Download 26 Somatic-neurological syndromes

METHODICAL INSTRUCTIONS
FOR INDIVIDUAL WORK OF STUDENTS IN PREPARATION FOR
PRACTICAL CLASSES
Subject
Neurology
Topic.
Somatic-neurological syndromes
Year
Faculty
IV
Medical
2
1. Topicality: Paying attention to the fact that nervous system is a regulator of basic functions of
human body, and presence of close connection practically in every somatic disease with abnormalities
of CNS, topicality of studying of these pathologies with the purpose of optimization of treatment-andprophylactic measures in somatic-neurological syndromes (SNS) are indisputable.
2. Specific purposes:
To be able to differentiate somatic-neurological syndromes, to know factors of their origin, to be able
to prescribe treatment.
3. Basic knowledge, skills and competences which are necessary for topic studying (
interdisciplinary integration)
Subject
To know
To be able to
1 Anatomy
Anatomy
of
CNS, To know definitions
vegetative NS
subjects
2 General
physiology To know pathogenetic levels To know definitions
(neurophysiology)
of development of stable subjects
(functional) abnormalities in
SNS state of CNS
3 Physiopathology
To know pathophysiological To know definitions
mechanisms of neuronic subjects
abnormalities
Histology
To know morphological To know definitions
changes in diseases which subjects
result in SNS
4 Nervous diseases – clinical Clinical
picture
of To know definitions
picture, diagnostics
therapeutic
diseases, subjects
Клініка
терапевтичних
захворювань, effect of
factors of toxic extreme
influence.
5 Biochemistry
To
know
biochemical To know definitions
findings of blood and urine subjects
rate
6 Pharmacology
Pharmacological
To know definitions
medications of neurotropic subjects
effect
of given
of given
of given
of given
of given
of given
of given
4. Tasks for individual work during preparation for classes:
1. To acquaint with classification of vessel, cardiac diseases, and diseases of alimentary tract, urinary
system, systemic diseases, and blood diseases.
2. To acquaint with classification and pathological states CNS in response of biochemical, toxic and
ischemic influence.
3. To know basic nosologies which result in development of SNS.
а) The list of the basic terms, characteristic, which students must master in preparation for the
class:
№
Term
Definition
3
1.
Somatic-neurological
syndromes
Somatic-neurological syndromes – states, caused by
influence of somatic pathology.
2.
Cardiocerebral disorders
Abnormality of NS as a result from cardiac diseases
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Extreme factors
Factors of NS effect which are not physiological and result
in pathological changes.
4
Asthenia
It is characterized by increased fatigue, decreasing of
ability to work, worsening of memory and attention. These
abnormalities are usually accompanied by increased
excitability, irritability, emotional instability and lability of
mood. Emotional reactions are not equal to irritator
strength.
5) The list of theoretical questions:
1. Somatogenii
2. Neuroses, neurotic and vegetative syndromes which appear more often in SNS
3. Syndromes in somatic diseases – cephalgias, vegetative dysfunction etc.
с) Practical tasks made at the lesson:
1. Examination of patient’s status
2. Solving problems
Topic content:
Impairment of nervous system in case of cardiovascular system disease
Cardiocerebral disorders – depend on character of cardiovascular pathology
Systemic vascular disorders reveal as:
Neurasthenic (asthenic, phobic),
Hypothalamic,
Spasmodic syndromes,
Encephalopathy.
Phobic disorders are typical: fear, anxiety, inner uneasiness; concentrating at their feelings,
depression.
Cephalic syndrome often appears in patients with acquired defects of heart. The syndrome is
due to functional vasomotor abnormalities.
Stroke.
Infectious myocarditis appears especially against a background of impairment of mitral valve,
embolic ischemic stroke, meningitis, abscess of brain.
Ischemic cardiac disease course is accompanied by abnormality of nervous system function.
Cardiocerebral and cardiospinal syndromes often appear.
Neurotic abnormalities, sudden loss of consciousness, vascular attacks, and stroke and
dyscirculatory encephalopathy are typical for cardiocerebral syndrome. Cardiospinal syndrome
procceds as acute abnormality of spinal blood circulation or dyscirculatory myelopathy.
There are neurasthenia with neurosis-like fears, development of asthenohypochondriac
syndrome or depressive syndrome in case of chronical or acute coronary deficiency.
syncopal states (sudden loss of consciousness )
Ischemic cardiac disease is a basic risk factor of abnormality of brain blood circulation.
