LP4 Assignment: Nervous System Diseases and Disorders This assignment will asses

Question

LP4 Assignment: Nervous System Diseases and Disorders

This assignment will assess the competency 4. Explore nervous system diseases and disorders. (Ch. 10)

Directions: This chapter identified nine types of nervous system diseases and disorders. Create a chart listing the nine types of nervous system diseases and disorders, their definition, etiology, signs and symptoms of each disease or disorder, diagnostic procedures used to identify each disease or disorder, and treatment options for each disease or disorder. This chart can be created in a WORD or EXCEL document.

Chart must contain names chart nine types of nervous system diseases and disorders, their definition, etiology, signs and symptoms of each disease or disorder, diagnostic procedures used to identify each disease or disorder, and treatment options for each disease or disorder. This chart can be created in a WORD or EXCEL document.

Ensure proper spelling, grammar, formatting, and APA style in-text citations and references are used.

Nervous System Disease/Disorder Definition Etiology Signs and Symptoms Diagnostic Procedures Treatment

Explanation / Answer

NERVOUS SYSTEM DISEASE/DISORDER

DEFINITION

ETIOLOGY

SIGNS & SYMPTOMS

DIAGNOSTIC PROCEDURES

TREATMENT

Also known as Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) or Landry’s Syndrome, is an acute inflammatory condition involving the spinal nerve roots, peripheral nerves and selected cranial nerves.

It may follow

2.Multiple Sclerosis (MS)

MS is a diffuse, chronic, inflammatory demyelinating disease of the CNS. Also known as the Disseminated Sclerosis. It is primarily a disorder of the myelin sheath.

No known cause. There are three theories:

Weakness

Spasticity

Intention tremor

Ataxia

Fatigue

incoordination

Numbness

Tingling

Impaired vibration and proprioception

Dysesthesia

Blurring of vision

Diplopia

Nystagmus

3.Bell’s Palsy

It is an acute inflammatory disorder that affects the facial nerve (7th CN). It is characterized by an acute paralysis of the face related to inflammation and swelling of the facial nerve within the facial canal or at the stylomastoid foramen.

4.Parkinson’s Disease

It is a chronic progressive neuromuscular condition characterized by rigidity, bradykinesia, resting tremor and postural abnormalities

5.Syringomyelia

It is the acquired development of a cavity (syrinx) within the central spinal cord,

MRI is the investigation of choice

6.Amylotrophic lateral sclerosis (ALS)

Also known as Lou Gehrig’s disease is characterized by degeneration of a select group of motor neurons cells and their axons located in the spinal cord and cranial nerve nuclei.

7.Transverse myelitis

Myelitis is an inflammation of the spinal cord. When the lesion is limited longitudinally to a few segments it is described as transverse myelitis.

8.Meningitis

Inflammation of the layes of meninges (pia and arachnoid usually)

9.Myasthenia Gravis

It is characterized by fluctuating weakness of skeletal muscles especially ocular muscles and other muscles innervated by cranial nerves with improvement on cholinergic drugs.

NERVOUS SYSTEM DISEASE/DISORDER

DEFINITION

ETIOLOGY

SIGNS & SYMPTOMS

DIAGNOSTIC PROCEDURES

TREATMENT

1. Gullian- Barre Syndrome (GBS)

Also known as Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) or Landry’s Syndrome, is an acute inflammatory condition involving the spinal nerve roots, peripheral nerves and selected cranial nerves.

It may follow

• viral infection, e.g. Campylobacter jejuni and cytomegalovirus infection.
• Toxic or metabolic causes such as diabetes, alcohol abuse, chronic exposure to heavy metals

• Rapid onset
• Symmetrical weakness, begins from the legs and progresses to the arms (paralysis starts distally and moves proximally)
• Motor impairment may vary from mild weakness of distal LE muscles to total paralysis of the peripheral, axial, facial and extraocular musculature.
• Tendon reflexes are diminished or absent
• Sensory symptoms such as hyperaesthesia, paresthesia, numbness and decreased vibration and position sense are common.
• Sensory disturbance has a glove-and-stocking pattern
• pain

• Lumbar puncture
• Electromyogram (EMG)
• Nerve Conduction Velocity (NCV)

• Supportive care with prevention of respiratory and autonomic complications.

