CENTRAL NERVOUS SYSTEM Flashcards
(159 cards)
1
Q
CRANIAL NERVE DISORDERS - DEFINITION
A
- The cranial nerves are 12 pairs of nerves that emerge from the brain and are responsible for providing motor and sensory functions
- Cranial nerve disorder refers to impairment of one of the 12 cranial nerves that emerge from the underside of the brain, pass through openings in the skull, and lead to parts of the head, neck and trunk
2
Q
CRANIAL NERVE DISORDERS - TYPES
A
- Trigeminal neuralgia
o Disorder of the 5th cranial nerve
o Sudden, severe, shock like symptoms across the face - Hemifacial spasm
o Where the blood vessels constrict the 7th cranial nerve
o Frequent involuntary twitching of the face - Glossopharyngeal neuralgia
o Compression of the 9th cranial nerve
o Sharp, jabbing px deep in the throat - Base skull tumours
o Can affect any nerve - Geniculate neuralgia
o Deep ear px - Occipital neuralgia
o Distinct type of headache
o Characterised by sudden and recurring jabs of piercing, throbbing, chronic px
3
Q
CRANIAL NERVE DISORDERS - SIGNS AND SYMPTOMS
A
- Specific S&S depend on the cranial nerve that is affected
- Intermittent attacks of excruciating facial px
- Vertigo
- Hearing loss
- Weakness
- Paralysis
- Facial twitch
4
Q
GLAUCOMA - DEFINITION
A
- Group of eye conditions that damage the optic nerve
- The optic nerve sends visual information from your eye to your brain and is vital for good vision
5
Q
GLAUCOMA - CAUSE
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- Glaucoma develops when the optic nerve becomes damaged
- As the nerve gradually deteriorates, blind spots develop in your vision
- This nerve damage is usually related to increased pressure in the eye
- Elevated eye pressure happens as a result of a build up of fluid that flows throughout the inside of the eye
- Fluid is known as aqueous humor
6
Q
GLAUCOMA - CAUSE - OPEN-ANGLE GLAUCOMA
A
o Most common form
o Drainage angle formed by the iris and cornea remains open
o But other parts of the drainage system don’t drain properly
o This may lead to a slow, gradual increase in eye pressure
7
Q
GLAUCOMA - CAUSE - ANGLE-CLOSURE GLAUCOMA
A
o Occurs when the iris bulges
o The bulging iris partially or completely blocks the drainage angle
o The fluid cant circulate through the eye and pressure increases
o May occur suddenly or gradually
8
Q
GLAUCOMA - CAUSE - GLAUCOMA IN CHILDREN
A
o May be born with it
o Can also develop it within the first few years of life
o Blocked drainage, injury or an underlying medical condition may cause optic nerve damage
9
Q
GLAUCOMA - CAUSE - PIGMENTARY GLAUCOMA
A
o Small pigment granules flake off from the iris and block or slow fluid drainage from the eye
o Leads to a deposit of pigment granules on tissue located at the angle where the iris and cornea meet
o Granule deposits cause an increase in pressure
10
Q
GLAUCOMA - POPULATION AFFECTED
A
- People from black, Asian and Hispanic heritage over 40
- All other people over 60
11
Q
GLAUCOMA - RISK FACTORS
A
- High internal eye pressure, also known as intraocular pressure
- Age over 55
- Black, Asian or Hispanic heritage
- Certain medical conditions
o Diabetes
o Migraines
o High blood pressure
o Sickle cell anaemia - Corneas that are thin at the centre
- Extreme near-sightedness or farsightedness
- Eye injury or certain types of eye surgery
- Taking corticosteroid medications, especially eye drops, for a long time
12
Q
GLAUCOMA - CLINICAL PRESENTATION - OPEN ANGLE GLAUCOMA
A
o No symptoms in early stages
o Gradually, patchy blind spots in the peripheral vision
o In later stages, difficulty seeing things in your central vision
13
Q
GLAUCOMA - CLINICAL PRESENTATION - ACUTE ANGLE-CLOSURE GLAUCOMA
A
o Severe headache
o Severe eye px
o Nausea or vomiting
o Blurred vision
o Halos or coloured rings around lights
o Eye redness
14
Q
GLAUCOMA - CLINICAL PRESENTATION - NORMAL-TENSION GLAUCOMA
A
o No symptoms in early stages
o Gradually blurred vision
o In later stages, loss of side visio
15
Q
GLAUCOMA - CLINICAL PRESENTATION - GLAUCOMA IN CHILDREN
A
o Dull or cloudy eye (infants)
o Increased blinking (infants)
o Tears without crying (infants)
o Blurred vision
o Near sightedness that gets worse
o Headache
16
Q
GLAUCOMA - CLINICAL PRESENTATION - PIGMENTARY GLAUCOMA
A
o Halos around lights
o Blurred vision with exercise
o Gradual loss of peripheral vision
17
Q
GLAUCOMA - PROGNOSIS
A
- There are treatments for glaucoma but no cures as it’s a lifelong condition
- Medications - Eye drops
- Laser therapy
- Surgery
o MIGS (minimally invasive glaucoma surgery)
o Can help slow down vision loss but cant restore lost vision or cure glaucoma - Glaucoma is a chronic and progressive condition that causes some degree of vision loss overtime
- Blindness is a rare complication so prognosis isn’t awful
18
Q
PAPILLEDEMA - DEFINITION
A
- Medical term for swelling of the optic disc
- Almost always bilateral
19
Q
PAPILLEDEMA - CAUSE
A
- High intracranial pressure causes papilledema
- Other causes include
o Hypertension
o Tumours
o Infection, bleeding or inflammation in the brain or the meninges
o Cerebral venous sinus thrombosis (blood clot in a vein in your brain)
o Iron-deficiency anaemia
o Medication use
o Idiopathic intracranial hypertension
20
Q
PAPILLEDEMA - POPULATION AFFECTED
A
Overweight women
21
Q
PAPILLEDEMA - RISK FACTORS
A
- Risk factors are those that raise intracranial pressure
o Space occupying lesions
Tumour
Subarachnoid haemorrhage
Decreased absorption of cerebrospinal fluid
Change in the dynamics of cerebrospinal flow through the ventricles
Increased production of cerebrospinal fluid (rare) - Risk factors for idiopathic intracranial hypertension include
o Recent weight gain
o Underlying associated conditions
Polycystic ovarian syndrome
Anaemia
Thyroid disease
Sleep apnoea
22
Q
PAPILLEDEMA - CLINICAL PRESENTATION
A
- Some people have no symptoms
