Neurological Disorders Dr. Kline FSU-PC. I. Neurological Disorders The normal functioning of the CNS can be affected by a number of disorders, the most.

Neurological Disorders

Dr. KlineDr. Kline

FSU-PCFSU-PC

I. Neurological Disorders

The normal functioning of the CNS can be The normal functioning of the CNS can be affected by a number of disorders, the most affected by a number of disorders, the most common of which are common of which are headaches, tumors, headaches, tumors, vascular problems, infections, epilepsy, vascular problems, infections, epilepsy, head trauma, demyelinating diseases, and head trauma, demyelinating diseases, and metabolic & nutritional diseasesmetabolic & nutritional diseases. .

A. Vascular Diseases in the brain: Minor to total Minor to total reduction in blood flow to the neurons reduction in blood flow to the neurons

deprives the cells of oxygen & glucose, resulting in deprives the cells of oxygen & glucose, resulting in interference with cellular metabolisminterference with cellular metabolism..

Disruption of cellular metabolism, caused by reduced Disruption of cellular metabolism, caused by reduced blood flow, lasting longer than blood flow, lasting longer than 10 min. 10 min. , results in , results in cell death for neurons in that brain region. cell death for neurons in that brain region.

These disorders account for These disorders account for most common causes of most common causes of death & chronic disability in the Western worlddeath & chronic disability in the Western world..

1. Stroke (Cerebral vascular accident) Results from severe severe interruption of blood Results from severe severe interruption of blood

flow to the brain (usually affecting arteries). flow to the brain (usually affecting arteries).

The onset of a stroke may span days to years, The onset of a stroke may span days to years, often with little-to-no warning.often with little-to-no warning.

A stroke produces A stroke produces an infarctan infarct (area of dead or (area of dead or dying tissue resulting from obstruction of blood dying tissue resulting from obstruction of blood vessels normally supplying area).vessels normally supplying area).

What factors influence the severity of deficits resulting from a stroke?

Location of the blockageLocation of the blockage Size of the blood vesselsSize of the blood vessels --prognosis is better if blockage occurred in --prognosis is better if blockage occurred in

small vessels rather than larger vessels. small vessels rather than larger vessels. Relative health of surrounding vesselsRelative health of surrounding vessels Age of patient (younger has better chance of Age of patient (younger has better chance of

recovery)recovery) How quickly patient is seen following strokeHow quickly patient is seen following stroke

2. Cerebral Ischemia- insufficient supply of blood to brain, are like mini-strokes. Decreases in blood flow result of 3 causes:Decreases in blood flow result of 3 causes: A. A. ThrombosisThrombosis-a plug or clot in a blood vessel that -a plug or clot in a blood vessel that

remains remains at its point of formationat its point of formation..

B. B. EmbolismEmbolism -moving (clot, bubble of air, sack of cells, -moving (clot, bubble of air, sack of cells, or fat deposit) from larger vessel into a smaller vessel. or fat deposit) from larger vessel into a smaller vessel.

--often effect middle cerebral artery of left side of --often effect middle cerebral artery of left side of brain which is near speech comprehension for many.brain which is near speech comprehension for many.

C. C. Cerebral arteriosclerosisCerebral arteriosclerosis-thickening & hardening of -thickening & hardening of arteries that reduces blood flow. arteries that reduces blood flow.

3. Migraine Stroke

People with classic migraines often experience a transient People with classic migraines often experience a transient ischemic attack with some neurological symptoms. These ischemic attack with some neurological symptoms. These include:include:

Impaired sensory functioning (vision)Impaired sensory functioning (vision) Numbness of skinNumbness of skin Difficulties in moving & aphasia (Language Disorder)Difficulties in moving & aphasia (Language Disorder)

*Account for a significant proportion of strokes in young *Account for a significant proportion of strokes in young people under 40. people under 40.

*Occurs more in females than males.*Occurs more in females than males. *Cause is unknown (may be vasospasm).*Cause is unknown (may be vasospasm).

4. Cerebral Hemorrahage

Massive bleeding in the brain. Onset is abrupt & Massive bleeding in the brain. Onset is abrupt & may be quickly fatal. Prognosis often poor.may be quickly fatal. Prognosis often poor.

Causes: Causes: HypertensionHypertension Congenital defects of cerebral arteriesCongenital defects of cerebral arteries Leukemia & other blood disordersLeukemia & other blood disorders Toxic chemicals Toxic chemicals

5. Aneurysms

Vascular dilations resulting from localized Vascular dilations resulting from localized defects in the elasticity of the vessel.defects in the elasticity of the vessel.

