CNS Disorders :CNS Disorders EMS Professions Temple College


Pathophysiology of CNS Emergencies :Pathophysiology of CNS Emergencies Structural Changes Often due to Trauma but not always Circulatory Changes Inadequate Perfusion Alterations of ICP Response to insult Toxic Metabolic states Alteration to blood chemistry or introduction of toxins Psychiatric ‘mimicking’


ICP Review :ICP Review CBF is a factor of CPP & CVR If CPP , then CBF  If CVR , then CBF most likely  CPP = MAP - ICP MAP = Diastolic + 1/3 PP PP = SBP - DBP PCO2 has greatest effect on CVR Sympathomimetics may  CVR


ICP Review :ICP Review As PCO2 , CVR  Therefore, if PCO2 , CVR  Then, as CVR  , CBF  Normal ICP < 15 mm Hg As ICP , CPP  then CBF  Compensation for  ICP via  MAP Cushing’s Reflex (Triad) Cushing’s triad with coma indicates possible herniation


Altered Mental Status :Altered Mental Status


Coma :Coma A decreased state of consciousness from which a patient cannot be aroused Mechanisms Structural lesions Toxic Metabolic states Psychiatric ‘mimicking’


Brain injury :Brain injury Recall that Brain injury is often shown by: Altered Mental Status Seizures Localizing signs


Is unconsciousness itself an immediate life threat? :Is unconsciousness itself an immediate life threat? Loss of airway Vomiting, aspiration YES, IT IS!


Altered Mental State :Altered Mental State Manage ABC’s Before Investigating Cause!


Initial Assessment/Management :Initial Assessment/Management Airway Open, clear, maintain If trauma or + history, control C-spine Breathing Presence? Adequacy (rate, tidal volume)? High concentration O2 on ALL patients with altered mental status Assist ventilations prn Circulation Pulses? Adequate Perfusion?


Investigate Cause :Investigate Cause DERM D = Depth of Coma E = Eyes R = Respiratory Pattern M = Motor Function


D = Depth of Coma :D = Depth of Coma What does patient respond to? How does he respond? Avoid use of non-specific terms like “stuporous”, “semi-conscious”, “lethargic”, “obtunded”


D = Depth of Coma :D = Depth of Coma AVPU Glasgow Scale (later) Describe level of consciousness in terms of reproducible findings


E = Eyes :E = Eyes Pupils Size - mid, dilated or constricted measurement - e.g. 4 mm Shape - round, oval, pontine Equality - equal in size Symmetry - equal in reaction/response Response to light Yes or No How?


R = Respiratory Pattern :R = Respiratory Pattern Depth Unusually deep or shallow? Pattern Regular or Unusual pattern Can you identify the pattern?


M = Motor Function :M = Motor Function Paralysis? Where? Muscle tone? Rigid or Flaccid Movement? Where? What is it like? Posturing? How? Symmetrical Motor Function?


Physical Exam :Physical Exam Vital Signs Shock? Increased ICP? Hypoxia/Hypercarbia Diagnostics Dysrhythmias? Blood glucose Oxygen saturation


Physical Exam :Physical Exam Detailed (Head-to-Toe) Exam Injuries causing coma? Injuries caused by coma? Clues to the cause


Probable Causes of AMS :Probable Causes of AMS Not enough Oxygen Not enough Sugar Not enough blood flow to deliver oxygen, sugar Direct brain injury Structural Metabolic


Differentiating AMS Causes :Differentiating AMS Causes Structural Asymmetrical deficits Unequal pupils Afebrile History of trauma, structural abnormality Often a rapid onset Metabolic Symmetrical deficits Equal pupils (? altered function) ? Fever History of metabolic disorder or illness Rapid onset less likely


Management :Management Maintain ABCs Attempt to identify cause Mainstays of therapy Oxygenation/Ventilation IV fluids appropriate for the patient D50 (if hypoglycemic) Narcan if possibility of opiate OD Flumazenil in known benzo only OD


