Vascular Disorders: Cerebrovascular Accident (Stroke)

1
Vascular DisordersCerebrovascular Accident
(Stroke)

• A cerebrovascular accident (CVA) occurs when the
  brain is damaged by a sudden disruption in the
  flow of blood to a part of the brain or by
  bleeding inside the head.

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Cerebrovascular Accident (Stroke) (contd.)

• Common symptoms include sudden
• severe headache
• partial or total loss of the ability to
  articulate ideas or comprehend spoken or written
  language (aphasia)
• weakness (hemiparesis), numbness, or paralysis
  (hemiplegia), confusion, or impaired
  consciousness
• loss or blurring of vision, double vision
  (diplopia)
• dizziness, loss of balance or coordination

3
Cerebrovascular Accident (Stroke) (contd.)

• Causes
• a CVA is usually a result of one of three types
  of vascular disorders
• blood clot (cerebral thrombosis)
• cerebral hemorrhage
• cerebral embolism
• artery blockage (atherosclerosis) or hypertension
  (high blood pressure)

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Cerebrovascular Accident (Stroke) (contd.)

• Treatment
• immediate medical intervention within three hours
  of stroke may limit brain damage. It includes
• immediately chewing an aspirin
• anticoagulants (to prevent clotting of blood)
• surgery to improve circulation and remove clots

5
Cerebrovascular Accident (Stroke) (contd.)

• Prevention
• Known risk factors include
• smoking
• excesses in diet and alcohol consumption
• high blood pressure
• diabetes

6
Transient Ischemic Attack

• Transient ischemic attacks (TIAs) are temporary
  episodes of impaired neurologic functioning
  caused by an inadequate flow of blood to a
  portion of the brain.

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Transient Ischemic Attack (contd.)

• Symptoms
• sudden weakness or numbness down one side of body
  (hemiparesis)
• dizziness
• dysphagia
• confusion

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Transient Ischemic Attack (contd.)

• Diagnosis
• history and physical examination
• cranial MRI scan
• CT scan
• EEG

9
Transient Ischemic Attack (contd.)

• Treatment
• aspirin (as soon as symptoms appear)
• anticoagulants
• surgery (if needed to increase blood flow to the
  affected area)

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Cerebral Concussion

• A concussion is bruising of the cerebral tissue
  that is caused by violent back and forth movement
  of the head.
• Blunt force trauma may also cause this condition.
• A concussion causes a disruption of normal
  electrical activity in the brain, but the brain
  itself usually is not injured.

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Cerebral Concussion (contd.)

• Symptoms
• immediate loss of consciousness
• can be followed by a period of amnesia
• shallow respiration
• slower pulse
• muscle tone flacid
• Upon gaining consciousness, patient might
  experience
• headache
• nausea/vomiting
• blurred vision
• sensitivity to light (photophobia)

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Cerebral Concussion (contd.)

• Diagnosis
• complete neurological examination
• CT scan
• Treatment
• bed rest
• observation for behavioral changes

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Cerebral Contusion

• Contusion involves bruising the tissues along or
  just beneath the surface of the brain.
• A contusion is more serious than a concussion.

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Cerebral Contusion (contd.)

• Symptoms
• vary according to site and extent of injury and
  persist more than 24 hours
• range from temporary consciousness to coma
• when conscious
• severe headache
• slight paralysis or weakness affecting one side
  of the body
• drowsiness, lethargy, combative mood

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Cerebral Contusion (contd.)

• Diagnosis
• a complete neurological examination
• CT scan
• Treatment
• hospitalization so vital signs can be monitored

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Spinal Cord Injuries Paraplegia and Quadriplegia

• Paraplegia is the loss of nerve function below
  the waist and results in paralysis of the lower
  trunk and legs.
• Quadriplegia is the loss of nerve function below
  the cervical region, resulting in paralysis of
  arms, hands, trunk, and legs.

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Paraplegia and Quadriplegia (contd.)

• Symptoms
• Paraplegia
• loss of motor and sensory control in lower
  extremities and trunk
• loss of bladder, bowel, and sexual function
• Quadriplegia
• loss of motor and sensory control in upper and
  lower body
• low blood pressure (hypotension)
• high body temperature (hyperthermia)
• slow heart rate (bradycardia)
• respiratory problems

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Paraplegia and Quadriplegia (contd.)