The vessels distend like a “balloon” until The vessels distend like a “balloon” until they are vulnerable to rupture.they are vulnerable to rupture.

Most common symptom is severe headache, Most common symptom is severe headache, often present for many months to years.often present for many months to years.

Treatment for vascular disorders:

Drug therapy (anticoagulants to dissolve clots or Drug therapy (anticoagulants to dissolve clots or prevent clotting)prevent clotting)

Vasodilators to dilate vesselsVasodilators to dilate vessels Drugs used to treat hypertensionDrugs used to treat hypertension Salty solutions to reduce edema in brainSalty solutions to reduce edema in brain Surgery to repair damaged vessels; total removal Surgery to repair damaged vessels; total removal

of aneurysm.of aneurysm.

B. Head Trauma Injuries

Brain injury from head trauma is most common Brain injury from head trauma is most common form of brain damage in people under 40.form of brain damage in people under 40.

There are two types of Head Trauma Injuries:There are two types of Head Trauma Injuries: Open-head & closed-head injuries.Open-head & closed-head injuries.

Ways in which Head trauma may damage the brain:

1. By directly damaging neurons & support cells (e.g., 1. By directly damaging neurons & support cells (e.g., gunshot wound).gunshot wound).

2. By causing blood flow disruption leading to a stroke 2. By causing blood flow disruption leading to a stroke (closed-head injury).(closed-head injury).

3. By causing bleeding in the brain which causes the brain to 3. By causing bleeding in the brain which causes the brain to swell. swell.

4. By making the brain vulnerable to infection (open-head 4. By making the brain vulnerable to infection (open-head injuries).injuries).

1. Open-Head Injuries: Results from injury to brain in which the skull is Results from injury to brain in which the skull is

penetrated either by projectiles (gunshots/missile penetrated either by projectiles (gunshots/missile wounds) or other moving objects.wounds) or other moving objects.

Most people with open-head injuries do not lose Most people with open-head injuries do not lose consciousness & produce distinctive symptoms that consciousness & produce distinctive symptoms that may undergo rapid & spontaneous recovery.may undergo rapid & spontaneous recovery.

Deficits are specialized & often resemble those of Deficits are specialized & often resemble those of surgical excisions. surgical excisions.

2. Closed-Head Injuries

Caused by a blow to the head (car accident, Caused by a blow to the head (car accident, blunt instrument swung at head).blunt instrument swung at head).

Damage may be three-foldDamage may be three-fold:: A. Damage at site of blow is called a A. Damage at site of blow is called a coupcoup. .

B. The brain may shift & hit the opposite side B. The brain may shift & hit the opposite side of the skull producing an additional bruise of the skull producing an additional bruise (contusion) known as a (contusion) known as a countercoupcountercoup. .

Closed-Head Injuries (Contd.) C. The brain may suffer additional damage, resulting from C. The brain may suffer additional damage, resulting from

shearing of nerve fibers which produce microscopic lesions.shearing of nerve fibers which produce microscopic lesions.

Frontal & temporalFrontal & temporal areas are most likely to be damaged in areas are most likely to be damaged in closed-head injuries.closed-head injuries.

These injuries are commonly accompanied by loss of These injuries are commonly accompanied by loss of consciousness (from damage to brainstem fibers), edema consciousness (from damage to brainstem fibers), edema (swelling), & hemorrhaging. (swelling), & hemorrhaging.

Length of coma often is positively correlated with severity Length of coma often is positively correlated with severity of damage.of damage.

Behavioral impairments resulting from closed-head injuries: 1. Discrete impairment of functions mediated by 1. Discrete impairment of functions mediated by

brain regions that sustained direct impact (coup brain regions that sustained direct impact (coup & countercoup).& countercoup).

2. Microscopic lesions caused by shearing of 2. Microscopic lesions caused by shearing of neurons results in widespread damage. neurons results in widespread damage.

Mental recovery from Closed-Head Injury:

Most mental recovery occurs rapidly in the first 6-9 Most mental recovery occurs rapidly in the first 6-9 months following injury.months following injury.

Memory functions recover more slowly than general Memory functions recover more slowly than general intellectual functions. Depending on length of coma & intellectual functions. Depending on length of coma & amnesia following injury, prognosis may be very good.amnesia following injury, prognosis may be very good.

Personality changes may be pronounced; person may Personality changes may be pronounced; person may be less likely to recover their personality than they are be less likely to recover their personality than they are to recover general intellectual functioning.to recover general intellectual functioning.

C. Epilepsy

Results from recurrent seizures (disruptions in neural Results from recurrent seizures (disruptions in neural firing) of various types that disturb consciousness.firing) of various types that disturb consciousness.

