Human Body Nervous System Pathology and Diagnostic Tests

permanent, non-progressive disorder affecting major motor control areas of brain leading to paralysis

spastic

brain trauma before, during, or shortly after birth caused by injury or infection

• can affect both arms and legs or an arm and leg on one side of the body
• *muscles and joint contractures (arms tucked in toward side, knees crossed or touching)
• *abnormal gait
• *difficulty with precise small motor skills
• *below average intelligence
• *drooling
• *problems with speech, hearing, vision
• *seizures

MRI, CT

orthopedic devices, PT, OT, visual and hearing aids, muscle relaxants, anticonvulsants

usually a normal life expectancy (depending od severity)

cerebral palsy

Amyotrophic Lateral Sclerosis (ALS)

1941

idiopathic; rarely genetic

• subtle initially with no effect on involuntary muscles or intellect (IT WILL WORSEN)
• *weakness in hands, arms, legs, muscles of speech, swallowing and breathing
• *clumsiness
• *twitching and cramping (hands and feet)
• *slurred speech
• *difficulty breathing

• More common in men, middle-age onset
• *neuromuscular exam (shows weakness, atrophy, stiffness, abnormally rapid knee jerk reflex, non sensory abnormalities
• *EMG
• *Nerve Conduction Velocity shows slow speed of nerve conduction and decreased muscle action potentials

• No cure
• *antiglutimate/neuroprotective medication riluzole (Rilutek) to slow progresson
• *skeletal muscle relaxants to relieve spasticity
• *eventual need of respirator

Yes, terminal (3-5 years after onset)

• Electroencephalography (EEG)
• *records electrical activity in cerebral cortex
• *electrodes placed on head to record activity, amplify it, and produce brain waves
• *Dx of sleep disorders, tumors, epilepsy, brain death

• Electromyography (EMG)
• *measures electrical signals in muscle at rest and during contraction to assess nerve damage
• (needle electrode in muscle to record muscle's action potential)

• Nerve Conduction Velocity (NCV)
• * Measures how fast an impulse travels through a nerve (nerve is stimulated and electrodes record nerve's action potential)
• *Often done with an EMG

• *between 3rd and 4th vertebrae
• *AKA spinal tap
• *reasons: to get a sample of CSF, relieve pressure of accumulating CSF, inject radiopaque dye for x-ray, instill meds (epidural)

Magnetic resonance imaging

loss of motor and sensory function when communication with brain is altered

spinal cord, brain, or nerve injury

• Quadriplegia: all four extremities and trunk
• Paraplegia: lower extremities
• Hemiplegia: one side/half of body

neurological assessment, MRI, CT, myelography

inner material (nucleus pulposus) of intervertebral disk protrudes outward towards spinal cord compressing nerves

slipped disk, ruptured disk

spinal trauma, strain (lifting), intervertebral joint degeneration

lumbar region

vary by location; back pain worsened by movements (coughing, sneezing, bending, etc.), numbness, weakness, sciatica

spinal x-ray, MRI, CT, myelography

rest, PT, analgesics, NSAIDS, muscle relaxants, steroid injections, surgery (if severe)

degeneration of nerves

multiple neuritis, polyneuritis, or peripheral neuropathy

• Nerve damage caused by:
• *Trauma
• *Infection (bacterial or viral)
• *Metabolic disease
• *Toxins (lead, arsenic, etc.)
• *Vitamin deficiency, especially B12
• *Autoimmune disease (Lupus, RA, Guillain-Barre Syndrome)

pain, numbness, tingling, loss of sensation, muscular weakness; possible loss of autonomic functions (BP, heart rate, digestion, bladder function)

NCV and EMG

supportive; elimination of causative factors if possible

viral infection along course of nerve that causes painful rash (SHINGLES)

reactivation of varicella-zoster virus (chickenpox) which lies dormant in nerves until immune system is compromised

Elderly

unilateral pain, tingling, or burning followed by eruption of vesicular rash (spine around to anterior abdomen or chest)

clinical

antivirals (acyclovir--Zovirax, famciclovir--Famvir, valacyclovir--Valtrex)

usually lasts a few weeks, but pain can linger indefinitely after rash is gone

inflammation or compression of seventh cranial nerve (facial) that causes paralysis of muscles on one side of face

may be viral (Herpes Simples, Epstein-Barr)

facial weakness, drooping of mouth, drooling, diminished sense of taste, pain in jaw or behind or in front of ear, excessive tearing, Bell's Palsy Phenomenon (eyes roll upward when person attempts to close them)

clinical (rule out CVA--cerebrovascular accident--Stroke)

antivirals, analgesics, corticosteroids, temporary eye patch

good with spontaneous remission occurring within eight weeks

acute, rapidly progressing disorder of the immune system (attacks myelin on peripheral nerves)

often follows viral infection or immunization; can also affect young

sudden onset of bilateral muscle weakness, numbness, and tingling that begins in legs and ascends to upper body and arms, loss of deep tendon reflexes, paralysis; may progress to affect respiratory muscles

clinical, NCV studies, EMG, CSF analysis that will show increased protein

plasmapheresis (removes harmful plasma components), high-dose immunoglobulin meds, mechanical ventilation

most recover, but may have residual weakness indefinitely; can be fatal