• Causes
• compression of vertebrae
• Trauma to the thoracic and lumbar regions of the
  spine (T1 and below) usually results in
  paraplegia.
• hyperflexion of neck
• Trauma to the cervical vertebrae (C5 or above)
  can result in quadriplegia.
• hyperextension of spine
• Trauma occurring above C3 is usually fatal.

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Paraplegia and Quadriplegia (contd.)

• Diagnosis
• complete assessment of neurologic functioning
• spinal radiographic films
• MRI scans
• CT scans

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Paraplegia and Quadriplegia (contd.)

• Treatment
• Main goals
• restoration of normal alignment and stability of
  spine
• decompression of the spinal cord, nerves, and
  vertebrae
• early rehabilitation
• Surgery
• Medications

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Intervertebral Disk DisordersDegenerative Disk
Disease

• Intervertebral disks are located between the
  vertebrae.
• The degeneration is usually the result of
  constant wearing on the disk through misalignment.

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Degenerative Disk Disease (contd.)

• Symptoms
• pain that radiates down the nerve path
• burning
• can include loss of motor function in the legs
• numbness and associated weakness of the legs

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Degenerative Disk Disease (contd.)

• Diagnosis
• Various imaging
• MRI scan
• myelogram with contrast
• rarely CT scan

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Degenerative Disk Disease (contd.)

• Treatment
• resting back and lower extremities
• bracing back
• analgesics, NSAIDs
• surgical intervention might be necessary (spinal
  fusion, freeing trapped nerves).
• severe cases electrical stimulation of the skin
  to relieve pain or a continuous flow of morphine

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Herniated and Bulging Disk

• A herniated disk is a rupture of the nucleus
  pulposus, an elastic pulpy mass lying in the
  center of each intervertebral cartilage, which is
  housed in a circular wall structure (annulus).
• When the nucleus pulposus extends into the inner
  annulus only, it is considered a bulging disk.
• When the nucleus pulposus extends through the
  inner and outer annulus, it is considered a
  herniated disk.

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Herniated and Bulging Disk (contd.)
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Herniated and Bulging Disk (contd.)

• Symptoms
• Patient experiences severe back pain.
• Pain may radiate from back to buttocks, thigh,
  and leg.
• Possible disability can occur if disk pinches or
  pushes against spinal nerves.

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Herniated and Bulging Disk (contd.)

• Causes
• sudden impact
• improper body mechanics when lifting
• poor posture
• aging (can cause disk to degenerate)

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Herniated and Bulging Disk (contd.)

• Treatment (conservative)
• bed rest for 24 to 48 hours
• hot and cold packs
• muscle relaxants
• analgesics
• back brace
• Treatment (advanced)
• Surgical excision of the herniated disk or
  related procedures to relieve the pressure
  against the spinal cord

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Sciatic Nerve Injury Spinal Stenosis

• Spinal stenosis is brought about by trauma,
  degeneration, or rupture of the nucleus pulposus
  within intervertebral disks L4 through S1 (lower
  back).
• The degeneration or rupture exerts pressure
  directly on the sciatic nerve, sending impulses
  down into the leg.

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Sciatic Nerve Injury Spinal Stenosis (contd.)
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Sciatic Nerve Injury Spinal Stenosis (contd.)

• Symptoms
• sharp, radiating pain from the sciatic nerve down
  the leg and to the foot
• numbness
• pain in lower back, buttocks, thighs, or calves
• inability to sit or stand

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Sciatic Nerve Injury Spinal Stenosis (contd.)

• Treatment
• bed rest for 24 to 48 hours
• back brace
• strengthening core muscles (after inflammation
  subsides)
• medications (analgesics, muscle relaxants,
  anti-inflammatories, and, in some cases,
  narcotics)
• physical therapy
• surgical intervention (partial or complete
  removal might be necessary in some cases)

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Functional Disorders Headache

• A pain located in the head that is not confined
  to any one specific nerve area
• Two physiologic causes
• Tension headache results from strain on facial,
  neck, and scalp muscles.
• Vascular headache is brought on when excess fluid
  in the blood vessels of the head causes the
  vessels to change in size.

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Functional Disorders Headache (contd.)

• Symptoms
• Pain may vary from dull to severe, be constant or
  intermittent, and have a throbbing, pressure, or
  penetrating sensation.
• This may signal an underlying disorder or disease
  (hypertension, stroke, brain tumor, or
  encephalitis) but in most cases does not.

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Functional Disorders Headache (contd.)