- Headaches
o May be worse in the mornings or when lying down - Transient visual obscuration’s
o Periods of about 5 to 15 seconds when vision gets blurry, goes grey or blacks out
o Usually happen when you change posture
o Can be unilateral or bilateral - Diplopia
- Nausea
- Vomiting
- Neurological symptoms
o May include problems with movement or thinking - Vision loss worsens as the condition progresses
23
Q
PAPILLEDEMA - PROGNOSIS
A
- If its due to idiopathic intracranial hypertension you may be prescribed a carbonic anhydrase inhibitor such as acetazolamide
- If this doesn’t work surgical procedures are available
- Maintaining a healthy weight is a long-term strategy
- Should treat the underlying cause (if there is one)
- If it is caught early the outlook is good
- It needs to be treated because of the potential for blindness and other neurological effects
24
Q
OPTIC NEURITIS - DEFINITION
A
Occurs when inflammation damages the optic nerve
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OPTIC NEURITIS - CAUSE
- Exact cause is unknown
- Believed to develop when the immune system mistakenly targets the substance covering the optic nerve, resulting in inflammation and damage to the myelin
- The following autoimmune conditions are associated with optic neuritis
o Multiple sclerosis
o Neuromyelitis optica
o Myelin oligodendrocyte glycoprotein (MOG) antibody disorder
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OPTIC NEURITIS - POPULATION AFFECTED
Females aged 20-40
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OPTIC NEURITIS - RISK FACTORS
- Age - Adults 20 – 40
- Sex - Women much more likely
- Race - Occurs more often in white people
- Genetic mutations
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OPTIC NEURITIS - CLINICAL PRESENTATION
- Usually only affects one eye
- Pain
o Often worsened by eye movement
o Sometimes the px feels like a dull ache behind the eye
- Vision loss in one eye
o Most people have at least some temporary reduction in vision, but the extent of loss varies
o Noticeable vision loss usually develops over hours or days and improves over several weeks to months
o Vision loss is permanent in some people
- Visual field loss
o Side vision loss can occur in any pattern, such as central vision loss or peripheral vision loss
- Loss of colour vision
o Often affects colour perception
o Pt may notice colours appear less vivid than normal
- Flashing lights
o Some people report flashing or flickering lights with eye movements
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OPTIC NEURITIS - PROGNOSIS
- May resolve spontaneously without treatment
- If visual function is poor, a course of IV methylprednisolone (steroid medication) with a tapering course of oral steroids afterwards had been shown to speed recovery of visual function
- It improves in about 80% of pt over a few weeks
- Some people have continued visual change, reduced colour vision or more difficulty with night-time vision
- Occasionally it recurs and requires retreatment
- Many people have complete resolution of their symptoms
30
OPTIC NERVE ATROPHY - DEFINITION
- Optic atrophy is a condition that affects the cranial nerve
- The cranial nerve carries impulses from the eye to the brain
- Atrophy means to waste away or deteriorate
- It is not a disease in itself but is a sign of a potentially more serious condition
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OPTIC NERVE ATROPHY - CAUSE
- Where something interferes with the optic nerves ability to transmit impulses
- The interference can be caused by numerous factors; including
o Glaucoma
o Stroke of the optic nerve
Anterior ischemic optic neuropathy
o A tumour that is pressing on the optic nerve
o Optic neuritis
An inflammation of the optic nerve caused by multiple sclerosis
o A hereditary condition in which the person experiences loss of vision first in one eye, and then in the other
Known as Leber’s hereditary optic neuropathy
o Improper formation of the optic nerve
Congenital problem
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OPTIC NERVE ATROPHY - POPULATION AFFECTED
White people aged 10 – 50
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OPTIC NERVE ATROPHY - RISK FACTORS
- High cholesterol
- High blood pressure
- Sudden drop in blood pressure or blood loss
- Swollen arteries in the head
- Clogged arteries
- Heart disease
- Diabetes
- Sleep apnoea
- Smoking
- Migraines
- Glaucoma
34
OPTIC NERVE ATROPHY - CLINICAL PRESENTATION
- Symptoms relate to a change in vision
- Specifically
o Blurred vision
o Difficulties with peripheral vision
o Difficulties with colour vision
o Reduction in sharpness of vision
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OPTIC NERVE ATROPHY - PROGNOSIS
- No real cure or treatment
- Important to have regular eye exams
- Prognosis depends on what is causing the problem
o E.g. if the problem is optic neuritis, the pt can usually count on getting their vision back when the inflammation goes away
o If the cause is something else, the pt vision might not improve
36
OPTIC NERVE NEUROPATHY - DEFINITION
Sudden loss of vision due to an interruption of blood flow to the anterior of the optic nerve
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OPTIC NERVE NEUROPATHY - TYPES
o Arteritic AION
Caused by inflammation of arteries supplying blood to the optic nerve
o Nonarteritic AION
Caused by reasons other than inflammation of the arteries
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OPTIC NERVE NEUROPATHY - CAUSE - ARTERITIC AION
o Dangerous condition
o Caused by inflammation of arteries supplying blood to the optic nerve
o Inflammation is due to a condition called giant cell arteritis (GCA) or temporal arteritis, which caused inflammation of medium and large sized arteries
o 3x more common in women
o Most often affects people over the age of 55
