2. 2
Learning Outcomes
6.1 Identify key structures of the neurological
system
6.2 Discuss the roles of structure and function
played by the neurological system
6.3 Define and spell terms related to neurology
6.4 Identify characteristics of common neurological
diseases and disorders, including description,
incidence, etiology, signs and symptoms,
diagnosis, treatment, and prognosis
3. Structures of the Nervous System
• Neurons
• Sense changes
• Transmit messages
• Facilitate movement
4. 4
Structures of the Nervous System
• Dendrites
• Extensions of the cell body, receive information and
send impulses
• Axons
• Transmit nerve impulses away from the cell body
• Myelin sheath
• Provides insulation to axon
• Along with nodes of Ranvier, enables axon to conduct
impulses at rapid rate
6. 6
Central Nervous System
• Meninges
• Provide supportive structure for small blood
vessels on the brain’s surface
• Protect the brain and spinal cord by housing
cerebrospinal fluid (CSF)
• CSF
• Circulates and provides a cushion to protect
against injury from impact
7. Peripheral Nervous System
• 31 pairs of spinal
nerves
• Each named for and
corresponds to
vertebra above it
• Associated areas of
skin: dermatomes
8. Peripheral Nervous System
• 12 cranial nerves
• Originate in brain
and brainstem
• Innervate eyes, ears,
nose, face, tongue,
and throat and neck
muscles
• Nerves in arms and
legs
9. 9
Which of these statements is true regarding
stroke?
A. With ischemic stroke a vessel in the brain
ruptures and bleeds
B. Risk factors for hemorrhagic stroke include
atrial fibrillation and clotting disorders
C. Physical effects are usually on the opposite
side of the body as the stroke area in the brain
D. Hypotension is a risk factor
10. Peripheral Nervous System
• Autonomic nervous
system (ANS)
• Controls involuntary
functions
• Is divided into
sympathetic and
parasympathetic
nervous systems
11. 11
Autonomic Nervous System
• Controls involuntary functions
• Divided into sympathetic nervous system and
parasympathetic nervous system
• Responsible for fight-or-flight response
• Parasympathetic nervous system has the
opposite response
• Dominates during nonstressful times
12. 12
Stroke
• Etiology
• Hemorrhagic stroke: blood vessel in the brain
ruptures and bleeds
• Risk factors
• Hypertension
• Aneurysms
• Arteriovenous malformations (AVMs)
22. 22
All of the following are possible symptoms of
brain abscess EXCEPT:
A. Nuchal rigidity
B. Headache
C. Hemiparesis
D. Seizures
23. 23
Brain Abscess
• Etiology
• Infection
• Head injuries
• Head-surgery sites
• Ear, sinus, or teeth infection
• Infections within lungs, heart, or kidneys
• Fungi or bacteria enter brain tissue, usually through the
bloodstream
• Inflammation brings WBCs, which collect along with
dead microorganisms and debris, and abscess grows
24. 24
Brain Abscess
• Signs and Symptoms
• Slow or sudden onset (over 1 to 2 weeks)
• Headache
• Aching or stiffness in neck, shoulders, or back
• Vomiting
• Seizures
• Vision changes
• Fever and chills
• Weakness
• Hemiparesis
25. 25
Brain Abscess
• Signs and Symptoms
• Changes in movement and coordination
• Mental-status changes
• Confusion
• Irritability
• Lethargy
• Possible coma
• Dysphasia
• Changes in movement and coordination
27. 27
Brain Abscess
• Treatment
• IV antibiotics
• Surgery
• Needle aspiration
• Increased ICP may be treated with:
• Corticosteroids
• Diuretics
28. 28
Poliomyelitis
• Etiology
• Poliovirus enters through nose or mouth,
multiplies in intestines, is absorbed into
bloodstream, and travels to CNS
• Direct contact with infected respiratory
secretions or feces
29. Poliomyelitis
• Signs and Symptoms
• Most people are
asymptomatic
• Nausea and vomiting
• Anorexia
• Abdominal pain
• Fever
• Headache
• Paralysis
• Respiratory failure
• Postpolio syndrome up to
40 years later
• Recurrence of fatigue and
weakness
• Back and leg pain
• Nuchal rigidity
• Severe headache
• Meningitis
30. 30
Poliomyelitis
• Diagnosis
• Signs and symptoms
• Neurological-examination findings
• Stool and throat cultures
• Serum and CSF analysis
• Treatment
• Analgesics for head and body aches
• Respiratory support as needed
• Physical therapy
• Nutritional support
• Promotion of bowel and bladder function
31. Guillain-Barré Syndrome (GBS)
• Etiology
• Exact cause not understood
• 60% of the time, viral infection
precedes the disorder by 2 to
4 weeks
• Signs and Symptoms
• Develop over 2 weeks
• Weakness
• Paresthesia
• Ascending paralysis
• Dysphasia
• Dysphagia
• Urinary retention
• Rapid or slow heart rate
• Altered blood pressure
• Severe pain in back, buttocks,
thighs, or shoulders
• Peak within 3 to 4 weeks,
plateau for several days, then
slowly improve
32. 32
Guillain-Barré Syndrome (GBS)
• Diagnosis
• CSF analysis
• Electromyography (EMG)
• Nerve conduction velocity (NCV) studies
• Respiratory function tests
• Possible muscle biopsy
• Treatment
• Plasmapheresis
• IV immunoglobulin
• Possible respiratory and nutritional care
• Physical therapy
33. 33
Which of these is true regarding Parkinson
disease?