AEIOU TIPS :AEIOU TIPS Alcohol Epilepsy Insulin Overdose Uremia (Metabolic causes) Trauma Infection Psychogenic Stroke/Syncope


Cerebrovascular Accident AEIOU TIPS :Cerebrovascular Accident AEIOU TIPS


Cerebrovascular Accident :Cerebrovascular Accident Any disease process that disrupts blood flow to a distinct region of the brain Transient Ischemic Attack (TIA) S/S less than 24 hours without permanent neuro deficits


Cerebrovascular Accident :Cerebrovascular Accident 500,000/yr in US 25% die Survivors often socially, financially devastated $20 billion in medical costs, lost wages


Cerebrovascular Accident (CVA) :Cerebrovascular Accident (CVA) Pathophysiology Thrombosis (brain itself) Embolus (head, neck or heart) Hemorrhage (within brain) Ischemia (systemic blood flow)


Predisposing Factors: Modifiable :Predisposing Factors: Modifiable Hypertension Cigarette smoking Diabetes Mellitus Heart disease Hyperlipidemia Cardiovascular disease Chronic atrial fibrillation Sickle cell disease Polycythemia Hypercoagulability Birth control pill use Cocaine use


Predisposing Factors: Unmodifiable :Predisposing Factors: Unmodifiable Age Gender Race Prior stroke Heredity


CVA Mechanisms :CVA Mechanisms Ischemic stroke--80 to 85% Hemorrhagic stroke--15 to 20%


CVA Origin :Thrombus Embolus Aneurysm Arrhythmia Hypovolemia CVA Origin


Ischemic Stroke :Ischemic Stroke Blood vessel occlusion Thrombosis Embolism Plaque fragments from carotids Chronic atrial fibrillation Fat particles IV substance abuse particulates Systemic hypoperfusion Pump failure Hypovolemia


Ischemic Stroke Syndromes :Ischemic Stroke Syndromes Transient Ischemic Attack (TIA) Neurological deficits that resolve in 24 hours or less (most in 30 minutes) Commonly result from carotid artery disease Same symptoms as CVA Often warning sign of impeding CVA 5% risk of stroke per year


Ischemic Stroke Syndromes :Ischemic Stroke Syndromes Dominant Hemisphere Infarction Contralateral weakness, numbness Contralateral blurring of vision of half the visual field in both eyes Difficulty pronouncing words (dysarthria) Difficulty speaking or understanding speech (dysphasia or aphasia)


Ischemic Stroke Syndromes :Ischemic Stroke Syndromes Nondominant Hemisphere Infarction Contralateral weakness, numbness Contralateral visual field cut Neglect of contralateral extremities Constructional apraxia (difficulty drawing figures like a clock face) Dysarthria Usually NOT dysphasic or aphasic


Ischemic Stroke Syndromes :Ischemic Stroke Syndromes Vertebrobasilar Syndrome Involves blood flow to brainstem, cerebellum, and visual cortex Dizziness, vertigo Diplopia Dysphagia Ataxia, bilateral limb weakness


Hemorrhagic Stroke :Hemorrhagic Stroke 30 to 50% 30-day mortality Younger patient population Two subtypes: Intracerebral, usually 2o to hypertension Subarachnoid, usually from berry aneurysms


Hemorrhagic Stroke Syndromes :Hemorrhagic Stroke Syndromes Intracerebral Hemorrhage Headache, nausea, vomiting precede deficits Patients commonly have decreased LOC with extreme hypertension Contralateral hemiplegia, hemianesthesia Possible aphasia, extremity neglect depending on hemisphere involved


Hemorrhagic Stroke Syndromes :Hemorrhagic Stroke Syndromes Subarachnoid Hemorrhage


CVA Assessment :CVA Assessment Presentation of CVA varies with area(s) of brain involved and type of CVA


