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Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain
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Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Dec 25, 2015

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Page 1: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Welcome to week 6Chapter 16

Neurology and the Brain

Page 2: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Review of errors from the bones

Page 3: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Nervous System

Neurology: diagnosis and treatment of diseases and disorders of the nervous systemNeurologist: specializes in the field of neurology Neurosurgeon: focuses on a surgical approach to treatment

Page 4: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Brain • Housed in the skull and connected to the spinal

cord through the opening at the skull base called the foramen magnum

• 10,000 varieties of neurons and trillions of supportive cells (called glia) and nerve connections

• Miles of tiny blood vessels• Messages are transmitted through nerve fibers on

pathways throughout the central nervous system

Page 5: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Page 6: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• The Cerebrum– Uppermost and largest part of the brain– Composed of tissue that encompasses about two-

thirds of total brain mass– Is the site where highest neural processing takes

place—language, memory function.– Divided into right and left hemisphere

• Separated by great longitudinal fissure• Communicate with each other through corpus callosum

Page 7: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Cerebral cortex – Covers the surface of the cerebrum and carries out the

functions of the cerebrum– Composed of millions of neurons and glia– Called the “thinking brain” and the “gray matter” of the

brain because of its appearance – Formed by folds (gyri) and grooves between them (sulci)

which permit the brain to perform more complex tasks

Page 8: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• White matter: Beneath the cerebral cortex– Does not do any real thinking but connects parts of

the brain to each other– Basal ganglia: Islands of nerve-cell clusters which

play a role in control of movement• Right and left hemisphere divided into 4 lobes:

– Frontal: Largest of the four lobes – motor and speech skills

– Parietal: Interpret sensory information– Temporal: Auditory sensors– Occipital: Visual processing centers of the brain

Page 9: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Limbic System• Located in the cerebrum and part of the cerebral cortex• Called “the feeling brain” because it is the brain’s center

of emotion and involved in controlling emotional responses and behaviors that are necessary for survival

• Structures:– Hippocampus: Called “the brain’s memory center” and

involved in the formation and retrieval of memories– Amygdala: Controls emotional impact of thoughts and

situations

Page 10: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Limbic System (continued)– Pituitary: Actually an endocrine gland and produces

hormones that respond to various situations– Hypothalamus: Regulates automatic functions such

as temperature, hormone production, sleep and wake cycles, and appetite

– Thalamus: Serves as a relay station for almost all sensory impulses coming and going through cerebral cortex

Page 11: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Brainstem – Lowest extension of the brain that connects

cerebrum to the spinal cord– Major sensory and motor pathway for impulses

running to and from the cerebral cortex – Regulates critical vital functions such as heartbeat

and respirations• Cerebellum

– Attached to the brainstem – Called “little brain” because it has folds and grooves

like cortex– Performs functions below level of conscious thought

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Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Meninges • Three protective connective tissue layers– Dura mater: thick outermost layer – Arachnoid membrane: web-like middle layer

• Subdural space: The space between dura and arachnoid membrane

– Pia mater: The inner layer of meninges closest to the brain

Page 13: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Ventricles – Four chambers where cerebral spinal fluids (CSF) is

produced • Lateral ventricles (2): Located in cerebral hemispheres • Third ventricle: Located in the midline cavity of the brain• Fourth ventricle: Located near the brainstem

Page 14: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Ventricles produce cerebral spinal fluid (CSF) which:– Surrounds the brain and protects it from damage – Gives the brain buoyancy – Takes harmful substances away from the brain– Transports hormones to other areas of the brain

Page 15: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Spinal Cord: A long, tube-like column of nerve tissue extending form the base of the skull to the lumbar spine– The main pathway of communication between the

brain and the rest of the body– Surrounded by bony covering, meninges, and CSF – Is actually a complex organ consisting of gray matter

and white matter, like the brain, as well as a system of nerves that enable it to possess an intelligence of its own

Page 16: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Peripheral Nervous System