A. It is caused by a deficiency of
endorphins
B. Pill-rolling hand tremor is a common
symptom
C. Patients often complain of dry mouth
D. It is usually treated with
corticosteroids
34. 34
Parkinson Disease
• Etiology
• Deficiency of dopamine
• Neurotransmitter released by axon terminal to inhibit or excite a
target cell
• Critical to nerve-impulse transmission
• Signs and Symptoms
• Gradual onset of aching and fatigue in extremities
• Resting hand tremor
• Generalized muscle rigidity
• Pill-rolling hand tremor
• Masklike facial expression
35. 35
Parkinson Disease
• Signs and Symptoms
• Soft, quiet voice
• Bradykinesia
• Shuffling gait that speeds out of control
• Stooped posture
• Difficulty initiating movements
• Dysphagia
• Drooling
• Possible dementia
39. 39
Multiple Sclerosis
• Diagnosis
• Other disorders must be ruled out
• MRI and CT scans indicate reveal MS plaques
• Treatment
• Administer corticosteroids
• Protect immune system
• Regular, moderate exercise
• Good nutrition
• Adequate rest
• Stress management
40. 40
Amyotrophic Lateral Sclerosis (ALS)
• Etiology
• 90% unknown
• Hereditary cause in 10% of cases
• Signs and Symptoms
• Affects motor nerves
• Muscle weakness and fatigue
• Begins in extremities
• Progresses to trunk and head
• Progressive paralysis
• Dyspnea
• Dysphasia
• Dysphagia
42. 42
All of these are possible causes of dementia
EXCEPT:
A. Pick disease
B. Huntington disease
C. Parkinson disease
D. Guillain-Barré syndrome
43. Dementia
• Etiology
• Neuritic plaques
• Neurofibrillary tangles
• Contributors
• Advanced age
• Genetics
• Some viruses
• Previous brain injuries
• Cardiovascular disease
• Vitamin B12 or folate
deficiency
• Brain infection
• Diabetes
• Decrease in
neurotransmitters
• Other causes of dementia
• Vascular: multiple strokes
• Alcoholism
• Pick disease
• Huntington disease
• Parkinson disease
• Hypothyroidism
• Syphilis
• AIDS
44. 44
Dementia
• Signs and Symptoms
• Pattern of onset depends on type and cause
• Alzheimer dementia begins gradually and progresses
slowly
• Three stages
• Stage I: progressive short-term memory loss
• Stage II: deterioration of intellectual ability, personality changes,
speech and language problems, impaired judgment, and
continued worsening of memory, as well as possible paranoia,
delusions, hallucinations, seizures, and depression
• Stage III: total dependence on others for care; may also display
paranoia, delusions, hallucinations, seizures, and depression
45. 45
Dementia
• Diagnosis
• History
• Neurological-examination findings
• Presenting signs and symptoms
• Cognitive screening tests are used to evaluate short-
term memory and reasoning
• Rule out nutritional deficiencies and other treatable
disorders
• CT scan or MRI to rule out stroke or brain lesions
46. 46
Dementia
• Treatment
• Treatment of the underlying cause, if known
• Cholinesterase inhibitors to temporarily enhance
cognitive function by preventing breakdown of
acetylcholine
• Medications for behavior management
• Antipsychotics
• Antidepressants
• Anxiolytics
• Benzodiazepines
• Measures to maximize function and provide safety
48. Huntington Disease
• Diagnosis
• Medical history
• Neurological
examination
• MRI or CT scan
• DNA analysis
• Treatment
• No cure
• Focus on safety and
quality of life
• Education and emotional
support for patient and
caregivers
• Medications
• Antipsychotics
• Antidepressants
• Nutritional support
49. 49
Cerebral Concussion and Contusion
• Etiology
• Head trauma
• Contrecoup injury
• Rapid acceleration followed by deceleration throws
the brain forward and backward
50. Cerebral Concussion and Contusion
• Signs and Symptoms
• Concussion
• Brief loss of consciousness
• Confusion
• Disorientation
• Headache
• Drowsiness
• Visual changes
• Contusion
• Same as with concussion
plus:
• More prolonged loss of
consciousness
• Vomiting
• Memory problems
51. 51
Cerebral Concussion and Contusion
• Diagnosis
• Neurological evaluation
• Report of symptoms
• CT scan
• Salt-and-pepper appearance confirms cerebral
contusion
• Spinal films
52. 52
Cerebral Concussion and Contusion
• Treatment
• Rest
• Analgesics
• Hospitalization for severe concussion and
cerebral contusion with aggressive
management of ICP
53. 53
Treatment of spinal-cord injury includes all
EXCEPT:
A. Use of Gardner-Wells tongs
B. Epidural steroid injection
C. Application of halo traction brace
D. Spinal fusion
54. 54
Spinal-Cord Injury
• Etiology
• Traumatic or violent injury
• Signs and Symptoms
• Loss of function
• Loss of sensation
• Loss of reflexes
• Diagnosis
• Neurological-evaluation findings
• Spinal x-rays
• CT scan
• MRI
55. 55
Spinal-Cord Injury
• Treatment
• Stabilization with Gardner-Wells tongs and
traction
• Surgery
• Removal of bone fragments and hematomas
• Spinal fusion
• Later application of halo traction brace enables
increased mobility
56. 56
Subdural and Epidural Hematomas
• Etiology
• tearing of blood vessels
• high-velocity rotational or linear force
• hematoma expands for 6-8 hours, strips away
dura
• Risk factors
• Age
• alcohol abuse
• anticoagulant medication
57. Subdural and Epidural Hematomas
• Signs and Symptoms
• Epidural hematoma
• Loss of consciousness
• Abnormal pupil response
• Posturing
• Possible lucid interval
• Subdural hematoma
• Slower onset by as much
as 2 weeks
• Recent head injury
• Variable levels of
consciousness
• Headache
• Irritability
• Seizures
• Disorientation
• Amnesia
• Dizziness
• Nausea and vomiting
• Difficulty walking
• Dysphasia
58. 58
Subdural and Epidural Hematomas
• Diagnosis
• CT scan
• MRI
• Cerebral arteriogram
• Treatment
• Surgery to remove hematoma and stop further
bleeding
59. Skull Fracture
• Etiology
• Head trauma
• Signs and Symptoms
• Linear:
• May be asymptomatic
• May have swelling
• CSF or blood drainage
from the ear or nose
• Loss of consciousness
• Temporary or permanent
hearing loss
• Facial numbness
• Facial paralysis
• Ataxia
• Vocal-cord paralysis
70. 70
Migraine Headache
• Etiology
• Not fully understood
• Familial
• Theories include:
• Trigeminal nerve involvement
• Imbalances in neurotransmitters (e.g., serotonin)
• Vascular dilation and inflammation
71. 71
Migraine Headache
• Etiology
• Risk factors and triggers
• Hormonal changes
• Some foods
• Stress
• Bright lights
• Fumes, perfumes, and smoke
• Exertion or fatigue
• Environmental changes
• Some medications
72. 72
Migraine Headache
• Signs and Symptoms
• Aura
• Throbbing
• Unilateral or bilateral pain
• Nausea with or without vomiting
• Photophobia
• Phonophobia
• Last between 4 and 72 hours
• Frequency: from once a year to as often as every week
74. 74
All of the following are typical of tension
headaches EXCEPT:
A. They are usually unilateral
B. They may be episodic or chronic
C. Pain is typically described as a dull
ache
D. Auras are common beforehand
75. 75
Tension Headache
• Etiology
• Muscle tension in scalp, neck, jaw, or upper
shoulders
• Contributors include:
• Poor posture
• Lack of sleep
• Alcohol use
• Missed meals
• Noise
76. 76
Tension Headache
• Signs and Symptoms
• Chronic or episodic
• Last minutes to days
• Bilateral dull, aching sensation
• Pressure or a bandlike tightness encircling head
• Location
• Forehead
• Base of the head
• Neck
• Triggered by situational stress
77. 77
Tension Headache
• Diagnosis
• Medical history
• Description of symptoms
• Physical examination
• Treatment
• OTC analgesics
• Relaxation
• Massage
• Biofeedback
• Stress-management activities
78. 78
Peripheral Neuropathy
• Etiology
• Exact cause unknown
• Associated with:
• Diabetes
• Alcoholism
• AIDS
• Rheumatoid arthritis
• Systemic lupus erythematosus
• Ingestion of toxic substances and some drugs
• Nerve injury from prolonged immobility or compression
79. Peripheral Neuropathy
• Signs and Symptoms
• Nerve pain
• Numbness
• Weakness
• Muscle twitching
• Atrophy
• Muscle cramps
• Loss of movement
• Loss of coordination
• Symptoms related to
autonomic nerve damage
• Blurred vision
• Dizziness
• Diarrhea
• Constipation
• Urinary incontinence
• Impotence
81. Bell Palsy
• Etiology
• Inflammation of seventh
cranial nerve
• Possible viral infection
• Signs and Symptoms
• Paralysis of one side of
face
• Twitching
• Weakness
• Drooling
• Eye dryness
• Impaired taste
• Excessive tearing
• Headache
• Ringing in the ears
• Difficulty eating or drinking
83. 83
Which of these is true about trigeminal
neuralgia?
