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Transcript of Cerebral Vascular Accident - Mercer County …behrensb/documents/documents/2011nervoussystem… ·...
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Cerebral Vascular Accident
Communication Difficulties
Aphasia
Inability to comprehend or express language
Receptive aphasia (Wernicke’s)
Fluent speech that may not make sense
Inability to read or understand spoken word (L frontal
lobe)
Inability to process information in the brain
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Cerebral Vascular Accident
Communication difficulties
Expressive aphasia (Broca’s)
Severe difficulty in verbal expression
Moderate to severe naming and repetition difficulties
Non-fluent, effortful, slow speech
Impaired in writing abilities
Due to large, deep lesion in frontal
lobe
Comprehension is excellent
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Cerebral Vascular Accident
Dysarthria
Words cannot be articulated clearly
Agraphia
Impaired writing ability
Alexia
Impaired reading ability
Agnosia
Inability to recognize objects and their meaning
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CVA Timeline
Cerebral Infarct
Immediate and gradual
Edematous brain tissue
Neurologic deficits
Few days
Edema subsides
Seriousness improves
Survival rate increases
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Spinal Cord Injury
Primary injury
Structural damage occurring instantly after the
traumatic event
Primary destruction of the neurons at the level of
injury
Secondary injury
Cascade initiated shortly after injury
Ischemia
hypoxia
Edema
Harmful biochemical events
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Spinal Cord Injury
Clinical manifestations:
Depend on level of injury
Differences may exist between motor and sensory
levels of impairment
Complete lesion: complete loss of sensory and
motor function below level of lesion
Incomplete lesion: partial loss of sensory and
motor function below level of lesion
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Spinal Cord Injury
Clinical manifestations
Autonomic system changes
Muscle tone changes
Respiratory complications
Cardiovascular conditions
Pressure ulcers
Bowel and bladder control
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Guillain-Barre Syndrome
Auto immune disease triggered by previous
infection or trauma
Symptoms evolve rapidly
Muscle weakness
Tingling
Can result in almost total paralysis
Recovery may take years
May have residual weakness
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Guillain-Barre Syndrome
PT
PROM in initial stages
Avoid overfatigue with therex
Gain training
Balance/coordination
ADL training
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Infectious Diseases of the CNS
Meningitis
Inflammation of the meninges of the brain and
spinal cord
Syphilis
Develops years after exposure
Generalized paresis
Ataxic motion & decreased kinesthetic sense
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Viral Diseases of the CNS
Encephalitis
Acute inflammatory disease of brain
Caused by viral invasion or
hypersensitivity initiated by virus
West Nile virus
Post vaccine encephalitis
Poliomyelitis
Post polio syndrome
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Viral Diseases of the CNS
Rabies
Excitement, aggressiveness, dementia, paralysis and then death
Herpes
Zoster “shingles” vesicles along sensory nerves
Simplex – unilateral eruption
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Multiple Sclerosis (MS) Dymylenation of axons of white matter cause
formation of plaques
Plaques (lesions) slow or block neural
transmission resulting in: Weakness
Sensory loss
Visual dysfunction
Other symptoms
Signs and symptoms vary greatly from person
to person
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MS
Sensory
Loss of touch
Paresthesia
Blurred vision
Motor
Muscle weakness
Unsteady gait
Uncoordinated movement
Intention tremor
Balance dysfunction
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MS
Chronic illness manifested in multiple forms
and courses
Relapsing-remitting
Secondary progressive
Primary progressive
Progressive relapsing
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MS
diagnosis
Difficult process
Usually requires elimination of other diseases
Prognosis:
Average frequency of attacks 1x/yr
Vary in severity
Life expectancy reduced by modest amount
25% will require assistance with ADLs
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MS
PT
More energy in a.m, fatigue in early afternoon,
some recovery in the evening
Postural control
Functional independence
Balance
Aquatic therapy (???)
