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Nervous System Diseases & Disorders. Mr. Nichols PHHS. CNS anatomy. Major parts of the brain Cerebrum Cognitive center (thought, memory) Level of consciousness Cerebellum Center of balance & coordination Brain stem Center of automatic functions Blood pressure, respiration, etc.

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cns anatomy
CNS anatomy
  • Major parts of the brain
    • Cerebrum
      • Cognitive center (thought, memory)
      • Level of consciousness
    • Cerebellum
      • Center of balance & coordination
    • Brain stem
      • Center of automatic functions
        • Blood pressure, respiration, etc.
  • Any pain occurring in the head
  • Acute or chronic
  • Numerous etiologies
  • Very common condition
    • May be a symptom of other diseases
      • Infections, neoplasms, inflammatory diseases, etc.
  • Due to irritation, inflammation of any pain-sensitive structure
  • Brain itself is not a source of headache
  • Diagnostic procedures and testing:
    • Physical exam (PE), CT scan, LP (lumbar puncture or spinal tap), EEG, routine x-rays, MRA, MRI and more
migraine headache
Migraine Headache
  • Recurrent, usually severe headache of vascular origin
  • More common in females (3 to 1)
    • Family history in 70-80%
  • Onset common in adolescence or early adulthood
    • 80% have first migraine by 30YOA
  • Usually become less frequent with age
migraine headache1
Migraine Headache
  • 10-20% US population have migraines
  • 2nd most common cause of HA in US
    • Muscle tension HA is #1
  • S/S:
    • Intense throbbing headache, uni-or bilateral
    • Nausea, vomiting, dizziness, tinnitus
    • Visual disturbances
    • With or without aura (classical vs. common)
    • Duration from 4-72 hours
migraine headache2
Migraine Headache
  • Etiology:
    • Vasoactive chemicals (peptides) in brain (serotonin and dopamine)
    • Stimulate inflammatory cascade
    • This causes vasodilation
    • Serotonin appears to be most important factor
subarachnoid headache
Subarachnoid Headache
  • Due to a subarachnoid hemorrhage
  • 80% SAH due to ruptured intracranial aneurysm
    • Berry aneurysm, saccular, acquired due to hemodynamic stress at bifurcations
  • About 28,000 SAH/yr in US
  • Mean age is 50 YOA
  • Accounts for 6-8% strokes in US
subarachnoid headache1
Subarachnoid Headache
  • Most common etiology of non-traumatic intracranial hemorrhages
  • S/S: “worst headache of my life”
    • Rapid onset, neck stiffness (nuchal rigidity), low back pain, photophobia, nausea & vomiting, seizures in 10-25%
    • 10% mortality immediately
    • Up to 60% mortality in 1st month
head trauma
Head Trauma
  • #1 cause of trauma deaths in US
  • Many possible mechanisms of injury:
    • Falls
    • Motor vehicle crashes
    • Assaults
shaken baby syndrome
Shaken Baby Syndrome
  • Vigorous episode of shaking the baby by the arms, torso, or chest
    • Most victims less than 3 years of age
  • Produces characteristic injury pattern:
    • Neurological injury
      • Mental retardation, seizures, hearing loss
      • Intracranial hemorrhage or edema, coma
    • Retinal hemorrhages
shaken baby syndrome1
Shaken Baby Syndrome
  • One version of child abuse
  • First described in 1946
  • Part of overall pattern of child abuse:
    • Multiple fractures
    • Bruises in all stages of healing, often axial
    • Often abuse from non-biological parent or caregiver
shaken baby syndrome2
Shaken Baby Syndrome
  • Brain injuries:
    • Hemorrhage (SDH)
    • Cerebral edema & raised pressure
      • More common
  • Prognosis:
    • 1/3rd mortality
    • 1/3rd with permanent neurological disabilities
epidural and subdural hematomas
Epidural and Subdural Hematomas
  • Epidural Hematoma
    • Hemorrhage above the dura layer
    • Arterial bleeding
      • Parietal skull fx, middle meningeal artery
    • “lucid” interval
  • Subdural Hematoma
    • Below the dura
    • Venous bleeding
    • More common
edh sdh
  • S/S:
    • Altered level of consciousness (coma or lethargy), headache
    • Hemiparesis (right or left)
    • Unilateral dilated pupil
  • Treatment:
    • Neurosurgical drainage of the hematoma
cerebral concussion
Cerebral Concussion
  • Disruption of brain function without actual physical brain injury
  • Typically follows a blow to the head
  • Often, not always, has loss of consciousness
  • S/S: headache, nausea, dizziness, amnesias, disorientation, vertigo, photophobia
