seizures, meningitis, increased intracranial pressure, strokes, Parkinson's disease, and Alzheimer's disease. For each condition, it outlines signs and symptoms, diagnostic testing, treatment options, nursing considerations, and interventions.
- Traumatic spinal cord injuries can result in complete or incomplete paralysis below the site of injury. Common causes include motor vehicle accidents, falls, or sports injuries that result in hyperextension, compression, or torsion of the spinal cord.
- Different types of spinal cord injury syndromes exist depending on the location and nature of damage. Complete injuries result in total loss of motor and sensory function below the injury, while incomplete injuries spare some function.
- Management involves immobilization, monitoring for complications like autonomic dysreflexia, and potentially surgical decompression or stabilization depending on the nature of the injury. Outcomes depend on the severity and level of injury.
This document discusses orthostatic hypotension, including its definition, causes, symptoms, diagnosis, and management. Orthostatic hypotension is defined as a decrease in blood pressure within 3 minutes of standing compared to lying down. It may be caused by neurogenic issues like Parkinson's disease or non-neurogenic issues like dehydration. Symptoms include lightheadedness, dizziness, and weakness. Diagnosis involves measuring blood pressure in lying and standing positions. Management includes both non-pharmacological approaches like compression garments and leg exercises, as well as pharmacological treatments like fludrocortisone and midodrine.
1. A 70-year-old woman collapsed at home and was found confused by her daughter. EMS determined she may have had a stroke and transported her to the hospital within 30 minutes of the collapse.
2. At the hospital, she was found to have high blood pressure, left-sided weakness, and a CT scan showed a blood clot in her carotid artery causing a right hemisphere stroke.
3. Her risk factors included a history of untreated hypertension and a previous transient ischemic attack. She was diagnosed with an ischemic stroke likely due to atherosclerosis.
This document provides an overview of the approach to brain trauma management in the intensive care unit. It discusses:
1. Using a multidisciplinary team approach and following protocols to consistently provide great care for traumatic brain injury patients.
2. Identifying and treating both primary brain injuries from the initial trauma and secondary injuries that can develop over time through techniques like intracranial pressure monitoring and control, seizure prophylaxis, and infection prevention.
3. Preventing secondary injuries like herniation, edema, and reduced blood flow through careful monitoring, normalization of physiology, and medical or surgical interventions when needed. The goal is to prevent further brain damage after the initial trauma.
Stroke or Cerebrovascular incident, is defined as an abrupt onset of a neurological deficit that is attributable to a focal vascular cause.
The clinical manifestations of stroke are highly variable because of the complex anatomy of the brain
This document provides information on seizure disorder including definitions, etiology, phases, classification, clinical manifestations, investigations, and management. It defines a seizure as a transient, uncontrolled electrical discharge in the brain that interrupts normal function. Seizures can be partial or generalized and are classified further. Management involves drug therapy using antiepileptics, surgery such as resection or callosotomy, and vagus nerve stimulation. Nursing care focuses on safety and managing medication. Complications include injury and decreased quality of life.
Complex regional pain syndrome (CRPS) is a chronic pain condition that usually affects the limbs. It is divided into two types. Type I is not linked to nerve damage while Type II is linked to nerve damage. CRPS involves burning pain, changes in skin temperature and color, swelling, and reduced range of motion. While the pathophysiology is not fully known, it likely involves increased neurogenic inflammation, altered sympathetic nervous system function, autoimmunity, and central and peripheral sensitization. Treatment involves a multidisciplinary approach including medications, physical and occupational therapy, nerve blocks, implants, and in some cases surgery.
Seizures are caused by abnormal electrical activity in the brain. There are many types of seizures that can cause mild to severe symptoms depending on which part of the brain is affected. Seizures are generally managed through medication, emergency response during seizures, ongoing nursing assessment, and diagnostic evaluation by medical providers when needed.
PHYSIOTHERAPY MANAGEMENT OF POST STROKE PATIENT.Jonasbrother2013
This document provides an overview of physiotherapy management for stroke. It begins with definitions of stroke and transient ischemic attack. It then discusses risk factors, types, signs and symptoms, diagnosis, and medical management of stroke. The remainder of the document focuses on the physiotherapy assessment and treatment approaches in both the acute and post-acute stages. The assessment covers various body functions and structures, while the treatment approaches aim to improve motor function, mobility, balance, sensation, flexibility, strength, and reduce spasticity to achieve functional independence.