A. It is also called tic douloureux
B. Pain may be triggered by brushing the
teeth
C. It may be treated with anticonvulsants
D. All of these
84. 84
Trigeminal Neuralgia
• Etiology
• Various theories
• Pain triggers
• Chewing
• Shaving
• Applying makeup
• Talking
• Drinking
• Brushing teeth
• Smiling
• Touching the face
• Feeling a cool breeze
85. 85
Trigeminal Neuralgia
• Signs and Symptoms
• Episodes of severe, sudden stabbing, shooting,
or shocklike pain in face
• Increase in frequency and intensity
• Atypical TN is less severe, causes constant
aching or burning pain
• Usually unilateral
86. Trigeminal Neuralgia
• Diagnosis
• Physical-examination
findings
• MRI to rule out multiple
sclerosis and other
disorders
• Treatment
• Analgesics
• Anticonvulsants
• Antidepressants
• Antispasmodics
• Injections
• Surgery
• Heat or cold application
• Complementary therapies
• Chiropractic treatments
• Acupuncture
• Meditation
• Hypnosis
87. Epilepsy
• Etiology
• Congenital or acquired
• Triggers
• Withdrawal from
antiseizure medication
• Head trauma
• Illness
• Emotional or physical
stress
• Fatigue
• Specific foods or chemicals
• Flickering or flashing lights
• Signs and Symptoms
• Depend on type of
seizure
• See Table 6-2
88. Epilepsy
• Diagnosis
• History
• Description of symptoms
• Description of seizure activity
• Neurological evaluation
• Various diagnostic studies
• Electroencephalogram (EEG)
• CT scan
• MRI scan
• Lumbar puncture (LP) (see Box 6-
7)
• Treatment
• Anticonvulsant medication
• Surgery may reduce severity
and frequency of seizures
and increase responsiveness
to medication
• Vagal-nerve stimulator implant
• Excision of brain tissue
• Corpuscallosotomy
89. 89
Transient Global Amnesia
• Etiology
• Exact cause unknown
• Theory includes temporary circulation disruption to parts
of brain
• Possible triggers
• Cold-water immersion
• Severe emotional or physical stress
• Sexual activity
• Recent migraine headache
• Medical procedures
90. 90
Transient Global Amnesia
• Signs and Symptoms
• Loss of recent memory with retention of personal
identity and distant memory
• Episode lasts less than 24 hours
• Absence of neurological deficits
• Ability to function normally
• Possible headache or anxiety-related symptoms
• Symptoms resolve within 12 to 24 hours
91. 91
Transient Global Amnesia
• Diagnosis
• Witness’s description of event
• Description of recent memory loss and other symptoms
• Neurological examination
• Absence of deficits during or after the event
• Tests to rule out other diagnoses
• EEG
• CT
• Treatment
• None
92. Credits
• Publisher: Margaret Biblis
• Senior Acquisitions Editor: Andy McPhee
• Manager of Content Development: George Lang
• Developmental Editor: Stephanie Rukowicz
• Director, Electronic Publishing (EP): Maria Zacierka
• Senior Developmental Editor, EP: Kirk Pedrick
• Design Associate: Joe Clark
• Project Editor, EP: Alexis Zanetti
• Production Manager: Bob Butler
The publisher is not responsible for errors of omission or for consequences from application of
information in this presentation, and makes no warranty, expressed or implied, in regard to its
content. Any practice described in this presentation should be applied by the reader in accordance
with professional standards of care used with regard to the unique circumstances that may apply in
each situation.
Notas do Editor
Learning Outcomes
6.1 Identify key structures of the neurological system.
Learning Outcomes
6.1 Identify key structures of the neurological system.
6.2 Discuss the roles of structure and function played by the neurological system.
6.3 Define and spell terms related to neurology.
PLUS…
Dendrites act to sense changes in the body’s internal environment by receiving information from other neurons or from sensory receptors and sending impulses to the main cell body.
Axons are long, cordlike structures that transmit nerve impulses away from the cell body to other neurons, target organs, or muscles.
The myelin sheath wrapped around each axon is composed of specialized cells made of a largely lipid substance that provides insulation to the axon, similar to the rubber covering on an electrical cord.
The myelin sheath and the interspersed junctions, called nodes of Ranvier, allow the axon to function efficiently so that it can conduct impulses at an rapid rate.
Learning Outcomes
6.1 Identify key structures of the neurological system.
PLUS…
Cerebrum
The corpus callosum connects and coordinates activity between the cerebrum’s two hemispheres.
The convolutions of the surface area are where nerve cell bodies are located.
The cerebral cortex, or gray matter, of the cerebrum is involved in sensory perception, emotions, and muscle control.
The basal ganglia in the white matter of the cerebrum organize motor function.
Cerebellum
The cerebellum is responsible for posture, balance, and coordination.
Brainstem
The brainstem is an essential pathway that conducts impulses between the brain and spinal cord.
Spinal Cord
The spinal cord is the pathway for sensory impulses to the brain from the rest of the body and for motor impulses from the brain to the rest of the body.
It also mediates the stretch, defecation, and urination reflexes.
It is surrounded and protected by the vertebral column.
Learning Outcomes
6.1 Identify key structures of the neurological system.
6.2 Discuss the roles of structure and function played by the neurological system.
6.3 Define and spell terms related to neurology.
Learning Outcomes
6.1 Identify key structures of the neurological system.
6.2 Discuss the roles of structure and function played by the neurological system.
6.3 Define and spell terms related to neurology.
PLUS…
Dermatomes
In some disorders, pain or other sensations caused by spinal-nerve injury are felt along the associated dermatome rather than at the actual site of injury.
Learning Outcomes
6.1 Identify key structures of the neurological system.
6.2 Discuss the roles of structure and function played by the neurological system.
Learning Outcomes
6.1 Identify key structures of the neurological system.
6.2 Discuss the roles of structure and function played by the neurological system.
Learning Outcomes
6.1 Identify key structures of the neurological system.
6.2 Discuss the roles of structure and function played by the neurological system.
6.3 Define and spell terms related to neurology.
PLUS…
Fight-or-Flight Response
Prepares a person for action, whether running from danger or responding in some other way.
Causes physical changes within the body.
Increased heart rate and force.
Increased blood pressure.
Increased blood glucose levels.
Bronchodilation (expansion of airways).
Decreased intestinal peristalsis (wavelike movement).
These changes provide the body with increased energy and oxygen while slowing some functions (such as digestion) which are less important at the time.
Parasympathetic Nervous System
Has the opposite effect of the fight-or-flight response.
Decreased heart rate.
Bronchoconstriction (narrowing of airways).
Increased peristalsis.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
A stroke, also called a cerebrovascular accident (CVA) or brain attack, is the sudden loss of neurological function due to vascular injury to the brain.
Incidence
More than 700,000 individuals suffer from strokes annually in the United States.
At greatest risk are those over age 65 with a family history of cerebrovascular disease.