Seizures may be classified based on potential cause:Seizures may be classified based on potential cause:

------Symptomatic seizuresSymptomatic seizures-caused by infection, trauma, -caused by infection, trauma, tumor, toxic chemical, vascular problem, etc.tumor, toxic chemical, vascular problem, etc.

--------Idiopathic seizuresIdiopathic seizures- appear spontaneously; with no - appear spontaneously; with no apparent cause.apparent cause.

Symptoms of Epilepsy

1. 1. An aura or warning of a seizure that’s An aura or warning of a seizure that’s about to occurabout to occur..

E.g., may be an odor, noise, or visual imageE.g., may be an odor, noise, or visual image

2. 2. Loss of consciousnessLoss of consciousness (ranges from complete (ranges from complete collapse to staring off into space).collapse to staring off into space).

3. 3. MovementsMovements (ranging from minor such as (ranging from minor such as small twitching to large convulsions). small twitching to large convulsions).

Types of Epilepsy

1. 1. Focal seizures-Focal seizures- seizures occur in a locus seizures occur in a locus (particular place in brain) & then spread.(particular place in brain) & then spread.

E.g., symptoms may start with twitching in one E.g., symptoms may start with twitching in one digit of the hand and quickly spread to the other digit of the hand and quickly spread to the other fingers & arm.)fingers & arm.)

2. 2. Complex partial seizuresComplex partial seizures – usually originate – usually originate in the temporal lobe (sometimes the frontal in the temporal lobe (sometimes the frontal lobe). lobe).

Stages of Complex partial seizures

1. Subjective feelings, forced thoughts, alterations in 1. Subjective feelings, forced thoughts, alterations in mood, dejavumood, dejavu

2. Automatisms, which are stereotyped repetitive 2. Automatisms, which are stereotyped repetitive movements such as lip smacking, chewing, fidgeting.movements such as lip smacking, chewing, fidgeting.

3. Postural changes in which person may assume 3. Postural changes in which person may assume catatonic postures.catatonic postures.

3. Generalized seizures

Are bilaterally symmetrical without local onset.Are bilaterally symmetrical without local onset.

Grand Mal attack is accompanied by loss of Grand Mal attack is accompanied by loss of consciousness, stereotyped motor behavior.consciousness, stereotyped motor behavior.

4. 4. Petit mal attack-Petit mal attack- Brief loss of awareness Brief loss of awareness during which there is little motor activity such as during which there is little motor activity such as blinking, turning the head, rolling the eyes, etc.blinking, turning the head, rolling the eyes, etc.

Treating Epilepsy

1. Anticonvulsant drugs are used to treat this.1. Anticonvulsant drugs are used to treat this. (E.g., Dilantin, phenobarbital, etc.)(E.g., Dilantin, phenobarbital, etc.)

Mode of action is unknown, may work by Mode of action is unknown, may work by stabilizing weak neural membrane in abnormal stabilizing weak neural membrane in abnormal cells. cells.

2. Surgery to remove focus of epilepsy if known.2. Surgery to remove focus of epilepsy if known.

D. Brain Tumors

A mass of cells that grow & have no use.A mass of cells that grow & have no use.

Brain tumors grow from glia & other support Brain tumors grow from glia & other support cells, not the neurons themselves.cells, not the neurons themselves.

Tumor growth varies depending on type of Tumor growth varies depending on type of tumor, where its located, & type of cell that it tumor, where its located, & type of cell that it grows from.grows from.

Types of Brain Tumors

1. 1. GliomasGliomas- tumors that arise from glial cells & - tumors that arise from glial cells & infiltrate the brain. May be benign to malignant.infiltrate the brain. May be benign to malignant.

About 45% of all tumors are gliomas. About 45% of all tumors are gliomas. A. A. AstrocytomasAstrocytomas-result from growth of -result from growth of

astrocytes. Usually not malignant & may be astrocytes. Usually not malignant & may be treated fairly easily. Prognosis is good.treated fairly easily. Prognosis is good.

B. B. GlioblastomasGlioblastomas-highly malignant, rapidly -highly malignant, rapidly growing. growing.

2. Meningiomas- attached to meninges. Are encapsulated on outside of brain. Usually benign.

3. 3. Metastatic TumorsMetastatic Tumors- a tumor that results in - a tumor that results in the brain from tumor cells carried from the body the brain from tumor cells carried from the body elsewhere (breast, liver, lung, etc.).elsewhere (breast, liver, lung, etc.).

Treatment for tumors

Surgery to remove tumors if operable.Surgery to remove tumors if operable.

Radiation to reduce or shrink tumors.Radiation to reduce or shrink tumors.