• Plasmapheresis is the treatment of choice in acute patients.

• Immunosuppressive drugs are given.

• Analgesics for pain.

• Steroids are not indicated.

• Daily infusion of immunoglobulin IV is given for the first 2 weeks

• When respiratory assistance is likely to exceed 2 weeks, tracheostomy is done.

2.Multiple Sclerosis (MS)

MS is a diffuse, chronic, inflammatory demyelinating disease of the CNS. Also known as the Disseminated Sclerosis. It is primarily a disorder of the myelin sheath.

No known cause. There are three theories:

• Caused by a slow-acting virus infection suppressing the immune system
• An autoimmune response
• Genetic predisposition

• Sudden onset
• Motor disturbances include:

Weakness

Spasticity

Intention tremor

Ataxia

Fatigue

incoordination

• Sensory symptoms:

Numbness

Tingling

Impaired vibration and proprioception

Dysesthesia

• Visual Symptoms:

Blurring of vision

Diplopia

Nystagmus

• Urinary incontinence or urinary retention
• Urinary urgency
• Dysartria
• Impotence
• Vertigo
• Dysphagia
• Depression
• Emotional Lability
• Trigeminal neuralgia

• MRI of brain and spinal cord
• Lumbar puncture

• During exacerbation patients are treated with bed rest and limited activity until symptoms subside.
• Steroids in case of acute exacerbation.
• Muscle relaxants are used to reduce spasticity.
• Anticholinergic drugs and intermittent catheterization are used for bladder management
• Beta blockers are used to prevent tremors.
• Anticonvulsant for seizures
• Analgesics and NSAIDs for pain.

3.Bell’s Palsy

It is an acute inflammatory disorder that affects the facial nerve (7th CN). It is characterized by an acute paralysis of the face related to inflammation and swelling of the facial nerve within the facial canal or at the stylomastoid foramen.

• Uncertain
• Maybe associated with viral infection eg herpes simplex

• Sudden onset
• Pain and ache behind the ear are the first symptom
• Weakness and a sensation of pricking, tingling on the face
• One side of the face is expressionless
• Eye cannot be closed on the affected side
• Eye on the affected side may produce tears
• There is excessive salivation
• Impairment of taste
• Difficulty in speaking
• Wrinkles disappear from the forehead
• Face becomes asymmetrical and drawn to the normal side

• MRI
• CT scan

• Symptomatic treatment with analgesics.
• In case of complete paralysis, after 5 days treatment with steroids.
• Galvanic stimulation is given
• Plastic surgery when severe paralysis persists after 6 months
• Use of eye drop if no lacrimation
• Surgical decompression of facial nerve in the canal.
• Protect the eyes from direct sun exposure and during sleep.

4.Parkinson’s Disease

It is a chronic progressive neuromuscular condition characterized by rigidity, bradykinesia, resting tremor and postural abnormalities

• Unknown
• Gene mutation
• Viral infection
• Genetic predisposition

• Rigidity either lead pipe or cogwheel
• Natural arm swing is absent
• Mask like fixed expression
• Handwriting becomes micrographic
• Bradykinesia (slowness in movement)
• Balance deterioration
• Freezing before walking
• Drooling
• Voice becomes low pitched, slurred and monotonous with little rhythm but an increased pace (fast mumble)
• Pill rolling tremor
• Dysphagia
• Dementia
• Bladder dysfunction

• Thorough neurological examination
• PET Scan

• No cure
• Chemotherapy :Levodopa and carbiodopa
• Surgery: Stereitactic thalamotomy (rarely used) and tissue autotransplantation

5.Syringomyelia

It is the acquired development of a cavity (syrinx) within the central spinal cord,

• Usually caused by abnormal formation of posterior fossa and foramen magnum
• Spinal Dysraphism
• Spinal Cord Injury
• Idiopathic Syringomyelia

• Loss of pain and temperature sensation in a cape-like distribution over the arms, shoulders and upper body
• Painless burns are a classic sign
• Light touch, vibration and position sense in the feet are affected.
• Muscle wasting and weakness that begins distally and progresses proximally
• Tendon reflexes are lost
• Claw hand maybe present
• Maybe respiratory muscle involvemet
• Winging of scapula
• Kyphoscoliosis is usually associated.