• Treatment
• If no underlying cause is found, the typical
  treatment includes
• analgesics
• muscle relaxants
• minor tranquilizers
• muscle massage
• warm bath

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Migraine

• periodic severe headaches that may completely
  incapacitate the individual and are almost always
  accompanied by other symptoms

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Migraine (contd.)

• Symptoms
• bilateral throbbing pain
• nausea
• vomiting
• visual auras (zigzagging lines, flashing lights)
• high sensitivity to light

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Migraine (contd.)

• Treatment
• bed rest in a quiet, dark room
• analgesics
• drug therapy (vasoconstrictors) to constrict
  blood vessels
• antiemetics (to control vomiting)
• relaxation therapy
• biofeedback

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Epilepsy

• a chronic brain disorder characterized by sudden
  episodes of abnormal intense electrical activity
  in the brain, which results in seizures
• Epileptic seizures are classified as either
• partial
• generalized

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Epilepsy (contd.)

• Symptoms
• partial seizure can involve motor movement, such
  as
• rhythmic twitching
• compulsive lip smacking
• picking at clothing
• sensory auras
• amnesia of the attack

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Epilepsy (contd.)

• Symptoms (contd.)
• generalized seizures include
• absence attacks (also called petit mal)
  characterized by frequent but transient lapses of
  consciousness and only rare spasms
• tonic-clonic attacks (also called grand mal)
  severe form of epilepsy characterized by seizures
  involving spasms and loss of consciousness

43
Epilepsy (contd.)

• Causes
• pathologic conditions associated with seizure
  include
• scar tissue on the cerebral cortex from infection
  or trauma
• tumor of the cerebral cortex
• cerebral edema
• stroke
• birth trauma (cerebral palsy)
• drug toxicity (alcoholism)

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Epilepsy (contd.)

• Treatment
• anticonvulsive medications
• surgical intervention (rare) to remove a lesion
  in the brain

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Epilepsy (contd.)

• First aid for seizures
• Do
• Cushion head.
• Loosen tight neckwear.
• Turn person to the side.
• Look for identification.
• Dont
• Put anything in mouth.
• Hold person down.

46
Parkinson Disease

• a slowly progressive neurologic disorder that is
  linked to decreased dopamine production in the
  brain and is characterized by tremor, weakness of
  resting muscles, and a shuffling gait

47
Parkinson Disease (contd.)

• Symptoms
• stooped posture
• shuffling gait
• head bowed, body flexed forward, prone to falling
• pill-rolling (tremor of the thumb and
  forefinger)
• expressionless facial features
• muffled speech
• difficulty swallowing

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Parkinson Disease (contd.)

• Treatment
• no cure known managing symptoms only
• physical therapy
• drug therapy
• levodopa and carbidopa (drugs the body converts
  to dopamine)
• antidepressants
• anticholinergics (for tremor and rigidity)

49
Huntington Chorea

• a hereditary degenerative disease of the cerebral
  cortex and basal ganglia (mass of gray matter at
  the base of the cerebral hemisphere), which
  causes progressive atrophy of the brain

50
Huntington Chorea (contd.)

• Symptoms
• loss of musculoskeletal control (mild fidgeting
  to lip smacking)
• speech difficulties
• deterioration of emotional state (personality
  changes, moody behavior, loss of memory,
  paranoia, dementia)

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Huntington Chorea (contd.)

• Treatment
• Since no cure is known, treatment focuses on
  symptom control of erratic movement and agitation
  through drug therapy.
• Eventually, residential care could be necessary.

52
Amyotrophic Lateral Sclerosis

• also known as Lou Gehrig disease, a progressive
  motor neuron disease that results in motor atrophy

53
Amyotrophic Lateral Sclerosis (contd.)

• Symptoms
• initially, small, involuntary contractions
  (fasciculations) of the forearms and hands
• as disease progresses, muscle atrophy sets in and
  creates difficulties with
• speech
• swallowing
• chewing
• breathing

54
Amyotrophic Lateral Sclerosis (contd.)

• Treatment
• Since no cure is known, treatment is directed at
  controlling symptoms through drug therapy,
  maintaining pulmonary function, and providing
  supportive services.

