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Disorders and Diseasesof the Neuroskeletal System
and the Central Nervous SystemBy: Andrea Bonde
Segmental Vs. Axonal Demyelination
Demyelination is the root cause of the symptoms that people with MS experience. When it occurs the speed at which messages pass along the nerves is slower than normal. Even
when the patches of scarring caused by demyelination have healed and re-myelination has occurred, the response time of the nerve endings tends to remain slower.
Segmentaloriginally described in
experimental lead poisoning, is characterized by
breakdown and loss of myelin over a few segments. The
axon remains intact and there is no change in the neuronal body. The loss of saltatory
conduction that results from segmental demyelination
leads to decrease of conduction velocity and
conduction block.
AxonalClinically, neuropathy causes
weakness and atrophy of muscle, loss of sensation or
altered sensation (pain, paresthesias), and weak or
absent tendon reflexes. Nerve conduction studies can
distinguish demyelinative neuropathy (slowing of conduction velocity or conduction block) from
axonal neuropathy (low-action potential amplitudes).
Re-innervation
Restoration of nerve function to a part from
which it was lost; it may occur
spontaneously or be achieved by nerve
grafting.
Study• 77 heart transplant recipients• 1-5 years after transplantation• Partial reinnervation was observed in 52 patients at
various times after transplantation
• Reinnervation extent correlated with time after
surgery but also inversely with donor age and recipient age
Guillain-Barre Syndromea serious disorder that occurs when the body's defense immune system
mistakenly attacks part of the nervous system. This
leads to nerve inflammation that causes muscle
weakness and other symptoms.
www.gbs-cidp.org – Support Group
Hydrocephalus
The term hydrocephalus is derived from the Greek words "hydro" meaning water and "cephalus"
meaning head. As the name implies, it is a condition in which the primary characteristic is
excessive accumulation of fluid in the brain.
Vasogenic Vs. CytoxicCerebral Edema
Cerebral edema is an excess
accumulation of water in the
intracellular and/or extracellular spaces
of the brain.
Vasogenic edema: occurs due to the
failure of tight junctions and
astrocyte processes which normally
maintain an adequate blood-brain barrier.
Epidural Vs. SubduralHematoma
Epidural Vs. SubduralHematoma
Epidural(EDH) is the
accumulation of blood in the
potential space between brain dura
and bone.
SubduralA collection of blood on the surface of the
brain. Accumulation of
blood between the the dura and the
brain.
IntraparnchymalHematoma
Traumatic Intraparenchymal hemorrhage is bleeding into the tissue of the brain caused by trauma to the head. This type of
bleeding can cause a hematoma which expands inside the brain, pushing aside adjacent brain tissue and compressing it. The term
intraparenchymal basically means "within the brain tissue".
Slit hemorrhageA small tear within the
brain that starts to hemorrhage.
Lacunar infarctsLacunar infarcts are small (0.2 to 15 mm in diameter)
noncortical infarcts caused by occlusion of a single penetrating branch of a large cerebral artery. These
branches arise at acute angles from the large arteries of the circle of Willis, stem of the middle cerebral artery (MCA), or the basilar artery. Although this
definition implies that pathological confirmation is necessary, diagnosis in vivo may be made in the
setting of appropriate clinical syndromes and radiological tests.
Bacterial vs. ViralMeningitis
Meningitis is an inflammation of the
tissue around the spinal cord and brain.
There are three (3) types of bacteria (germs) that
cause the disease: H. Influenzae (Hib), Strep
pneumoniae, and Neisseria meningitidis.
Viral meningitis is relatively common and
can be caused by different viruses. The
most common cause is from a group of viruses
known as enteroviruses.
Cerebral ToxoplasmosisToxoplasmosis is
an infectious disease caused by
the one-celled protozoan parasite Toxoplasma gondii.
Cats, the primary carriers of the organism,
become infected by eating rodents and birds
infected with the organism. Once
ingested, the organism reproduces in the intestines of cats,
producing millions of eggs known as oocysts,
which are excreted in cat feces daily for
approximately two weeks.
In the United States, it is estimated that
approximately 30% of cats have been infected by T.
gondii.
Myotonia
Tennessee Fainting goats have myotonia as well as humans.
