This document provides an overview of various neurological disorders and conditions. It begins by covering peripheral nerve disorders like neuropathy, myasthenia gravis, and muscular dystrophy. It then discusses specific neuropathies including diabetic neuropathy and nerve compression syndromes. Other sections address neurological diseases and disorders such as Guillain-Barre syndrome, multiple sclerosis, Parkinson's disease, stroke, epilepsy, headaches, and neurological infections. For each topic, it provides details on presentation, pathogenesis, clinical features, management, and treatment.
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.
Myasthenia gravis (MG) is a long-term neuromuscular disease that leads to varying degrees of skeletal muscle weakness. The most commonly affected muscles are those of the eyes, face, and swallowing. It can result in double vision, drooping eyelids, trouble talking, and trouble walking.
Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement
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.
Myasthenia gravis (MG) is a long-term neuromuscular disease that leads to varying degrees of skeletal muscle weakness. The most commonly affected muscles are those of the eyes, face, and swallowing. It can result in double vision, drooping eyelids, trouble talking, and trouble walking.
Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement
Multiple sclerosis (MS) is a demyelinating disease of central nervous system which includes brain and spinal cord.
it affect the myelin and by damaging the the myelin producing cell -Oligodendrocytes, which leads to sensory, motor and cognitive problems.
A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die.
A seizure is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in your behavior, movements or feelings, and in levels of consciousness. If you have two or more seizures or a tendency to have recurrent seizures, you have epilepsy.
"Demystifying Common Neurological Disorders: A Primer for Future Healthcare Professionals with Dr. Ganesh"
đ Greetings, aspiring healthcare professionals! I'm Dr. Ganesh, and today, we're embarking on an educational journey tailored for undergraduate students in medicine, nursing, and pharmaceutical sciences. We'll be demystifying some of the common neurological disorders, laying the groundwork for your future careers in healthcare.
Multiple sclerosis (MS) is a demyelinating disease of central nervous system which includes brain and spinal cord.
it affect the myelin and by damaging the the myelin producing cell -Oligodendrocytes, which leads to sensory, motor and cognitive problems.
A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die.
A seizure is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in your behavior, movements or feelings, and in levels of consciousness. If you have two or more seizures or a tendency to have recurrent seizures, you have epilepsy.
"Demystifying Common Neurological Disorders: A Primer for Future Healthcare Professionals with Dr. Ganesh"
đ Greetings, aspiring healthcare professionals! I'm Dr. Ganesh, and today, we're embarking on an educational journey tailored for undergraduate students in medicine, nursing, and pharmaceutical sciences. We'll be demystifying some of the common neurological disorders, laying the groundwork for your future careers in healthcare.
Diabetes Mellitus (DM) is a chronic metabolic disorder characterized by high blood sugar levels over a prolonged period. It can lead to various complications affecting multiple organ systems in the body. These complications can be broadly categorized into two types: acute and chronic. I'll provide an overview of both types below, but please note that this description will not be 3000 words long. If you need a more detailed and lengthy explanation, you may need to consult medical textbooks or academic sources.
**Acute Complications of Diabetes Mellitus:**
1. **Hypoglycemia:** This is a sudden drop in blood sugar levels, which can lead to symptoms like confusion, shakiness, sweating, and, if severe, loss of consciousness.
2. **Hyperglycemia:** High blood sugar levels can result in diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS), both of which are serious medical emergencies.
**Chronic Complications of Diabetes Mellitus:**
1. **Macrovascular Complications:**
a. **Cardiovascular Disease:** Diabetes increases the risk of heart attacks, strokes, and peripheral vascular disease due to atherosclerosis.
b. **Hypertension:** High blood pressure is common in individuals with diabetes, further increasing the risk of heart disease.
2. **Microvascular Complications:**
a. **Diabetic Retinopathy:** Affecting the eyes, this condition can lead to vision impairment and blindness.
b. **Diabetic Nephropathy:** This involves kidney damage and can eventually progress to kidney failure, requiring dialysis or transplantation.
c. **Diabetic Neuropathy:** Nerve damage can lead to symptoms like numbness, tingling, and pain in the extremities. It can also affect the digestive system and lead to gastroparesis.
3. **Dermatological Complications:**
a. **Skin Infections:** High blood sugar levels can impair the immune system, making individuals more susceptible to skin infections.
4. **Foot Complications:**
a. **Diabetic Foot Ulcers:** Neuropathy and poor blood circulation can lead to foot ulcers, which can become infected and, in severe cases, require amputation.
5. **Gastrointestinal Complications:**
a. **Gastroparesis:** This condition affects the stomach's ability to empty food properly, leading to digestive issues.