The document discusses epilepsy and antiseizure drugs. It defines epilepsy as a neurological disorder involving recurrent seizures. It describes the anatomy of the brain, common triggers for seizures, classification of seizures, and drugs commonly used to treat epilepsy such as carbamazepine, valproate, phenytoin, and levetiracetam. Optimum treatment involves using one drug initially and increasing the dose gradually while monitoring for side effects and therapeutic drug levels.
approachtomuscleweakness modified- By Sir Ghani.pptxZOHAIB57
1) The document discusses differentiating between true muscle weakness and fatigue, and provides an algorithmic approach to evaluating the cause of weakness.
2) Key points include differentiating acute vs. chronic onset, unilateral vs. bilateral involvement, and determining if signs are upper or lower motor neuron.
3) Common causes discussed include stroke, spinal cord lesions, peripheral neuropathies, myasthenia gravis, and myopathies. The algorithm provides guidance on determining the localization and cause based on history and exam findings.
This document discusses syncope, including its definition, mechanisms, causes, evaluation, and management. Key points include:
1. Syncope is defined as a transient loss of consciousness due to decreased blood flow to the brain. Common causes include neurally-mediated syncope, orthostatic hypotension, and cardiac arrhythmias or structural heart disease.
2. Evaluation of syncope involves determining if the loss of consciousness is attributable to syncope, assessing for underlying heart disease, and identifying important historical features that suggest potential causes. Initial testing may include ECG, cardiac monitoring, and tilt table testing.
3. Insertable loop recorders can help correlate transient symptoms to arrhythmias when events are
extrapyramidal system 3-210108074605.pdfShinilLenin
1. The document discusses the extrapyramidal system and disorders of the extrapyramidal system. The extrapyramidal system includes the basal ganglia and brainstem nuclei that control voluntary motor function.
2. Disorders of the extrapyramidal system can cause either hypokinetic or hyperkinetic movement disorders. Hypokinetic disorders include Parkinson's disease which causes bradykinesia, resting tremor, and rigidity.
3. Parkinson's disease is caused by the degeneration of dopaminergic neurons in the substantia nigra. It typically presents in older adults and its symptoms worsen over time.
This document provides information about epilepsy, including its definition, types of seizures, causes, symptoms, diagnosis, treatment and classification of antiepileptic drugs. Some key points:
- Epilepsy is a chronic neurological condition characterized by recurrent seizures. Seizures have focal or generalized onset in the brain.
- Common causes include genetic factors, brain injury, infections, tumors and metabolic imbalances. Symptoms vary depending on the seizure type and location in the brain.
- Diagnosis involves patient history, physical exam, EEG, imaging and lab tests. Treatment involves antiepileptic drugs to reduce seizures, with drug choices based on seizure type.
- Major antiepileptic drug classes work
Multiple sclerosis (MS) is a chronic disease that affects the central nervous system by demyelinating neurons. It most commonly affects people between 20-40 years of age and women more than men. The cause is unknown but is thought to involve an autoimmune reaction triggered by a viral infection. Symptoms vary depending on the areas of the brain and spinal cord that are affected and can include problems with mobility, sensation, vision, and bladder or bowel function. Diagnosis involves neurological exams, MRI scans to detect lesions, and ruling out other possibilities. Treatment focuses on managing relapses, reducing disease progression, and alleviating symptoms, using medications, physical therapy, and lifestyle changes. Nursing care centers around addressing issues like impaired mobility
This document provides information on cerebral vascular accidents (CVA), also known as stroke. It defines CVA as a disruption of blood supply to the brain caused by ischemia or hemorrhage. It lists risk factors such as age, gender, family history, hypertension, and diabetes. It describes the two main types of CVA as ischemic and hemorrhagic. Signs and symptoms vary depending on the area of the brain affected but may include paralysis, speech difficulties, vision loss, and sensory changes. Diagnosis involves imaging tests and evaluation of neurological function. Treatment focuses on supporting vital functions, reperfusion therapies, and rehabilitation to prevent complications and support recovery.
This document discusses different states of impaired consciousness including confusion, drowsiness, stupor, vegetative state, minimally conscious state, locked-in syndrome, and catatonia. It describes the typical clinical features and underlying pathologies of each state. The roles of the reticular activating system and structures like the thalamus and brainstem in maintaining normal consciousness are also outlined. Common structural lesions and metabolic disturbances that can cause a comatose state are discussed at the end.