CVA Presentation :CVA Presentation Brain can show injury in only three ways: Decreased LOC Seizures Localizing signs Hemiparesis or hemiplegia Dysphasia (Receptive or expressive) Visual disturbances Gait disturbances Inappropriate affect Bizarre behavior Incontinence


Cincinnati Prehospital Stroke Scale :Cincinnati Prehospital Stroke Scale Have patient smile (“Facial Droop”) Normal: Both sides of face move equally well Abnormal: One side does not move as well as other Have patient close eyes and hold arms out (“Arm Drift”) Normal: Both arms drift same amount or do not drift Abnormal: One arm does not drift or one drifts down compared to other or can’t move arms Have patient say, “You can’t teach an old dog new tricks.” (“Speech”) Normal: Correct words, no slurring Abnormal: Slurs words, uses inappropriate words, or unable to speak


Assessment :Assessment Signs & Symptoms Ischemic S&S usually of slower onset Hemiparesis or hemiplegia Numbness or decreased sensation of face or unilateral Altered LOC or coma Convulsions Visual disturbances Slurred or inappropriate speech Headache or dizziness


Assessment :Assessment Signs & Symptoms Cerebral Embolus with rapid onset Emboli from valvular HD or Afib rapid onset Often with an identifiable cause (e.g. Afib, Valvular heart disease, recent long bone fracture)


Assessment :Assessment Signs & Symptoms Cerebral hemorrhage associated with rapid onset high mortality rate Often with severe HA (“Worst headache ever”) N/V Rapid decrease in LOC or seizure Coma, Cushing’s and Herniation


Assessment :Assessment History Associated Altered LOC or Seizure? Onset/Precipitating factors? Initial symptoms and progression? Dizziness, Severe HA, N/V Previous CVA or TIA? Previous neuro deficits? Concomitant illnesses? Sickle Cell Disease Atrial fibrillation Risk factors for stroke & thrombus formation? BCP, Smoking HTN, CVD


Assessment :Assessment Physical Exam Mental Status & Behavior Extremity Motor & Sensory Gait Pupils & Vision Cincinnati Prehospital Stroke Scale Evidence of Cushing’s or Herniation Blood glucose level


CVA Management :CVA Management Basic Objective Improve cerebral blood flow and oxygenation


CVA Management :CVA Management Airway If no gag reflex, intubate Otherwise, position to ensure drainage of secretions Suction prn Breathing Oxygen via NRB Ventilate with BVM and O2 if rate or tidal volume inadequate Intubate if herniating


CVA Management :CVA Management Controlled hyperventilation if intracranial hemorrhage suspected with increased ICP and neurologic deterioration Indicators Sudden onset Headache Rapid loss of consciousness Seizures Unequal pupils


CVA Management :CVA Management Circulation Check blood glucose level Hypoglycemia may mimic CVA Treat hypoglycemia with D50 Establish IV Access Draw blood samples TKO avoid solutions with glucose Monitor ECG 10% of CVAs are associated with cardiac event 12 Lead ECG if suspected ischemia


CVA Management :CVA Management Do not assume patient cannot understand because they cannot talk Position appropriately: If hypertensive, semireclined (head slightly elevated) If normotensive, on affected side If hypotensive, supine


CVA Management :CVA Management Increased Blood pressure treated ONLY if strongly suggestive of ischemic stroke If systolic >220 or diastolic >120 consider gradual blood pressure reduction Labetalol Nitropaste Nitroprusside Controlled reduction Return to pre-CVA levels, NOT to “normal”


CVA Management :CVA Management Thrombolytic agents Consider for all patients with ischemic CVA presenting within 3 hours of onset Early recognition of ischemic stroke and administration of thrombolytics can prevent/limit loss of neurologic function Requires CT scan!!!