• Relaxation of muscle is impaired• Can affect any muscle group
• Repeated effort needed to relax•Trouble releasing grip on objects, rising from a seated position and many other
problems• Abnormality in the muscle membrane• Often associated with inherited
neurological disorders
Dermatomyositisis a muscle disease
characterized by inflammation and a
skin rash. It is a type of
inflammatory myopathy.
The disease is treated with anti-inflammatory medicines called corticosteroids and drugs that
suppress the immune system.
Cerebral HemorrhagicInfarctionHappens
when blood flow to a part of the brain
stops.
AKACerebrovascular disease
CVACerebral infarction
Cerebral hemorrhageIschemic stroke
Stroke – ischemicCerebrovascular accident
Stroke - hemorrhagic
Cerebrospinal FluidThe cerebrospinal fluid (CSF) is
produced from arterial blood by the choroid plexuses of the lateral and
fourth ventricles by a combined process of diffusion, pinocytosis and
active transfer. A small amount is also produced by ependymal cells
CSF from the lumbar region contains 15 to 45 mg/dl protein (lower in
childen) and 50-80 mg/dl glucose (two-thirds of blood glucose).
Lumbar Puncture
A lumbar puncture (also called a spinal tap) is a procedure to collect and look at the fluid
(cerebrospinal fluid, or CSF) surrounding the brain and spinal cord.
Types of brain herniation1. Uncinate/Uncal
rranstentorial herniation2. Central transtentorial
herniation3. Subfalcine (cingulate)
herniation4. Extracranial
(transcalvarial) herniation5. Upward cerebellar
herniation6. Tonsillar (downward cerebellar) herniation
is when the brain tissue is pushed from its normal position and protrudes into adjacent compartments or may even push out of the skull if there is an opening present.
Axonal InjuryDAI involves
massive loss of neuronal function
towards the central area of the brain,
well away from any areas of direct
trauma with the skull.
Vascular InjuryPeripheral vascular injuries may result from penetrating or blunt
trauma to the extremities. If not recognized and treated
rapidly, injuries to major arteries, veins, and nerves may have disastrous consequences resulting in the loss of life and
limb.
Embolisma blockage in one of the
arteries of the body due to a blood clot that has broken
off from another location in the body (embolus) and
traveled through the bloodstream to lodge in a
small blood vessel. The blockage may limit or stop
blood flow. An embolism is a clot that
travels from the site where it formed to another location
in the body.
ThrombusA thrombus is a blood clot that forms in a vessel and remains
there. This can result in damage, destruction (infarction), or even death of the tissues (necrosis) in
that area.
Event Community(fatal)
Hospital(fatal) Total
DVT (Deep Vein Thrombosis) 108,889 (649) 269,734 (1,609) 378,623 (2,258)
According to the US Census data of 2000
“Brain Dead”It is now considered by the medical profession
and supported by legal and some ethical consensus that if a person's entire brain is
dead, the person is dead.
“Respirator Brain”A swollen and congested brain with necrotic and
autolytic changes seen in patients who have been
on a respirator.
Brain AutolysisIn 1993 conducted a clinico-
neuropathological study on 60 cases of brain death. The average duration
of brain death was 99 hours. Autolysis of the cerebellar granular
layer and the pituitary gland was evident in all cases.
Autolysis – is a breakdown of a part or whole cell or tissue by self-produced enzymes
ConcussionAn alteration of conscious
awareness after head trauma. The collection of symptoms following a
concussion is called the postconcussion syndrome (PCS),
and include dizziness, nausea, vomiting, headache,
disorientation, forgetfulness, irritability, depression, mood swings, insomnia, and loss of
libido. Most cases of PCS resolve after a few months, but
approximately 20% of cases can involve longer term problems.
Coup Vs. CountrecoupInjury
Coup Vs. ContrecoupInjuryA "coup" injury is the
initial site of impact.
A contrecoup injury happens at the opposite side as the site of injury,
so if you struck your forehead, the brain
injury would be at the back of the brain.
Global vs. FocalCerebral ischemia
Global ischemia in man develops after transient circulatory arrest with resuscitation or after near-
drowning
Focal ischemia follows transient or permanent flow reduction in the territory of a
cerebral artery.
Due to:• Hanging
•Circulatory arrest• Drowning
Due to:•Hemispheral stroke• Transient ischemic
attack
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