Dec 23, 2015
Anatomy and Physiology
Nervous system: brain, spinal cord, nerves
Central Nervous System (CNS) and Peripheral Nervous System (PNS)
CNS: brain and spinal cord PNS: autonomic nervous system, cranial
and spinal nerves
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Common Signs and Symptoms Common signs and symptoms
HeadacheNausea and vomitingWeaknessMood swingsFever
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Common Signs and Symptoms Symptoms specific to CNS
Stiffness in neck, back, or extremitiesInability to move any part of the bodySeizures or convulsionParalysisVisual difficulties
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Common Signs and Symptoms Symptoms specific to CNS
Inability to speakParalysisExtreme or prolonged drowsinessStupor, unconsciousness, amnesia, extreme
forgetfulness
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Common Signs and Symptoms Common diagnostic tests
Cerebrospinal fluidMeasuring intracranial pressureX-rays of skull and vertebral columnMyelogram
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Common Signs and Symptoms Common diagnostic tests
AngiogramElectroencephlogramCAT ScanMRI
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Infectious Diseases
EncephalitisInflammation of brain tissue caused by
bacteria and virusesSymptoms:
○ Headache, stiff neck and back○ Fever and lethargy○ Confusion and even coma
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Infectious Diseases
EncephalitisTreatment:
○ Supportive○ Antiviral medication may be effective
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Infectious Diseases
MeningitisInflammation of meninges or coverings of
brain and spinal cordCauses:
○ Bacterial and viral○ Fungi○ Toxins such as lead and arsenic
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Infectious Diseases
MeningitisSymptoms
○ High fever○ Severe headaches○ Photophobia
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Infectious Diseases
MeningitisSymptoms
○ Stiffness and resistance in neck (nuchal rigidity)
○ Drowsiness○ Stupor○ Seizures○ Coma
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Infectious Diseases
MeningitisDiagnosis: collect spinal fluid to find causeTreatment
○ Antibiotics for bacterial infection○ Antipyretics○ Anticonvulsants○ Quiet dark environment
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Infectious Diseases
PoliomyelitisViral infection affecting brain and spinal cordVaccine has eliminated the disease in the
United StatesVirus is spread by oropharyngeal secretions
and infected feces
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Infectious Diseases
PoliomyelitisSymptoms
○ Muscle weakness○ Neck stiffness○ Nausea and vomiting
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Infectious Diseases
Poliomyelitis Diagnosis: clinical examination, throat,
feces, and spinal fluid cultureTreatment: supportive therapy including
analgesics and bedrest during acute phase
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Infectious Diseases
Poliomyelitis Long-term physical therapy and braces may
be neededIf respiratory system involved, mechanical
ventilation may be needed
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Infectious Diseases
TetanusHighly fatal infection of nerve tissue caused
by bacteria Clostridium tetaniFirst symptom is stiffness of the jaw,
commonly called “lockjaw”
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Infectious Diseases
RabiesCaused by virusPrimarily affects animals such as dogs, cats,
raccoons, squirrels Transmitted to humans through bite of an
infected animal
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Infectious Diseases
RabiesSymptoms
○ Fever and pain○ Convulsions and rage○ Spasms and paralysis of muscles for
swallowing
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Infectious Diseases
RabiesSymptoms
○ Throat spasms leading to hydrophobia○ Inability to swallow; drooling of frothy saliva
Treatment ○ Clean infection site and rabies vaccine
injectionsNo cure
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Infectious Diseases
ShinglesViral disease caused by herpes zosterItching, painful red rash, and small vesicles
on sensory nerve pathsSymptoms last ten days to several weeks
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Infectious Diseases
ShinglesDiagnosis
○ Appearance of lesions○ Viral culture test
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Infectious Diseases
ShinglesTreatment
○ Antiviral medications○ Analgesics○ Antipyretics○ Antipruritic medications
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Transient Ischemic Attacks TIAs or mini-strokes Insufficient blood to brain Symptoms
Weakness of arm and/or legDizzinessSlurred speechMild loss of consciousness
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Transient Ischemic Attacks Symptoms last few minutes to an hour Diagnosis is made by angiogram Surgery to improve blood flow
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Functional Disorders
Degenerative Disk Disease Headache Epilepsy Bell’s Palsy
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Functional Disorders
Degenerative Disk DiseaseDegeneration or wearing away of the
intervertebral diskWearing away allows vertebrae to bump or
rub against each other
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Functional Disorders
Degenerative Disk DiseaseSymptoms:
○ Difficulty walking○ Radiating pain in back and in one or both legs
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Functional Disorders
Degenerative Disk DiseaseDiagnosis:
○ X-ray○ Myelogram○ CAT or MRI
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Functional Disorders
Degenerative Disk DiseaseTreatment
○ Rest back and legs○ Back brace○ Analgesics and anti-inflammatory drugs○ Exercise to ease pain○ Surgery
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Functional Disorders
Headaches - one of the most common disorders in humans
Caused by two mechanismsTension on facial, neck, and scalp musclesVascular changes in arterial size of vessels
inside head
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Functional Disorders
Headaches Contributing factors
StressToxic fumesNoiseLack of sleepAlcohol consumption
