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Neurological Disorders

Neurological Disorders . Big four of brain injury Head injury Tumors Stroke Epilepsy Outcomes depend on Location of injury Size and depth of kill Age/health/medical care/attitude of patient. Causes. Often, car accident Accidental injury from NOT wearing helmet Why problematic:

Samuel
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Neurological Disorders

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  1. Neurological Disorders • Big four of brain injury • Head injury • Tumors • Stroke • Epilepsy • Outcomes depend on • Location of injury • Size and depth of kill • Age/health/medical care/attitude of patient

  2. Causes • Often, car accident • Accidental injury from NOT wearing helmet • Why problematic: • Swelling • Bleeding • Treatment • Reduce swelling and bleeding • Drugs • Opening the skull (Trephoning!) • Outcome is highly variable • No recovery • Some recovery • Personality changes

  3. Tumors • Definition • Abnormal division and growth of cells • Note: NOT from neurons (they can’t divide) • Generally from • Glia cells • Meninges • Pituitary gland • Cells from tumors outside CNS (metastases) • Name of tumor ends in “oma” • Glioma • Meningioma

  4. Malignant vs. Benign • Malignant=cancerous, invasive • Benign is generally encapsulated • Malignant tumors destroy the normal neurons in region • Benign tumors do damage by compressing brain, leading to impaired function and/or damage

  5. Outcomes • Depends on whether you can get to it • If get all (benign) and IS benign- good prognosis • If malignant: less good outcome • Can do more damage going into brain to get to-damage the “good” parts • Dangers of radiation treament: killing good cells • Particularly developing brain of children • Also increases risk of reproductive problems • Retardation in children • Newer techniques: gamma knife

  6. Cerebrovascular Accidents • Definition • Cerebrovascular accidents or CVA • Note: aren’t really “accidents” • Two major types: • Hemorrhagic stroke • Blood vessel ruptures • Bleeding, loss of oxygen • Blook in tissue causes inflammation and cell death • Obstructive stroke • Block of blood flow by thrombus (blood clot) or embolus (plaque from wall of blood vessel) • Block of arteries and /or capillaries decreases blood flow to the region; this decreases oxygen • Result: neurons die

  7. Obstructive stroke

  8. TIA or transient ischemic attack • Mini stroke or mild stroke • Often: no lasting deficits of function • Cause for concern: may be precursor to bigger event • About 1/3 of people with TIA’s will go on to have stroke • Treatment • If within 2 hours, no previous stroke in past (2) weeks-TPT • Other clots busting therapies • No longer give coumadin or warfarin (blood thinners)- seem to do more damage • Often: aspirin or super-aspirin, plaque busters and wait • Biggest treatment: immediate therapies • Speech therapy • Physical therapy • Occupational therapy • Cognitive retraining for rehabilitation

  9. Epilepsy and Seizures • Definition • Seizure = abnormal electrical activity (neuronal discharges) in brain • May result from tumors, trauma, infection, drug withdrawal or actual seizure disorder • Often, cause remains unknown • Characterized by sudden and transient episodes of abnormal phenomena of motor (convulsion), sensory, autonomic or psychic events • Seizure disorder: epilepsy • Pattern of seizures • Pattern to type of seizures • Are recurrent

  10. Effects of seizures What caused by? Caused by hyperexcitable neurons Orginate at particular site (the focus) Spread to surrounding normal neuronal tissue Effects of seizures depend on Location of the focus Size and magnitude of spread Aura: often preceded by an aura or sensation that reflects function of focus area E.g.: smell or vision effects http://faculty.washington.edu/chudler/flash/hom.html

  11. Sensory Homunculus Motor Homunculus

  12. Generalized Seizures: Spread to much of brain • Tonic-clonic • Also called grand mal or major motor • Massive contraction of all skeletal musculature (tonic phase) • Then rhythmic jerking movements (clonic phase) • Followed by depression of CNS (Post-ictal phase) • Individual may • Fall to ground • Hit body parts/breaks limbs • Lose consciousness during post ictal • Lose bowel/bladder function • Be extremely disoriented

  13. Generalized seizures • Absence or petit mal • Abrupt but brief loss of consciousness, amnesia or awareness • “spacing out” • Not fall down, no real post ictal period • Often see in children, some grow out of

  14. Generalized Seizures • Atonic seizures • Loss of postural muscle tone • Often with sagging of head and falling • See in “fainting” goats: fainting goats • http://www.rfaintingfarm.com/faintshots.htm • Just fall down

  15. Partial Seizures: Remain localized • Simple Partial seizures • Minimal change in consciousness • Localized motor: specific motor groups • Spreads along motor cortex- also called Jacksonian • Sensory • Psychic • Autonomic • Note: follows humunculus

  16. Partial Seizures: Complex • Psychomotor or temporal lobe seizures • Confused and altered behavior with loss of consciousness • Includes phenomena of simple seizures above, but now also add loss of consciousness • Not all of brain, but localized • Strong aura

  17. Hypothalamic seizures • Focus is in hypothalamus • Get changes in the 4 F’s • Sexual behaviors • Rage behaivors • Eating behaviors • Fear behaviors • Can separate out from “behavioral issues” • Functional analysis • No environmental elicitor

  18. Status Epilepticus • Generally, seizures last seconds to minutes • Here- seizures are continuous • Results: lack of oxygen, disrupted blood flow • Since brain regulates body, get body disruptions • Causes neurons to die

  19. Treatments • Typical drug treatments • Acts to prevent spread of excitation • some suppress the focus • Lowers potassium • Some act by potentiating the inhibitory effect of GABA • No anticonvulsant is universal, rather specific drug for each type

  20. Types of drugs • Anxiolytics • Valium, ativan • Stop the seizure by relaxing muscles • GABA agonists/mimics • Oldies but goodies • Phenytoin: Dilantin (never use generic!!!!!) • Phenobarbital (Luminol)

  21. Types of Drugs • Carbamezepine • Tegretol, carbatrol, • Also Atretol, Convuline, Epito, Macrepan, Carbadac, Carpaz, Degranol, Teril, Temporol, Trileptal oxcarbazepine • Valproic Acid: valproate sodium • Depekane, depakote, divalproex sodium • Also depacon, convulex, depalept, epilim, olept, orfiril, valporal, epival

  22. Types of drugs • GABA analogues • Gabitril, tiagabine • Neurotin, gabapentin • Clonazepam (klonopin) • Miscellaneous anticonvulsants • Keppra, levetiracetam • Lamictal, lamictin, lamogine, lamotrigine • Mysoline, primidone • Topomax, tompiramate • Zonegran, zonisamide • http://www.crazymeds.org

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