CVA Management :CVA Management Think like AMI of the Brain Time is tissue Therapy Mainstays Oxygenation/Ventilation IV Access Rapid assessment & differential Treat associated conditions (hypoglycemia, hypoxia, hypotension) Rapid Transport to appropriate facility CT Scan & Thrombolytics vs. CT Scan & Neurosurgery


SyncopeAEIOU TIPS :SyncopeAEIOU TIPS


Syncope :Syncope aka Fainting Pathophysiology Brief loss of consciousness caused by transient cerebral hypoxia May be caused by lack of glucose or seizure activity in the brain


Syncope :Syncope Types Postural Inadequate blood flow to brain due to position Vasovagal Excessive vagal stimulation Carotid Sinus stimulation/pressure Cardiogenic Dysrhythmia, usually bradycardia Stokes-Adams Syndrome


Syncope :Syncope Types Tussive “coughing spell” resulting in  intrathoracic pressure causing  venous return to the heart most often in overweight male smokers with chronic bronchitis Micturation associated with urination, usually in patients who have consumed EtOH and compounded by increased vagal stimulation


Syncope :Syncope Assessment History of the event Often preceded by sensation of light-headedness Rapid return of consciousness is most common Past History History of vertigo Similar past episodes Many possible causes


Syncope :Syncope Management Manage ABCs Clear airway and Assist ventilations as needed Oxygen NRB (initially) Calm & Reassure Assess for underlying cause ECG Blood glucose History (present and past) Physical Exam Treatment based on underlying cause


SeizuresAEIOU TIPS :SeizuresAEIOU TIPS


Seizures :Seizures Alteration in behavior/consciousness 2° unstable, uncoordinated electrical activity in the brain Often a result of altered membrane permeability Manifested by sudden, brief episodes of: altered consciousness altered motor activity altered sensory phenomena unusual behavior


Seizure Categories :Seizure Categories Generalized Tonic-Clonic (grand mal) AKA Convulsions Absence (petit mal) Partial Simple partial Complex partial Hysterical


Seizure Etiology :Seizure Etiology CVA Hypoxia Infection/Fever Drug/alcohol withdrawal Poisoning/OD Thyrotoxicosis Head trauma Hypoglycemia Brain neoplasms Psychiatric disorders Eclampsia Hypocalcemia Anything that injures brain can cause seizures


Seizures Etiology :Seizures Etiology Most epileptic seizures are idiopathic in origin


Generalized Seizures :Generalized Seizures Petit Mal Absence Sz Children No LOC Grand mal aka Convulsions Common Often w/Aura Sudden LOC Tonic / Clonic Postictal phase Status epilepticus


Generalized Seizures :Generalized Seizures Symmetrical No local onset Irritable focus difficult to identify Near simultaneous activation of entire cortex Focus may begin deep in brain and spread outward


Generalized Seizures :Generalized Seizures Tonic-Clonic Seizures (Grand Mal) Aura (preictal phase) Loss of consciousness/postural tone Tonic phase Hypertonic (tetanic) phase Clonic phase Post-ictal phase May experience transient neurologic deficits (Todd’s paralysis)


Generalized Seizures :Generalized Seizures Absence Seizure (Petit Mal) Brief loss of awareness (10 - 30 seconds) Usually no loss of postural tone May occur 100+ times a day Primarily pediatric problem Often described as “daydreaming”, not paying attention Usually disappear as child matures


Partial Seizures :Partial Seizures Seizure begins locally May remain localized or spread to entire cortex Result from focal structural lesion in brain


Partial Seizures :Partial Seizures Simple Localized clonic activity Abnormal sensory symptoms Usually no LOC May progress Jacksonian March (Seizure) Complex Change in behavior Preceded by aura Repetitive motor behavior No recall May progress


Partial Seizures :Partial Seizures Simple partial seizures (No loss of consciousness) Focal motor seizures Local clonic activity May display Jacksonian march Sensory seizures Autonomic seizures


Partial Seizures :Partial Seizures Complex partial seizure (psychomotor or temporal lobe seizures) Distinctive aura Loss of consciousness Automatisms May be mistaken for drunks or psychotics May experience episodes of rage