• Lies outside the central nervous system• Consists mainly of nerves that connect the brain and

spinal cord to sensory receipts. Muscles, and glands• Delivers messages from the CNS to other nerves outside

the CNS and from those nerves back to the CNS– Afferent nerves: Carry information to the CNS from the rest of

the body– Efferent nerves: Carry information from the CNS to the rest of

the body

Page 17: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Cranial Nerves – Total of 12 pairs of nerves that exit from the brain – Most control sensory and motor functions of the

head and neck• Spinal Nerves

– Total of 31 pairs located between the vertebrae of the spine

– Each communicate with a different area of the body– Cauda equina: bottom of the spinal cord, shape of a

horse’s tail

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Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Types of Spinal Nerves:- Motor nerves: from brain to spinal cord and body- Sensory nerves: from body back to spinal cord and brain- Dermatomes: regions of the body supplied by sensory nerves Autonomic Nervous System: supplies nerves to all the internal organsAlso called visceral nerves because they related to the viscera, the soft internal organs of the body Control involuntary movements of smooth muscle, cardiac muscle and endocrine glands.

Page 19: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Common Neurologic Diseases and Treatments

• Meningitis: Infection causing inflammation of the meninges– Bacterial meningitis: from bacteria in the blood

(bacteremia) – Viral meningitis: most common form of meningitis

• Treatments – Immediate, aggressive treatment with antibiotics – Vaccines: Hib and Prevnar

Page 20: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Hydrocephalus: Excess buildup of CSF in the brain – Congenital hydrocephalus: present a birth– Acquired hydrocephalus: developed later in life– Noncommunicating: obstruction in the ventricles– Communicating: problems with actual production or

absorption of CSF

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Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Treatments – Drugs to reduce pressure from CSF buildup (Diamox,

Lasix) – Lumbar puncture (LP) to reduce pressure from CSF

buildup and to test CSF fluid for problems– Ventriculoperitoneal (VP) shunt: Allows excess CSF to

flow away from the brain to other parts of the body where it can be absorbed

– Ventriculostomy: Opening made surgically between the ventricles, allowing CSF to flow unobstructed

Page 22: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Aneurysm: An abnormal dilation in a vessel’s wall – Cerebral aneurysm: aneurysm at the base of the

brain – Hemorrhage: ruptured aneurysm – Subarachnoid hemorrhage: rupture of aneurysm into

the subarachnoid space• Treatments

– Microvascular clipping: Cutting off the flow of blood to the aneurysm

– Coil embolization: Packing the aneurysm with platinum coils to block blood flow to the aneurysm

Page 23: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Seizure Disorder and Epilepsy– Seizure: a sudden abnormal discharge of electrical

activity in the brain – Epilepsy: neurologic disorder characterized by

recurrent seizures • Seizure: Two Main Categories:

– Partial Seizures: Those that begin in a particular area of the brain

• Simple partial seizures: No change in consciousness• Complex partial seizures: Consciousness altered

Page 24: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Generalized Seizures: Originate in several areas of the brain– Tonic-clonic (grand mal) seizures – Absence (petit mal) seizures– Myoclonic seizures• Status epilepticus: A prolonged seizure, or series of

seizures, that lasts more than 30 minutes during which time patient is unconscious. A medical emergency

Page 25: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Epilepsy: A group of neurological disorders characterized by uncontrolled electrical discharges from the cerebral cortex – considered a chronic, incurable condition unless there is a reversible cause (illness, toxicities)

• Treatments:– Oral anticonvulsants (many brand names: Depakene,

Depakote, Dilantin, Keppra, Klonopin, Lamictal, Neurontin, Topamax, Tegretol, Trileptal)

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Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Treatments (Continued)– Surgical Options:

• Temporal lobectomy: Removal of the portion of the temporal lobe causing seizures

• Subpial resection: A series of cuts in the brain to help isolate the section of the brain causing seizures

• Corpus callosotomy: Severs the right and left hemispheres of the brain

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Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Parkinson Disease: Motor system disorder as a result of nerve cells in the brain that control body movement begin to deteriorate– Nerves that produce dopamine become impaired, causing

extreme loss of muscle control, resulting in rigid limbs, slowness of movement (bradykinesia), or impaired balance and coordination.