6. **Sexual Dysfunction:**
a. **Erectile Dysfunction (in men) and Sexual Dysfunction (in women):** Diabetes can impact sexual function.
7. **Mental Health Complications:**
a. **Depression and Anxiety:** Managing diabetes can be emotionally challenging, leading to mental health issues.
8. **Pregnancy Complications:**
a. **Gestational Diabetes:** This occurs during pregnancy and can lead to complications for both the mother and baby.
It's important to note that proper management of diabetes through lifestyle modifications, medication, and regular medical check-ups can help reduce the risk of these complications. Additionally, advances in medical research continue to improve ou
A brief presentation regarding etiology , clinical features , and management of chronic limb ischemia. It was presented by our unit at Department of surgery , Patna medical college
Chest pain or discomfort
Common presenting symptom of cardiovascular disease
May be cardiac or noncardiac in origin.
Cardiac â angina, MI, pericarditis, mitral valve prolapse, dissecting aortic aneurysm
Non cardiac â anemia (physical exertion), cervical disc disease, anxiety, trigger points etc
Follows pattern of ulnar nerve distribution (heart supplied by C3-T4 spinal segments)
Radiating pain to neck, jaw, upper trapezius, upper back, shoulder or arms (commonly left
5. Diabetic neuropathy
ī¨ 30 â 40% of diabetic patients in UK will develop
significant nerve damage during their lives due to sub-
optimal control
ī¨ Small fibre neuropathy
ī¨ Autonomic neuropathy
ī¨ Motor neuropathy
ī¨ Large fibre neuropathy
ī¨ Complications
ī¤ Callus and plantar neuropathic ulcers
ī¤ Infection
6. Diabetic neuropathy
ī¨ Acute painful neuropathies, radiculopathies and
mononeuropathies
ī¤ Constant burning, parasthesiae, shooting pains
ī¤ Either symmetrical sensory stocking distribution (both feet) or
single or adjacent nerve roots affecting:
īŽ feet and/or legs or one or both thighs
īŽ Often wasting
īŽ May be weakness leading to falls
īŽ âdiabetic amyotrophyâ/ proximal motor neuropathy due to
radiculopathy or femoral neuropathy
ī¤ Contact discomfort (eg. clothes)
ī¤ Insomnia
7. Nerve compression
ī¤ Median nerve compression
īŽ in carpal tunnel syndrome occurs in up to 10% patients
īŽ Diagnosis difficult if severe neuropathy involving hands
īŽ Requires nerve conduction studies
īŽ Surgical decompression
ī¤ Ulnar nerve compression
īŽ Usually at elbow (groove of medial epicondyle)
īŽ Pain and paraesthesia along medial aspect of forearm and numbness in little
and ring fingers
īŽ May be wasting and weakness of ulnar-innervated small muscles of hand
ī¤ Common peroneal nerve neuropathy
īŽ Nerve runs around head of fibula
īŽ Presents with foot drop and may have wasting of tibialis anterior (weak foot
dorsiflexion, toe extension and foot eversion)
8. Guillain-Barre syndrome
ī¨ Acute peripheral neuropathy affecting motor more than
sensory nerves
ī¨ Usually follows infection
ī¨ Clinical features
ī¤ Symptoms over days/weeks
ī¤ Bilateral flaccid weakness
ī¤ Loss of tendon reflexes
ī¤ May affect muscles of respiration
ī¤ Burning pains and numbness
9. Myaesthenia gravis
ī¨ Autoimmune disorder
ī¨ Most patients have antibodies to acetylcholine receptors
at neuromuscular junction
ī¨ Rare (annual incidence 0.4 in 100000)
ī¨ Clinical features
ī¤ Fatiguable ptosis
ī¤ Diplopia with limitation of eye movements
ī¤ Facial weakness
ī¤ Dysphagia
ī¤ Dysarthria
ī¤ Neck and limb muscle weakness (fatiguable)
ī¤ Can involve respiratory muscles
11. Myopathy
ī¨ Weakness of trunk and proximal limb muscles
ī¨ May be weakness of neck flexion and/or
extension and muscles of facial expression
ī¨ Gait waddling
12. Inflammatory myopathies
ī¨ Polymyositis
ī¤ May occur in association with autoimmune connective tissue