55
Transient Global Amnesia

• a temporary amnesia of short duration (several
  hours) that is marked by sudden onset, loss of
  recent memories, and an inability to form new
  memories

56
Transient Global Amnesia (contd.)

• Symptoms
• sudden onset of memory loss (includes current and
  recent events but not self-identity)
• confusion
• repetitive questioning (Where am I?, etc)
• no recollection of events of past few hours or
  possibly days when amnesia period ends

57
Transient Global Amnesia (contd.)

• Cause is uncertain.
• Suspected links
• stress or emotional events
• swimming or immersion in cold water
• previous migraine headache
• Prognosis is good recurrence very unlikely.

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Chapter 13Lesson 13.3
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Peripheral Nerve Disorders Peripheral Neuritis

• degeneration of the peripheral nerves that extend
  to the extremities, leading to muscle weakness
  and sensory loss

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Peripheral Neuritis (contd.)

• Can be caused by
• chronic alcohol use
• infectious diseases (mumps, pneumonia,
  diphtheria)
• toxicity from various substances (arsenic, lead,
  etc.)
• metabolic or inflammatory diseases (diabetes,
  rheumatoid arthritis, gout, lupus)
• nutritional deficiency diseases

61
Peripheral Neuritis (contd.)

• Symptoms
• clumsiness
• loss of sensation in hands and feet
• wasting of muscle tone
• glossy or red appearance to skin
• decreased sweating
• possible foot drop

62
Peripheral Neuritis (contd.)

• Treatment
• eliminate exposure to toxic substances
• correct any nutritional deficiencies
• control underlying diseases
• stop alcohol consumption (if applicable)
• physical therapy
• analgesics

63
Trigeminal Neuralgia (Tic Douloureux)

• Pain originates from fifth cranial nerve, also
  called the trigeminal nerve.
• Most cases have no identified cause, but
  occasionally the condition is related to tumor,
  compression of a nerve, multiple sclerosis, or
  shingles.

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Trigeminal Neuralgia (Tic Douloureux) (contd.)
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Trigeminal Neuralgia (Tic Douloureux) (contd.)

• Symptoms
• sudden onset of excruciating pain that may affect
  one or more nerve branches
• ophthalmic branch causes pain in the eye and
  forehead
• maxillary branch involves the nose, upper lip,
  and cheek
• mandibular branch affects lower lip and outer
  portion of the tongue and cheek near the ear

66
Trigeminal Neuralgia (Tic Douloureux) (contd.)

• Treatment
• analgesics for pain
• surgical intervention might be necessary to
  dissect nerve roots.
• cessation of smoking (if applicable)

67
Bell Palsy

• disorder of the facial nerve that causes a sudden
  onset of weakness or paralysis of facial muscles
• can result from blockage of impulses from the
  facial nerve caused by compression of the nerve

68
Bell Palsy (contd.)

• Symptoms (usually unilateral)
• pain or drawing sensation behind the ear
• inability to open or close the eye
• drooping of mouth
• drooling of saliva
• distorted facial expression

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Bell Palsy (contd.)

• Treatment
• warm, moist gentle heat
• massage
• facial exercises
• prednisone (synthetic steroid) to reduce edema of
  facial nerve
• analgesics
• electrotherapy to stimulate nerves and prevent
  atrophy of muscles

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Trigeminal Neuralgia and Bell Palsy
Compare/Contrast

• Similarities
• both caused by disorder of facial nerve
• sudden onset
• unilateral

Differences Trigeminal extreme pain no motor
function impairment prognosis varies

• Bell Palsy
• sudden paralysis
• motor function impaired
• prognosis is good if treated early

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Infectious Disorders Meningitis

• inflammation of the meninges, the membranous
  coverings of the brain, and the spinal cord

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Infectious Disorders Meningitis (contd.)

• Symptoms
• vomiting
• headache that increases in intensity with
  movement or shaking of head
• neck stiffness (nuchal rigidity)
• drowsiness
• irritability
• high sensitivity to light (photophobia)
• hypersensitivity of the skin

73
Infectious Disorders Meningitis (contd.)

• Diagnosis
• includes a lumbar puncture to determine if
  cerebrospinal fluid (CSF) has increased levels of
  white blood cells, protein, and glucose
• if so, resulting growth of microbes in cultured
  CSF confirms diagnosis

74
Infectious Disorders Meningitis (contd.)

• Treatment
• aggressive antibiotic therapy
• anticonvulsive drugs to control seizure activity
• aspirin or acetaminophen for headache
• dark and quiet environment

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Encephalitis

• Encephalitis is an inflammation of the brain that
  leads to cerebral edema and subsequent cell
  destruction.
• Most cases are the result of a bite from an
  infected mosquito.
• Can also be caused by viruses or the toxins from
  chickenpox, measles, or mumps.