Cerebrovascular disease is caused by atherosclerosis of cerebral arteries, which is the narrowing and loss of elasticity of vessels due to accumulation of fatty cholesterol deposits.
Etiology
Aneurysm: weak, bulging area in a vessel.
Arteriovenous malformations are abnormal clusters of tiny veins connected directly to tiny arteries without a capillary bed between.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Thrombotic: caused by a blood clot.
Embolic: a substance in the bloodstream becomes lodged in a vessel (part of blood clot, air bubble, fat embolism, etc.).
Atrial fibrillation: a type of heart irregularity in which the atria quiver uncontrollably. Because they don’t empty efficiently, blood clots sometimes form there, and if they dislodge from the left atrium, they can float to a vessel in the brain causing a stroke; if they dislodge from the right atrium they float to the capillaries in the lungs and cause a pulmonary embolism. Both types can be deadly.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Dysphasia: difficulty speaking.
Dysphagia: difficulty swallowing.
Gait: manner of walking.
Paresthesia: abnormal sensation.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
A transient ischemic attack (TIA) is the temporary impairment of neurological functioning due to a brief interruption in blood supply to a part of the brain.
Unlike with a stroke, impairment is only temporary in nature; neurological function is fully restored within minutes or hours.
Incidence
An estimated one-quarter of a million Americans experience a TIA each year.
Rates are higher in Hispanic and African American populations.
Etiology
Emboli: tiny particles of atherosclerotic plaque or tiny blood clots that dislodge from a heart valve or artery wall and travel in the bloodstream to the brain.
Because of their tiny size, emboli are quickly dissolved by the body’s protective mechanisms before permanent damage results.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Deficits usually resolve within minutes or hours.
Signs and symptoms may resolve by the time the patient is evaluated.
Therefore, a careful history and description from the patient and any witnesses is essential.
TIA must be taken seriously because it is a possible warning sign of a future stroke.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Diagnosis
A CT scan is done to examine cerebral arteries.
Carotid Doppler studies may identify carotid-artery narrowing.
Prognosis
TIAs are self-limiting and resolve on their own.
However, they should be viewed as a warning sign that the individual is at high risk of stroke—a leading cause of death in the United States.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Encephalitis is inflammation of the brain and is usually associated with meningitis, which is inflammation of the meninges.
The two combined are known as encephalomeningitis.
Incidence
Encephalitis affects approximately 20,000 Americans each year.
Etiology
Viruses, usually arboviruses (a group of viruses carried by insects, such as mosquitoes and ticks), herpesvirus, HIV, and viruses that cause influenza, measles, chickenpox, and rabies.
Signs and Symptoms
There are many; these are some of the more common ones.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Prognosis
The prognosis for encephalitis depends on the timeliness of diagnosis and treatment.
In many cases, rehabilitation and therapy is needed for the treatment of residual neurological deficits.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Meningitis is an infection of the meninges, the spinal cord, and CSF, and is usually caused by an infectious illness.
Incidence
Between 5,000 and 15,000 Americans suffer from meningitis each year.
Those at greatest risk include infants and children and those in the military or in dormitories.
Other risk factors include a history of splenectomy, active and passive exposure to tobacco smoke, and exposure to those who are ill with meningitis.
Etiology
The most common infecting organisms include Streptococcus pneumoniae and Neisseria meningitidis.
Fortunately, the practice of including the Hib vaccine with childhood immunizations has drastically reduced the incidence of Haemophilus influenzae meningitis.
Some types of bacterial and viral meningitis are contagious and may be transmitted through exposure to large-droplet respiratory or oral secretions by coughing or kissing.
Those who live in the same household or have close physical contact with infected people are at greatest risk; therefore, counseling about how to prevent disease transmission is important (see Box 6-2).
Signs and Symptoms
Nuchal rigidity: pain and stiffness of the neck with a resulting reluctance to flex the head forward.
Photophobia: light sensitivity.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Diagnosis
Examination of cerebrospinal fluid (CSF) may reveal slight cloudiness due to increased white blood cells, protein, glucose, and bacteria.
Positive Kernig sign: a reflex contraction along with pain in the hamstring muscles when attempting to extend the leg after flexing the hip.
Brudzinski sign: Neck flexion causes flexion of the hips when the patient is lying in a supine position.
Treatment
Treatment for meningitis must be aggressive to reduce the risk of death and disability.
Differentiating bacterial from viral meningitis is important in determining the appropriate treatment and preventing transmission.
Furthermore, identifying the specific causative organism in cases of bacterial meningitis is crucial in determining the appropriate antibiotic.
In the case of bacterial meningitis, family members and those with close direct contact may be treated with antibiotics as a preventive measure.
Prognosis
Viral meningitis is usually less severe than bacterial meningitis, with a better prognosis.
Bacterial meningitis has a greater risk of causing brain damage, disability, and even death.
Mortality rates are between 10% and 40%, with the highest rates in the elderly.
Between 11% and 19% of those who survive meningitis will suffer permanent deficits, such as hearing loss, mental retardation, and limb loss.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
A brain abscess is a collection of pus anywhere within the brain.
Incidence
Approximately 1,500 to 2,500 cases of brain abscess are reported annually in the United States.
It most commonly occurs in people between the ages of 30 and 50, although it can happen to individuals of any age.
At highest risk are those with weakened immune systems.
Etiology
The causative organism is usually a streptococcus, but a variety of other bacteria, fungi, and even parasites may cause brain abscess.
The area becomes enclosed within a membrane, which isolates the infection and protects the brain; however, the combination of the abscess with edema from inflammation increases pressure on the brain, which can impair circulation.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Signs and Symptoms
Hemiparesis: partial or incomplete paralysis on one side of the body.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
Plus…
Signs and Symptoms
Dysphasia: difficult or painful speech.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Diagnosis
MRI will reveal a mass once the lesion has become encapsulated.
CBC: Complete blood count may indicate an elevated white-blood-cell count.
Blood cultures may reveal the causative organism if septicemia is the underlying cause.
Needle biopsy of the abscess itself is the most accurate way to identify the organism involved.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Treatment
Brain abscess is very serious and must be treated aggressively.
Surgery may be done to open and drain the infected material.
Deep abscesses may be drained by needle aspiration.
Prognosis
Untreated brain abscess has an extremely high mortality rate.
However, those who receive appropriate treatment before coma occurs have an 80% to 95% chance of survival.
Prognosis is poorer for those with multiple abscesses or abscess located deep within the brain.
Possible complications include recurrent seizures, meningitis, recurrence of infection, and permanent neurological deficits.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Poliomyelitis, also called polio and infantile paralysis, is an acute viral neurological infection.
It has four variations, some of which lead to paralysis and some of which do not.
Incidence
Poliomyelitis was once common on a global level, with epidemics occurring during warm seasons.
The number of poliomyelitis cases in the United States peaked during the 1950s.
The disease has since essentially been eliminated within this country due to widespread vaccination programs.
However, the continued importance of vaccination was highlighted by a case of imported polio in 2005 in an unvaccinated American who had traveled overseas.
Small outbreaks continue to occur in countries throughout the world.
Most vulnerable are those who are very young, very old, or pregnant, and those whose immune systems are suppressed.