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OPTIC NERVE NEUROPATHY - CAUSE - NONARTERITIC AION
o Most common form of AION
o Majority of people affected are over 50
o Both men and women affected equally
o Caused by one of the following
A drop in blood pressure to such a degree that blood supply to the optic nerve is devreased
Increased pressure inside the eyeball
Narrowed arteries
Increased blood viscosity
Decreased blood flow to the optic nerve where it leaves the back of the eye
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OPTIC NERVE NEUROPATHY - POPULATION AFFECTED
- Adults over 50
- A-AION – women more than men
41
OPTIC NERVE NEUROPATHY - RISK FACTORS
- High blood pressure
- Diabetes mellitus
- High cholesterol
- Smoking
- Sleep apnoea
- Heart disease
- Blocked arteries
- Anaemia or sudden blood loss
- Sudden drop in blood pressure
- Sickle cell trait
- Vasculitis
42
OPTIC NERVE NEUROPATHY - CLINICAL PRESENTATION - NA-AION
o Sudden, painless loss or blurring of vision in one eye
Usually noticed upon waking from a nights sleep or a nap
o Decreased visual activity
o Dyschromatopsia
o A RAPD
Relative afferent pupillary defect
o Swollen optic nerve with splinter haemorrhages
o Visual field defect
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OPTIC NERVE NEUROPATHY - CLINICAL PRESENTATION - A-AION
o Px in the temples
o Px when chewing
o Scalp px or tingling
o Neck px
o Muscle aches and pains
Esp in upper legs or arms
o General fatigue
o Loss of appetite
o Unexplained loss of weight
o Fever
44
OPTIC NERVE NEUROPATHY - PROGNOSIS
- Prognosis depends on the type of optic neuropathy
- A-AION usually causes a greater degree of vision loss than NA-AION
- Degree of loss will depend on the location and amount of optic nerve that is damaged
- In NA-AION, about 40% of pt show some amount of improvement in central vision in the months after loss of vision or visual field
- Although 25% of pt with AION in 1 eye will develop it in the other eye in the next 3 years
- Treatment
o A-AION = basically the same treatment as giant cell arteritis (corticosteroid therapy)
o NA-AION = treatment is for the underlying cardiovascular disease or the risk factors that help trigger and aggravate NA-AION
45
MACULAR DEGENERATION - DEFINITION
- Also known as age-related macular degeneration
- An eye disease that affects central vision
- Top cause of vision loss in people over 50
- 2 types
o Dry (atrophic) - Up to 90% have the dry form
o Wet (exudative)
46
MACULAR DEGENERATION - CAUSE
- Inherited eye disease
- Occurs when the macula at the back of the eye starts to deteriorate for an unknown reason
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MACULAR DEGENERATION - CAUSE - DRY
o Develops when tiny yellow protein deposits called drusen form under the macula
o The build-up deposits dry and thin the macula
o Vision loss tends to occur gradually
o Most people don’t completely lose central vision
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MACULAR DEGENERATION - CAUSE - WET
o Occurs when abnormal blood vessels develop under the retina and macula
o The blood vessels leak blood and fluid
o Because of the fluid build-up a bulge forms in the macula
o May see dark spots in centre of vision
o Can quickly lead to total loss of central vision loss
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MACULAR DEGENERATION - POPULATION AFFECTED
White people over 50
50
MACULAR DEGENERATION - RISK FACTORS
- Older age - Over 50
- Family hx
- Being overweight
- Smoking
- Hypertension
- Diet high in saturated fats
- Being of European descent
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MACULAR DEGENERATION - CLINICAL PRESENTATION
- Many people don’t have symptoms until the disease progresses
- Blurred vision
- Blank or dark spots in field of vision
- The appearance of waves or curves in straight lines
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MACULAR DEGENERATION - PROGNOSIS
- No cure
- Prognosis depends on degree of vision loss
- Not everyone will experience significant vision loss
- Many treatments
o Nutritional supplements
o Antivascular endothelial growth factor (anti-VEGF)
o Photodynamic therapy (PDT)
- Many precautions you can take
o Quit smoking
o Lose weight
o Stay physically active
o Maintain healthy blood pressure and cholesterol levels
o Eat a healthy diet
- Things that can help you live with it
o Wear eyeglasses or contact lenses
o Use brighter lights at home or at work
o Read with a magnifying device
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HOW DIABETES AFFECTS THE OPTIC NERVE
- Diabetes can damage the eyes over time and cause vision loss, even blindness
- Eye diseases that can affect people with diabetes include
o Diabetic retinopathy
o Macular oedema
o Cataracts
o Glaucoma
- Early diagnosis and treatment can go a long way toward protecting eyesight
- Managing diabetes and getting regular eye tests can prevent these conditions
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HOW MULTIPLE SCLEROSIS AFFECTS THE OPTIC NERVE
- Visual problems is the first sign of MS in many people
- Eye diseases that can affect people with MS include
o Optic neuritis
o Nystagmus
o Diplopia
- Prognosis is good for recovery from many vision problems associated with MS
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HOW HYPERTENSION AFFECTS THE OPTIC NERVE
- High blood pressure can damage the tiny, delicate blood vessels that supply blood to the eyes
- This can cause
o Retinopathy
Damage to the blood vessels in the retina
o Choroidopathy
Fluid build-up under the retina
o Optic neuropathy
Nerve damage
- Treatment and lifestyle changes can help control high blood pressure and reduce the risk of developing these eye diseases
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HOW A B12 DEFICIENCY AFFECTS THE OPTIC NERVE