Similar to Clinical Significance of autonomic nervous System (20)
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
2. Classification Of Clinical Autonomic
Disorders
1. Autonomic disorders with brain
involvement:
A. Associated with multisystem degeneration
B. Unassociated with multisystem
degeneration(Focal CNS disorders)
2. Autonomic disorders with spinal cord
involvement
3. Autonomic neuropathies
A. Acute/Subacute autonomic neuropathies
B. Chronic peripheral autonomic neuropathies
7. 3.Genitourinary :
• Difficulty in micturition, urinary incontinence,
recurrent infections due to atonic bladder
• Erectile dysfunction and retrograde
ejaculation
4. Pupillary :
• Decreased pupil size
• Resistance to mydriatics
• Delayed or absent reflexs to light
8. 5. Sudomotor :
• Nocturnal sweats without hypoglycaemia
• Gustatory sweating
• Anhidrosis; fissures in the feet
6.Vasomotor :
• Feet feel cold, due to loss of skin vasomotor responses
• Dependent oedema, due to loss of vasomotor tone and
increased vascular permeability
• Bullous formation
9. Clinical test of autonomic Function
1. Tests of Cardiovascular autonomic functions:
Non Invasive Bed Side test
• Blood pressure response to standing or vertical
tilt or head up tilt test (Fall ≤ 20/10 mmHg)
• Heart rate response to standing and 30:15
R-R ratio (ECG)( ≥ 1.04)
• Heart rate variation with respiration( ≥ 15 b/m)
• Isometric exercise-(↑DBP 15mmHg)
• Valsalva ratio ≥ 1.4
• Plasma noradrenaline level- (rise on tilting)
• Plasma vasopressin level- (rise with induced
hypotension)
10. Invasive Test:
• Valsalva maneuver
• Baroreflex sensitivity
• Infusion of pressor drugs – (↑BP,↓HR)
2.Test for thermoregulatory functions:
• Sympathetic skin response test
• Quantitative sudomotor axon reflex
test(QSART)
• Thermoregulatory sweat test
• Sweat imprint test
11. 3.Test of vasomotor reaction:
• BP response to sustained hand grip
• BP response to mental stress
• Cold pressor test
• Radiant heating of trunk
• Immersion of hand in hot water
4.Miscellaneous tests:
• Lacrimal function: Schirmer test
• Test of pupillary Innervation
• Bladder function- Cystometrogram
• Penile erection- Nocturnal penile tumescence
• GIT motility- Barrium swallow/ manometry
12. Valsalva Maneuver
• Response assesses the integrity of the baroreflex
Control of HR ( parasympathetic) and BP
(adrenergic).
• Procedure :
Supine
Exhale against closed glottis
Or Into a manometer exp. Pressure of 40 mmHg
For 10-15 seconds
Measuring changes in HR and beat to beat BP
Four phases, Phase І & ІІІ mechanical
13.
14.
15.
16. Sympathetic skin response
• Sympathetic skin response(SSR)is a momentary change
of the electrical potential of the skin generated by sweat
gland .It originates by activation of reflex arc with
different kinds of internal or externally applied arousal
stimuli.
• Important electrophysiological autonomic test that can
be performed in the EMG Laboratory.
• Reflex Arc :
Afferent pathway : Somatosensory myelinated fibers
Central processing : Mescenphalic reticular formation,
Posterior thalamus & Cortical structures.
Efferent pathway : Preganglionic myelinated and
postganglionic nonmyelinated axons and the
neuroglandular junction
18. SYMPATHETIC SKIN RESPONSE :CONTD…
• Response shape is most often either biphasic or triphasic in
the hands, and biphasic in the feet; it is seldom monophasic.
The amplitude of hand waveform larger and shorter latencies
than feet.
Generally absent response are considered to be abnormal.
The amplitude of the SSR is age dependent. SSR is normally
present in both hands and feet under the age of 60 years,but
in subjects older than 60 years it is found in only 50% of feet
and in 73% of hands
19. SYMPATHETIC SKIN RESPONSE :CONTD…
• Most Common type of Stimulus is an electrical shock
(10-30mA) delivered at a peripheral nerve, most
commonly median nerve.
