Diseases of the Nervous System

Meningitis
 Haemophilus influenzae meningitis:
 leading cause of bacterial meningitis in children
under 5 years of age. It occurs most frequently
in children from 1 month up to 4 years with a
peak at 6 to 9 months.
 The infection usually spreads from somewhere
in the respiratory tract to the bloodstream and
then to the meninges (the membranes that
cover the brain). At the meninges, the bacteria
produce infection and inflammation causing
serious illness and sometimes death
 Symptoms   
 Irritability, poor feeding in infants
 Fever (in young infants the temperature
may actually be below normal)
 Severe headache (older children)
 Nausea and vomiting
 Stiff neck or pain in neck when flexed
 Pain in back when neck is flexed
foreward and chin brought toward chest
(older children)
 Unusual body posturing
 Photophobia
 Complications   
 Roughly 20% of patients may experience
some hearing loss.
 Some patients will have brain damage,
which can include seizures, mental
retardation, hydrocephalus ("water on the
brain"), learning disorders, abnormalities
in speech and language development,
and behavioral problems
 Meningococcal Menigitis:
 infection caused by the bacterium
Neisseria meningitidis that causes
inflammation of the membranes covering
the brain and spinal cord.
 The death rate ranges from 5% to 15%,
with young children and adults over 50
having the highest risk of death.
 Symptoms:
 Rash, pinpoint red spots
(petechiae)
 Complications :
 Brain damage
 Shock
 Increased spinal fluid
pressure
 Myocarditis (inflammation
of the heart)
 Hydrocephalitis (blockage
of spinal fluid in brain)
 Deafness
 Paralysis of various muscles
 Mental retardation
 Pneumococcal meningitis:
 Streptococcus pneumoniae is the most common
cause of meningitis in adults, and the second
most common cause of meningitis in children
older than 6 years old.
 Prevention   
 Early treatment of pneumonia and ear infections
caused by pneumococcus may decrease the risk of
meningitis. There are also two effective vaccines on
the market to prevent pneumococcus infection.
 The current recommendations are for people at high
risk for pneumonia, children, and everyone over the
age of 55 to be vaccinated.
 Treatment   
 Antibiotic therapy should be started as soon as
possible. Ceftriaxone is one of the most commonly
used antibiotics.
 If antibiotic resistance is suspected, vancomycin or
rifampin are used.
 Prognosis   
 With early treatment, the outcome is better. However,
20% of people who contract this disease will die of it
and 50% have serious long-term complications
Leprosy
 Alternative names: Hansen's disease    
 An infectious disease, known since Biblical times, which is
characterized by disfiguring skin lesions, peripheral nerve
damage, and progressive debilitation.
 Causes, incidence, and risk factors  
 Leprosy is caused by the organism Mycobacterium leprae.
 It is a difficult disease to transmit and has a long
incubation period, which makes it difficult to determine
where or when the disease was contracted.
 Children are more susceptible than adults to contracting
the disease.
 2 common forms
 tuberculoid and lepromatous,
 Both forms produce lesions on the skin
 lepromatous form is most severe, producing large disfiguring
nodules.
 All forms of the disease eventually cause peripheral neurological
damage (nerve damage in the extremities) manifested by sensory
loss in the skin and weakness of the muscles.
 People with long-term leprosy may lose the use of their hands or
feet due to repeated injury which results from absent sensation.
 Leprosy is common in many countries in the world, and in
temperate, tropical, and subtropical climates.
 Approximately 100 cases per year are diagnosed in the United
States. Most cases are limited to the South, California, Hawaii,
and U.S. island possessions.
 Effective medications exist, and isolation of victims in "leper
colonies" is unnecessary.
 The emergence of drug-resistant Mycobacterium leprae, as well
as increased numbers of cases worldwide, have led to global
concern about this disease.
 Symptoms include:
 one or more hypopigmented skin lesions that
have decreased sensation to touch, heat, or
pain
 skin lesions that do not heal after several weeks
to months
 numbness or absent sensation in the hands and
arms, or feet and legs
 Muscle weakness resulting in signs such as foot
drop (the toe drags when the foot is lifted to take
a step)
 Treatment   
 Medications used to eliminate the microorganism and
to reduce symptoms include:
 Dapsone
 Rifampin
 Clofazimine
 Ethionamide
 Aspirin, prednisone, or thalidomide are used for the control of
inflammation (e.g., "erythema nodosum leprosum") that may
occur with therapy
 Expectations (prognosis)   
 Early recognition is important. Early treatment limits
damage by the disease, renders the person
noninfectious, and allows for a normal lifestyle.
 Complications   
 permanent nerve damage
 cosmetic disfigurement
Polio
 Symptoms   
 There are three basic patterns of polio infection:
subclinical infections, nonparalytic, and paralytic.
 Most (95%) are subclinical infections, which may go
unnoticed.
