Neurological Disorders

Definitions of Key Words

• Receptor: A structure specialized to detect a stimulus.
e.g. Nerve endings and sense organs
• Nociceptor: is pain receptor which responds to tissue
damage resulting from trauma, ischemia, or excessive
stimulation (as heat or chemicals).
• Sensation: is a conscious awareness of a stimulus.
• All sensory information cannot produce sensation.
• Sensory receptors transmit four kinds of information
as:
location, intensity, duration
• Sensory projection: is the ability of brain to locate the
site of stimulation.
• Projection pathway: is the pathway followed by
sensory signal to its ultimate destination in CNS.
 Somatosensory System
• Somatosensory system is defined as the sensory system
• associated with different parts of the body.
• Sensations are:
• 1. Somatic sensations
• 2. Visceral sensations
• 3. Special sensations.
• Somatic Sensations
• Somatic sensations are the sensations arising from skin,
muscles, tendons and joints. These sensations have
specific receptors, which respond to a particular type of
stimulus.
• Special Sensations
• Special sensations are the complex sensations for which
the body has some specialized sense organs.
• These sensations are usually called special
senses. Sensations of vision, hearing, taste
and smell are the special sensations.
• Visceral sensations arising from viscera
 Pain

• Pain is a subjective experience, usually arising from

activity within the neural structures, and (usually)
leads to an unpleasant sensation in a part/parts of
the body.

• It may arise in response to:

1) damage to body tissues
2) changes in the functions of the brain/nerve
tissue itself
3) biochemical changes
 Pain Perception

• Pain perception is a protective mechanism for

the body
• Pain is a sensation warns of a potential or actual
damage of tissue and alerts the victim to avoid or
treat it.
• Enables the individual to protect the tissues
against further body damage.

Severe damage to body parts has been observed

in conditions leading to an absence or reduction
in the perception of pain
 Pain
• Pain is divided into two main types:
• Fast pain .......experienced within 0.1 sec
• Slow pain....... experienced 1 sec or later
• Fast pain is described as sharp, acute, or pricking
pain (almost confined to skin)
• Slow pain is described as burning, aching, or
throbbing pain as in case of abscess or arthritis
• Slow pain can occur in any tissue.
• Somatic pain
• Visceral pain
 Pain Sensory Nerve fibers

• Fast pain travels in peripheral nerves in large

diameter A delta fibers at velocity of b/w 6 and
30 m/sec.
• Slow pain travels in the small diameter C fibers
at velocity b/w 0.5 to 2 m/sec.
• The main excitatory neurotransmitters released
by the A delta and C fibers is the amino acid
glutamate.
• A neuropeptide substance P is also released by C
fibers
 Mechanism of Pain Relief
• Heat therapy induces vasodilation: drawing
blood into the target tissues. Increased blood
flow delivers needed oxygen and nutrients
and pain releivers, and removes cell wastes.
• The warmth decreases muscle spasm, relaxes
tense muscles, relieves pain, and can increase
range of motion.
 Hot or Cold Fomentation?
• It depends upon the condition, however, as a
general rule of thumb, use ice (psychrotherapy)
for acute injuries or pain, along with
inflammation and swelling.
• Use heat (thermotherapy) for muscle pain or
stiffness.
 Transcutaneous Electrical Nerve
Stimulation (TENS)
• TENS to relieve pain for several different types of
illnesses and conditions. They use it most often to
treat muscle, joint, or bone problems that occur
with illnesses such as osteoarthritis or fibromyalgia,
or for conditions such as low back pain, neck pain,
tendinitis, or bursitis.
• Mechanism
• TENS activates a complex neuronal network to
reduce pain. At specific frequencies and intensities
TENS activates large diameter afferent fibers. This
afferent input is sent to the central nervous system
to activate descending inhibitory systems
to reduce hyperalgesia.
 Brain stroke

A stroke occurs when an artery to the brain becomes blocked or

ruptures, resulting in death of an area of brain tissue due to loss of
its blood supply (cerebral infarction) and symptoms that occur
suddenly.
 COMMON TYPES OF BRAIN STROKE