Global elimination of the disease is estimated to be 99% complete; the goal is total eradication.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Signs and Symptoms
Paralysis may involve one or more extremities.
Some individuals require mechanical ventilation.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Diagnosis
CSF is tested for the presence of the virus.
Serum is tested for the presence of antibodies.
Treatment
There is no cure for poliomyelitis; therefore, treatment is supportive.
Some individuals may require mechanical ventilation.
Physical therapy helps patients to maintain flexibility and muscle function.
Other care is aimed at meeting nutritional needs and promoting bowel and bladder function.
Prognosis
Prognosis is generally good, depending upon how extensive the disease and symptoms are and whether diagnosis and treatment are timely and appropriate.
Paralysis occurs in less than 5% of individuals, and full recovery may occur.
Death is rare, but possible.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
GBS, also known as acute inflammatory demyelinating polyneuropathy, is an acute inflammatory disorder causing rapidly progressing paralysis, which is usually temporary, and sometimes also sensory symptoms.
Incidence
GBS is a rare disorder that affects as many as 6,000 Americans each year.
It affects individuals of all ages and all races, men slightly more often than women.
Etiology
Viral infections precede GBS about 60% of the time.
Examples include influenza, the common cold, intestinal viral infection, viral hepatitis, HIV, and mononucleosis.
Other possible triggers include Hodgkin disease and surgery.
There is speculation that GBS may be related to an autoimmune response in which the myelin sheath becomes eroded.
Signs and Symptoms
Ascending paralysis may reach as high as the chest.
This impairs the individual’s ability to breathe in 30% of cases; these patients may require mechanical ventilation.
Less-common form of GBS causes descending paralysis or hemiparalysis (one-sided paralysis).
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Diagnosis
Diagnosis may be difficult, due to the different ways in which GBS can present and the variability of symptoms.
Several different tests are performed to reach a diagnosis.
CSF analysis reveals increased protein level in 90% of cases without an increase in white blood cells.
This test may be repeated, since protein level generally peaks several weeks after the onset of symptoms.
EMG and NCV studies reveal a slowing of nerve impulses in muscle tissue (see Box 14-7).
Respiratory function tests may be done to determine the degree of respiratory-muscle compromise and help determine whether mechanical ventilation is needed.
Occasionally, muscle biopsy is done to differentiate GBS from other disorders.
Treatment
There is no known cure.
However treatment is available which reduces the severity and duration of symptoms.
Plasmapheresis, also called plasma exchange, is a procedure in which the patient’s blood is filtered or cleansed of the harmful antibodies.
An alternative treatment is IV administration of immunoglobulin that contains healthy donor antibodies, which are thought to block the action of the patient’s harmful antibodies.
These treatments shorten peak symptom time by as much as 50%.
Patients often require supportive care, which includes hospitalization for respiratory and nutritional care.
Physical therapy may be initiated to preserve muscle function and joint mobility.
Prognosis
Approximately 80% to 85% of those with GBS recover fully within 6 to 18 months.
Others suffer some degree of chronic weakness or altered sensation.
Mortality rate is approximately 5%, usually related to respiratory complications.
Relapse may occur in as many as 10% of cases.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Parkinson disease is a chronic degenerative disease of the central nervous system that results in movement disorders and changes in cognition and mood.
Incidence
Parkinson disease affects 1.5 million Americans, is most common in patients over age 65, and is more common in men than women.
Etiology
The cause is not fully understood.
There is a familial tendency.
With a deficiency in these neurotransmitters, nerve impulses are transmitted less efficiently.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Bradykinesia: a slow, hesitating pattern of movement.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Treatment
There is no known cure.
A multidisciplinary team approach is required to help the patient and family cope.
Prognosis
Because Parkinson disease is a progressive, degenerative disorder with no known cure, the outlook may be disheartening for those affected.
Average life expectancy from the time of diagnosis is 10 years.
However, many individuals live much longer and, with supportive care, are able to maintain a good quality of life.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Multiple sclerosis (MS) is a chronic autoimmune disease in which there is destruction of myelin and nerve axons within several regions of the brain and spinal cord.
There are several different types of MS; the most common is the relapsing-remitting type, which affects 85% of patients with MS.
It is characterized by increasingly frequent attacks in which the individual experiences exacerbation (aggravation of symptoms or increase in severity) of symptoms alternating with periods of remission.
Incidence
Approximately 500,000 people in the United States have been diagnosed with MS.
It is twice more common in women than men, with typical onset between the ages of 20 and 40.
It is more common among those living in cold climates.
Etiology
The cause of MS is not fully understood, although there is thought to be an autoimmune basis.
Autoimmune diseases occur when the body’s immune system loses the ability to distinguish self cells from nonself cells.
As a result, the immune system attacks the body’s own misidentified cells and tissues.
In the case of multiple sclerosis, the central nervous system is affected, resulting in inflammation and degeneration of the myelin sheath that protects nerve fibers.
Attacks are usually episodic, resulting in repetitive episodes of disrupted nerve-impulse conduction.
Triggers for MS include infections, viruses, and pregnancy.
There is also a familial component; children of patients with MS are 15 times more likely to develop MS than the average person.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Signs and symptoms
Symptoms are widely variable and tend to come and go.
Vertigo: sensation of severe dizziness.
Tinnitus: ringing, buzzing, tinkling, or hissing sound in the ear.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Treatment
There is currently no cure for MS.
Some medications may reduce the frequency and severity of relapses for some types of MS. However, they are expensive and not effective in every case.
Therefore, therapy must be individualized.
Prognosis
Prognosis for patients with MS varies and depends on the type of MS involved.
Typically, life expectancy is 7 years less than that of the general population.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Amyotrophic lateral sclerosis (ALS), also called Lou Gehrig disease, is a chronic, progressive, degenerative neuromuscular disorder that destroys motor neurons of the body.
Incidence
ALS affects approximately 30,000 Americans, with nearly 6,000 new cases diagnosed each year.
Men are affected more than women, and whites are more commonly affected than other races.
Typical onset is between the ages of 40 and 70.
Signs and Symptoms
ALS affects the motor nerves and usually leaves sensory nerves and cognitive function intact.
Muscle weakness and fatigue usually begins in the extremities and progresses to the trunk and head.
It eventually affects respiratory muscles and muscles of the head, neck, and face.
As a result, individuals become progressively paralyzed and eventually experience difficulty with breathing, speech, and swallowing.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Diagnosis
There is no specific diagnostic test for ALS; the diagnosis is achieved by ruling out other disorders.
EMG and NCV may reveal muscle fasciculation (visible, involuntary twitching of muscle fibers) and fibrillation (quivering or spontaneous contraction of muscle fibers).
Muscle biopsy reveals atrophy (wasting).
Treatment
There is no cure.
Medication may extend survival time.
The focus of care is on support and palliation, with the goal of helping the individual to maintain an optimal level of independent function.
Palliative care is care that attempts to relieve pain and suffering but does not provide a cure.
Priority must be given to protecting respiratory function.
Medications may be used to decrease muscle spasticity, relieve pain, and reduce oral secretions.
A multidisciplinary approach to care is essential and should involve the patient, patient’s family, physician, nurses, medical assistants, therapists, case managers, and hospice workers.
The patient and family should be given information about community resources, support groups, and advance directives.