 Clinical poliomyelitis affects the central nervous
system (brain and spinal cord) and is divided into
nonparalytic and paralytic forms.
 It may occur after recovery from a subclinical
infection.
 SUBCLINICAL INFECTION: no symptoms, or
symptoms lasting 72 hours or less
 Slight fever
 headache
 general discomfort or uneasiness (malaise)
 Sore throat
 red throat
 vomiting
 NONPARALYTIC POLIOMYELITIS
 symptoms last 1 to 2 weeks
 Moderate fever
 headache
 Stiff neck
 vomiting
 diarrhea
 Excessive tiredness, fatigue
 irritability
 pain or stiffness of the back, arms, legs, abdomen
 muscle tenderness and spasm in any area of the body
 Neck pain
 pain front part of neck
 Neck stiffness
 Back pain or backache
 Leg pain (calf muscles)
 Skin rash or lesion with pain
 muscle stiffness
 PARALYTIC POLIOMYELITIS
 fever, occurring 5 to 7 days before other symptoms
 headache
 stiff neck and back
 Muscle weakness, asymmetrical
 Abnormal sensations (but not loss of sensation) of an area
 sensitivity to touch, mild touch may be painful
 Difficulty beginning to urinate
 constipation
 Bloated feeling of abdomen
 Swallowing difficulty
 Muscle pain
 Muscle contractions or muscle spasms, particularly in the calf, neck, or
back
 drooling
 Breathing difficulty
 irritability or poor temper control
 positive Babinski’s reflex
 Treatment   
 The goal of
treatment is to
control symptoms
while the infection
runs its course.
 Tetanus: A disease caused by the toxin of the
bacterium Clostridium tetani that affects the
central nervous system, sometimes resulting in
death.
 Infection begins when the spores are introduced into
an injury or wound.
 The spores germinate, releasing active bacteria that
multiply and produce a neurotoxin, called
tetanospasmin.
 Tetanospasmin selectively blocks inhibitory nerve
transmission from the spinal cord to the muscles,
allowing the muscles to go into severe spasm.
 Prevention   
 Tetanus is completely preventable by active tetanus
immunization (vaccine).
 Tetanus immunizations are begun in infancy as a
series of DPT shots (D = diptheria, P = pertussis or
whooping cough, and T = tetanus).
 Boosters are given to teenagers and older adults as
Td shots (adult tetanus and diphtheria) or singly as
just tetanus.
 Immunization is considered to provide protection for
ten years.
 Studies in the army suggest that good protection
persists up to 12 years after the last immunization.
 Symptoms   
 spasms and tightening of the jaw muscle (hence the
name lockjaw)
 Stiffening of the neck and other muscles
 Spasms of the neck and other muscles
 Stiffness of the chest muscles
 Stiffness of the abdominal muscles (abdominal
stiffness)
 Spasms and stiffness of the back muscles, often
causing arching (opisthotinosis)
 Tetanic seizures (painful, powerful bursts of muscle
contraction)
 Irritability
 fever
 Treatment   
 Control and reverse the tetany with antitoxin, tetanus immune
globulin.
 Penicillin can be given to kill the Clostridium tetani; other
antibiotics such as clindamycin, erythromycin, or metronidazole
can be used in patients who are allergic to penicillin.
 Remove and destroy the source of the toxin through surgical
exploration and cleaning of the wound (debridement).
 Treat symptoms with supportive therapy.
 Muscle spasms can be treated with muscle relaxants such as
diazepam. 
 Bedrest with a non-stimulating environment is also
recommended (dim light, reduced noise, and stable
temperature).
 Sedation may be necessary to keep the affected person quiet.
  Respiratory support with oxygen, endotracheal tube, and
mechanical ventilation may be necessary.
 Botulism

 Signs and Symptoms:

Infant botulism is usually seen in children
under 6 months of age. The children may
receive medical attention because of
symptoms such as constipation, poor sucking
action, a weak cry, and a general,
progressive muscle weakness.
 Description:
 Infant botulism is caused by Clostridium bacteria that
live in soil and dust.
 These bacteria may also contaminate foods,
especially honey. 
 Clostridium bacteria produce a toxin (poison) called
botulinum toxin, which blocks the normal messages
between muscles and nerves and affects muscles
everywhere in the body.
 The toxin usually affects intestinal muscles first.
 Infant botulism occurs worldwide, and 98% of cases
occur in infants between 1 to 6 months of age.
 In the United States, most cases of infant botulism
cannot be prevented, since the spores of Clostridium
bacteria are found in soil everywhere.
 Duration:
 Infants with infant botulism may require hospital-
based support for an extended period.
 In severe cases of infant botulism, the child may
require several weeks of hospitalization and even
respiratory support.
 Contagiousness:
 No special isolation or precautions are needed since
this infection is not transmitted from person to
person.
 Prevention:
 Most cases of infant botulism cannot be prevented.
 Parents can eliminate one risk factor by not feeding
honey to children under age 1 year.
