Powerpoint

The Spectrum of Brain Disorders

Neil Porter, MD

Assistant Professor

Department of Neurology

University of Maryland

Case 1 – Phineas Gage

Phineas Gage

Railroad foreman in 1848 Involved in an accident whereby a 3-foot

tamping iron was blown though his skull, landing 25 yards away.

Phineas Gage – Reconstruction

Phineas Gage

Gage had no weakness but underwent a personality change from solid and dependable to “fitful, irreverent and grossly profane”

Reconstruction of Gage Injury

The rod

apparently

injured

both

frontal lobes.

Conclusion

The brain is an amazing and complex instrument that is not well understood.

Goals and Objectives

Goal: To gain an appreciation of the range of disorders affecting the human brain

Objectives– To become familiar with categories of brain

disorders– To become familiar with features of these

various disorders– To learn about some specific examples of

disorders in each category

Definitions

Neurology

The study of the human nervous system within medicine.

Nervous System– Brain – Spinal Cord– Nerves

Neurologist

A doctor trained in Neurology.

Tools of the Neurologist

History

Physical Exam

“Laboratory Tests”

Categories of Brain Disorders

Circulation problems (Strokes) Infections/Inflammatory conditions Tumors Seizures/epilepsy Trauma Chemical disorders Developmental disorders Degenerative disorders

Organization of the Talk

For each category– Features of each disorder

– Types of disorders within each category

– Case (example)

Circulation problems (Strokes)

People with strokes suddenly lose function such as walking, lifting or speaking due to poor circulation or bleeding into the brain.

Circulation problem: Types

Stroke (poor circulation to part of the brain)– Blood clot– Bleed

Poor circulation in general due to heart attack or cardiac arrest

Circulation (Stroke): Case

One of my high school teachers suffered a stroke months ago, being left with right-sided weakness and loss of speech. He is slowly getting better with therapy.

Infections/Inflammation: Features

People with brain infections generally have fever, headache and confusion.

Infections/Inflammation: Types

Infections – Meningitis (infected spinal fluid)– Encephalitis (infected brain)– Abscess (infected pocket within the brain)

Inflammation (auto-immune)– Lupus

Infections/Inflammation: Case

A healthy 25 year-old engineer lost his ability to read over a period of months. He was found to have encephalitis, and over a treatment period of 2 years finally returned to normal.

Tumor Features

Tumor patients usually have worsening headaches, and possible weakness or numbness. Alternatively patients may come in with a seizure.

Tumor Types

“Primary” – start in the brain– On the surface of the brain (meningiomas)– Inside the brain (gliomas) (like Kennedy)

“Secondary” – travel to the brain– Metastatic cancer

Tumor: Case

Teddy Kennedy recently had a seizure. He was found to have a large brain tumor. He has received surgery and possible radiation and remains in the Senate.

Seizures/epilepsy: Features

Epilepsy is the tendency to have seizures (uncontrolled electrical brain activity). People with epilepsy may suddenly have staring spells or shaking spells or they may just “fall out.”

Seizures/epilepsy: Types

Focal seizures (involve part of the brain)

Generalized seizures (involve the whole brain)

Seizures/epilepsy: Case

A young girl started doing poorly in school. Her teacher noted increased staring spells and less participation in class. She was found to have seizures and did fine after starting treatment.

Generalized seizure on EEG

Trauma: Features

People in accidents may have sudden problems (coma, confusion, amnesia) due to injury to their brains.

Trauma: Types

Concussion (brain shock) Contusion (brain bruise) Bleed

Trauma: Case

A 19 year-old girl was admitted to Shock-Trauma after being involved in a car accident. She was in a coma for 3 weeks and then woke up after going to a rehab center. She is now home and back to work.

Chemical (metabolic): Features

Chemical disturbances generally affect people’s thinking, leading to confusion or sleepiness within a short period of time.

Chemical (metabolic): Types

Salt imbalance (electrolyte imbalance) Hormone problems (glandular) Nutrition problems Medications Drug intoxications Poisoning

Chemical (metabolic): Case

A 60 year-old man with longstanding alcohol abuse is brought to the emergency room because he is agitated, confused and feeling that bugs are crawling on him.

Developmental Disorders: Features Children who are born with strokes, genetic

conditions, or infections can have problems with their development.

Developmental Disorder: Types

Cerebral Palsy Mental retardation Autism

Developmental Disorder: Case

A 4 year-old boy had problems getting along with others at pre-school. He made poor eye contact and began getting upset when anyone disturbed the layout of his bedroom.

Degenerative Disorders: Features

Degenerative conditions generally involve the slow loss of skills such as thinking, walking over years

Degenerative Disorders: Types

Alzheimer’s Disease Parkinson’s Disease Lou Gehrig’s Disease

Degenerative Disorder: Case

My father did masonry, tailoring, etc., until he began losing his memory at 66. He was eventually diagnosed with Alzheimer’s Disease. He slowly lost the ability to work, drive, and even talk, despite treatment.

Summary

The brain is a wonderful organ! The brain is a complex organ! The brain is understandable. The brain is not well understood!

Questions and Comments?