disorders
ī¨ Dermatomyositis
ī¤ Rash affects face and knuckles
ī¤ In minority of cases may have associated malignancy
ī¨ Inclusion body myositis
ī¤ Selective involvement of finger flexors and quadriceps
14. Spinal root disease (radiculopathy)
ī¨ Cervical radiculopathy
ī¤ Prolapse of intervertebral disc may compress cervical nerve as exits
ī¤ Neck pain, muscle weakness, loss of tendon reflex, sensory impairment
ī¤ Drugs, physiotherapy, may need surgery
ī¨ Prolapsed lumbar intervertebral disc
ī¤ S1 root
īŽ Low back pain and tenderness
īŽ Pain down leg from buttock to ankle (sciatica)
īŽ Wasting and weakness of gastrocnemius and soleus)
īŽ S1 sensory loss
īŽ Depressed ankle reflex
ī¤ L5 root
īŽ Sciatic pain
īŽ Foot drop (weakness extensor hallucis longus)
īŽ L5 dermatomal sensory impairment
16. Multiple sclerosis
ī¨ Most common chronic neurological disorder affecting
young people
ī¨ In most typical form is characterised by lesions
separated in time and space in central nervous system
ī¨ More common in temperate than tropical climate
ī¨ More common in females (M:F 1.5:1)
ī¨ Usual age of presentation is between ages of 20 â 40
ī¨ Prevalence in UK of 1 in 1000
17. Multiple sclerosis
ī¨ Pathophysiology
ī¤ Affects white matter of brain and spinal cord
ī¤ Inflammatory cells present and myelin damaged
ī¤ Foci of inflammation and demyelination known as plaques
ī¤ Initially inflammation and oedema, followed by loss of myelin and
then gliosis (scar tissue)
ī¤ Leads to reduction in conduction velocity
ī¤ Thought that environmental agent (eg. virus) triggers condition in
genetically susceptible individual
18. Multiple sclerosis
ī¨ Presentation
ī¤ Visual disturbance
īŽ Optic neuritis caused by inflammatory demyelination of one optic
nerve
īŽ Pain around one eye especially on eye movement
īŽ Blurred vision which may progress to monocular blindness over days
or weeks
īŽ Loss of colour vision
ī¤ Limb weakness and sensory disturbance
īŽ Lesion in spinal cord or cerebral hemispheres
īŽ May have tingling sensation down back +/or limbs on neck flexion
īŽ Symptoms may be worse after hot bath
19. Multiple sclerosis
ī¨ Course
ī¤ Relapsing-remitting
īŽ After episode may be complete or near-complete
resolution of symptoms (80% patients)
īŽ After further episodes may be some residual disability
ī¤ Secondary progressive
īŽ Steady progression without resolution
ī¤ Primary progressive
īŽ 10% patients have this form of disease with no clear
relapses and remissions
21. Multiple sclerosis
ī¨ Management
ī¤ If relapse severe enough to limit function â treat
with steroids
ī¤ Symptom control
īŽ Spasticity, fatigue, bladder disturbance, depression,
pain
ī¤ Disease modifying therapy
īŽ Interferon beta and glatiramer acetate
22. Parkinsonâs disease
ī¨ Degenerative condition affecting extrapyramidal pathways
(neurotransmitter dopamine)
ī¨ Affects dopaminergic neurones in substantia nigra of midbrain
projecting to striatum of basal ganglia
ī¨ Symptoms occur when 60-80% nigrostriate neurones lost
ī¨ Mean age of onset 60 years
ī¨ Positive family history unusual but some gene mutations identified
ī¨ Clinical triad:
ī¤ Akinesia
ī¤ Rigidity
ī¤ Tremor
23. Parkinsonâs disease
ī¨ Gait
ī¤ Flexed/stooped posture
ī¤ Difficulty defending balance
ī¤ Difficulty initiating walking (âfreezingâ)
ī¤ Steps small and shuffling
ī¤ Festinant
ī¤ Normal arm swing lost
ī¤ Risk of falls
25. Parkinsonâs disease
ī¨ Treatment
ī¤ Medical
īŽ Levodopa (often in combination with DOPA decarboxylase inhibitor)
īŽ Dopamine receptor agonists
īŽ Selegiline (monoamine oxidase inhibitor type B)
īŽ Entacapone (catechol-O-methyltransferase inhibitor)
īŽ Amantadine
ī¤ Surgical
īŽ Stereotactic thalamotomy (severe tremor)
īŽ Pallidotomy (drug-induced dyskinesias)