• Normal mean onset latency and amplitude of 1.5 ± 0.1
sec and 3.1 ± 1.8 mV for the hands, and 2.05 ± 0.10 sec
and 1.4 ± 0.8 mV for the feet.
20. Orthostatic Hypotension
• Reduction of SBP at least 20mmHg or DBP at least 10mmHg
after 3min of Standing or Head up tilt on a tilt table, is a
manifestation of sympathetic Vasoconstrictor failure.
• Causes:
1.CNS autonomic failure:
• MSA
• PD
• Lewy body dementia
• Pure Autonomic Failure
• Spinal cord trauma, infraction
• Centrally Acting Anti hypertensive drugs and other drugs
24. Management of Orthostatic
Hypotension
• Treatment of specific Cause.
• Removal of Drugs or Conditions that aggravate
the autonomic symptoms.
• Patient educations
• High Salt diet :(10-20g/d)
• High Fluid intake: 2L/d
• Elevate Head of bed 10cm.
• Maintain postural Stimuli
• Learn physical Counter maneuvers
• Long leg elastic stocking
• Correct Anemia
25. Management of Orthostatic
Hypotension Cont…..
Pharmacological treatment:
• Fludrocortisone
• Midodrine
• Droxidopa
• Pyridostigmine
• NSAID
• Combination of Atomoxetine and yohimbine
• Desmopressin
• Erythropoetin
26. Complex Regional pain Syndrome
• Two types:
A. Types 1: Reflex Sympathetic dystrophy (RSD)
B. Types 2: Causalgia –Specific peripheral nerve
/trunk lesion
Reflex Sympathetic Dystrophy:
After injury-minor Shoulder/limb trauma,
,MI,stroke,Fractures
One Limb, Vasomotor & Sudomotor abnormalities
Allodynia, Hyperpathia,Spontaneous pain
Unrelated to severity of initial trauma
Not confined to the distribution of a single
peripheral nerve , Burning or Electrical
27. RSD continue
Divided into 3 clinical phase
Phase 1: within weeks to 3 months
• Pain and swelling in the distal extremity
• Warm, edematous, tender joints
• Increase sweating and hair growth
Phase 2: 3-6 months-Thin, shiny, cool skin
Phase 3: Additional 3-6 months
• Atrophy of skin and subcutaneous tissue
• Flexion contracture
29. Horner′s Syndrome
• Horner′s syndrome consists of
(1) Constriction of the pupil (miosis),
(2) Slight drooping of the eyelid ( partial ptosis),
(3) Enophthalmos,
(4) Loss of sweating (anhydrosis).
• All these symptoms result from an interruption
of the sympathetic nerve supply to the head and
neck.
31. Horner’s syndrome
Classical triad:
• Miosis–(constricted pupil)- due
to unopposed action of iris
constrictor muscle
• Partial ptosis- due to Muller
muscle paralysis
• Loss of hemifacial sweating
(Anhydrosis)
32. Other Features:
Enophthalmos ( weakness of muller′s
muscle)
Iris heterochromia-(with the affected eye
being hypopigmented)-Congenital horner
syndrome/Children younger than 2 yrs/long
standing
Normal light & Accomodation reflex
Normal eye movement
33. Arise from the hypothalamus (1st
order neuron)
Descend uncrossed through the
brainstem
Terminate in the lateral column
level of C8-T2
Exit the spinal cord at the level of
T1 and enter the cervical
sympathetic chain (2nd order neuron)
Ascending through the
sympathetic chain, it synapse’s
at the superior cervical ganglion
34. • Post ganglionic exit the superior
cervical ganglion and ascend along the
Internal Carotid artery
(3rd order neuron)
• Through short and long ciliary nerve,
innervates dilator pupillae
• Travels along the external carotid
artery to innervate the blood vessels
and sweat glands of the face.
35.
36. 1st 0rder neuron lesion
First order neuron (the descending sympathetic tract
within central nervous system) defect could include:
• loss of sweating of the ipsilateral side of the body ( face, arm,
upper trunk)
37. First order neuron lesions
Lesions in Hypothalamus, Brainstem, High
Cervical cord
• Large Pituitary tumor / Expanding tumor
•Brainstem Stroke (LMS), Tumor( glioma),MS
• Syringobulbia, Syringomyelia
• Neck Trauma: Cervical myelopathy, Traumatic
dislocation of Cervical vertebrae
38. 2nd order neuron lesion
Second order neuron (preganglionic horner)
Loss of sweating limited to ipsilateral face.