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Functional Disorders
Headaches May be acute or chronicPain may be constant, pressure, throbbing,
stabbing, intermittentTension, cluster, following lumbar puncture,
migraine
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Functional Disorders
HeadachesDiagnosis
○ History and physical examination○ X-ray○ EEG, MRI, and CAT
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Functional Disorders
HeadachesTreatment
○ Analgesics○ Bedrest and muscle massage ○ Muscle relaxants○ Warm baths○ Biofeedback
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Functional Disorders
EpilepsyChronic disease of brainIntermittent episodes of abnormal electrical
activity in brainMost common symptom is seizureConvulsions include petit mal, grand mal
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Functional Disorders
EpilepsyDiagnosis
○ EEG○ CAT scan○ Cerebral angiogram○ Blood tests
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Functional Disorders
EpilepsyTreatment
○ Anticonvulsive medications○ Close monitoring and adjusting of medications
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Functional Disorders
Bell’s PalsyAffects facial nerve (7th cranial), causing
unilateral paralysisAffects individuals 20 to 60 years of age
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Functional Disorders
Bell’s PalsySymptoms
○ Drooping weakness of eye○ Drooling of saliva○ Unable to whistle or smile○ Distorted facial appearance
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Functional Disorders
Bell’s PalsyDiagnosis
○ History and symptomsTreatment
○ Analgesics and anti-inflammatory medication
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Functional Disorders
DementiaLoss of mental ability due to loss of neurons
or brain cellsMost common dementia is senility Most common cause of senile dementia is
Alzheimer's disease
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Functional Disorders
Alzheimer's DiseaseForm of dementiaAffects individuals 70 and olderEarly symptoms
○ Short-term memory loss○ Inability to concentrate○ Slight changes in personality
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Functional Disorders
Alzheimer's DiseaseSymptoms of disease progression
○ Diminished communication skills○ Meaningless words○ Inability to form sentences○ Increased forgetfulness○ Irritability and agitation
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Functional Disorders
Alzheimer's DiseasePositive diagnosis: autopsyInitially may be made by ruling out other
brain diseasesTreatment is supportiveNo cure
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Functional Disorders
Vascular DementiaAtrophy and death of brain cells due to
decreased blood flowAtherosclerotic plaque can cause decreased
blood flow and is common with aging
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Functional Disorders
Vascular DementiaSymptoms
○ Changes in memory, personality, and judgment
○ Irritability, depression, and sleeplessness○ Lacks personal hygiene
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Functional Disorders
Vascular DementiaDiagnosis
○ Blood flow testing and history and physicalTreatment
○ Increasing blood flow to brain○ Carotid endarterectomy
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Functional Disorders
Head Trauma DementiaDeath of brain cells due to head traumaSymptoms
○ Decrease in mental intellect and cognitive function
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Functional Disorders
Head Trauma DementiaDiagnosis
○ History○ Cranial X-rays○ MRI and CT
Treatment○ Correct damage if possible
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Functional Disorders
Substance-Induced DementiaBrain cell death from drug toxicity and toxinsCauses mental impairment and decreased
cognitive ability
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Sleep Disorders
InsomniaInability to fall or stay asleepRelated to stress, pain, fear, depression,
caffeine, alcohol, nicotine, and bronchodilators
Treatment○ Identifying and removing cause
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Sleep Apnea
Sleep disorder characterized by periods of breathlessness
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Sleep Apnea
SymptomsDaytime sleepinessExtreme snoringPersonality changesDepressionImpotence
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Sleep Apnea
DiagnosisMonitor affected individual during sleep for
apnea and low blood oxygen levels
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Sleep Disorders
Sleep ApneaTreatment
○ Based on cause○ Weight loss○ Surgery to correct nasal obstruction○ Oxygen during sleep○ Medications to stimulate breathing
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Tumors
Primary and secondary Benign and malignant Symptoms
HeadacheVomiting and seizuresMood and personality changesVisual disturbance and loss of memory
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Tumors
DiagnosisClinical symptomsX-ray, CT, and MRIBiopsy
Treatment: surgery, radiation, and chemotherapy
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Trauma
Concussions and ContusionsBlow to head by an object, fall, or other
trauma such as an automobile accidentDisruption of normal electrical activity in
brain
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Trauma
Concussions and ContusionsCauses immediate unconsciousnessMay last a few seconds to several hoursConcussion is less serious than a contusion
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Trauma
Concussions and ContusionsContusion is bruising of the brain Outcomes:
○ Can lead to a hematoma○ Increased intracranial pressure (ICP)○ Permanent brain damage
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Trauma
Concussions and ContusionsDiagnosis
○ History of injury○ Neurologic examination○ Cranial X-ray○ CT and MRI
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Trauma
Concussions and ContusionsTreatment
○ Bedrest and direct observation○ Individual should be checked every 2 to 4
hours ○ Monitor changes in consciousness, eye pupil
size, mood, and behavior
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Trauma
