2. SEIZURE DISORDER
• Transient neurologic event of paroxysmal
abnormal or excessive cortical electrical
discharges that are manifested by
disturbances of skeletal motor function,
sensation, autonomic visceral function,
behavior, or consciousness
• Due to an alteration in membrane potential
that makes certain neurons abnormally
hyperactive and hypersensitive to changes in
their environment
4. BRAIN AND CEREBELLAR
DISORDERS (CONT.)
• Generalized seizures involve the entire brain
from the onset of the seizure
• Partial seizures are those in which abnormal
electrical activity is restricted to one brain
hemisphere
• Status epilepticus is a continuing series of
seizures without a period of recovery
between seizure episodes and can be life-
threatening
5. BRAIN AND CEREBELLAR
DISORDERS (CONT.)
Diagnosis and Treatment of Seizures
• Electroencephalograms assess the electrical
patterns of brain regions
• Laboratory studies identify
metabolic/nutritional deficits, infections, and
exposure to toxins
• Antiseizure medications prevent or reduce
seizure episodes; seizure precautions prevent
injury
6. DEMENTIA
• A syndrome associated with many
pathologic processes and characterized by
progressive deterioration and continuing
decline of memory and other cognitive
changes
• Important to first rule out manageable causes
of dementia; often cause unknown
7. DEMENTIA (CONT.)
• The dementia of Alzheimer disease is
characterized by degeneration of neurons in
temporal and frontal lobes, brain atrophy,
amyloid plaques, and neurofibrillary tangles
• Cause remains unknown, although genetic
and environmental triggers are suggested
• Synthesis of brain acetylcholine is deficient
and treatment is aimed at increasing
acetylcholine levels by reducing
acetylcholine reuptake
9. PARKINSON DISEASE
• May be idiopathic or a consequence of the
use of certain drugs
• Dopamine deficiency in the basal ganglia is
associated with symptoms of motor
impairment
• Difficulty initiating and controlling movements
results in akinesia, tremor, and rigidity
• Tremor occurs at rest and hand tremors
exhibit pill-rolling movements
• Attempts to passively move the extremities
are met with cogwheel rigidity
11. PARKINSON DISEASE (CONT.)
• General lack of movement, loss of facial
expression, drooling, propulsive gait, and
absent arm swing
• Treatment is aimed at restoring brain
dopamine levels or activity by administration
of dopamine precursors, dopamine agonists,
monoamine oxidase inhibitors, and
anticholinergics
• Antidepressant therapy may be needed and
surgical procedures may be helpful for motor
symptoms
13. CEREBRAL PALSY
• Diverse group of crippling syndromes that
appear during childhood and involve
permanent, nonprogressive damage to
motor control areas of the brain
• Classified on the basis of neurologic signs and
symptoms, with the major types involving
spasticity, ataxia, dyskinesia, or a mix of one
or more of the three
14. CEREBRAL PALSY (CONT.)
• Etiology may include prenatal infections, or
diseases of the mother; mechanical trauma
to the head before, during, or after birth;