Hysterical “Seizures” :Hysterical “Seizures” Usually in front of audience Usually follow interpersonal stress Movements asymmetrical or purposeful Does not fall, hit head, bite tongue Incontinence rare Recalls things said, done during “seizure”


Assessment :Assessment Seizure Assessment Duration Seizure Postictal phase Typical for the patient? Onset Events before HA Aura Trauma Vision Disturbances


Assessment :Assessment Recent History Trauma to the head/brain HA / Neck Pain Pregnancy Brain tumor Recent Infection/Illness CVA Symptoms Introduction of Poisons into body


Assessment :Assessment Past History Diabetes Mellitus Seizure Disorder Tumor CVA Medications Recreational Drug Use Alcohol abuse


Assessment :Assessment Physical Exam Evidence of trauma Evidence of alcohol, drug abuse Rash, stiff neck Pregnant CVA Signs Incontinence


Status Epilepticus :Status Epilepticus Two or more seizures without intervening conscious period Usually due to medication non-compliance Management same as for other Seizures just more aggressive


Seizure Management :Seizure Management Patient actively seizing Do NOT restrain Do NOT put anything in mouth Oxygen NRB if possible ECG Monitor when possible IV Access Lg Bore, NS Assess blood glucose


Seizure Management :Seizure Management Patient actively seizing If hypoglycemic: Assess IV patency FIRST!! Dextrose 50% 12.5 - 25 grams IV push Consider Thiamine 100 mg slow IV push Diazepam, slow IV administration until seizure stops or until ~ 10 mg Usually aimed at 2.5 mg doses, one after another Phenobarbital, 100 mg/min IV push to a total ~390 mg or seizure stops Barbiturate coma NMB & Intubation


Seizure Management :Seizure Management Current Mainstays of Therapy for Actively Seizing Patient Diazepam Lorazepam Phenobarbital “New” Therapy Phosphenytoin Other Considerations Glucose MgSO4 Paraldehyde Dilantin (phenytoin) 18mg/kg at 25 mg/min


Seizure Management :Seizure Management After seizure stops: Open -Clear- Maintain airway O2 via NRB Assist ventilations if needed Roll patient onto side protecting head Reassess ABCDs Assess blood glucose Physical Exam and History Most seizure deaths are due to anoxia


Seizure Management :Seizure Management If the patient is epileptic, do these seizures match what is “normal” for him? Just because the patient is epileptic, he does NOT have to be having an epileptic seizure!


Mandatory Transports :Mandatory Transports First time seizures Seizure patient off medications Change in seizure pattern Associated with trauma Pregnant patient Status epilepticus Associated with increased body temperature Not always; Seldom in young children Has infection been diagnosed and treatment initiated?


Insulin: Hypo/Hyperglycemia AEIOU TIPS :Insulin: Hypo/Hyperglycemia AEIOU TIPS


Insulin :Insulin Hypoglycemia Hyperglycemia DKA HHNC


Insulin :Insulin Assessment Medical Alert Tag/Bracelet Evidence of DM Medications Fruity breath odor Signs of repeated SQ injections Blood glucose level (See Endocrine for further assessment)


Insulin :Insulin Management Hypoglycemia Management ABCs: Oxygen/IV/ECG Dextrose 50% (adult), 12.5 - 25 grams IV push via patent line Consider Thiamine 100 mg slow IV push Dextrose 25% (children), 0.5 - 1 grams IV push (2-4 cc/kg) via patent line Carbohydrate meal Assess for underlying cause Consider transport


Insulin :Insulin Management DKA/HHNC Management ABCs: Oxygen/IV/ECG Ventilate/Intubate prn Fluid administration titrated to signs of shock 250 cc boluses and reassess Consider administration of Regular Insulin (consult medical control) Assess for underlying cause Transport


Alcohol AEIOU TIPS :Alcohol AEIOU TIPS


Alcohol :Alcohol “Dead drunk” Mixed overdose May be associated with Head trauma Hypoglycemia EtOH present in up to 40% of AMS patients