26. Other movement disorders
ī¨ Chorea
ī¤ Randomly distributed, irregular timed muscle jerks
ī¨ Athetosis
ī¤ Inability to sustain body part in one position (eg fingers)
ī¨ Tremor
ī¨ Dystonia
ī¨ Tics
ī¨ Drug-induced
ī¨ Restless legs syndrome
ī¨ Stiff person syndrome
27. Stroke
ī¨ Third most common cause of death in developed world
(annual incidence 2 per 1000 population)
ī¨ Rapidly developing symptoms or signs
ī¨ If resolve within 24 hours â transient ischaemic attack
ī¨ Mechanism
ī¤ Infarction
īŽ thrombotic (thrombosis of arteries in CNS â degenerative,
inflammatory, trauma)
īŽ Embolic (cardiac valve disease, AF, recent MI)
ī¤ Haemorrhage
30. Stroke
ī¨ Complications
ī¤ Pneumonia
ī¤ Deep venous thrombosis and pulmonary embolism
ī¤ Myocardial infarction
ī¤ 10% of patients with cerebral infarction die in first 30 days post-
stroke
ī¤ 50% remain dependent
ī¤ Long-term disability
īŽ Pressure sores, seizures, falls, spasticity, depression
31. Stroke
ī¨ Treatment
ī¤ If no haemorrhage start aspirin (+/- dipyridamole)
ī¤ Clopidogrel can be used in patients intolerant of aspirin
ī¤ Thrombolysis
īŽ iv tissue plasminogen activator (alteplase)
īŽ Within 3 hours of stroke onset
ī¨ Prevention
ī¤ Modify risk factors
īŽ Smoking
īŽ Diet (inc lower cholesterol)
īŽ Blood pressure
īŽ Diabetic control
32. Subarachnoid haemorrhage
ī¨ Causes
ī¤ Rupture of aneurysm
ī¤ Arteriovenous malformation
ī¤ Trauma
ī¤ Blood vessels weakened by infection (v rare)
ī¨ Features
ī¤ Sudden severe headache with photophobia, vomiting, neck
stiffness
ī¨ Management
ī¤ 30-40% die within few days of onset
ī¤ Signif risk of rebleeding in 6 weeks after onset
ī¤ Nimodipine
ī¤ Aneurysm clipped or coiled
33. Intracerebral haemorrhage
ī¨ 10% of all strokes
ī¨ Large haematomas have poor prognosis (>50%
mortality) â risk of hydrocephalus and coning
ī¨ Causes
ī¤ Hypertension
ī¤ Bleeding into tumours
ī¤ Trauma
ī¤ Blood disorders
ī¤ Blood vessel disorders
34. Epilepsy
ī¨ 1% of population suffer from epilepsy (recurring
tendency to have seizures)
ī¨ Definition
ī¤ â paroxysmal disorder in which cerebral cortical neuronal
discharges result in intermittent, stereotyped attacks of altered
consciousness, motor or sensory function, behaviour or emotionâ
ī¨ Classification
ī¤ Partial (simple or complex)
ī¤ Generalised (absence, myoclonic, tonic-clonic, tonic, atonic)
35. Partial seizures
ī¨ Simple partial seizure
ī¤ Arise in one cortical area (most commonly temporal lobes)
ī¤ Usually brief
ī¤ Discharge remains localised (eg focal motor, sensory or psychic
symptoms)
ī¤ No loss of awareness
ī¨ Complex partial seizure
ī¤ Impairment of awareness during attack
ī¤ Frequently altered or âautonomicâ behaviour
ī¤ Reactive automatisms â may be able to do simple task
ī¨ Partial onset with secondary generalisation
ī¤ Epileptic discharge spreads to both cerebral hemispheres
37. Tonic-clonic seizures
ī¨ May have prodrome or no warning
ī¨ Tonic phase â rigidity
ī¨ Often cyanosed
ī¨ Clonic phase â jerking (about 2 mins)
ī¨ May be incontinent or bite cheek/tongue
ī¨ Post-ictal confusion and tiredness
38. Conditions that mimic epilepsy
ī¨ Syncope
ī¤ Lasts <30 secs, pale, little/no confusion after event
ī¨ Cardiac
ī¤ arrhythmia, outflow obstruction
ī¨ Transient ischaemic attacks
ī¤ Usually last longer, rarely LOC
ī¨ Narcolepsy, cataplexy
ī¨ Metabolic disturbance
ī¨ Non-epileptic attacks
40. Migraine
ī¨ Unilateral headache
ī¨ Associated with nausea, vomiting, visual disturbance
ī¨ Typical onset teens and twenties
ī¨ Aura may be phase of vasoconstriction
ī¨ Then vasodilatation of extracerebral vessels may cause
headache
ī¨ Treatment
ī¤ simple analgesia initially
ī¤ triptan (5HT1 R agonist)
ī¤ Prophylactic agents
īŽ Propranolol
īŽ pizotifen
41. Other headaches