Prognosis
Life expectancy is only about 5 years from the time of diagnosis.
Death is usually due to respiratory complications.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment and prognosis.
PLUS…
Dementia, sometimes called senility, is a progressive neurological disorder with numerous causes, in which an individual suffers an irreversible decline in cognition due to disease or brain damage.
Cognition is thinking that includes language use, calculation, perception, memory, awareness, reasoning, judgment, learning, intellect, social skills, and imagination.
Some forms of dementia are chronic, progressive, and ultimately fatal.
Over 60% of dementia cases are caused by Alzheimer disease.
Dementia is marked by deficits in reasoning and judgment, and it progressively impairs a person’s ability to participate in occupational and social activities.
Incidence
Dementia has numerous causes, which makes it difficult to estimate the actual incidence.
The most common type, Alzheimer dementia, is estimated to affect between four and five million Americans.
However, experts estimate that by the year 2050, the number may increase to 14 million.
This disorder costs nearly $100 billion each year in direct and indirect health-care costs.
Dementia is most common among those over age 65, and prevalence approaches 40% to 50% among those over age 85.
The early-onset type of Alzheimer dementia is familial and affects individuals between the ages of 30 and 60.
Etiology
See Box 6-3.
Other disorders such as depression and delirium are commonly confused with dementia because the signs and symptoms are similar (see Box 6-4).
Delirium is an acute, reversible state of agitated confusion marked by disorientation, hallucinations, or delusions.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Signs and Symptoms
Short-term memory loss (STML) includes forgetting things from today, recent days or weeks, or even the past couple of months.
People with STML may not recall what they ate for breakfast or a conversation from a few minutes or hours ago.
The individual with early dementia usually is able to recall events from distant past (childhood, early years of marriage, etc.).
Long-term memory functions over months to years.
Individuals suffering from long-term memory loss may eventually forget their own family members, their career, and their childhood.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Diagnosis
A common cognitive screening test is the Mini-Mental State Examination (MMSE).
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Treatment
Patients with early dementia may respond to efforts to reorient them to time and place; this strategy becomes less effective, though, as dementia progresses.
Support resources for patients with Alzheimer disease and their families are available, including adult day services, respite care, support groups, and home health-care services.
In addition, caregivers should be counseled on making the home environment safer for the patient with Alzheimer disease or other forms of dementia (see Box 6-5).
Prognosis
There is no cure for Alzheimer disease or most other types of dementia.
Therefore, care is focused on promoting safety and quality of life and on providing information and support to the caregiver.
Life expectancy for patients with Alzheimer disease is variable but averages 8 to 10 years from the onset of symptoms.
Death is due not to the disease itself but to its complications, most commonly including infection of various types (such as pneumonia) and immobility and injury associated with falls.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Huntington disease (HD), also called Huntington chorea, is an inherited progressive degenerative neurological disease that results in physical and mental decline.
It was first studied in the late 1800s by a physician named George Huntington, who used the Greek term chorea, which means “dance,” to refer to the typical involuntary, jerky movements made by individuals with this disease.
Incidence
Estimates of the incidence of HD vary widely between 1,500 and 30,000 for the United States.
Incidence varies by region and ethnicity, with the highest rate in those of Western European descent.
Onset is usually in the mid-40s but may occur at any age.
Etiology
HD is inherited and is caused by an identified abnormal gene that is passed from either parent to the child.
The likelihood of developing HD is 50% when one parent has the gene.
Signs and Symptoms
The individual walks in a progressively unsteady and staggering manner.
As swallowing becomes more impaired, patients are at increased risk of choking as well as nutritional deficits.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Treatment
Antipsychotics and antidepressants may be used to treat psychiatric symptoms and movement disorders.
Nutritional needs must be met by ensuring adequate intake of calories, vitamins, and minerals, as well as adapting food to meet the individual’s declining chewing and swallowing ability.
Prognosis
The prognosis for HD is extremely grim.
Life expectancy from onset varies between 15 and 25 years.
Symptoms progress until death, which is usually the result of a complication such as respiratory infection, choking, malnutrition, or injury from a fall.
The suicide rate varies from 7% to 27%.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Cerebral concussion is a vague term which refers to a brief loss of consciousness or episode of disorientation or confusion following a head injury.
Cerebral contusion refers to bruising of brain tissue and is therefore the more severe of the two injuries.
Incidence
More than 1.5 million Americans suffer from traumatic brain injury each year.
Fortunately, approximately 75% of these cases involve only mild concussion.
The incidence of head injury is greatest in adolescents, elderly patients, men, and African Americans.
Etiology
A contrecoup injury is one in which a rapid acceleration followed by deceleration throws the brain forward and backward within the skull (see Fig. 6-9).
As a result, delicate brain tissue and small vessels may be torn by force or cut by sharp protrusions within parts of the skull.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Signs and Symptoms
Symptoms of contusion are more severe than those of concussion, due to tiny cerebral hemorrhages.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Diagnosis
A CT scan is recommended for those with loss of consciousness lasting more than 1 minute and those with deteriorating neurological status.
A CT scan revealing a salt-and-pepper appearance caused by tiny hemorrhages confirms the diagnosis of cerebral contusion.
Spinal films should also be done to rule out spinal injury.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Prognosis
Prognosis for those with mild concussion is good.
Those with more severe concussion may develop postconcussion syndrome, which includes memory problems, depression, and dizziness.
The prognosis for cerebral contusion is more guarded, with a risk of escalating ICP and microhemorrhages progressing to hematoma.
In either case, compression of the brain increases the risk of further injury, with a higher likelihood of permanent neurological deficit.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Spinal-cord injury (SCI) involves traumatic bruising, crushing, or tearing of the spinal cord.
Transection (cutting across) of the spinal cord may be partial or complete, depending on the mechanism of injury (means by which injury occurred).
Incidence
Approximately 14,000 individuals in the United States suffer from acute SCI each year, and another 300,000 to 400,000 are living with some degree of chronic disability as a result of SCI.
More than 80% of acute SCI patients are young white men.
Alcohol or mood-altering drugs are a factor in more than half of all spinal-cord injuries.
Signs and Symptoms
Deficits occur below the site of the injury.
With time, medical care, and therapy, some return of function may occur.
The degree of permanent deficit is widely variable and depends on the location, extent, and nature of the injury.
Some individuals with relatively minor injury may regain full function, while others may be left with permanent paralysis.
Diagnosis
Radiological studies reveal vertebral fractures, hematoma, spinal-cord compression, and other injuries.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Treatment
Gardner-Wells tongs allow application of traction to stabilize the spine until the patient is stable enough for surgery.
Spinal fusion: surgical immobilization of adjacent vertebrae by grafting of bone or insertion of hardware.
Prognosis
Victims of SCI often suffer profound, life-altering injury as well as severe emotional trauma.
Long-term prognosis varies and depends on the location, type, and severity of injury.
In general, the higher the injury on the spinal cord, the more severe the consequences and the grimmer the prognosis.
As the patient moves into the rehabilitation phase, emphasis is placed on restoration of optimal function and independence.
Rehabilitation takes many months.
Many patients require special medical care and must pay careful attention to self-care for the remainder of their lives in order to avoid such complications as pressure ulcers and autonomic dysreflexia (see Box 6-6).