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Encephalitis (contd.)

• Symptoms
• headache
• elevated body temperature
• neck and back stiffness
• muscular weakness
• restlessness
• visual disturbances
• lethargy
• mental confusion that may progress to
  disorientation and even to coma

77
Encephalitis (contd.)

• Diagnosis
• blood tests
• cerebrospinal fluid sample
• EEG

78
Encephalitis (contd.)

• Treatment
• antiviral agents effective against herpes simplex
  encephalitis.
• otherwise
• mild analgesics for pain
• anticonvulsive
• antibiotics for any present infection

79
Guillain-Barré Syndrome

• An acute, rapidly progressive disease of the
  spinal nerves
• This condition is thought to have an autoimmune
  basis and has been known to follow a respiratory
  infection or gastroenteritis.

80
Guillain-Barré Syndrome (contd.)

• Symptoms
• tingling and numbness of feet and hands at onset
  of disease
• followed by
• increasing muscle pain and tenderness
• progressive muscle weakness
• paralysis
• difficulty swallowing

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Guillain-Barré Syndrome (contd.)

• Treatment
• hospitalization required for observation
• blood plasma washed to remove antibodies (called
  plasmapheresis) and speed recovery

82
Brain Abscess

• a collection of pus anywhere in the brain tissue
• can be caused by a local infection or secondary
  infections elsewhere in the body

83
Brain Abscess (contd.)

• Symptoms
• headache (prime symptom)
• other symptoms depend on location and extent of
  abscess, amount of cranial pressure, and can
  include
• nausea and vomiting
• visual disturbances
• unequal pupil size (anisocoria)
• seizures

84
Brain Abscess (contd.)

• Treatment
• intravenous antibiotics
• mannitol or steroids to reduce cerebral edema
• surgical drainage of abscess to relieve pressure

85
Poliomyelitis and Postpolio Syndrome

• Poliomyelitis is a viral infection of the gray
  matter of the spinal cord that causes a selective
  destruction of the motor neurons.
• Postpolio syndrome is a condition affecting
  poliomyelitis patients several decades after the
  initial attack, characterized by fatigue,
  muscular deterioration, pain in the joints, and
  respiratory problems.

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Poliomyelitis and Postpolio Syndrome (contd.)

• Symptoms
• low-grade fever
• profuse discharge from nose
• malaise
• these symptoms are followed by
• muscle weakness
• stiff neck
• nausea and vomiting
• atrophy of muscles
• muscle and joint deterioration

87
Poliomyelitis and Postpolio Syndrome (contd.)

• Treatment
• analgesics
• moist heat
• bed rest
• physical therapy
• leg braces
• mechanical ventilation

88
Intracranial Tumors (Brain Tumors)

• These tumors can be primary (originate in the
  brain itself) or secondary (cancer that has
  metastasized from another area of the body).

89
Intracranial Tumors (Brain Tumors) (contd.)

• Symptoms result from a displacement and
  compression of normal brain tissue by the tumor
  and include
• headache (usually dull, constant, and worse at
  night or in the morning)
• seizures
• nausea and vomiting
• loss of consciousness
• cognitive dysfunction (memory problems and
  personality changes)

90
Intracranial Tumors (Brain Tumors) (contd.)

• Diagnosis
• detailed history
• neurologic examination
• diagnostic imaging studies
• cranial MRI (preferred option)
• functional MRI
• tissue sample (from surgery or biopsy)

91
Intracranial Tumors (Brain Tumors) (contd.)

• Treatment primary tumors
• benign and malignant tumors often treated
  similarly
• surgery
• radiotherapy
• chemotherapy
• anticonvulsants to treat seizures
• corticosteroids to help decrease intracranial
  pressure
• anticoagulants to prevent blood clotting

92
Intracranial Tumors (Brain Tumors) (contd.)

• Treatment secondary tumors
• focuses on relief of neurological symptoms and
  long-term tumor control
• patients with solitary brain lesions and no other
  sites of metastasis undergo
• surgery
• whole brain radiation therapy

93
Intracranial Tumors (Brain Tumors) (contd.)

• Prognosis
• The five-year survival rate for all types of
  brain tumors combined is 32, which is among the
  lowest for all types of cancer.