Schedule rest breaks, avoid over stressing or over
heating
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Parkinson’s Disease
Chronic, progressive disease of the motor
component of CNS
Etiology: not fully understood
Genetic
Exposure to toxins, infections
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Parkinson’s Disease
Dysfunction with subcortical grey matter in
basal ganglia
Substantia nigra loses ability to produce
dopamine
Movement disorder with dysfunction of
movement preparation and execution
Lesions change the character of movement
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Parkinson’s Disease
Clinical manifestations:
Tremor
Rhythmic, back-and-forth motion of thumb and
finger- “pill rolling”
Most obvious at rest or during stress
Rigidity
Gait and postural changes
Dementia
Flat affect
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Parkinson’s Disease
Clinical manifestations
Bradykinesia or akinesia
Bradykinesia- Slowness of movement
Akinesia- disorder of movement initiation
Freezing may occur
Weakness and fatigue
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Parkinson’s Disease
Treatment
Levodopa- improves most of major symptoms
Converted to dopamine
Used in combination with Carbidopa (inhibits
breakdown of levodopa)
Deep brain stimulation
Prognosis
Does not significantly decrease life expectancy
when diagnosed between 50 and 60
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Diseases of the CNS
Huntington’s Disease
Neurodegenerative disease with involuntary
gyrating movements and progressive dementia
Genetic disorder
Atrophy of the cortex
Appears in midlife
Mental incapacitation by 50-60
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Huntington’s Disease
Pathogenesis
Atrophy and loss of nerve cells in the basal
ganglia
Volume of brain decreases
Atrophy of motor cortex of the frontal lobe
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Huntington’s Disease
Clinical manifestations
Choreiform movements- involuntary gyrating
movements
Dysarthria
Dysphagia
Personality and behavioral changes
Progressive dementia
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Huntington’s Disease
Prognosis
Advance of disease is slow
Death 10 to 30 years after onset
Treatment
Symptomatic
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Diseases of the CNS
Alzheimer’s Disease
Form of dementia
Idiopathic etiology and incurable
Atrophy of the cortical parts of the frontal and
temporal lobes of the brain
Progressive loss of cognitive functions
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Alzheimer’s Disease
Clinical manifestations:
Early symptoms may be overlooked
Memory loss
Speech difficulties
Personality changes
Functional disorders
Depression
Abnormal motor signs
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Alzheimer’s Disease
Prognosis
4th leading cause of death in adults
Onset to death- 7-11 years
PT
Increased risk for falls
Maintain function
Assistive devices
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Amyotrophic Lateral Sclerosis (ALS)
Motor weakness and Progressive wasting of
muscles in the extremities
Generalized muscle loss and death (3-10 yrs)
Etiology unknown
Pathology
Degeneration of motor cells in the spinal cord,
brainstem, cerebral cortex
Leads to denervation and atrophy of muscles
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ALS
Clinical manifestations
Progressive wasting and atrophy of muscles
Difficulty chewing and swallowing
Death due to respiratory muscle paralysis
Cognitive impairments may be present
In most, intellect is not affected
Treatment
No cure
Symptomatic therapy
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Neoplasms
Brain tumors have high mortality rate
Compress vital centers
50% are primary tumors, 50% are metastasis
Etiology
Unknown
May have genetic or familiar link
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Neoplasms
Gliomas
Arise from glial cells
All are malignant
80% are astrocytic tumors
Astrocytomas- less malignant
Glioblastoma multiforme- highly malignant
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Neoplasms
Precursors and undifferentiated cells
Medulloblastomas
Originate from fetal cell precursors
Found in children
Limited to cerebellum
Grow rapidly
Poor prognosis
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Neoplasms
Meningioma
Arise from meninges
Most are benign
May cause epileptic seizure or motor deficits
Prognosis good
Surgical excission
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Neoplasms
Neuromas
Tumors arising from nerves
Most are benign
Can originate along cranial or spinal nerves
Can originate along peripheral nerves
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Neoplasms
Metastasis to brain
50% of brain tumors
Mets from lung, breast, melanoma
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Alcoholism
Continued consumption of large quantities of alcohol with dependency
Alcohol is a neurotoxin
Cortical atrophy
Progressive mental deterioration
Loss of memory
Inability to concentrate
Irritability
Adverse effects on striated muscle cells
Cerebellar atrophy
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Nervous System Diseases
Headaches
Any diffuse pattern in
any portion of the head
Cause
Irritation of one or
more of the pain
sensitive structures in
the head, neck, back
cranial arteries, veins,
cranial nerves, spinal
nerves and cervical
muscles
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Nervous System Diseases
Migraine Headache
Incapacitating headache
with
Nausea
Vomiting
Visual disturbances
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Peripheral Nerve Diseases
Bell’s Palsy
Disease of the facial nerve (7th cranial nerve)
Paralysis of muscles on one side of the face
Occurs between 20-60
Idiopathic or vascular ischemia or viral or
autoimmune
15% of those with Lyme’s Disease
develop bilateral Bell’s
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Peripheral Nervous System
Peripheral neuropathy
Etiology:
Diabetes
Guillain-Barre Syndrome
Alcoholism
Auto immune diseases
Cancer
Thyroid dysfunction
Infections
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Peripheral neuropathy
Symptoms:
Pain
Weakness and atrophy
Cramping
Altered sensation