• Ischemic stroke: It occurs as a result of an obstruction within a

blood vessel supplying blood to the brain.
• Hemorrhagic stroke: It occurs when a weakened blood vessel
ruptures.
• Transient Ischemic Attack (TIA): It is an ischemic stroke which is
caused by a temporary clot.
• It is a warning or ministroke.
CT findings
 PREVELANCE
• Worldwide, stroke is the second most common cause of
death. In the United States, strokes are the fifth most
common cause of death and the most common cause of
disabling nervous system damage in adults. In the United
States, about 795,000 people have a stroke, and about
130,000 die of stroke each year.
• Strokes are much more common among older people than
among younger adults, usually because the disorders that
lead to strokes progress over time. Over two thirds of all
strokes occur in people older than 65. Stroke is more
common among women than among men, and nearly 60%
of deaths due to stroke occur in women, possibly because
women are on average older when the stroke occurs.
 Brain Arterial Circulation
• Blood supply to the brain is so critical that it is
furnished by several arterial anastomoses, especially
an array of arteries called the arterial circle (circle of
Willis), which surrounds the pituitary gland and
optic chiasm. The arterial circle receives blood from
the internal carotid and basilar arteries.
• Only 20% of people have a complete arterial circle.
It consists of
• 1. two posterior cerebral arteries,
• 2. two anterior cerebral arteries
• 3. two posterior communicating arteries,
• 4. One anterior communicating artery.
 Con….
• The circle of Willis begins to form when the right
and left internal carotid artery (ICA) enters the
cranial cavity and each one divides into two main
branches: the anterior cerebral artery (ACA) and
middle cerebral artery (MCA).
• The circle of Willis provides collateral blood flow
between the anterior and posterior circulations of
the brain, protecting against ischemia in the event
of vessel disease or damage in one or more areas.
 Cerebral Circulation

• Total blood flow to the brain fluctuates less than

that of any other organ (about 700 mL/min at rest).
• Such constancy is important because even a few
seconds of oxygen deprivation causes loss of
consciousness, and 4 or 5 minutes of anoxia is time
enough to cause irreversible brain damage.
• The brain regulates its own blood flow in response
to changes in BP and chemistry.
• The cerebral arteries dilate when the systemic BP
drops and constrict when BP rises
Cerebral circulation
 Cerebral Circulation

• The main chemical stimulus for cerebral autoregulation is pH.

• Poor cerebral perfusion allows CO2 to accumulate in the brain
tissue.
• This lowers the pH of the tissue fluid and triggers local
vasodilation, which improves perfusion.
• hypocapnia, raises the pH and stimulates vasoconstriction, thus
reducing perfusion and giving CO2 a chance to rise to a normal
level.
• Hyperventilation (exhaling CO2 faster than the body produces it)
induces hypocapnia, which leads to cerebral vasoconstriction,
ischemia, dizziness, and sometimes syncope.
 Hypoxia, Ischemia, and Infarction
• The brain requires a constant delivery of glucose
and oxygen from the blood.
• Although the brain accounts for only 1% to 2% of
body weight, it receives 15% of the resting cardiac
output and accounts for 20% of the total body
oxygen consumption.
• The brain is a highly aerobic tissue.
• The brain may be deprived of oxygen by any of
several mechanisms: functional hypoxia in a setting
of a low partial pressure of oxygen; impaired
oxygen-carrying capacity; or ischemia, either
transient or permanent, after interruption of the
normal circulatory flow.
 TIA

• Brief episodes of cerebral ischemia produce

transient ischemic attacks (TIAs),
characterized by temporary dizziness, light-
headedness, loss of vision or other senses,
weakness, paralysis, headache, or aphasia.
• A TIA may result from spasms of diseased
cerebral arteries. It lasts from just a moment
to a few hours and is often an early warning of
an impending stroke.
 5 Warning Signs of Stroke

• Sudden numbness or weakness in the face,

arm or leg (especially on one side of the
body).
• Sudden confusion or trouble speaking or
understanding speech.
• Sudden vision problems in one or both eyes.
• Sudden difficulty walking or dizziness, loss of
balance or problems with coordination.
• Severe headache with no known cause.
 Risk Factors of Stroke