ī¨ Cluster headache
ī¤ Unilateral headache
ī¤ Severe attacks pain around one eye
ī¤ Lasts 20 â 120 mins
ī¤ Usually recurs several times a day
ī¤ Pattern continues for days, weeks or months
ī¤ Then symptom-free for weeks-months
ī¤ Treatment
īŽ Steroids initially, then methysergide, verapamil or pizotifen
ī¨ Tension-type headache/ chronic daily headache
ī¤ May be due to neck muscle contraction
ī¤ Amitriptyline may help
42. Facial pain
ī¨ Trigeminal neuralgia
ī¤ Compression of trigeminal sensory root
ī¤ Unilateral facial pain with trigger areas
ī¤ Treat with carbamazepine initially
ī¤ May require surgery
ī¨ Post-herpetic neuralgia
ī¤ Post-shingles of a branch of trigeminal nerve
ī¤ Persistent facial pain after rash healed
ī¤ May respond to amitriptyline, carbamazepine
43. Neurological infections
ī¨ Bacterial
ī¤ Meningitis
īŽ Neisseria meningitidis, Haemophilus influenza, Streptococcus
pneumoniae
ī¤ Brain abscess
īŽ May complicate otitis media
īŽ Raised intracranial pressure, focal signs, seizures
ī¤ Parameningeal infections
īŽ Pus in epidural space
ī¤ Tuberculosis
ī¤ Syphilis
ī¤ Lyme disease
ī¤ Leprosy
44. Neurological infections
ī¨ Viral infections
ī¤ Viral meningitis
īŽ Mumps, enterovirus
ī¤ Viral encephalitis
īŽ Commonest cause Herpes simplex
īŽ Headache, fever, reduced LOC, may have seizures
ī¤ Herpes zoster
īŽ Dormant in dorsal root ganglion after chickenpox
īŽ May reactivate as shingles
īŽ Pain and itching of single or adjacent dermatomes, following by
vesicular rash
ī¤ Retroviral infections
īŽ Meningitic illness may occur at seroconversion
īŽ Slowly progressive dementia
īŽ Risks of immunocompromise (infection, tumour)
50. Cerebral palsy
ī¨ Pre- or peri-natal insult
ī¤ Fetal hypoxia or infection
ī¤ Prematurity
ī¤ Traumatic delivery (intracranial haemorrhage)
ī¨ Clinical features:
ī¤ Spastic diplegia
īŽ May have shortening and deformity of legs
ī¤ Spastic hemiplegia
īŽ Associated with hemisensory deficits, learning difficulties and
epilepsy
ī¤ Athetoid cerebral palsy
īŽ Movement disorder develops in early childhood. Usually normal
cognitive function
51. Spinal dysraphism (spina bifida)
ī¨ Failure of closure of neural tube during development
ī¨ Defect of overlying skin
ī¨ Abnormal development of bony structures
ī¨ Particularly affects lumbosacral region
ī¨ Myelomeningocoele
ī¤ Parts of spinal cord in meningeal sac
ī¤ Paraplegia and incontinence
ī¨ Spina bifida occulta
ī¤ Mildest form
ī¤ Failure of fusion of vertebral arches
52. Congenital disorders (continued)
ī¨ Infantile hydrocephalus
ī¤ Enlargement of head
ī¤ Delayed development, learning difficulties, seizures, spastic
paraparesis
ī¤ Neurosurgery â eg. ventricular shunt
ī¨ Cerebral structural disorders
ī¤ May be incidental findings or may delay development
ī¨ Intrauterine infection
ī¤ Rubella
īŽ Cataracts, hearing loss, learning difficulties, congenital heart disease
ī¤ Neurosyphilis
īŽ Adult disease plus deafness, keratitis, deformed teeth
56. Muscular dystrophy
ī¨ Dystrophinopathies (mutations of X-linked gene for
muscle protein dystrophin)
ī¤ Duchenne muscular dystrophy
īŽ Boys develop proximal weakness in early childhood
īŽ Difficulty rising from squatting position (use hands to âclimbâ up legs â
Gowersâ sign)
īŽ Pseudohypertrophy of calf muscles (muscle replaced by fatty tissue)
īŽ Progressive disability
ī¤ Becker muscular dystrophy
īŽ Presents in adolescence or adult life
īŽ Can have normal lifespan but progressive disability
ī¤ Limb-girdle dystrophies
60. Neurorehabilitation
ī¨ Aim âto restore patients to maximum capability and
independence within limits set by their disability and
their needsâ
ī¨ Multidisciplinary teams
ī¤ Physiotherapy
ī¤ Occupational therapy
ī¤ Speech therapy
ī¤ Neuropsychology
ī¤ Social work