4. 1. Aseptic meningitis : caused by viral or secondary to
lymphoma, leukemia, or human immunodeficiency
2. Septic meningitis is caused by bacteria such as
Streptococcus pneumoniae and Neisseria
Meningitis is classified as
septic or aseptic.
1. Meningeal infections generally originate in one of two ways:
(1) Through the bloodstream as a consequence of other
(2) Or by direct spread: that may occur after a traumatic injury
to the facial bones or secondary to invasive procedures.
2. Once the causative organism enters the bloodstream, it crosses
the blood-brain barrier and infect the meninges.
6. 3. The inflammatory response stimulated by the immune
system in response to the infection, causing the meninges to
swell, in an attempt to stop the spread of infection.
4. The CSF can also infected from the affected meningeal tissue
while circulates through the subarachnoid space
5. Infection of the CSF can cause further swelling of the
meninges, leading to increased intracranial pressure in the
skull and pressing on the brain.
7. 1. Headache and fever,
2. Petechial rash,
3. Disorientation and memory impairment,
4. Lethargy, unresponsiveness, and coma may develop as the
5. ICP increases secondary to brain swelling or hydrocephalus
Signs and symptoms
8. Signs of meningeal irritation include
1. Stiff neck, is an early sign.
2. Positive Brudzinski's sign: Flexing patient’s neck produces
flexion of the knees and hips; passive flexion of lower
extremity of one side produces similar movement for opposite
3. Positive Kernig's sign : When the patient is lying with the
thigh flexed on the abdomen, the leg cannot be completely
4. Photophobia : extreme sensitivity to light
11. The most serious form of head injury is known as a traumatic
brain injury (TBI).
The most common causes of TBIs are : Falls, motor vehicle
crashes, being struck by objects, and assaults
Risk factor of TBIs
Age : People in the 15- to 19-year age group at highest risk for
Gender : Males are twice as likely as females to sustain a TBI.
Race : African Americans have high mortality rates
12. 1. Primary injury : is the initial damage to the brain that results
from the traumatic event. This may include contusions,
lacerations, and torn blood vessels due to impact, acceleration/
deceleration, or foreign object penetration.
2. Secondary injury : evolves over the ensuing hours and days
after the initial injury and results from inadequate delivery of
nutrients and oxygen to the cells
Types of traumatic brain injury :
17. Clinical Manifestations
1. Persistent, localized pain usually suggests that a fracture is
2. Swelling may occur in the region of the fracture
3. Hemorrhage from the nose, pharynx, or ears, and blood may
appear under the conjunctiva.
4. Ecchymosis may be seen over the mastoid
5. CSF escapes from the ears (CSF otorrhea) and the nose (CSF
rhinorrhea) in basilar skull fractures.
18. Cerebrovascular accident (CVA), ischemic stroke, or “brain
attack” is a sudden loss of function resulting from disruption
of the blood supply to a part of the brain.
19. 1. large artery thrombotic strokes : caused by atherosclerotic plaques in the
large blood vessels of the brain.
2. small penetrating artery thrombotic strokes : affect one or more vessels
and are the most common type of ischemic stroke.
3. cardiogenic embolic strokes :
• associated with cardiac dysrhythmias, usually atrial fibrillation
• may associated with valvular heart disease and thrombi in the left
4. cryptogenic strokes : have no known cause
5. other : such as illicit drug use, coagulopathies, migraine, and spontaneous
dissection of the carotid or vertebral arteries.
Types of Ischemic strokes based
on the cause:
22. Clinical Manifestations
1. Numbness or weakness of the face, arm, or leg, especially
on one side of the body
2. Confusion or change in mental status
3. Trouble speaking or understanding speech
4. Visual disturbances
5. Difficulty walking, dizziness, or loss of balance or
6. Sudden severe headache
23. Multiple sclerosis
Multiple sclerosis (MS) is an immune-mediated, progressive
demyelinating disease of the CNS, which refers to the
destruction of myelin, the fatty and protein material that
surrounds certain nerve fibers in the brain and spinal cord that
results in impaired transmission of nerve impulses.