• Smoking
• Diabetes
• High cholesterol
• Physical inactivity and obesity
• Carotid or other cerebral arterial disease
• Certain blood disorders
 Major modifiable risk factors
• The major modifiable risk factors for both types of stroke are
• High blood pressure
• High cholesterol levels
• Diabetes
• Insulin resistance (an inadequate response to insulin), which occurs
in type 2 diabetes
• Cigarette smoking
• Obesity, particularly if the excess weight is around the abdomen
• Consumption of too much alcohol
• Lack of physical activity
• An unhealthy diet (such as one that is high in saturated fats, trans
fats, and calories)
• Depression or other mental stresses
Parkinson's Disease
 Parkinson's Disease
 Parkinson disease is a slowly progressive chronic
degenerative disease of nervous system
associated with destruction of brain cells , which
produce dopamine.
 It primarily affects the neurons of the basal
ganglia.
 It is also called Parkinsonism or Paralysis agitans.
 Parkinson's disease involves an imbalance
between dopamine and acetylcholine, two
chemicals involved in transmitting signals from
the brain
 Etiology
 Parkinson disease affects men and women about
equally and useually occurs after the age of 50.
 Parkinson disease occurs due to lack of
Dopamine caused by demage of basal ganglia.It
is mostly due to the destruction of Substantia
nigra and the Nigrostraital pathway,which has
dopaminergic fibers.Demage of basal ganglia
useually occurs because of the following causes:
1. Viral infection of brain like Encephalitis
 Etiology
2. Cerebral arteriosclerosis
3. Injury to basal ganglia
4. Destruction or removal of dopamine in
basal ganglia .It occurs mostly due to long-
term treatment with antihypertensive drugs
like reserpine.
Drug-induced parkinsonism.
5. Idiopathic parkinsonism
 Signs and Symptoms
 Parkinson disease develops very slowly and the early signs
and symptoms may be unnoticed for months or even for years
.Often the symptoms start with a mild noticeable tremor in
just one hand.
Following are the common signs and symptoms of parkinson
disease.
 Tremor
 Regidity
 Bradykinesia
 Akinesia
 Hypokinesia
 Postural instability
 Speech problems
 Emotional changes
 Dementia
 Complications
• Thinking difficulties
• Depression and emotional changes
• Swallowing problems
• Sleep problems and sleep disorders
• Bladder problems
• Constipation
• Blood pressure changes.
• Smell dysfunction.
• Fatigue
• Pain
• Sexual dysfunction
Meningitis
,
 Meningitis:
• Meningitis is the inflammation of the
protective membranes covering the brain and
spinal cord, known collectively as the
meninges.
 Pathophysiology
• Microorganisms (bacteria, viruses etc) reach the nervous system by
many routes. The most common route is the blood stream and bacteria
in the nasopharynx may enter the blood stream during an upper
respiratory infection. Once the organisms reaches the brain. The CSF in
the subarachnoid space and the arachnoid membrane infected.
• The infection is then spread rapidly through out the meninges and
eventually invades the ventricles. The inflammatory response to the
infection tends to increase CSF production with a moderate increase in
pressure. In bacterial meningitis, the pus secretion produced quickly
spreads to other areas of the brain through the CSF.
• If this process extends into the brain parenchyma, cerebral edema and
increased ICP become more problem.
 Signs and symptoms:
• Fever
• Altered consciousness, irritability.
• Vomiting, poor appetite.
• Seizures 20 - 30%
• Stiff neck or nuchal rigidity

(stiff neck + Brudzinski + Kernig signs)

 Management
• Treat seizures in the setting of meningitis immediately.

• Administer antibiotics.

– Antibiotics must not be delayed for more than 30 minutes once the
decision to treat has been made.
– A delay to antibiotics is associated with poorer outcomes.

• Blood tests.

– Blood cultures.
– Full blood count.

– Glucose, urea and electrolytes.

• Lumbar Puncture.

– Delay to LP should not delay antibiotic administration.

