Spinal Cord injury
�Represents damage to the neural elements of the spinal cord
�Disorder primarily of young adults
�The most common cause is being in a motor vehicle crash, falls, violence, sports injuries, attempted suicide and occupational injuries
�Most __________ invol
Types of SCI include:
�Fractures
�Dislocations
�Subluxation (partial dislocation)
�Flexion injury
�Extension injury
�Compression injury
Spinal Cord injury
�Most often results from vertebral injuries to: C1-C2, C4-C7, & T12-L2
�Injuries to C1-C7 = quadriplegic
�Injuries to T1-T7= paraplegic
�Half side = hemiplegic
�Traumatic forces cause injury by compressing the tissue, pulling or exerting a traction on the
Incomplete spinal cord injury
*Implies there is some residual motor or sensory function below the level of the injury
*Types of incomplete SCI include:
� Central cord syndrome
� Anterior cord syndrome
� Brown-sequard syndrome
� Conus medullaris syndrome
Central cord syndrome
�Occurs when the injury is primarily in the central gray or white matter of the cord
�Motor function of the upper extremities is affected, but the lower extremities may notbe affected or may be affected to a lesser degree
�More common in elderly with narr
Anterior Cord syndrome
�Usually caused by damage from infarction of the anterior spinal artery
�Results in damage to the anterior 2/3 of the cord
�Results in loss of motor function, loss of pain and temperature sensation
�The posterior 1/3 is unaffected. This preserves position
Brown-sequard syndrome
�Damage of the hemisection of the anterior and posterior cord
�Loss of voluntary motor function and Proprioception from the ipsilateral side, and loss of temperature sensation and pain form the contralateral side below the lesion
Conus Medullaris syndrome
�Involves damage to the Conus medullaris or the sacral cord and lumbar nerve roots in the neural canal
�Function deficits are flaccid bowel, bladder and sexual function
�Cauda equina syndrome
Spinal shock
�Characterized by complete loss of reflex function in all segments below the level of the lesion
�Involves all skeletal muscles: bowel, bladder, sexual function, and autonomic control
�Last 7-20 days following onset but may persist for as long as 3 months
Autonomic hyperreflexia (dysreflexia)
�May occur anytime after spinal shock resolves
�Associated with a massive, uncompensated CV response to stimulation of the SNS
�Usually affects individuals with injury at T6 or above
�Most common precipitation cause is a distended bladder or rectum
�When
TIA (Transient Ischemic Attacks)
�Strokes in evolution
�when blood flow to a part of the brain stops for a brief period of time
�Thrombotic particles cause intermittent or temporary blockage of circulation
�For a true ________ all neurological deficits must resolve within 24 hrs and leav
Ischemic CVA
�Caused by an interruption of blood flow in a cerebral vessel (Thrombotic or Embolic)
�The most common type of stroke
�Cerebral atherosclerosis is the most common cause of __________. Found most often in arterial bifurcations
Thrombotic CVA
�Patho: thrombi cause arterial occlusion (blood clots)
�s/s: acute onset (hrs to days), occasional HA, no LOC, frequent Hx of TIA
�Rx: decrease edema and ICP
Embolic CVA
�Patho: occlusion of aorta or carotids by something other than blood /a moving blood clot that travels from its origin to the brain
�s/s: acute onset, often moderate HA, occasional brief LOC, no/occasional Hx of TIA
�Rx: anticoagulants eliminate cause
Hemorrhagic CVA
�Patho: infrequent history of TIA - caused by HTN, aneurysms, rupture of vessels, advancing age
�s/s: acute onset, frequent HA, stiff neck, LOC, and blood in the CSF
�Rx: stop bleed, decrease ICP and vasospasm
�Less common than ischemic stroke
�Associated
Risk factors for CVA (stroke)
�Age
�high cholesterol
�HTN
�Heart disease
�Gender
�Race
�Smoking
�Prior stroke
�DM
�Alcohol use
�Cocaine and illicit drug use
�Sedentary life style
�Sickle cell, Polycythemia, blood disorders
Manifestations of CVA (stroke)
�Are determined by the cerebral artery that is affected, are of brain tissue that is supplied by that vessel and by the adequacy of collateral circulation
�Always sudden
�Usually one sided
�Unilateral weakness, unilateral numbness, vision loss, language d
Meningitis
�Inflammation of the pia mater, the arachnoid and the CSF-filled subarachnoid space
�Usually caused by an infection
�Two main types include acute infections meningitis (acute pyogenic meningitis -usually bacterial) and acute lymphocytic meningitis (usuall
Causes of bacterial meningitis
�Streptococcus pneumonia
�Haeomophilus influenza
�Neisseria meningitides (menigococcus)
�Risk factors:
Basilar skull fractures, otitis media, sinusitis or mastoiditis, neurosurgery, dermal sinus tracts, systemic sepsis, of immunocompromise
Patho of Bacterial Meningitis
�The bacterial organism replicate and undergo lysis in the CSF
�They release endotoxins or cell wall fragments
�These substances initiate the release of inflammatory mediators
�Neutrophils bind to and damage the endothelial cell of the BBB permitting flui