Embolic stroke or unthrombotic stroke can develop against its background.
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Cardiac rhythm disturbances usually result in syncopal attack (loss of consciousness),
epileptic seizure and abnormalities of brain blood circulation.
Nervous system impairment in case of respiratory tract diseases.
Respiratory tract diseases (bronchitis, pneumonia, bronchial asthma, emphysema and
tuberculosis of lungs) can result in different neurological abnormalities. Neurasthenic syndrome, acute
and chronical encephalopathy, abnormality of brain blood circulation and decompensation of old focal
lesion of brain tissues are often appear.
Digestive apparatus Projection pain in Zahar’n’s or Head’s zones and referred pain (radiculalgia, celiac-plexus
syndrome) concern pain syndromes.
Polyneuritic syndrome appears in patients with stomach ulcer and colitis (in case of
hypovitaminosis B).
Impairment of nervous system in liver diseases.
Impairment of nervous system in such case is due to abnormalities of disintoxicative function
and exchange function of liver.
Neurasthenic syndrome, hypochondriac syndrome, syndrome of acute and chronical liver
metabolic encephalopathy, encephalomyelopathy, mielopathy,
polyradiculoneuropathic, plexal
syndrome appear.
Brain edema, polyneuropathy, plexal syndrome often are complications.
Impairment of nervous system in pancreas diseases
Clinical syndromes: neurasthenic syndrome, syndrome of acute and chronical pancreatic
encephalopathy, encephalomyelopathy. Shock of protein-degrading enzymes (tripsin, chemotripsin,
lipases, amylases) play a great role in pathogenesis of neurological abnormalities.
Impairment of adrenal glands reveals as abnormalities of hormones production (gluco,
mineralocorticoids, androgens) and results in vegetative and trophic abnormalities: adiposity,
osteoporosis, muscle atrophy etc.
Thyroid gland diseases demonstrate hyper- or hypothyroidism.
Hyperthyroidism is accompanied by development of neurasthenic syndrome, encephalopathy,
myopathic and myasthenic syndromes.
Hypothyroidism results in asthenic, myopathic syndromes or encephalopathy.
There are neurasthenic syndrome, diabetic polyneuropathy, metabolic encephalopathy, diabetic
coma and cerebral stroke in pancreatic diabetes.
Diabetic (hyperglycemic) coma is due to fast increase of hyperglycemia, abnormality of acidbase balance and osmotic characteristics of extracellular fluid. Precoma usually precedes development
of coma. Headache and pain in supracranial region increase, thirst and polyuria are also observed in
patient during precoma. Later psychomotor agitation, clonic convulsions are observed, breathing
becomes slower and deeper, there is drowse and a patient loses consciousness. However sudden
development of hyperglycemic coma may occur. In deep coma a patient lies motionless, there are
miotic pupils, cogged-wheel breathing, offensive acetone breath, skin is dry and hot to the touch, rapid
pulse of weak filling, oligo- or anuria are observed. Focal symptomatology is not revealed in
neurological status, but muscle tone is low, tendon reflex are slowed, there may be pathological plantar
reflexes.
Hyperglycemic coma is characterized by rapid development (during several minutes). A patient
feels hungry; there is general weakness, hyperhidrosis. There is typical feeling of inner tremor that
turns into general psychomotor agitation at background of which a patient loses consciousness. Skin is
pale and wet, there are mydriatic pupils, muscle tone is increased, tonoclonic spasms are observed.
There is a low level of glucose in blood. Hyperglycemic coma appears when glucose level is lower
than 0,6 mmol per L, though neurological abnormalities appear in uncritical hypoglycemia(2,3—
1,7mmol per L).
Impairment of nervous system in diseases of blood system.
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(anemia, leucosis, myelomatosis, lymphogranulomatosis, hemorrhagic diathesis) cause both
impairments of central and peripheral nervous systems. Thus there are such neurological syndromes
as: meningeal, radicular, compression syndromes, acute abnormalities of brain blood circulation,
funicular myelosis.