  • Testing is done to rule out other injuries
  • Treatment: supportive, observation
cerebral contusion
Cerebral Contusion
  • Bruising of the brain tissue
    • Cerebral edema around the contusion is common
  • Mechanism: a blow to the head, usually localized force
  • S/S: headache, variable loss of consciousness, variation from concussion-like symptoms to coma with hemiparesis
cerebral contusion1
Cerebral Contusion
  • Testing: CT scan to examine extent of brain injury & possible brain herniation
  • Treatment: variable
    • Monitoring of ICP, meds to decrease brain swelling, usually surgery is not helpful, other supportive care in ICU
disorders that cause paralysis
Disorders that cause paralysis
  • Hemiplegia
    • Loss of muscle control & sensation on one side of the body (L or R)
  • Paraplegia
    • Loss of muscle control & sensation on the lower part of the trunk and lower extremities
  • Quadriplegia
    • Paralysis of all four extremities
  • Etiology: most frequently stroke
    • Also intracranial tumor or hemorrhage
  • Other S/S: weakness of half of the face, aphasia, agnosia, apraxia, agraphia, alexia, etc.
paraplegia quadriplegia
Paraplegia & Quadriplegia
  • Etiology: most commonly spinal cord injuries due to trauma
  • Other S/S: loss of bowel & bladder control, sexual dysfunction
    • S/S of quadriplegia also include:
      • Low blood pressure and pulse
      • Variable loss of respiratory control
cns infections
CNS Infections
  • Acute Bacterial Meningitis
    • Acute inflammation & infection of the CSF & the meninges
    • Etiology: bacterial, viral, or fungal
      • Source may be spread from blood or nasopharynx
    • Most severe type = bacterial
      • Most common bacteria involved are Strep pneumoniae & Neisseria meningitidis
acute bacterial meningitis
Acute Bacterial Meningitis
  • S/S: Headache, nausea, vomiting, fever, seizure, nuchal rigidity, drowsiness, coma
  • Testing: lumbar puncture makes the diagnosis
  • Characteristic rash with Neisseria m.
  • Treatment: antibiotics or antifungals and supportive care
brain abscesses
Brain Abscesses
  • Localized collection of pus
  • Most commonly in:
    • Cerebellum
    • Frontal or temporal lobes of cerebrum
  • Etiology: spread from some other nearby or distant infection
brain abscesses1
Brain abscesses
  • S/S: depending on location, may resemble hemorrhage or CVA
  • Treatment:
    • Antibiotics
    • Surgical drainage of the abscess
peripheral nerve diseases
Peripheral Nerve Diseases
  • Peripheral neuritis (peripheral neuropathy)
    • Noninflammatory degenerative disease of nerve supplying the distal extremities
    • Commonly males, 30-50 YOA
    • Etiology: numerous, including alcohol, heavy metal, drug, poisons, TB & infections, diabetes, lupus, nutritional, etc
peripheral neuropathy
Peripheral neuropathy
  • S/S: muscle weakness, paresthesias, pain, tenderness, atrophy, loss of reflexes
    • Gradual in onset usually
  • Diagnostics: EMG
  • Treatment: varies with cause
bell s palsy
Bell’s Palsy
  • Disorder of the facial nerve (cranial nerve VII)
  • Unilateral paralysis/paresis of the facial muscles
  • Usually transient
  • Typically in patients 20-60 YOA
bell s palsy1
Bell’s Palsy
  • Etiology: idiopathic technically
    • Viral etiology is strongly suspected
    • Autoimmune, ischemic, etc
  • S/S: facial asymmetry, drooping mouth, drooling, incomplete closure of eye (Bell’s phenomenon)
  • Treatment: antiviral drugs and steroids usually
cerebrovascular accident cva
Cerebrovascular Accident (CVA)
  • Focal neurological impairment due to lack of blood supply to an area of the brain lasting more than 24 hours
  • Clinical condition is called stroke
  • 2 types of stroke:
    • Ischemic: embolic or thrombotic, 75% CVA’s
    • Hemorrhagic: 25% CVA’s
  • Risk factors: same as for cardiovascular disease, smoking, HTN, hyperlipidemia, diabetes, etc. TIA’s, oral contraceptives
  • S/S: hemiplegia or hemiparesis, dysphagia, speech impairment, diplopia & loss of visual fields, lack of coordination, confusion, sensory impairment
  • Diagnostics: CT scan to rule out hemorrhage or tumor
  • Treatment:
    • Thrombolytic medicines “Clot busters” if stroke symptoms of 3 hrs or less
    • Supportive care, nutritional, PT & OT
transient ischemic attacks tia
Transient Ischemic Attacks (TIA)
  • Focal neurological impairment due to transient lack of blood supply to an area of the brain, lasting less than 24 hrs.