MRI is the investigation of choice

• Approach depends on progression of symptoms and the presence or absence of an associated chiari malformation.
• If Chiari malformation is present- Surgical decompression at the foramen magnum
• IF no Chiari malformation- Syringoplasty

6.Amylotrophic lateral sclerosis (ALS)

Also known as Lou Gehrig’s disease is characterized by degeneration of a select group of motor neurons cells and their axons located in the spinal cord and cranial nerve nuclei.

• Etiology is unknown. Theories include:
• Slow acting virus infection
• Toxic degeneration
• Autoimmune reaction
• Hormonal abnormalities
• Lead toxicity

• Progressive weakening and wasting of distal musculature
• Painful muscle spasms and paresthesia
• Spasticity
• Dysphagia
• Slurred speech
• Difficulty breathing

• EMG
• NCV
• MRI
• Lumbar puncture
• Muscle biopsy
• Blood and urine tests

• Treatment is symptomatic
• Gastrostomy / tracheostomy or both for patients with swallowing difficulty.
• Tranquilizers and antidepressants
• Postural drainage to remove secretions

7.Transverse myelitis

Myelitis is an inflammation of the spinal cord. When the lesion is limited longitudinally to a few segments it is described as transverse myelitis.

• Viral infection such as cytomegalovirus
• It can be associated with bacterial infection

• Localized low back pain
• Sudden paresthesia in the legs
• Sensory loss begins in the distal part of legs and ascends upwards
• Paraparesis progressing to paraplegia
• Urinary bladder and bowel dysfunction
• Pain is the primary presenting symptom
• Arm and hand incoordination
• Tendon reflexes are diminished or lost
• Abdominal reflexes are lost below the level of lesion.
• Plantar response maybe absent at first then becomes extensor

• MRI
• CT Scn
• Myelography

• No cure
• Treatment focuses on relieving the inflammation.
• Steroids arethe most common treatment
• Ibuprofen and bed rest is recommended.

8.Meningitis

Inflammation of the layes of meninges (pia and arachnoid usually)

• Meningococci (above 4 yrs)
• Pneumococci (above 45 years)
• Haemophilus influenza (within 4 years)
• Middle ear infection (commonest)
• Droplet infection
• Head injury

• Temperature is raise 102 degree F to 104 degree.
• Headache
• Photophobia
• Generalised flexed attitude
• Neck rigidity
• Kernigs sign is positive
• Pupils are iirregular and irregularly react to light
• Vomiting
• Plantar response is extensor
• Jerks are brisk
• Anterior fontanelle is bulged in children
• Papilloedema becomes prominent
• Cranial nerve palsy

• Blood examination
• Lumbar puncture
• CT scan

• Bed rest
• Chemotherapy: choice of agent depends on sensitivity test
• If there is circulatiry collapse 5 % dextrose in normal saline IV drip is started with steroids
• Symptomatic treatment of headache with aspirin
• Polyvitamins are given

9.Myasthenia Gravis

It is characterized by fluctuating weakness of skeletal muscles especially ocular muscles and other muscles innervated by cranial nerves with improvement on cholinergic drugs.

• Unknown
• Due to presence of circulating antibodies (IgG) to acetyl choline receptors
• Thymic hyperplasia in 70 % cases

• Abnormal fatigue of skeletal muscles. Prominent at the end of the day.
• Earliest symptom is ptosis and diplopia
• Tiredness during chewing, swallowing, speaking and in movement of limbs.
• Tongue is weak and furrowed on either side known as trident tongue.
• Due to weakness of masseter muscle mouth may not close and the jaw hangs down (hanging jaw sign)
• Relapses are seen during emotional upset, pregnancy, severe exercise or premenstrual period.

• Acetyl choline receptor antibodies maybe present in 90% of cases
• Chest X-ray (PA)
• Ct Scan
• Muscle biopsy

• Avoid fatigue, exercise, infection,etc.
• Prostigmine is given orally 4 times daily
• Pyridostigmine maybe given

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