Symptoms of Bacterial Meningitis
�Fever and chills
�Stiff neck
�Back, abd and extremity pains
�N/V
�Seizures
�Cranial nerve palsies
�Focal Cerebral signs
�Petechial rash (meningococcal)
Diagnosis of Bacterial meningitis
�Physical exam
�Lumbar puncture
Usually cloudy and purulent CSF
Increase pressure of CSF
Lg amt of neutrophils
Increased protein
Decrease in Glucose
Viral Meningitis
�Manifests in much the same way as bacterial meningitis
�Course is less severe
�CSF findings are different
Lymphocytes in fluid, protein is only mod. Elevated, sugar usually is normal
�Self-limiting and usually only requires symptomatic treatment
�Can be
Encephalitis
�Generalized infection of the parenchyma of the brain or spinal cord
�Usually caused by a virus, but may be caused by bacteria, fungi, and other organisms
*Mode of transmission is bite of a mosquito, rabid animal, or ingestion
�Patho: local necrotizing he
Alzheimer's disease
Cortical atrophy with slender gyri and prominent sulci
�One of the most common cause of severe cognitive dysfunction in elderly
�Exact cause is unknown
�Accounts for 50-70% of all cases of dementia
�Nearly half of persons 85 years of age and older have it
Alzheimer's patho
�microscopic examination-protein in neurons become distorted and twisted forming a tangle called a neurofibrillary tangle
�proteins accumulate->groups of nerve cells, degenerate and coalesce around and amyloid core
�appear like plaques (senile plaques)->d
Additional degenerative diseases
�Parkinson's
�Huntington's
�Multiple sclerosis
�Amyotropic lateral sclerosis
Parkinson's
�Degenerative disorder of the basal ganglia
�Failure of dopamingergic (dopamine secretion) cells to produce sufficient dopamine
�Onset: >40 years with peak in 60's
�Secondary caused by other disorders than Parkinson's disease (infection, trauma, neoplasm,
Huntington's
�Known as chorea (dance like movement)
�Rare, hereditary degenerative disorder involving the basal ganglia and cerebral cortex
�Onset occurs after the person has already passed it on to their children (autosomal dominant)
�Depletion of GABA (gamma-aminobu
Multiple Sclerosis
�Common disorder involving destruction of CNS myelin, sparing of the peripheral nervous system
�Most prevalent CNS demyelinating disorder and leading cause of neurologic disability in early adulthood (20-40yrs, females 2:1 over males)
�Inflammation occurs
Course of disease (MS)
�1. Relapsing-remitting
Characterized by episodes of acute worsening with recovery and stable course between relapses
�2. Secondary progressive disease
Gradual neurologic deterioration with or without superimposed acute relapses in a person with previous
Rx of MS
�Directed at modifying course of disease
�Minimally affected require no treatment
�Encouraged to maintain a healthy lifestyle, good nutrition, adequate rest and relaxation
�Avoid excessive fatigue, physical deterioration, emotional stress, viral infection
Amyotropic Lateral Sclerosis (ALS)
�Degenerative disorder diffusely involving lower and upper motor neurons. Scarring of the corticospinal tract results
�Classic ________(Lou Gehrig disease) begins in early 40's and peaks in the 50's. male to female ratio 3:2
�Weakness may begin in any or
Neural tube defects
�Caused by an arrest in the embryological development. Incidence of 0.7-1.0 per 1000 births in the USA. But strong association with fetal death obscures the actual number
�A group of disorders characterized by failure of closure of the neural tube with co
Types of neural tube defects:
�Spina Bifida: a failure of closure of the posterior vertebral arches
�Spina Occulta
�Spina cystic: when Spina bifida is complicated by Herniation of the meninges through a defect
*Meningocele: herniated membranes that consist of meninges only through a b
Spina Occulta
�Less serious form of Myelomeningocele
�Defect occurs in the lumbar or sacral area of the spine because of incomplete fusion of the vertebral laminae
�More common than Myelomeningocele
�Usually causes no deficits
�Physical findings: abnormal growth of hai
Meningocele
�Protrusion of the meninges through a vertebral defect
�Spinal cord is not involved
�__________is present at birth as a protruding sac at the level of the defect
�Rx: surgical repair
Myelomeningocele
�Herniation of the meninges, spinal fluid, spinal cord and nerves through a vertebral defect
�80% occur in the lumbosacral region
�Covering membrane may leak CSF increasing the risk of infection and either bowel or bladder dysfunction
�Deficits may worsen
Anencephaly
�Diminished fetal brain tissue->incompatible with life
�Patho: part of skull and brain are absent
�Incidence: 0.36 per 1000 births; risk increased as with any neural tube defect
�s/s: apparent at birth
�Rx: none, child is stillborn or dies shortly after b
Seizures in children
�Asphyxia
�Intracranial bleeding
�CNS infection
�Electrolyte imbalance
�Inborn error of metabolism
�Idiopathic
Disorders in children include infantile spasms, Lennox-Gastaut syndrome, juvenile myoclonic epilepsy and febrile seizures