- Vitamin B12 plays an important role in the production of red blood cells
- It helps create and regulate DNA and aids in the function of brain cells
- Can cause
o Disturbed or blurred vision
o Optic neuropathy
- Happens when the deficiency causes damage to the optic nerve that leads to your eyes
57
OCULAMOTOR NERVE PALSY - DEFINITION
- The oculomotor nerve is the 3rd of 12 cranial nerves (CN III)
- It is part of the autonomic nervous system
- It allows movement of the eye muscles, constriction of the pupil, focusing the eyes and the position of the upper eyelid
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OCULAMOTOR NERVE PALSY - FUNCTION
- Controls 4 of the 6 muscles that enable eye movement
- Elevate the upper eyelid
- Focus the eyes
- Respond to light by making the pupil smaller
- Move your eyes inward, outward, up and down and control torsion
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OCULAMOTOR NERVE PALSY - CAUSE
- Oculomotor palsy is a group of disorders affecting the CN III
- They occur when the third cranial nerve becomes paralyzed
- Can be present at birth
- May occur later in life due to
o Inadequate blood flow – causes a lack of oxygen that nerves need to function properly
o Nerve compression – abnormal pressure on a nerve
- Conditions that may cause oculomotor palsy include
o Brain aneurysm
o Brain tumour
o Head injuries
o Demyelinating disease
Multiple sclerosis
o Microvascular disease
Diabetes
High blood pressure
o Infections
HIV
Lyme disease
o Migraine
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TROCHLEAR NERVE PALSY - DEFINITION
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TROCHLEAR NERVE PALSY - CAUSE
- When the trochlear nerve doesn’t function as it should, its often due to 4th nerve palsy – trochlear nerve palsy
- A palsy occurs when illness or injury paralyzes nerves that control muscle movements
- In some people its congenital
o They are born with it
- It may also be due to trauma from rapid head movements
o Motor vehicle accidents
- The trochlear nerve is one of the more fragile cranial nerves because its long and thin
- Sometimes occurs after minor injuries
- Less common causes include
o Cavernous sinus syndrome
When an abnormal growth affects the trochlear nerve
o Guillain-Barre syndrome
o Lyme disease
o Meningioma
o Microvascular coronary disease (MCD)
o Shingles (herpes zoster)
o Superior oblique myokymia
Episodes of involuntary superior oblique muscle tightening that distorts vision
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TROCHLEAR NERVE PALSY - TREATMENT
- Treatment depends on what is causing symptoms
- Vision injuries causes by minor injuries often go away on their own
- For more severe palsy, treatments may include
o Eye patch to help the eye rest
o Special glasses to correct double vision
o Surgery to repair cranial nerve 4
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TRIGEMINAL NEURALGIA - DEFINITION
- Causes painful sensations like an electric shock on side of face
- Chronic P affects trigeminal nerve, which carries sensations from face to brain
- Variety of treatment, effectively manage it- medications, injections or surgery
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TRIGEMINAL NEURALGIA - CAUSE
- Trigeminal nerve function disrupted
- Contact between blood vessel and nerve at base of brain
- Contact puts pressure on nerve and causes it to malfunction
- Sometimes related to MS
- Tumour compressing nerve
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TRIGMINAL NEURALGIA - POPULATION AFFECTED
- 50+
- More common in women than men
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TRIGEMINAL NEURALGIA - RISK FACTORS
- Hypertension
- Arteriosclerotic changes
- Aging
- Family Hx
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TRIGEMINAL NEURALGIA - CLINICAL PRESENTATION
- Episodes of severe, shotting or jabbing P that may feel like and electric shock
- Spontaneous attacks triggered by things such as touching your face
- Attacks of P lasting a few seconds to several mins
- P occurs with facial spasms
- P in areas supplied by trigeminal- jaw, cheek, teeth, gums, lips or forehead
- P rarely occurs at night while sleeping
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TRIGEMINAL NEURALGIA - PROGNOSIS
- Episodes can occur daily or weekly or months
- 50% of people experience remission of at least 6 months
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ABDUCENS NERVE PALSY - DEFINITION
- Most common ocular motor paralysis in adults and second-most common in children
- Causes problems with eye movements
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ABDUCENS NERVE PALSY - CAUSE
- Caused by damage to the sixth cranial nerve or obstruction anywhere along its path from the brainstem to the eye
- Conditions known to cause sixth cranial nerve damage or inflammation can include:
- head injury
- injury during birth
- stroke
- brain aneurysm or tumour
- infection, such as Lyme disease, syphilis, tuberculosis, or meningitis
- inflammatory lesions, such as from sarcoidosis or lupus
- diabetic neuropathy
- multiple sclerosis
- cavernous sinus thrombosis, a condition caused by a blood clot behind your eye sockets
- mastoiditis, an infection in the bone behind the ear
- temporal arteritis
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ABDUCENS NERVE PALSY - POPULATION AFFECTED
- Anyone can be affected
- Especially those who have had a brain injury or stroke
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ABDUCENS NERVE PALSY - RISK FACTORS
- Head injury
- Stroke
- Having another underlying health condition
- Diabetes
- MS
- Infection
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ABDUCENS NERVE PALSY - CLINICAL PRESENTATION
- Because each eye has its own lateral rectus muscle and sixth cranial nerve, sixth nerve palsy can affect one or both eyes.
