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Lou Gehrigs Disease
- Amyotrophic Lateral Sclerosis: 40-60 years old more common in men in earlier ages but = after menopause
- rapidly progressive & fatal (2-5 years, usually due to resp failure)
- most common motor neuron disease in US
- Muscle atrophy (weakness and wasting of muscles under voluntary control) resulting form motor neuron degeneration and sclerosis of corticospinal tract in the lateral column of the spinal cord
- no accompanying sensory or cognitive changes
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amyotrophy
without muscle nutrition or progressive muscle wasting/atrophy
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traumatic brain injury assessment
- LOC
- breathing pattern
- PERRLA
- eye position
- skeletal muscle motor response
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Decorticate
- Hemispheric damage above the midrain
- toes pointed arms at chest
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Decerebrate
- Severe damage to diencephalon or midbrain
- toes pointed and arms at sides, wrists flexed
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symptoms of brain injury
- depends on area of brain injured/extent of injury
- highly variable
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types of brain injury
- coup: impact against object
- countercoup: impact within skull (head rebounds from wall)
- focal: specific and grossly observable lesions
- Diffuse: shaking effect, strains and distortions in the brain, seen with a microscope
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spinal cord injuries
- Damage to motor neuron
- much of injury due to cord ischemia
- all have potential for: loss of voluntary control, flaccid paralysis, decreased muscle tone, muscle atrophy, absent or decreased reflexes
- Long term loss depends on: level of injury, and extent of transection
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extents of spinal cord injuries
- c2: ventilator dependent; quadriplegic
- c4: move head, mouth, shoulders, diaphragm
- c6: weak hands, drive with hand controls
- t1: normal upper body; paraplegic
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Neuroplasticity
brain has ability to reorganize after disease or injury
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Brain bleeds
- Injury: sudden changes in motion can tear blood vessels because brain is floating in skull
- can happen in response to aneurysm or artery bursting as last stage of chronic HTN
- Bleeds shift and distort brain, may herniate brain tissue or compress vessels (leading to ischemia)
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Types of brain bleeds
- within brain: hemorrhagic stroke: generally arterial aneurysms bursting
- Epidural: between skull and dura: mostly arterial
- Subdural: between the dura and the pia matter: mostly venous
- Subarachnoid and intracerebral: between pia mater and the brain (into CSF) or brain tissue: venous or arterial
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symptoms of bleed
- severe headache
- change in LOC
- glasgow coma scale: eye opening, verbal response, motor response
- brain stem function: pupillary response, corneal reflex
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phases of seizures
- tonic: arms up, heels pushing back up, neck down
- clonic: legs bent, arms straight down, neck back
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seizures
- caused by sudden changes in the membrane potential of neurons
- seizure thresholds are lower in some due to more permeable plasma membrane: hyperthermia, hypoxia, hypoglycemia, hyponatremia, repeated sensory information, emotional/physical stress, fatigue, lack of sleep
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Stroke
- 20 % hemorrhagic: 50% mortality
- 80% ischemic: emobolic, thrombotic, treatment <3 hrs with fibrinolytic crucial
- 1/3 die 1/3 sig deficit 1/3 functional recovery
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signs of stroke
- numbness or weakness on one side of body
- confusion, trouble speaking or understanding
- visual disturbances
- dizziness, trouble walking
- severe headache (hemorrhagic stroke)
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cerebral blood flow
- basilar/vertebral: feeds cerebellum and brain stem: lack of flow affects gait, speech, swallowing, vision
- anterior cerebral: feeds frontal lobes: lack of flow causes contralateral motor sensory loss, impaired cognition, incontinence, aphasia
- Middle cerebral: middle of brain: lack of flow causes contralateral motor/sensory loss, aphasia, altered consciousness, neglect syndrome, most fatal
- Posterior cerebral: occipital and temporal: lack of flow causes vision and memory loss
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Right hemisphere affected
- spatial perceptual abilities
- judgment (loss of judgment with no awareness)
- Memory (short term memory loss)
- Mood (indifference, impulsive)
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Left hemisphere affected
- altered speech and understanding of it (aphasia)
- patient has slow cautious behavior style
- patient has difficulty learning new information
- patient has depression
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infections altering neuro function
- meningitis: Infection in subarachnoid space, often bacterial, recovery depends on prompts treatment, headache, fever, stiff neck
- Encephalitis: inflammation of the brain, often viral, difficult to diagnose
- Brain abscess: mostly bacterial, necrotizing, infections from neighboring structures (teeth, sinuses, ears) or penetrating wounds
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delirium vs dementia
- delirium: abrupt onset, typically physiologic cause, typically reversible IF treated, fluctuating course, Altered LOC's
- Dementia: progressive failure of cerebral functions, irreversible confused states, decline in intellectual ability
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3 consistent neuropathological hallmarks alzeimers
- amyloid-rich senile plaques
- neurofibrillary tangles
- neuronal degeneration
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Parkinsons Disease
- motor system disorder: result of the loss of dopamin-producing brain cells (people over 50)
- there are no test for PD
- 4 primary symptoms of PD are: tremor, rigidity, bradykinesia (slowness of movement), postural instability
- other symptoms: deppression, difficuly swallowing chewing speaking, urinary/bowel problems, skin problems, sleep disruptions
- difficulty walking talking or completing simple tasks
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treatment PD
- levadopa & carbidopa: delay conversion of levodopa into dopamin until it reaches brain because levodopa is needed to make dopamine to replenish the brains supply
- other drugs that mimin dopamine
- antiviral: amantadine reduces symptoms
- Surgery: Deep brain stimulation: electrodes implaned into brain and connected to pulse programmer, Pallidotomy: Part of the brain called globus pallidus is overactive so is destroyed by creating a scar which relieves movement symptoms/stiffness
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multiple sclerosis
- degeneration of previoiusly normal myelin with relative preservation of axons (degeneration of myelin with inflammatory edema occurs)
- age 20-40 (peak 30) 1 male: 2 Female
- May occur when a previous viral insult to the nervous system has occurred in a genetically susceptible individual
- cd4 crosses blood brain barrier and becomes autoreactive to myelin
- Symptoms: paresthesias(numbness tingling), Weakness, strange sensation of tightness banding ithching constriction, imbalance ataxia, visual changes
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