This automatic response of functioning parts of the nervous system to sensations that normally would be felt as painful is a potentially life-threatening complication that can occur in those with spinal-cord lesions above the sixth thoracic vertebra.
It may be triggered by a number of things, but the most common are bowel distention (stretching) caused by constipation and bladder distention caused by urine retention or a blocked catheter.
Other causes include rectal, pelvic, or urological examination, urinary tract infections, uterine contractions, pressure ulcers, and blood clots in the legs.
The effects of autonomic dysreflexia are immediate and profound.
Unless the patient gets immediate attention, it may progress to a stroke.
The most common causes of death for those who survive the initial injury are pneumonia, pulmonary embolism, and kidney failure.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment and prognosis.
PLUS…
A hematoma is a collection of blood that results from internal bleeding.
An epidural hematoma is a collection of blood between the dura mater (outer meningeal membrane of the CNS) and skull.
A subdural hematoma is a collection of blood between the dura mater and the arachnoid (middle or second layer of the meninges).
Incidence
Estimates of the incidence of epidural hematoma vary widely, from 40,000 to 200,000 cases per year.
An estimated 30,000 individuals suffer from subdural hematoma each year. Both types occur in people of all ages, though infants and elderly people are more vulnerable to subdural hematoma than other age groups.
Trauma caused by shaken-baby syndrome generally occurs before the age of 1 year.
Traumatic head injury to the elderly often occurs due to falls.
Etiology
Traumatic injury causes tearing of blood vessels, as happens with shaken-baby syndrome or contrecoup injuries.
Movement of the brain and meningeal layers within the skull causes a shearing force which tears vessels and injures brain tissue.
Epidural bleeding occurs rapidly because it usually involves arteries.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Signs and Symptoms
Symptoms of epidural hematoma are often related to increased ICP.
Pressure on the brain is increased as more blood collects.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Prognosis
Prognosis for either type of hematoma is variable and depends upon the severity of the injury, the amount of bleeding, and the timeliness of diagnosis and treatment.
Epidural hematoma develops in up to 3% of head injuries and has a mortality rate of 15% to 20%.
Acute subdural hematoma has a higher mortality rate, typically around 60%.
Those with epidural hematoma who exhibit a lucid interval have a better prognosis (with prompt surgical intervention) than those who are comatose the entire time.
Potential complications include increased ICP from edema, further bleeding, infection, and seizures.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
A skull fracture is a break in any of the bones of the skull.
There are several different types of fractures: linear (extending along the length of a bone), depressed (dented inward), comminuted (crushed into many pieces), and basilar (at the base of the skull)
Incidence
An estimated 42,000 Americans suffer skull fracture each year.
The majority of skull fractures are linear fractures.
Etiology
Examples of head trauma include falls, blows to the head from an object such as a rock, physical assault, athletic events, and motor vehicle accidents.
Signs and Symptoms
Ataxia: lack of coordination.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Nystagmus: involuntary back-and-forth or circular eye movement.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Prognosis
Prognosis for individuals with skull fracture is quite variable.
Those with a simple linear fracture usually recover fully with minimal treatment.
The prognosis for others depends upon the severity of the injury to the brain and the timeliness of intervention.
Potential complications include infection, abscess, meningitis, seizures, and permanent brain damage.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Spinal stenosis is the narrowing of an area of the spine.
It most typically affects the upper or lower back and puts pressure on the spinal cord and spinal-nerve roots.
Incidence
An estimated one-half million Americans suffer from spinal stenosis.
It is most common in those over 50 years of age.
Etiology
Congenital simply means “present at birth.”
Any of the conditions listed can result in compression of the spinal cord or spinal-nerve roots, causing the associated symptoms.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Signs and Symptoms
Symptoms gradually worsen over time.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Diagnosis
Myelography: radiography of the spinal cord and associated nerves after injection of a contrast dye.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Treatment
Nerve block: injection of anesthetic.
Prognosis
Prognosis is good with early detection and treatment.
Surgical decompression usually provides long-term relief and improvement in quality of life.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Sciatica is not a disorder in itself, but is the term used for pain, numbness, weakness, or tingling that is felt from the lower back along the pathway of the sciatic nerve into the legs.
Incidence
It is estimated that up to 40% of the U.S. population will suffer from sciatica at some time during their life.
It affects men and women equally.
Etiology
Piriformis syndrome: compression by tension from the piriformis muscle.
Uterine compression refers to pressure against the sciatic nerve during pregnancy.
Other causes include pelvic injury and active trigger points (muscle ischemia from injury or chronic contraction).
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Signs and Symptoms
Bilateral: symptom runs through the buttocks, down both legs, and into the feet (see Fig. 6-17).
Unilateral: one-sided.
Symptoms may be mild or extremely severe.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Prognosis
Prognosis for sciatica is variable.
In many cases, full recovery is achieved; in others, individuals may suffer some degree of disability.
Potential complications include deficits in sensation and movement.
For some individuals, sciatica becomes chronic.
Treatment
Surgery may be done to relieve pressure on nerves.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Migraine headaches are a familial disorder marked by episodes of severe throbbing headache that is commonly unilateral and sometimes disabling.
Incidence
Migraines affect more than 28 million Americans and are three times more common in women than in men.
Etiology
Migraines are worse early in life, and often improve in later years.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Many different foods can act as triggers.
Examples include red wine, beer, aged cheese, chocolate, aspartame, and monosodium glutamate.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Aura: a type of sensory warning prior to the onset of the migraine headache or a seizure.
Auras may include flashes of light, visual changes, or tingling in the arms or legs.
Bilateral: pertaining to both sides.
Phonophobia: sensitivity to sound.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Diagnosis
For headaches that are sudden or severe in onset or have changed significantly in frequency or character, more thorough neurological evaluation and diagnostic testing may be warranted.
Such tests might include a CT or MRI scan and a lumbar puncture so that cerebrospinal fluid can be evaluated.
Treatment
Mild migraines are sometimes responsive to a combination of acetaminophen (Tylenol), aspirin and caffeine.
This is the combination of ingredients found in preparations like Excedrin Migraine.
Triptans are a newer class of drugs that help to abort the migraine before it becomes severe.
People who experience more than two migraines per month may benefit from preventive medications, such as antihypertensives, antidepressants, and antiseizure medications.
Prognosis
In most cases, migraines cannot be totally eliminated; however, the prognosis for most individuals is good.
Effective management depends on identifying and eliminating or minimizing exposure to triggers and determining the most effective medication plan.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
A headache is a condition in which pain is felt in all or part of the head.
While there are many types and causes, tension headache is by far the most common type of nonmigraine headache.
Incidence
Headaches are extremely common.
In fact, 90% of the population of the United States reports at least one headache per year; an estimated 45 million Americans suffer chronic headaches.
Headaches are known to cost billions of dollars each year in treatment costs and lost productivity.
Tension headaches are experienced by people of all ages and races, male and female.
However, they are most commonly reported by women over the age of 20.
Etiology
Tension headaches are caused by muscle tension in the scalp, neck, jaw, or upper shoulders.
This tension is generally related to situational, physical, or emotional stress, anxiety, or depression.