- symptoms and the severity of the condition depend on whether both eyes are affected.
- Symptoms can include:
- Double vision.
- Poor eye alignment or strabismus.
- Head movement to maintain vision.
- headache
- nausea
- vomiting
- papilledema or swelling of the optic nerve
- vision loss
- hearing loss
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ABDUCENS NERVE PALSY - PROGNOSIS
- The long-term outlook for this condition depends on the cause
- When caused by a virus, vision can be fully restored when you recover from the virus
- Other causes, such as those caused by head injury and trauma, may leave residual effects.
- Surgery may be offered as a treatment option.
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FACIAL NERVE PALSY - DEFINITION
Causes sudden weakness in muscle of one side of face
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FACIAL NERVE PALSY - CAUSE
- Not clear
- Often related to viral infection
- Viruses sought to be linked:
1. Cold sores and genital herpes
2. Herpes zoster
3. Influenza
4. Hand-foot-and-mouth disease
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FACIAL NERVE PALSY - POPULATION AFFECTED
Pregnant, diabetic, influenza
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FACIAL NERVE PALSY - RISK FACTORS
- Pregnancy- especially third trimester
- Have upper respiratory infection- such as flu or cold
- Have diabetes
- Have high blood pressure
- Obesity
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FACIAL NERVE PALSY - CLINICAL PRESENTATION
- Rapid onset of mild weakness to total paralysis of one side of face
- Facial droop and difficulty making facial expressions
- Drooling
- P around jaw or behind ear
- Inc sensitivity to sound on affected side
- Headache
80
FACIAL NERVE PALSY - PROGNOSIS
Complete recovery in about six months
81
ACOUSTIC NEUROMA - DEFINITION
- Noncancerous, slow-growing tumour that develops on vestibular nerve leading from inner ear to brain
- Branches directly influence balance and hearing
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ACOUSTIC NEUROMA - CAUSE
- Linked with defect of gene on chromosome 22
- Normally this gene produces tumour suppressor protein that helps control growth of Schwan cells covering nerves
- Most cases, no known cause
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ACOUSTIC NEUROMA - POPULATION AFFECETD
Women between 30 and 60
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ACOUSTIC NEUROMA - RISK FACTORS
- Neurofibromatosis type 2- parent with rare genetic disorder neurofibromatosis type 2
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ACOUSTIC NEUROMA - CLINICAL PRESENTATION
- Easy to miss and may take years to develop
- Hearing loss- usually gradually worsening over months to years
- Tinnitus
- Unsteadiness/loss of balance
- Vertigo
- Facial numbness/loss of muscle movement
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ACOUSTIC NEUROMA - PROGNOSIS
Treatment includes regular monitoring, radiation and surgical removal
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BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) - DEFINITION
Most common cause of vertigo
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BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) - CAUSE
- Idiopathic
- Associated with minor to severe blow to head
- Less common causes include disorders that damage inner ear
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BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) - POPULATION AFFECTED
Women over 50
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BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) - RISK FACTORS
- 50+
- Women
- Head injury
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BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) - CLINICAL PRESENTATION
- Dizziness
- Vertigo
- Loss of balance/unsteadiness
- Nausea/vomiting
- Come and go, commonly last less than one minute
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BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) - PROGNOSIS
- Bothersome but rarely serious except when it inc chance of falls
- Can receive treatment during doctor visits
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LABYRINTHITIS - DEFINITION
- Inflammation of labyrinth- part of inner ear
- Inner ear infection- responsible for hearing and balance
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LABYRINTHITIS - CAUSE
- Mostly caused by virus, sometimes bacteria
- Bronchitis or other respiratory illness
- Viral infection of ear
- Herpes virus
- Stomach viruses
- Bacterial infections
- Measles, mumps, rubella, polio
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LABYRINTHITIS - POPULATION AFFECTED
Adults 30 to 60
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LABYRINTHITIS - RISK FACTORS
- Drinking large amounts of alcohol
- Fatigue
- History of allergies
- Recent viral illness, respiratory infection, or ear infection
- Smoking
- Stress
- Using certain prescription or nonprescription medicines (such as aspirin)
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LABYRINTHITIS - CLINICAL PRESENTATION
- Loss of balance
- Dizziness
- Vertigo
- Nausea/vomiting
- Blurry vision
- Hearing loss
- Tinnitus
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LABYRINTHITIS - PROGNOSIS
- Most people completely better within 2-3 months
- Symptoms usually go away within a week
99
MENIERE'S DISEASE - DEFINITION
Inner ear problem that can cause vertigo and hearing loss
100
MENIERE'S DISEASE - CAUSE
- Unknown
- May be due to extra fluid in inner ear called endolymph
- Isn’t clear what causes liquid build up
101
MENIERE'S DISEASE - POPULATION AFFECTED
- Can happen at any age
- Usually starts between 40-60
102
MENIERE'S DISEASE - RISK FACTORS
- Family Hx
- Pressure changes
- Stress
- Changes hormones
- Problems sleeping
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MENIERE'S DISEASE - CLINICAL PRESENTATION
- Regular dizzy spells
- Hearing loss
- Ringing in ear
- Feeling of fullness in ear
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MENIERE'S DISEASE - PROGNOSIS
- No cure