Lesion in common carotid artery, loss of sweating
involves the entire side of face.
Lesions:
• Anterior roots C8 ,T1 lesions: Tumor-
neurofibroma
• Lower brachial plexopathy : trauma,cervical rib
39. • Cervical sympathetic chain lesion:
Pancoast tumor
Aneurysm or dissection of aorta, CCA
Trauma / Surgery
Carotid angiography
Lymphadenopathy-Hodgkin′s disease
40. 3rd order neuron lesion
Postganlionic Horner Syndrome
Lesions occurring after vasomotor and
sudomotor fibers have branched off the
sympathetic chain
Anhidrosis is usually absent or limited to an area
above the ipsilateral medial aspect of forehead
and side of the nose.
Lesions :
• Internal carotid artery:
trauma/dissection/occlusion
• Middle fossa: tumor, granuloma
41. Argyll Robertson Pupil
• Argyll Robertson pupil is characterized by a small
pupil, which is of
1. Fixed size and irregular in shape
2. Does not react to light
3. But react to accommodation.
• Caused by neurosyphilis, diabetes, alcohol or any
midbrain lesion interrupting the fibers that run
from the pretectal nucleus to parasympathetic
nuclei of the oculomotor nerve on both sides.
42. Urinary Bladder Dysfunction
Following Spinal Cord Injuries
• The normal bladder is innervated as follows:
• Sympathetic innervation is from the first and
second lumbar segments of the spinal cord.
• Parasympathetic innervation is from the
second, third, and fourth sacral segments of
the spinal cord.
• Sensory nerve fibers enter the spinal cord at
the above segments.
43.
44.
45. Site of lesion Result
Atonic (lower motor
neuron)
Lesions of sacral segments of
cord (conus medullaris)
Lesions of sacral roots and
nerves, Loss of detrusor
contraction
Difficulty initiating
micturition, Bladde
distension with ove
Hypertonic (upper motor
neuron)
Pyramidal tract lesion in
spinal cord or brainstem
Urgency with urge
incontinence
Bladder sphincter
incoordination
(dyssynergia)
Incomplete bladde
emptying
Cortical Post-central
Pre-central
Frontal
Loss of awareness
bladder fullness, D
initiating micturitio
Inappropriate mictu45
46. • The atonic bladder occurs during the phase of spinal
shock immediately following the injury and may last
from a few days to several weeks.
• The bladder wall muscle is relaxed, the sphincter
vesicae is tightly contracted (loss of inhibition from
higher levels), and the sphincter urethrae is relaxed.
• The bladder becomes greatly distended and finally
overflows.
• Depending on the level of the cord injury, the patient
may or may not be aware that the bladder is full; there
is no voluntary control.
47. • Automatic reflex bladder occurs after the patient
has recovered from spinal shock
• Provided that cord lesion lies above the level of
parasympathetic outflow
• Normally found in infancy
• Since the descending fibres in the spinal cord are
sectioned,there is no voluntary control
• The bladder fills and empties reflexly
• Known as spastic neurogenic bladder
48. • The autonomus bladder is the condition that
occurs if the sacral segment of spinal cord or
cauda equina is destroyed
• No reflex control or voluntary control
• Bladder wall is flaccid,overflows, resulting in
continuous dribbling
49. • Uninhibited bladder is associated with urge
incontinence with sudden uncontrolled
evacuation and having no residual urine
• Results from lesions affecting frontal lobe,
parasagittal meningioma or aneurysm of
anterior communicating artery
51. Dysfunction in Erection and
Ejaculation Following Spinal Cord
Injuries
• The erection of the penis or clitoris is controlled
by the parasympathetic nerves that originate
from the second, third, and fourth sacral
segments of the spinal cord.
• Bilateral damage to the reticulospinal tracts in
the spinal cord above the second sacral segment
of the spinal cord will result in loss of erection.
52. • Ejaculation is controlled by sympathetic
nerves that originate in the first and second
lumbar segments of the spinal cord.
• severe bilateral damage to the spinal cord
results in loss of ejaculation.
53. • Sympathectomy is done as a method of
treating arterial disease , Like
Raynaud disease
Intermittent claudication
Hypertension