Alcohol :Alcohol Is it alcohol or is it something else? A patient is never “Just Drunk”


Alcohol :Alcohol Management Manage ABCs Clear airway and ventilate as needed Oxygen IV access prn Assess for other causes of AMS ECG Monitor Blood glucose level History of mixed poisoning or EtOH poisoning Physical exam Treat other causes


Overdose/PoisoningAEIOU TIPS :Overdose/PoisoningAEIOU TIPS


Overdose/Poisoning :Overdose/Poisoning Possible Overdose/Poisonings resulting in AMS Alcohol: Ethanol/Methanol Narcotics Sedative-hypnotics Solvent inhalation Stimulants


Overdose :Overdose Assessment Needle marks? Pupil responses? Slow respirations? Associated hypotension Odd behavior? Breath odors? Color of oral mucosa, vomitus? History of Recent Drug/Poison use?


Uremia/Metabolic CausesAEIOU TIPS :Uremia/Metabolic CausesAEIOU TIPS


Uremia (Metabolic Causes) :Uremia (Metabolic Causes) Uremia/Renal Failure Hyperthyroidism Hypothyroidism Addisonian Crisis Hepatic Coma/Encephalopathy


Uremia (Metabolic Causes) :Uremia (Metabolic Causes) Assessment Med Alert? Patient medications? Physical findings? The Physical Exam and History (recent and past) are most useful


TraumaAEIOU TIPS :TraumaAEIOU TIPS


Trauma :Trauma Concussion Cerebral contusion Intracranial hematoma Hypovolemia Hypoxia


Trauma :Trauma Assessment Physical findings? Evidence of brain injury History of recent or remote trauma?


Trauma :Trauma Altered Mental Status = Head Injury Until Proven Otherwise


Trauma :Trauma Head injury severity cannot be evaluated accurately in presence of shock


Trauma :Trauma Management Manage ABCs Spinal motion restriction if indicated Clear airway and secure prn Ventilate prn Oxygen Establish IV access, NS Fluid to titrate BP to ~ 90 mm Hg systolic Assess for other causes: ECG, Blood glucose Transport to trauma center


Infection/FeverAEIOU TIPS :Infection/FeverAEIOU TIPS


Infection :Meningitis Encephalitis Brain abscess Sepsis Fever Infection


Infection :Infection Assessment Headache? Fever? Sore throat? Stiff neck (nuchal rigidity)? Rash? Associated symptoms of systemic infection


Infection :Infection Management Infection Control Measures Manage ABCs clear airway and ventilate prn oxygen IV access prn Consider acetaminophen for fever fluid / rehydration


PsychogenicAEIOU TIPS :PsychogenicAEIOU TIPS


Psychogenic :Hysterical faking Catatonia “psychomotor disturbances characterized by physical rigidity, negativism, or stupor” may occur in schizophrenia, mood disorders or organic mental disorders Psychogenic


Psychogenic :Psychogenic Assessment Circumstances? Events leading up to this point Prior behavior? Similar past episodes Medications & PMHx


Assessment & Management of AMS :Assessment & Management of AMS


Primary Assessment :Primary Assessment Onset Mechanism (Kinematics) Preceding S/S Level of Consciousness AVPU GCS (later) Airway obstruction or compromise Fluid Unprotected airway (e.g. coma)


Primary Assessment :Primary Assessment Ventilatory ability Adequate Ventilatory rate and depth? Respiratory Insufficiency 2° to  ICP? (e.g. irregular patterns) Cardiovascular compromise Shock /hypotension /hypovolemia Hypertension


Primary Assessment :Primary Assessment Neuro Exam (motor & sensory) Posturing? Muscle Tone? Pupillary Reflexes? Extraocular Movements? Symmetry History Present and Recent Past


Management of AMS :Management of AMS Goals: Airway control/ maintenance Avoid hypoxia Cardiovascular stabilization Avoid hypotension/shock Interruption of cerebral injury Fix the root cause problem Protection from further harm Avoid secondary brain injury