exposure to nerve-damaging poisons or
reduced oxygen supply to the brain
• Treatment varies according to the nature and
extent of brain damage
• Muscle relaxants, anticonvulsant drugs,
orthopedic surgery, casts, braces, and
traction are among the therapies used
15. HYDROCEPHALUS
• Characterized by abnormal accumulation of
fluid in the cerebroventricular system
• Normal pressure hydrocephalus is due to an
increased volume of CSF
• Obstructive hydrocephalus is due to an
obstruction to the flow of CSF
• Communicating hydrocephalus occurs due
to abnormal absorption of CSF
17. HYDROCEPHALUS (CONT.)
• Medical treatment is limited
• Obstructions may be corrected surgically
• The most effective treatment for
management of hydrocephalus is surgical
correction employing a shunt
19. CEREBELLAR DISORDERS
• Cerebellum is responsible for coordinated
control of muscle action, excitation and
inhibition of postural reflexes, and
maintenance of balance
• Etiology of cerebellar disorders includes
abscess, hemorrhage, tumors, trauma, viral
infection, or chronic alcoholism
• Clinical manifestations include ataxia,
hypotonia, intention tremors, and
disturbances in gait and balance
20. MULTIPLE SCLEROSIS
• MS is a demyelinating disease of the CNS that
primarily affects young adults
• Risk of contracting MS is greater for persons
living above the 37th parallel
• Cause unknown, but immunologic
abnormalities and environmental factors are
suspected
• Demyelination can occur throughout the CNS
but often affects the optic and oculomotor
nerves and spinal nerve tracts
22. MULTIPLE SCLEROSIS
• Symptoms are slowly progressive; the disease
is marked by exacerbations and remissions
• Symptoms may include double vision,
weakness, poor coordination, and sensory
deficits; bowel and bladder control may be
lost; memory impairment is common
• Management is symptomatic; short-term
steroid therapy may be helpful during acute
exacerbations, and immune-modifying drugs
may slow progression of symptoms
24. SPINA BIFIDA
• Developmental anomaly characterized by
defective closure of the bony encasement of
the spinal cord (neural tube) through which
the spinal cord and meninges may or may
not protrude
• If anomaly not visible, condition is called
spina bifida occulta
• If there is an external protrusion of the saclike
structure, the condition is called spina bifida
cystica, and further classified according to
the extent of neural involvement
• Treatment is based on the severity of the
defect and neurologic dysfunction
25. AMYOTROPHIC LATERAL
SCLEROSIS
• ALS is a progressive disease affecting both
the upper and lower motor neurons
• Cause remains unknown
• Weakness and wasting of the upper
extremities usually occur, followed by
impaired speech, swallowing, and respiration
• Typically occurs between the ages of 40-60
years and affects men more than women
26. AMYOTROPHIC LATERAL
SCLEROSIS (CONT.)
• Clinical manifestations include weakness,
atrophy, cramps, stiffness, and irregular
twitching of muscle fibers
• Diagnosis is based on clinical signs and
symptoms, EMG, nerve conduction studies,
MRI, and serum laboratory testing
• The glutamate inhibitor, riluzole, may be
helpful in managing ALS
27. SPINAL CORD INJURY
• SCI is usually traumatic, a result of motor
vehicle accidents, falls, penetrating wounds,
or sports injuries
• The cord may be compressed, transected, or
contused
• Further injury may result from hemorrhage,
swelling, and ischemia
29. SPINAL CORD INJURY (CONT.)
• Spinal shock occurs immediately following SCI
and is characterized by temporary loss of
reflexes below the level of injury
• Muscles are flaccid; skeletal and autonomic reflexes
are lost
• Neurogenic shock may occur after SCI due to
peripheral vasodilation
• Hypotension and circulatory collapse can occur;
high spinal cord injuries can affect respiratory
muscles, leading to ventilatory failure
31. SPINAL CORD INJURY (CONT.)
• Autonomic dysreflexia is an acute reflexive
response to sympathetic activation below the
level of injury
• Visceral stimulation (full bladder or bowel) and
activation of pain receptors below the injury are
common stimuli
• Manifestations include hypertension, bradycardia,
flushing above the level of injury, and clammy skin
below the level of injury
• Prompt removal of the offending stimulus;
aggressive blood pressure management may be
needed
32. SPINAL CORD INJURY (CONT.)
• Treatment includes appropriate stabilization
of spinal vertebrae
• May be accomplished surgically with internal
fixation or with external fixation and bracing
• High-dose methylprednisolone may be used
to decrease secondary injury
• Intensive rehabilitation is required to maximize
function
33. GUILLAIN-BARRÉ SYNDROME
• Characterized by muscle weakness that
begins in the lower extremities and spreads to
the proximal spinal neurons
• Cause unknown; postinfectious immunologic
mechanism is suspected
• Progressive ascending weakness or paralysis,
may affect respiratory muscles
• Treatment is supportive; spontaneous
recovery usually occurs
34. BELL PALSY
• Bell palsy, or neuropathy of the facial nerve;
paralysis of the muscles on one side of the
face
• Symptoms include unilateral facial weakness,
facial droop and diminished eye blink,
hyperacusis, and decreased lacrimation
• Often self-limiting condition with unknown
cause
• Treatment is supportive, and spontaneous
recovery usually occurs
