-
The meninges of the brain and spinal cord become inflamed due to an infectious organism
Meningitis
-
Can be bacterial or viral in origin
Meningitis
-
Vaccines are now available to help protect against __________
Haemophilus influenzae type B (HiB) infection
-
The inflammatory response can result in hydrocephalus, edema, and increased intracranial pressure Increased risk of infarction (obstruction of local circulation resulting in necrosis of tissue)
Meningitis
-
Stretch or pressure to the meninges will cause the cardinal sign of meningitis
Headache, throbbing pain in neck
-
Meningitis typically caused by __________ found in the upper respiratory tract
Organisms
-
Neurological deficits remain in approximately ____%of people with bacterial meningiti
30
-
As inflammation progresses in bacterial meningitis, flexion of the neck will produce pain in the hips and knees (_____________ sign), due to tension on the meninges and neural structures
Brudzinski’s
-
Bacterial meningitis may have pain with combined hip flexion and knee extension (Kernig’s sign), due to tension on the meninges and neural structures________
(Kernig’s sign), due to tension on the meninges and neural structures
-
Bacterial meningitis is treated with
broad spectrum antibiotics
-
Antibiotics must be able to cross the ______ _____________ and achieve sufficient concentrations within the cerebrospinal fluid (CSF)
blood-brain barrier
-
Treatment for viral meningitis is typically
symptomatic
-
An acute inflammatory disease of the tissue of the brain caused by direct viral invasion or hypersensitivity initiated by the virus. Inflammation primarily of the gray matter
Encephalitis
-
Encephalitis, an acute inflammatory disease of the tissue of the brain caused by direct viral invasion or hypersensitivity initiated by the virus. Inflammation primarily of the _____ matter
gray
-
Encephalomyelitis can result from other viral infections:
◦ Measles ◦ Mumps ◦ Rubella ◦ Varicella
-
Clinical manifestations of encephalitis depend on the causal agent but can include
◦ Headache ◦ Nausea ◦ Vomiting ◦ Altered conciousness Treatment varies dep
-
Rare forms of spongiform encephalopathies transmitted by prions (infectious proteins that are abnormal forms of normal cellular proteins) that include: ◦Creutzfeldt-Jakob Disease ◦Bovine spongiform encephalopathy
Prion disease
-
The _______contains no nucleic acid but can replicate within the nervous system
prion
-
Accelerated death of _______cells (nerve cells in the middle layer of the cerebral cortex )resulting in ataxia (the inability to coordinate voluntary muscular movements)
purkinje's
-
purkinje’s cells
nerve cells in the middle layer of the cerebral cortex
-
the inability to coordinate voluntary muscular movements
ataxia
-
treatment for prion diseases;
only symptomatic and supportive care
-
Once diagnosed, rapid progression typically occurs and eventually fatal
Prion Disease
-
• AMYOTROPHIC LATERAL SCLEROSIS (ALS) • MULTIPLE SCLEROSIS (MS) • PARKINSON’S DISEASE
Degenerative Diseases of the CNS
-
Cause is unknown and characterized by degeneration and scarring of the motor neurons in the lateral aspect of the spinal cord, brainstem, and cerebral cortex
Amyotrophic Lateral Sclerosis (ALS)
-
“Most physically devastating of the neurodegenerative diseases”
ALS
-
More commonly known as Lou Gehrig’s disease
ALS
-
Peripheral nerve changes result in muscle fiber atrophy
ALS
-
Familial ALS (FALS) occurs in ____% of all ALS cases (inherited ________ trait)
5-10: autosomal trait)
-
ALS effects the pyramidal cells (pyramid shaped cells in the cerebral cortex) of the _____________and the surrounding premotor areas, sensory cortex and temporal cortex. Extensor muscles become weaker than flexor muscles
cerebral cortex
-
May see ________signs (neurons originating in the medulla) ◦ Difficulty with articulation ◦ Difficulty chewing ◦ Difficulty swallowing
bulbar
-
Inability to hold the eye closed against pressure is a standard clinical
test for ALS
-
Fasciculations (_____________) of the tongue are present with lower motor neuron dysfunction
muscular twitching
-
Dysarthria associated with ____ dysfunction ◦ Inability to shout or sing ◦ Hoarse voice quality
LMN
-
In ALS death usually occurs in ___ years after diagnosis, primarily from pneumonia related to respiratory compromise
2-5
-
Progressive dementia characterized by a slow decline in memory, language, visual spatial skills, personality and cognition
Alzheimer's
-
Incidence increases with age Growing evidence of relationship between AD and vascular disease May have a genetic component
Alzheimer's
-
No single cause Loss of neurons Changes in neurotransmitter
Alzheimer's
-
region of the brain involved in forming, storing and processing memory
Hippocampus
-
Amygdala
a region of the basal ganglia
-
First brain structure to show pathologic findings is the cerebral cortex ◦Select neurons: pyramidal cells with __________ __ _________ projections
corticocortical or hippocampal
-
Two characteristic brain findings of AD
◦Neurofibrillary tangles ◦Senile plaques
-
Prognosis: fatal in 7-11 years
AD
-
No cure, only symptomatic and supportive care Often first functional sign is the inability to learn new information
AD
-
Progressive hereditary disease characterized by abnormalities of movement, personality disturbances, dementia
Huntington's disease
-
Choreic movement:
brief, purposeless, involuntary and random
-
Autosomal dominant disease; all that inherit the gene will develop symptoms of the disease
Huntington's disease
-
Risk of Huntington's disease in each child of an affected adult
50%
-
Ventricles enlarge as a result of the atrophy of the _______ ______ in Huntington's disease.
basal ganglia
-
Extensive loss of small and medium sized neurons Atrophy of the putamen correlates with neurological symptoms Early on, involuntary movements may be thought of as “restlessness” (face and UEs)
Huntington's disease
-
In Huntington' disease, atrophy seen in the __________ and putamen
caudate
-
Chorea is increased by activities that require concentration or by increased emotions or task complexity. How do you test?
ask patient to perform rapid tongue movements
-
Neuropsychologic and psychiatric disorders are a part of Huntington’s disease:
◦ Personality changes ◦ Behavioral changes ◦ Irritability ◦ Depression ◦ Decreased work performance ◦ Violence ◦ Impulsivity ◦ Emotional lability (rapid emotional changes)
-
____% of persons affected with Huntington’s disease will attempt suicide
25
-
Patient education regarding safety issues If bradykinesia present, may have tendency to “freeze” Motor learning may be limited due to the disease processes Positioning important
Implications for PTA intervention-Huntington's disease
-
Hallmark: Sclerotic plaques distributed throughout CNS (Central Nervous System)
MS
-
In MS demyelization is ?
myelin sheath of the nerves is replaced by fibrous scarring, interfering with the transmission of messages along the nerves
-
In MS there is primarily _______ matter damage or lesions
white
-
lesions slow or block neuronal transmission resulting in
Weakness Sensory loss Visual dysfunction
-
MS occurrence in females:males is
2.5:1
-
In US approximately __________ people are affected by MS
450,000
-
Uncommon before adolescence. Incidence rises from teen years through age 35 and declines gradually
MS
-
MS a disease of ___________climates. In both hemispheres, prevalence ___________ with decreasing latitude
temperate: decreases
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