Concussion and ContusionsTreatment
○ Analgesics, stimulants, and sedatives should not be given to individuals with a head injury
○ Medications may mask the symptoms and make assessment difficult
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Trauma
Skull FractureGreatest danger is brain tissue damage
from bony fragments Potential of cutting brain, severing a vessel,
and causing a hematomaBrain damage may be temporary or
permanent
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Trauma
Skull FractureFracture near base of skull may injure
respiratory center and impair breathingInfection of brain tissue may be a problem
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Trauma
Skull FractureTreatment
○ Dependent on type and position of fracture○ Craniotomy may be necessary to relieve ICP○ Protective headgear may be necessary until
fracture is healed
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Trauma
Epidural and Subdural HematomaBlood vessels rupture and hemorrhageBlood seeps between bony skull and outer
meninges Pushes dura mater away from inner bony
skull
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Trauma
Epidural and Subdural HematomaEpidural Hematoma symptoms
○ Headache○ Dilated pupils○ Nausea, vomiting, and dizziness
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Trauma
Epidural and Subdural HematomaSubdural Hematoma
○ Usually the result of head hitting a stationary object
Blood collects between the dura mater and arachnoid layer
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Trauma
Epidural and Subdural HematomaSubdural Hematoma
○ Develops slowly over period of daysSymptoms
○ Hemiparesis○ Nausea, vomiting, dizziness○ Convulsions and loss of consciousness
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Trauma
Epidural and Subdural HematomaDiagnosis
○ Clinical history○ Cranial X-ray, CT or MRI
Treatment○ Decrease intracranial pressure○ Craniotomy called “bur holes”
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Spinal Cord Injury—Quadriplegia and Paraplegia
Injury to spinal cordResults in varying degrees of loss of
movementResults in varying degrees of loss of feeling
below the area of injury
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Spinal Cord Injury—Quadriplegia and Paraplegia
QuadriplegiaLoss of movement and feeling in the trunk
and all four extremities Loss of bowel, bladder, and sexual function
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Spinal Cord Injury—Quadriplegia and Paraplegia
ParaplegiaLoss of movement and feeling in trunk and
both legsLoss of bladder, bowel, and sexual function
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Spinal Cord Injury—Quadriplegia and Paraplegia
Emergency treatmentImmediate treatment is necessaryDo not move the victim unless surroundings
are unsafeMaintain position of spine with special
collars and backboards
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Spinal Cord Injury—Quadriplegia and Paraplegia
DiagnosisHistory of injuryNeurologic examSpinal X-rays, MRI, and CAT scan
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Spinal Cord Injury—Quadriplegia and Paraplegia
TreatmentRealignment and stabilization of the bony
spinal column Decompression or release of pressure on
spinal cordPrevent further injury
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Rare Diseases
Amyotrophic Lateral Sclerosis (ALS)“Lou Gehrig’s” diseaseDestructive disease of motor or movement
neurons
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Rare Diseases
Amyotrophic Lateral Sclerosis (ALS)Atrophy of muscles leading to progressive
loss of movement of hands, arms, and legsTreatment is supportive No cure
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Rare Diseases
Guillian-Barré SyndromeAcute, progressive disease affecting the
spinal nervesBegins 10 to 21 days after febrile illness
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Rare Diseases
Guillian-Barré SyndromeEarly symptoms include nausea, fever, and
malaiseWithin 24 to 72 hours paresthesia, muscle
weakness, and paralysis usually begins
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Rare Diseases
Guillian-Barré SyndromeSymptoms may progress for several days to
weeksOnce progression ceases, recovery beginsTreatment is supportiveRecovery is usually complete
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Rare Diseases
Huntington’s ChoreaInherited diseaseAppears during middle ageProgressive degenerative disease of brain
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Rare Diseases
Huntington’s ChoreaLoss of muscle control and choreaLeads to mental deteriorationPersonality change, moody behavior, loss of
memory, dementiaTreatment is supportiveNo cure
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Rare Diseases
Multiple Sclerosis (MS)Causes:
○ Demyelination of the nerves of the CNS ○ Allows information to “leak” from the nerve
pathway ○ Leads to poor or absent nerve transmission
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Rare Diseases
Multiple Sclerosis (MS)Symptoms:
○ Muscle weakness and lack of coordination○ Paresthesia○ Speech difficulty○ Loss of bladder function○ Visual disturbance especially diplopia
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Rare Diseases
Multiple SclerosisAffects adults between ages 20 and 40Periods of remission and exacerbationTreatment
○ Physical therapy○ Muscle relaxants in order to maintain muscle
tone and reduce spastic movement
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Rare Diseases
Parkinson’s DiseaseSlow, progressive brain degenerationDevelops between ages 50 and 60
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Rare Diseases
Parkinson’s Disease Classic symptoms
Rigidity and immobility of handVery slow speech pattern“Pill rolling” motion of fingersExpressionless facial appearance
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Rare Diseases
Parkinson’s DiseaseSymptomsAbnormal “bent forward” postureShort, fast-running steps, shuffling
appearance
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Rare Diseases
Parkinson’s DiseaseTreatment
○ Symptomatic○ Dopamine replacement○ Physical and psychological therapy
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