- Progressive disease which worsens over time
105
VESTIBULAR MIGRAINE - DEFINITION
Nervous system problem that causes vertigo in people who have a Hx of migraine symptoms
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VESTIBULAR MIGRAINE - CAUSE
- Unsure
- Potential misfires between nerve cells in brain
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VESTIBULAR MIGRAINE - POPULATION AFFECTED
- More common in women
- Symptoms tend to strike around 40
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VESTIBULAR MIGRAINE - RISK FACTORS
- Mood- stress/anxiety
- Poor sleep
- Dehydration/hunger
- Dietary triggers- e.g., caffeine
- Hormonal changes
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VESTIBULAR MIGRAINE - CLINICAL PRESENTATION
- Headaches and dizziness which comes and goes
- Nausea and vomiting
- Balance problems
- Sensitivity to sound
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VESTIBULAR MIGRAINE - PROGNOSIS
No cure, management of triggers can lead to normal life
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MENINGITIS - DEFINITION
- Infection and inflammation of the fluid membranes surrounding the brain and spinal cord
- These membranes are called meninges
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MENINGITIS - CAUSE - BACTERIAL
- Viral infections are most common cause of meningitis
- Followed by bacterial infections and rarely fungal and parasitic infections
- Bacterial meningitis
o Bacteria that enters the bloodstream and travels to the brain and spinal cord
o Can also occur when bacteria directly invades the meninges
o May be caused by an ear or sinus infection or a skull fracture
o Bacteria strains that most commonly cause meningitis are
Streptococcus pneumoniae
* Most common cause in infants, young children and adults in America
* Vaccine can help prevent this
Neisseria meningitidis
* Commonly causes upper respiratory infection but can cause meningococcal meningitis when they enter the bloodstream
Haemophilus influenzae
* Was once the leading cause in young children
* Vaccines have greatly reduced the number of cases
Listeria monocytogenes
* Pregnant people, new-borns, older adults and people with weakened immune systems are most susceptible
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MENINGITIS - CAUSE - VIRAL
o Usually mild and often clears on its own
o Most cases are due to a group of viruses called enteroviruses
o Most common in late summer and early fall
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MENINGITIS - CAUSE - CHRONIC
o Long lasting
o Can be caused by slow growing organisms such as fungi and Mycobacterium tuberculosis
o Invade the membranes and fluid surrounding the brain
o Develops over 2 weeks or more
o Symptoms are similar to acute meningitis
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MENINGITIS - CAUSE - FUNGAL
o Isn’t common in western countries
o May mimic acute bacterial meningitis
o Often contracted by breathing in fungal spores that may be found in soil, decaying wood and bird droppings
o Isn’t spread from person to person
o Affects people with a weakened immune system
o Can come back even after treatment
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MENINGITIS - CAUSE - PARASITIC
o Causes a rare type of meningitis called eosinophilic meningitis
o Can be caused by a tape worm infection in the brain or cerebral malaria
o Isn’t spread between people
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MENINGITIS - POPULATION AFFECTED
- Viral – children under 5
- Bacterial – people under 20
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MENINGITIS - RISK FACTORS
- Skipping vaccinations
- Age
o Most cases of viral meningitis occur in children under 5
o Bacterial meningitis is common in those under 20
- Living in a community setting
o College students living in dorms
o Personnel on military bases
o Children in boarding school or care facilities
- Pregnancy
o Increases the risk of an infection caused by listeria bacteria
o Increased the risk of miscarriage, still birth and premature delivery
- Weakened immune system
o AIDS
o Alcohol use disorder
o Diabetes
o Use of immunosuppressant drugs
o Having spleen removed
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MENINGITIS - CLINICAL PRESENTATION
- Early meningitis symptoms may be similar to the flu
- Symptoms may develop over several hours or over a few days
- Possible symptoms in anyone older than 2 years include
o Sudden high fever
o Stiff neck
o Severe headache
o Nausea or vomiting
o Confusion
o Trouble concentrating
o Seizures
o Sleepiness or trouble waking
o Sensitivity to light
o No appetite or thirst
o Skin rash in some cases, such as in meningococcal meningitis
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MENINGITIS - CLINICAL PRESENTATION - INFANTS
o Nigh fever
o Constant crying
o Being very sleepy or irritable
o Trouble waking from sleep
o Being inactive or sluggish
o Not waking to eat
o Poor feeding
o Vomiting
o A bulge in the soft spot on top of the baby’s head
o Stiffness in the body and neck
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MENINGITIS - PROGNOSIS
- Viral meningitis can go away on its own within about a week
- You can survive most forms of meningitis, though it is a very serious illness that requires immediate treatment
- Treatment depends on the cause
- Medications
o Antibiotics for bacterial meningitis
o Antifungal for fungal meningitis
o Antivirals for certain cases of viral meningitis, like herpesvirus and influenza
o Corticosteroids, like dexamethasone or prednisone, to reduce inflammation
o Pain relievers
o IV fluids to keep hydrated
- You should start to feel better within a few days to a week after starting treatment for meningitis
- Full recovery can take weeks to months
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EPILEPSY - DEFINITION
A CNS (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behaviour, sensations and sometimes loss of awareness
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EPILEPSY - CAUSE
- No identifiable cause in about half of people with the condition