 Professional Treatment:
 Doctors make the diagnosis of infant
botulism by checking the infant's stool for
Clostridium bacteria or
Clostridium botulinum toxin.
 A child with infant botulism is treated in a
hospital, usually in an intensive care unit.
 Botox:
 Botulinum toxin type A (BOTOX®) and botulinum toxin type B
(MYOBLOC(™)) are purified substances derived from a bacteria that
blocks the nerve signals from the brain to the muscle. By injecting
very tiny amounts into a specific facial muscle, only the impulse of
that muscle will be blocked, causing a local relaxation and
weakness.
 In this way, botulinum toxin acts as a muscle blockade to immobilize
the underlying cause of the unwanted lines and prevent "wrinkly"
expressions.
 Botulinum toxin type A (BOTOX®) has been used since 1980 to treat
many muscle disorders, such as lazy eye, and uncontrolled blinking.
 It was pioneered by dermatologic surgeons for cosmetic use in 1987.
 The FDA has granted approval to botulinum toxin type A (BOTOX®
COSMETIC) for the temporary improvement in the appearance of
moderate to severe glabellar vertical lines in adult men and women
65 or younger.
 The approval specifically applies to the vertical lines between the
eyebrows.
 Botulinum Toxin Therapy
 Treatment involves injection of very small amounts of
botulinum toxin into the underlying muscles to relax them.
 The actual treatment is well tolerated and takes just a few
minutes with no "down time" or prolonged recovery
period.
 Botulinum toxin takes effect about 3 to 7 days after
treatment.
 The improvement generally lasts about 3 to 4 months
before the effect gradually fades and muscle action
returns.
 It is anticipated that the average patient will require
reinjection at various intervals.
 With repeated treatments, atrophy (thinning) of the muscle
may occur which usually produces longer-lasting results.
 Other Applications
 Excessive sweating can be treated with injections
of a highly diluted form of botulinum toxin directly
into the underarm skin, or skin on the palms of the
hand and soles of the feet.
 There it paralyzes the sweat glands of the skin,
which are responsible for excessive perspiration.
 A single treatment session can provide months of
relief, and experts believe that injections can be
repeated indefinitely once or twice a year to
maintain dryness.
 Are there any side effects?
 Side effects are minimal and typically relate to the local
injection.
 Soreness or mild bruising, while uncommon, may occur
around the injection site.
 Makeup may be worn after treatment, but care should be
taken to avoid pressing or massaging the area for several
hours.
 A temporary headache is not uncommon after injections in
the forehead area, especially after the first treatment.
 In rare instances, patients may develop temporary
weakness of the neighboring muscles, a temporary
droopy brow or eyelid.
 All of these possible effects are likely to be mild and
temporary, and in most cases, do not significantly limit
routine activities.
 Rabies: fatal encephalitis
 Caused by rabies virus
 Contracted through bite of infected animal
 Bats, dogs, cats, rabbits, raccoons,
 Once virus enters nerves it is not accessible to
immune system until destroys CNS cells
 Symptoms:
 Preliminary symp. Are mild and varied
 Resemble many other infections
 When CNS becomes involved person
alternates between agitation and calm
 Muscle spasms of mouth and pharynx
 2 forms of rabies:
 Furious rabies: restless, then become excitable and
snap at anything
 Humans will sometimes bite too
 Paralysis sets in and flow of saliva increases
 Nervous control is progressively lost
 Paralytic rabies: only minimal excitability
 Animal or person remains relatively quiet and unaware
of surroundings
 A form of paralysis that is transient but sometimes fatal
 Treatment: injections or immunoglobulin
and antirabies vaccine
 Cryptococcus
Meninigitis:
 A rare fungal infection
caused by inhaling the
fungus, Cryptococcus
neoformans
 Symptoms   
 Chest pain
 Dry cough
 Headache
 nausea
 confusion
 Blurred vision or double vision (diplopia)
 Fatigue
 Fever
 Unusual and excessive sweating at night
 Glands, swollen WITHOUT nearby areas appearing
infected (e.g., red, painful, swollen)
 Prolonged bleeding, bruising easily
 Skin rash may be present
o Skin rash or lesion pinpointed rash (petechiae)
o Bleeding into the skin
o Bruises
 Unintentional weight loss
 Appetite, loss
 Abdominal fullness prematurely after meals
 Abdominal pain
 Abdomen, swollen
 Weakness
 Bone pain or tenderness of the breastbone (sternum)
 Numbness and tingling
o Nerve pain or pain along the path of a specific nerve
 Pain along a nerve root (major pathway from the spinal cord
 Treatment   
 Some infections require no treatment. However,
medical observation should continue for a year
to detect any progression of the disease. If
pulmonary lesions are present or the disease
spreads, antifungal medications are prescribed,
and treatment with these agents may be
prolonged.

Medications include:
 Amphotericin B
 Flucytosine
 Fluconazole