Other Neurologic Conditions :Other Neurologic Conditions


Headache :Headache Common complaint Many persons experience regularly ~ 1/3 due to migraine HA May be associated with significant pathology Characteristics Sudden vs Constant vs Recurring Generalized vs Localized Mild to Moderate to Severe Intensity of Pain Cause is often unknown


Headache :Headache Vascular Migraines Last minutes to hours to days Usually very intense, throbbing pain Photosensitivity N/V Often unilateral May be preceded by aura (not common) Occur commonly in women


Headache :Headache Vascular Cluster Series of headaches Usually last for a few minutes or a few hours Sudden, intense pain Usually unilateral May be accompanied by nasal congestion, irritated or watery eye (same side) Occur commonly in men


Headache :Headache Tension Most common headache Occur regularly Often awake in a.m. and worsens throughout the day Dull, ache Feels like pressure on neck and/or head


Headache :Headache Organic Not very common Due to some specific cause (illness/injury) in the body Tumor Infection Meningitis Hypoglycemia etc.


Headache :Headache Potentially Serious Pathologies Complaint “Worst headache ever” “It hurts right here” May localize at posterior neck at base of skull Possible subarachnoid hemorrhage Concern for possible intracranial hemorrhage


Neoplasms :Neoplasms Less common neoplasm Risk factors genetic exposure to radiation tobacco use occupational exposure to toxins medications/drugs/poisons diet


Neoplasms :Neoplasms Pathophysiology Most often a result of metastasis from another cancer (malignant) Assessment focused on the detailed neuro exam not a diagnosis diagnosis BUT should be included in the differential dx


Muscular Dystrophy :Muscular Dystrophy Genetic disorder Results in degeneration of muscle fibers Types Duchenne Fascioscapulohumeral Limb Girdle Myotonic


Muscular Dystrophy :Muscular Dystrophy Duchenne dystrophy most common childhood muscular dystrophy onset usually by age 6 symmetrical weakness and wasting of first the pelvic and leg muscles then pectoral and proximal upper extremities progresses and results in early death usually in adolescence


Multiple Sclerosis :Multiple Sclerosis Common demyelinating disorder of the CNS Results in patches of sclerosis (patches) in brain and SC Occurs primarily in young adults Typical S/S visual loss, diplopia nystagmus weakness, paresthesias symptoms may have periods of exacerbation and remission


Parkinson’s Disease :Parkinson’s Disease Degenerative changes in the basal ganglia result in deficiency of dopamine Characterized by rhythmical muscular tremors, rigidity of movement, and droopy posture Usually occurs after 40 years of age Leading cause of neuro disability > 60 years Estimated 500,000 in US


Central Pain Syndrome :Central Pain Syndrome Known as Trigeminal Neuralgia paroxysmal bursts of pain in one or more branches of the trigeminal nerve Often induced by touching trigger points in or about the mouth Causes tumor some medications (phenothiazines)


Bell’s Palsy :Bell’s Palsy Paresis or paralysis of the facial muscles usually unilateral Occurs in 23 of 100,000 persons Caused by dysfunction of the 7th cranial nerve cause is usually a viral infection other causes post trauma herpes simplex lyme disease idiopathic


Amyotrophic Lateral Sclerosis :Amyotrophic Lateral Sclerosis Progressive motor neuron disease aka ALS or Lou Gehrig disease disease of the motor tracts of the lateral columns and anterior horns of the SC results in progressive muscular atrophy, increased reflexes, and spastic irritability of muscles


Spina Bifida :Spina Bifida An embryolgic failure of fusion of one or more vertebral arches results in spinal cord exposure spinal cord may protrude outward various types based upon type of deformity Child requires frequent surgeries increased risk of latex allergies


Poliomyelitis :Poliomyelitis An inflammatory process of the Spinal Cord’s gray matter May be caused by the poliomyelitis virus Enters bloodstream and nervous system results in paralysis of the limbs Uncommon today in the US due to polio vaccine