- In the other half the condition can be traced to various factors including
o Genetic influence
o Head trauma
o Brain abnormalities
Brain tumours
Vascular malformations
Stroke is the most common cause in people over 35
o Infections
Meningitis
HIV
Viral encephalitis
Some parasitic infections
o Prenatal injury
Infection in the mother
Poor nutrition
Oxygen deficiencies
o Developmental disorders
Autism
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EPILEPSY - POPULATION AFFECTED
- Anyone
- Can affect people of all genders, races, ethnic backgrounds and ages
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EPILEPSY - RISK FACTORS
- Age - Onset of epilepsy is most common in children and older adults
- Family hx
- Head injuries - Responsible for some cases of epilepsy
- Stroke and other vascular diseases - These things can lead to brain damage that can trigger epilepsy
- Dementia
- Brain infections - Meningitis in particular
- Seizures in childhood - High fevers can be associated with seizures
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EPILEPSY - CLINICAL PRESENTATION
- Epilepsy is caused by abnormal activity in the brain so seizures can affect any processes your brain coordinates
- Seizure S&S include
o Temporary confusion
o Staring spell
o Stiff muscles
o Uncontrollable jerking movements of the arms and legs
o Loss of consciousness or awareness
o Psychological symptoms such as fear, anxiety or déjà vu
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EPILEPSY - CLINICAL PRESENTATION - FOCAL SEIZURES
Can occur with consciousness or with impaired awareness
Confusion
Migraine
Narcolepsy
Mental illness
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EPILEPSY - CLINICAL PRESENTATION - GENERALISED SEIZURES
Absence seizures
* Staring into space
Tonic seizures
* Stiff muscles and may affect consciousness
Atonic seizures
* Drop seizures
* Loss of muscle control
Clonic seizures
* Repeated or rhythmic, jerking muscle movements
Myoclonic seizures
* Usually appear as sudden or brief jerks or twitches
Tonic-clonic seizures
* Abrupt loss of consciousness and body stiffening, twitching and shaking
* Most dramatic type of epileptic seizures
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EPILEPSY - PROGNOSIS
- No cure for epilepsy
- Many options to treat epilepsy
- Treatments to control epilepsy include anti-seizure medications, special diets and surgery
- Anti-seizure medications
o Helps to control 60% to 70% of people with epilepsy
o Choice of medication depends on
Seizure type
Prior response to anti-seizure medications
Other medical conditions you have
Potential for interaction with other medications you take
Side effects of the anti-seizure drug
Age
General health
- Diet therapy
o Diets high in fat, moderate in protein and low in carbohydrates
- Surgery and devices
o Surgery options include
Resection
* Removal of abnormal tissue
Disconnection
* Cutting fibre bundies that connect areas of your brain
Stereotactic radiosurgery
* Targeted destruction of abnormal brain tissue
Implantation of neuromodulation devices
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PARKINSONS DISEASE - DEFINITION
A progressive disorder that affects the nervous system and the parts of the body controlled by the nerves
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PARKINSONS DISEASE - CAUSE
- Certain nerve cells (neurons) in the brain gradually break down or die
- Many of the symptoms are due to a loss of neurons that produce a chemical messenger in your brain – dopamine
- When dopamine levels decrease, it causes atypical brain activity, leading to impaired movement and other symptoms of Parkinson’s disease
- Exact cause is unknown but several factors appear to play a role
o Genes
o Environmental triggers
Certain toxins or environmental factors
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PARKINSONS DISEASE - POPULATION AFFECTED
Men at middle to late age
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PARKINSONS DISEASE - RISK FACTORS
- Age
o Ordinarily begins in middle or later life
o Risk increases with age
o Usually developed around 60 or later
- Heredity
o Having a close relative with the disease increases the chances that you will also develop it
o However risk is still small
- Sex
o Men more likely
- Exposure to toxins
o Ongoing exposure to herbicides and pesticides may slightly increase the risk
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PARKINSONS DISEASE - CLINICAL PRESENTATION
- S&S can be different for everyone
- Early signs may be mild and go unnoticed
- Symptoms often begin on one side of the body and usually remain worse on that side
- Tremor
o Rhythmic shaking, Usually begins in a limb, often in hand or fingers, Hand may tremor at rest, Tremor may decrease when pt is performing tasks
- Bradykinesia
o Slowed movement, Happens overtime, Can make simple tasks difficult and time consuming, Steps may become shorter, May become more difficult to get out of a chair
- Rigid muscles, Stiff muscles can be painful, May limit ROM
- Impaired posture and balance
o Posture may become stooped, May fall or have balance issues
- Loss of automatic movements
o May have decreased ability to perform unconscious movements; including Blinking, Smiling, Swinging arms when walking
- Speech changes
o May speak softly, quickly, slur or hesitate before talking, Speech may become more monotone
- Writing changes
o May become hard to write, Writing may appear small
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PARKINSONS DISEASE - PROGNOSIS
- Not curable
- Multiple ways to manage symptoms
- Treatments for Parkinson’s include
o Medications
Adding dopamine
Simulating dopamine
Dopamine metabolism blockers
Levodopa metabolism inhibitors
Adenosine blockers
o Deep brain stimulation
o Experimental treatments
Stem cell transplants
Neuron-repair treatments
Gene therapies and gene-targeted treatments
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MULTIPLE SCLEROSIS - DEFINITION
- Potentially disabling disease of CNS
- Immune system attacks myelin sheath that covers nerve fibres
- Causes communication problems between brain and rest of body