  • TIA’s indicate increased risk of CVA in the future
  • Resolve completely
  • Often 20-40 minutes in duration
transient ischemic attacks
Transient Ischemic Attacks
  • Symptoms: most commonly upper extremity clumsiness, weakness, paresthesias, visual field cuts (curtain-like)
  • Treatment: surgery for carotid plaque, anticoagulants
  • Chronic brain disorder characterized by seizures (abnormal, rapid, intense neuronal discharge)
  • Types of seizures:
    • Generalized (gran mal)
      • Involve entire body, unconscious
    • Partial: part of the body is involve, conscious
    • Petit mal: momentary, frequent unconscious episodes
  • Etiology: mostly idiopathic
    • Trauma, tumors, CNS infection, drugs & toxins, etc
  • S/S: in classic generalized seizure
    • Aura, tonic, clonic, post-ictal phases
    • Respiratory insufficiency & cyanosis
    • Incontinence of bowel & bladder
  • Treatment: acute and long-term anticonvulsant meds
degenerative neurological diseases
Degenerative Neurological Diseases
  • Alzheimer’s Disease
    • Fatal, long-term disease of the brain
    • Characterized by neurofibrillary tangles and senile “plaques”
    • Gradual & permanent deterioration of memory, judgment, cognitive and verbal skills
    • Geriatric disorder in general
alzheimer s disease
Alzheimer’s Disease
  • Etiology: unknown
  • S/S: previous section, end-stage is complete inattention to self
  • Diagnosis of exclusion
  • Treatment: some meds slow progression, supportive care of patient and family
parkinson s disease
Parkinson’s Disease
  • Movement disorder characterized by muscle rigidity & tremors
  • Usually males over 65 YOA
  • Etiology: unknown, related to dopamine deficiency in brain
parkinson s disease1
Parkinson’s Disease
  • S/S: bradykinesia, involuntary tremors, muscular rigidity
  • Treatment: dopamine replacement meds, PT, supportive
multiple sclerosis ms
Multiple Sclerosis (MS)
  • Chronic, progressive, demyelinating autoimmune disorder
    • Makes antibodies to myelin
  • Females (2:1)
  • Occurs during adult years, not geriatric
  • About 25,000 new cases/yr in US
  • S/S: variable, may last hours to weeks
    • Classically: eye symptoms, paresthesias, paralysis, mood swings, balance problems, often sudden onset with relapses
    • Treatment: beta-interferon products, corticosteroids, glatiramen acetate (synthetic myelin protein)
    • Usual cause of death is due to chronic disability issues
amyotrophic lateral sclerosis als
Amyotrophic Lateral Sclerosis (ALS)
  • Adult-onset motor neuron disease
  • Progressive degeneration & loss of motor function
  • Called Lou Gehrig’s Disease (1941)
  • Males between 50-60 YOA
  • About 6/100,000 adult population in US
  • 25,000-30,000 cases total in US
  • S/S: progressive muscle weakness, atrophy, and fasciculations (twitching)
    • Eventual involvement of mouth, respiratory muscles, end-stage is complete paralysis
    • 75-80% begin with limb involvement
    • Slurred speech, hoarseness, dysphagia, tripping & stumbling, trouble with usual daily activities
  • Sporadic form (nonhereditary) 90-95% cases
    • Inherited version is autosomal dominant
  • Mean time till ventilator dependent or death: 2-4 years
    • May survive 5-10 years on ventilator
cancers of the cns
Cancers of the CNS
  • Primary brain tumors
    • Benign or malignant
    • Most pediatric brain tumors are primary
    • Examples are astrocytoma, glioblastoma
  • Secondary brain tumors
    • Metastases from other sites
    • Most common tumors of the brain