24. The cause of MS
1. Autoimmune activity
2. Environmental factor
3. Genetic predisposition
4. Viruses : (not identified)
25. 1. Sensitized T and B lymphocytes cross the blood–brain barrier; their
function is to check the CNS for antigens and then leave.
2. In MS, sensitized T cells remain in the CNS and facilitate the infiltration of
other agents that damage the immune system.
3. The immune system attack leads to inflammation that destroys myelin and
oligodendroglial cells that produce myelin in the CNS.
4. Plaques of sclerotic tissue appear on demyelinated axons, further
interrupting the transmission of impulses.
Pathophysiology of Multiple
27. Types and courses of multiple sclerosis
1. Benign course : in which symptoms are so mild that patients do not seek
health care or treatment.
2. Relapsing remitting course : (80% to 85%), with complete recovery
between relapses; 50% of these patients progress to a secondary progressive
course, in which disease progression occurs with or without relapses.
3. Primary progressive course : (10%), in which disabling symptoms steadily
increase, with rare plateaus and temporary improvement; may result in
quadriparesis, cognitive dysfunction, visual loss, and brain stem syndromes.
4. Progressive relapsing course : (least common, about 5%), which is
characterized by relapses with continuous disabling progression between
28. Clinical Manifestations
1. fatigue, depression, weakness, numbness, difficulty in coordination,
loss of balance, and pain.
2. Visual disturbances: blurring of vision, diplopia (double vision),
patchy blindness (scotoma), and total blindness.
3. Spastic weakness of the extremities and loss of abdominal reflexes;
ataxia and tremor.
4. Cognitive and psychosocial problems; depression, emotional
lability, and euphoria.
5. Bladder, bowel, and sexual problems possible.
29. 1. Urinary tract infections, constipation
2. Pressure ulcers, contracture deformities, dependent pedal edema
4. Reactive depressions and osteoporosis
5. Emotional, social, marital, economic, and vocational problems
Secondary symptoms Related to
30. Alzheimer’s disease : is a progressive, irreversible,
degenerative neurologic disease that begins
insidiously and is characterized by gradual losses of
cognitive function and disturbances in behavior and
31. Risk factor for AD: is increasing age, environmental, dietary,
and inflammatory factors
Causes of AD : caused by a combination of various factors
Genetics, neurotransmitter changes, vascular abnormalities,
stress hormones, circadian changes, head trauma, and the
presence of seizure disorders.
34. Parkinson’s disease
Parkinson’s disease is a slowly progressing neurologic movement
disorder that eventually leads to disability.
Cause of Parkinson’s disease
4. excessive accumulation of oxygen free radicals,
5. viral infections, head trauma
6. chronic use of antipsychotic medications
7. some environmental exposures.
36. The cardinal signs of Parkinson’s disease :
3. bradykinesia (abnormally slow movements)
4. postural instability.
37. Huntington disease is a chronic, progressive, hereditary
disease of the nervous system that results in progressive
involuntary choreiform movement and dementia.
38. Pathology of Huntington disease
Huntington disease is caused by abnormal collecting of glutamine
in certain brain cell nuclei, causing cell death in :
1. The striatum of the basal ganglia, that is involved in the control
2. The cortex, the region of the brain associated with thinking,
memory, perception, and judgment.
3. The cerebellum, the area that coordinates voluntary muscle
39. Clinical Manifestations
1. The most prominent clinical features of the disease are chorea (abnormal
involuntary movements), intellectual decline, and, often, emotional
2. Constant writhing, twisting, and uncontrollable movements of the entire
3. Facial movements produce tics and grimaces;
4. speech difficult
5. difficult Chewing and swallowing
6. disorganized Gait ,
7. Bowel and bladder control is lost.
8. Progressive intellectual impairment