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MULTIPLE SCLEROSIS - CAUSE
- Unknown
- Considered to be autoimmune
- Reduced myelin exposes nerve fibres, interfering with speed and efficiency of message delivery
- Combination of genetic and environmental factors
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MULTIPLE SCLEROSIS - POPULATION AFFECTED
White women aged between 20-40
139
MULTIPLE SCLEROSIS - RISK FACTORS
- Age- 20-40
- Women 2-3x more likely
- Family Hx
- Certain infections- Epstein-Barr
- Race- white people
- Low vitamin D
- Chromosome 6p21 defect
- Smoking
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MULTIPLE SCLEROSIS - CLINICAL PRESENTATION
- Variable- depend on location and severity of nerve fibre damage
- Numbness or weakness to one or more limbs, typically occurs unilaterally
- Lack of coordination
- Unsteady gait or inability to walk
- Partial or complete loss of vision
- Prolonged double/blurry vision
- Vertigo
- Slurred speech
- Cognitive problems
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MULTIPLE SCLEROSIS - PROGNOSIS
- Can eventually cause permanent damage or deterioration of nerve fibres
- No cure however there are treatments to help speed up recovery from attacks, modify course of disease and manage symptoms
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TEMPORAL ARTERITIS - DEFINITION
- Inflammation of lining of arteries
- Aka giant cell arteritis
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TEMPORAL ARTERITIS - CAUSE
- Caused by inflammation of blood vessels
- This narrows blood vessels reducing amount of blood and oxygen to reach body tissue
- Almost any artery can be affected, most common in temples
- Cause unknown
- Believed to be due to abnormal attacks on artery walls by immune system
- Certain genes and enviro factors might be involved
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TEMPORAL ARTERITIS - POPULATION AFFECTED
White women over 70
145
TEMPORAL ARTERITIS - RISK FACTORS
- 70-80
- Women 2x
- White people
- PMR
- Family Hx
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TEMPORAL ARTERITIS - CLINICAL PRESENTATION
- Head P and tenderness
- Scalp tenderness
- Jaw P when chewing or opening mouth wide
- Fever
- Fatigue
- Vision loss/double vision
- Sudden permanent loss of vision
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TEMPORAL ARTERITIS - PROGNOSIS
- Prompt treatment with corticosteroid medication usually relives symptoms and might prevent vision loss
- Relapse common even with treatment
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DIZZINESS AND VERTIGO (CN8) - DEFINITION
- Dizziness is a term used to describe a range of sensations, such as feeling faint, woozy, weak or unsteady
- Vertigo is a sensation of whirling and loss of balance, associated particularly with looking down from a great height, or caused by disease affecting the inner ear or the vestibular nerve; giddiness.
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DIZZINESS AND VERTIGO (CN8) - CAUSE
- Inner ear problems- house sensors that help detect gravity and back and fourth motion
- Eyes- help determine where body is in space
- Sensory nerves- sends messages to brain about body movements and positions
- Circulation problems that cause dizziness- drop in blood pressure, poor blood circulation
- Neurological conditions- e.g., Parkinson’s
- Medication
- Anxiety disorders
- Anaemia
- Damage to CN8
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DIZZINESS AND VERTIGO (CN8) - POPULATION AFFECTED
Can happen at any age, more common in people over 65
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DIZZINESS AND VERTIGO (CN8) - RISK FACTORS
- Older adults
- Past episodes of dizziness
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DIZZINESS AND VERTIGO (CN8) - CLINICAL PRESENTATION
- False sense of motion or spinning (vertigo)
- Light-headedness of feeling faint
- Unsteadiness or loss of balance
- Feeling of floating, wooziness or heavy headedness
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DIZZINESS AND VERTIGO (CN8) - PROGNOSIS
- Most people get better without treatment
- Treatment will depend on cause
- ABs may be prescribed if caused by infection
- Exercises to improve balance
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MYASTHENIA GRAVIS - DEFINITION
Characterised by weakness and rapid fatigue of any muscle under voluntary control
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MYASTHENIA GRAVIS - CAUSE
- Antibodies
o Immune system produces antibodies that blocks or destroys muscle receptor sites for neurotransmitter acetylcholine
o With fewer receptor sites available, muscle receives fewer signals, resulting in weakness
o Can also impair function of protein called muscle-specific receptor tyrosine kinase (MuSK)
o This protein is involved in forming nerve-muscle junction
- Thymus gland
o Believed that thymus gland can trigger or maintain production pf antibodies which block Ach
o Common to have tumour in thymus gland, usually aren’t cancerous
- Mother to child- if treated promptly child usually recovers within two months after birth
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MYASTHENIA GRAVIS - POPULATION AFFECTED
- Can affect anyone
- Women more likely under 40
- Men over 60
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MYASTHENIA GRAVIS - RISK FACTORS
- Women between 20-30
- Men 60-70
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MYASTHENIA GRAVIS - CLINICAL PRESENTATION
- Muscle weakness worsens as affected muscle is used
- Usually improves with rest
- Muscle weakness can come and go
- Eye muscles
o Usually first sign
o Drooping of one or both eyelids
o Double vision
- Facial and throat muscles
o 15% of peoples symptoms involve throat/face
o Impaired speaking
o Difficulty swallowing
o Affects chewing
o Changes facial expressions
- Neck and limb muscles
o General weakness
o Can affect walking
o Weak neck muscles make it hard to hold head up
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MYASTHENIA GRAVIS - PROGNOSIS
No cure but treatment can help relive signs and symptoms