– LP may be delayed due to the severity of the child’s condition.
EPILEPSY
.
 EPILEPSY
• It is a group of chronic CNS disorders
characterized by recurrent, periodic and
unpredictable seizures.
• Seizures are sudden and uncontrolled
episodes of brain dysfunction resulting from
abnormal discharge of neuronal cells with
associated motor, sensory or behavioral
changes.
• Epilepsy is a disorder of the brain characterized
by repeated seizures. A seizure is usually
defined as a sudden alteration of behavior due
to a temporary change in the electrical
functioning of the brain. Normally, the brain
continuously generates tiny electrical impulses
in an orderly pattern. These impulses travel
along neurons — the network of nerve cells in
the brain — and throughout the whole body via
chemical messengers called neurotransmitters.
• In epilepsy the brain's electrical rhythms have
a tendency to become imbalanced, resulting
in recurrent seizures. In patients with
seizures, the normal electrical pattern is
disrupted by sudden and synchronized bursts
of electrical energy that may briefly affect
their consciousness, movements or
sensations.
 Con…
• Seizure
• True seizure
• Psuedo seizure
• Tonic
• Clonic
• Tonic clonic
• Epilepsy is usually diagnosed after a person
has had at least two seizures that were not
caused by some known medical condition,
such as alcohol withdrawal or extremely low
blood sugar
epilepsy
 Prevalence and Incidence

• According to the Epilepsy Foundation, epilepsy

affects three million people in the U.S. and 50
million worldwide. Epileptic seizures may be tied
to a brain injury or genetics, but for 70 percent
of epilepsy patients, the cause is unknown.
Epilepsy affects more than 300,000 children
under the age of 15 — and more than 90,000
young people in this group have seizures that
cannot be adequately treated
 Causes of Seizure Disorder
• Idiopathic (unknown)
• CNS defects or infection
• Head trauma
• Brain tumors
• CVA- cerebral vascular disease
• Metabolic disorders
•
EEG
ALZHEIMER DISEASE
 Definition
• Alzheimer’s disease (AD) is a chronic,
progressive, irreversible, degenerative
neurologic disease that begins insidiously and
is characterized by gradual loss of cognitive
function and disturbances in behavior and
affect.
 SIGNS & SYMTOMS
• Memory loss: A person may have difficulty taking in new information
and remembering information. This can lead to:
– repeating questions or conversations
– losing objects
– forgetting about events or appointments
– wandering or getting lost
• Cognitive deficits: A person may experience difficulty with reasoning,
complex tasks, and judgment. This can lead to:
– a reduced understanding of safety and risks
– difficulty with money or paying bills
– difficulty making decisions
– difficulty completing tasks that have several stages, such as getting dressed
• Problems with recognition: A person may become less able to recognize
faces or objects or less able to use basic tools. These issues are not due
to problems with eyesight.
 CON..
• Problems with spatial awareness: A person may have difficulty
with their balance, trip over, or spill things more often, or they
may have difficulty orienting clothing to their body when getting
dressed.
• Problems with speaking, reading, or writing: A person may
develop difficulties with thinking of common words, or they may
make more speech, spelling, or writing errors.
• Personality or behavior changes: A person may experience
changes in personality and behavior that include:
– becoming upset, angry, or worried more often than before
– a loss of interest in or motivation for activities they usually enjoy
– a loss of empathy
– compulsive, obsessive, or socially inappropriate behavior
• Mild Alzheimer’s disease
• People with mild Alzheimer’s disease develop
memory problems and cognitive difficulties that
may include the following:
• taking longer than usual to perform daily tasks
• difficulty handling money or paying the bills
• wandering and getting lost
• experiencing personality and behavior changes,
such as getting upset or angry more easily,
hiding things, or pacing
• Moderate Alzheimer’s disease
• In moderate Alzheimer’s disease, the parts of the brain
responsible for language, senses, reasoning, and
consciousness are damaged. This can lead to the following
symptoms:
• greater memory loss and confusion
• difficulty recognizing friends or family
• an inability to learn new things
• difficulty performing tasks with several stages, such as
getting dressed
• difficulty coping with new situations
• impulsive behavior
• hallucinations, delusions, or paranoia
• Severe Alzheimer’s disease
• In severe Alzheimer’s disease, plaques and
tangles are present throughout the brain,
causing the brain tissue to shrink
substantially. This can lead to:
• an inability to communicate
• dependency on others for care
• being unable to leave bed all or most of the
time
11/1/2023