Examples of physical stress include certain types of manual labor and prolonged work at a desk or computer.
Emotional stress is anything that causes feelings such as anxiety, anger, or frustration.
Contributors to tension headaches include poor posture, lack of sleep, alcohol use, and missed meals.
Pain may be worsened with noise.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Signs and Symptoms
Tension headaches can progress into migraines in people prone to migraines
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Diagnosis
The health-care provider carefully questions the patient about headache symptoms, including onset, location and duration of pain, character or quality of pain, and any other associated symptoms.
Treatment
Common OTC analgesics include acetaminophen (Tylenol) and ibuprofen (Advil, Motrin).
Prognosis
Prognosis for tension headache is good, since there is no underlying life-threatening pathology.
However, for many people these types of headaches can have significant impact on quality of life and productivity.
Individuals who do not experience relief or improvement with the treatment described here should see their health-care provider.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Peripheral neuropathy is a dysfunction of nerves that transmit information to and from the brain and spinal cord.
It is characterized by pain, altered sensation, and muscle weakness, and may affect a single nerve or nerve group or may affect multiple nerves.
Incidence
Experts do not agree about the definition of peripheral neuropathy, which makes its incidence difficult to estimate.
However, they all agree that it is extremely common.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Signs and Symptoms
Symptoms involve motor nerves, sensory nerves, or both, and vary widely depending on the nerve or nerves affected.
Damage to autonomic nerves related to involuntary or semivoluntary functions may result in such symptoms as blurred vision, dizziness, diarrhea, constipation, urinary incontinence, and impotence, among others.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Diagnosis
Blood tests may also be done to identify or rule out underlying medical disorders, such as diabetes or nutritional deficits.
Prognosis
The prognosis for peripheral neuropathy is variable, depending on the specific cause.
In cases where an underlying disorder can be cured or treated, the outlook is positive.
However, in some cases nerve damage is permanent.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Bell palsy is a disorder of the seventh cranial nerve that causes temporary weakness or paralysis of one side of the face.
It usually develops suddenly and takes months to resolve.
Incidence
Bell palsy affects approximately 40,000 individuals each year in the United States.
It is equally common in men and women and is most common between the ages of 15 and 60.
It is more common among pregnant women and patients with diabetes or upper respiratory infections.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Prognosis
The prognosis for those with Bell palsy is very good.
Recovery is complete in most cases but may take as long as 6 months.
In some cases the symptoms never fully resolve, and in a very small number of cases the paralysis may be permanent. Recurrences are rare.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Trigeminal neuralgia (TN), also called tic douloureux, is a neurological disorder that causes severe, episodic facial pain along the pathway of the fifth cranial (trigeminal) nerve.
Incidence
Onset of TN is most typical among those over the age of 50, although it can occur in younger individuals.
An estimated 60,000 to 180,000 Americans suffer from TN, women more frequently than men.
Etiology
The exact cause is unknown.
Theories include compression of the root of the trigeminal nerve, nerve injury, and multiple sclerosis.
The root of the trigeminal nerve may be compressed by blood vessels or lesions (see Fig. 6-19).
There is a possible connection with injury to the nerve or to multiple sclerosis.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Signs and Symptoms
Episodes of severe, sudden stabbing, shooting, or shocklike pain in the side of the face around the ears, jaw, cheeks, lips, nose, or eyes.
Both types of TN usually affect just one side of the face, although bilateral TN occurs around 10% of the time.
Many individuals experience disturbed sleep.
Some suffer nutritional deficits due to difficulty chewing and swallowing.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Treatment
Medication may be injected to numb or disable the nerve.
Surgical procedures may be done to relieve pressure on the trigeminal nerve or even disable it temporarily or permanently.
Prognosis
TN is one of the most painful conditions known and can have a significant impact on quality of life.
Some patients find help and encouragement through support groups.
In some cases the disorder resolves spontaneously; in others, medication or surgery provides partial or complete relief.
For some, the pain recurs at a later time, necessitating repeated treatments.
Possible side effects from some procedures include facial weakness, numbness, or paralysis, which may be temporary or permanent.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Epilepsy is a chronic disorder of the brain marked by recurrent seizures, which are repetitive abnormal electrical discharges within the brain.
Epilepsy seizure types are categorized as partial, generalized, and unclassified.
In generalized seizures, the excessive nervous activity affects both sides of the brain.
In partial seizures, also called focal or local seizures, activity begins in one part of the brain, but these seizures may occasionally evolve into generalized ones.
Incidence
An estimated three million Americans have epilepsy, and 200,000 new cases are diagnosed each year.
Those most commonly affected are children and those over age 70.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Treatment
Treatment of epilepsy is aimed at reducing the number and severity of seizures.
A variety of antiseizure medications are available; a certain amount of trial and error may be required to find the one that works best for a given individual.
For patients whose epilepsy does not respond to medication, surgical options may be considered, including:
Implantation of a vagal-nerve stimulator.
Excision of the brain tissue responsible for triggering the seizures.
Corpuscallosotomy: The corpus callosum is partially divided in two.
Treatment during an actual seizure should focus on protecting the individual from injury and providing privacy (when possible).
Nothing should be inserted in the individual’s mouth.
Prognosis
The prognosis for epilepsy is generally good, depending on the severity of the disorder and the patient’s responsiveness to treatment.
In some cases the seizures cannot be totally eliminated; in most cases, though, the severity and frequency can be reduced, resulting in an improved quality of life for the patient.
A life-threatening complication of epilepsy is status epilepticus, in which the individual experiences continuous or recurrent seizure activity.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Transient global amnesia (TGA) is a rare disorder, not caused by a neurological event or injury, involving the sudden, temporary loss of recent memory.
Incidence
An estimated 15,000 to 70,000 Americans suffer from TGA annually.
The typical age of those affected is greater than 50. TGA occurs equally in men and women.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Signs and Symptoms
A loss of recent memory occurs (covering days, weeks, or months), with retention of personal identity and distant memory.
The episode lasts less than 24 hours.
Of note is the absence of neurological deficits such as paralysis, weakness, numbness, loss of consciousness, seizures, or history of recent head injury.
During the event, individuals retain the ability to function normally, including using language and social skills, following directions, and recognizing familiar objects.
They may experience headache or anxiety-related symptoms such as trembling, sweating, increased heart rate, and emotional distress or agitation.
Symptoms generally resolve within 12 to 24 hours, after which the individual returns to a normal state with the usual ability to remember events.
Learning Outcomes
6.3 Define and spell terms related to neurology.
6.4 Identify characteristics of common neurological diseases and disorders, including description, incidence, etiology, signs and symptoms, diagnosis, treatment, and prognosis.
PLUS…
Diagnosis
Of note is the absence of other neurological deficits during or after the event.
Diagnostic tests such as EEG and CT scan are done to rule out other neurological events, such as stroke or seizures.
Treatment
TGA is self-limited, and symptoms completely resolve within 24 hours.
Therefore, no treatment is needed.
Prognosis
Prognosis for TGA is excellent because it causes no residual physical deficits, and recurrence is very uncommon.
However, a thorough evaluation should be done to rule out any concerns about stroke, transient ischemic attack, or seizure disorder.
TGA is a frightening and distressing event for the patient; emotional support and even counseling may be helpful.