• Treatments: Control of symptoms– Dopamine agonists: mimic effects of dopamine (common

drugs: carbidopa/levodopa, Parlodel, selegiline, coenzyme Q-10)

– Deep brain stimulation (DBS): Implanted device delivers mild electrical stimulation to brain to block brain signals that cause tremors

Page 28: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Multiple Sclerosis: An inflammatory disease of the nervous system that disrupts communication between the brain and other parts of the body– Caused by destruction of myelin (in the sheath) that

surrounds neuron, called demyelination– Name refers to the multiple areas of hardening on the

myelin sheaths covering neurons– Relapsing-remitting MS—most common form

• Treatments– Corticosteroids: Reduce inflammation– Muscle relaxants– Pain medication– Plasmapheresis: Plasma exchange

Page 29: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Bell’s palsy: Attack on the facial nerve– Cause unknown; viral infection may be a factor

• Treatments:– Antiviral medications (acyclovir)– Corticosteroids to reduce swelling of facial nerve

Page 30: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Trigeminal neuralgia: Disorder of the trigeminal nerve (cranial nerve V)– Also called tic douloureux – Sudden bursts of pain on one side of the face

• Treatments– Drugs to relieve pain and to reduce muscle spasms in

the face (seizure-type medications such as Tegretol, Dilantin, Neurontin, or Trileptal)

Page 31: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Treatments (Continued)– Surgical Treatments

• Microvascular decompression: Exposing and displacing the nerve away from the point of compression

• Percutaneous stereotactic rhizotomy: Destroying part of the nerve that causes pain

• Stereotactic radiosurgery: Applying ionizing radiation to the trigeminal nerve root, forming a lesion that interrupts transmission of pain signals to the brain

Page 32: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Brain Tumor: Abnormal growth of cells or tissue in the brain– Benign: Tumor does not contain cancer cells – Malignant: Tumor is life-threatening– Primary brain tumor: Originates in brain tissue– Secondary brain tumor: A brain tumor caused by a

cancer that originates in another part of the body

Page 33: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Glioma: Most common type of tumor that originates in the glial (supportive) tissue of the brain– Types of gliomas and where they form:

• Astrocytoma: also called glioblastoma multiforme • Ependymoma: lining of the ventricles • Oligodendroglioma: cells that produce myelin• Medulloblastoma: primitive (developing) nerve cells• Meningioma: from the meninges• Schwannoma: begins in Schwann cells• Craniopharyngioma: pituitary gland

Page 34: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Treatments – Craniotomy: Temporarily removing portion of skull to

remove tumor – Craniectomy: Permanently removing portion of skull and

replacing with synthetic plate– Debulking: Surgically reducing the size of a tumor that

cannot be completely removed– Transsphenoidal surgery: Accessing tumor through

incision in the sphenoid bone– Photodynamic therapy (PDT): Uses a light-sensitive drug

and laser light to kill cancer cells

Page 35: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Diagnostic Studies and Procedures • Neurological Assessments

– Glasgow Coma Scale (GCS): Assesses patient’s level of consciousness

– Mental status examination: Determines level of disordered thought processes

– Cranial nerve assessment: Reveals information about condition of the central nervous system

– Motor examination: Evaluates cerebral cortex and initiation of motor activity

• Pronator drift test

Page 36: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Neurological Assessments (Continued)– Sensory examination: Tests reaction to various

sensations– Cerebellar function tests: Evaluate coordination

and balance• Gait: Walking test (antalgic – limping) • Romberg: Tests for falling

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Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

– Cerebellar Function Tests (Continued)• Finger-to-nose test: Involves brain remembering position

sense with eyes closed• Heel-to-shin: Evaluates distance, power, and speed of

movement

– Reflex testing: Testing body’s automatic responses to outside stimuli

• Deep tendon reflexes: Knee jerks, ankle jerks• Babinski sign: Tests proper development of spine and

cerebral cortex

Page 38: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Laboratory Tests – Biopsy – Lumbar puncture (spinal tap)– Neurosonography (ultrasound)

Page 39: Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Welcome to week 6 Chapter 16 Neurology and the Brain.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Imaging Studies – Cerebral angiogram– CT scan– MRI/MRA– PET Scan– SPECT scan– EEG– Wada test

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Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Q and A