Vitamin В12 deficiency anemia (megaloblastic anemia, Addison-Biermer anemia) more often
results in beginning of demyelination with following axonal degeneration of pathways of posterior and
then lateral funiculus of spinal cord. It is clinically reveals as mielopathy (funicular myelosis). The
disease develops gradually and it is characterized by pain, paresthesias in lower extremities,
bathyesthesia, sensitive ataxia, lowering of deep knee-jerk reaction and Achilles reflex.
Brain membranes are often impaired in patient with acute leukemia, meningial syndrome and
impairments of oculomotor nerve, facial nerve and auditory nerve occur.
Focal symptoms as aphasia, hemiparesis, cerebellar abnormalities etc. appear when substance
of brain is introduced to pathological process.
Myelomatosis may cause compression of spinal roots, cauda equine or spinal cord.
Mononeuropathy sometimes appears as a result of amyloid deposition in vessels of peripheral nerves,
their ischemia or seepage. Compression of spinal cord (often on the level of СУ—ТУПІ vertebrae or
cauda equine) develops in lymphogranulomatosis too. Intracranial disseminated impairment can occur
from cervical nodes or by distension round lymphatic system.
Polycythemia which makes for increasing of blood viscosity and development of intravascular
fibrillation syndrome may causes the beginning both thrombotic stroke and hemorrhagic stroke.
Ischemic stoke of thrombotic genesis may complicate the course of drepancytic anemia.
Nervous system impairment in case of systemic diseases of connective tissue. (atrophic
arthritis, vasculitis – nodular periarteritis, temporal arteritis), systemic red lupus, scleroderma.
Autoimmune abnormalities are at the base of neurological complications.
Neurological
syndomes:
monoand
polyneuropathic
and
neurological,
encephalomyelopolyradiculous and amyotrophic.
Beginning of compression and ischemic (tunnel) syndromes are typical in case of atrophic
arthritis. Median nerve in wrist canal is impaired more often, cubital, radial, fibular and tibial nerves.
Numerous impairments of peripheral nerves with clinical sensor-motor manifistations are typical too.
Cervical myelopathy often develops and pain appears in cervical area of spine as a result of changes.
Nodular periarteritis is systemic impairment of arterioles. Pathology of peripheral region of
nervous system, impairment of distal nerves of extremities and cranial nerves, is typical.
Pain syndrome and dysesthesia are marked.
Among cranial nerves triple, facial and vestibular-cochlear nerves are impaired. Aseptic
meningitis and very seldom cerebral stroke occur when central nervous system is involved to the
process.
Temporal arteritis is characterized by pain in temporal region and narrowing of temporal
artery. Scotoma and diplopia may occur from time to time. Ablepsia is a serious impairment of this
disease (it results from neuropathy of visual nerve, retinopathy orretrobulbar neuritis).
There are cerebral complications of systemic red lupus:
Psychic disorders, epileptic seizure and stroke.
Myelinated polyneuropathy, and development of Guillain-Barré syndrome.
Antiphospholipid syndrome as independent primary disease - arterial thrombosis and venous
thrombosis: thrombocytopenia, involuntary abortion, - ischemic stroke, epilepsy, dementia, chorea,
myasthenia.
Scleroderma is manifested in neurology by onsets of jacksonian epilepsy, neuropathy, spinal
cord impairment that looks like tabes dorsalis. Vegetative disorders often occur.
Sympathic-adrenal and vagoinsular crisis are often observed in patients with neuroses. As a
rule, neuroses are caused by organic changes in hypothalamic region in endocrine system.
Neurotic syndromes revealed in crises are crisis reaction. B. D. Karvasarskiy (1980) marks out
following most typical syndromes for neuroses:
 Asthenic,
 Obsessive,
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


Phobic,
Hypochondriac and
neurotic depression syndrome.
Materials for self-control:
А. Tasks for self-control (tables, schemes, drawings, diagrams):
1. (tables, schemes, drawings, diagrams)
Information Sources
Lecture
1. Shcrobot S.I., Hara I.I. Neurology in lecture (Selected lectures) . Ternopil, TSMU,
«Ukrmedknyha», 2008. 319 p.
2. Reinhard Rohkamm. Color Atlas of Neurology © 2004 Thieme. 440 p.
3. Crash course Neurology by Anish Bahra and Katia Cikurel. Copyright 2006, Elsevier, Inc. 244
p.
4. Adams and Victors. Principles of neurology. © 2005 McGraw-Hill . Medical Publishing
Division.
5. Mayo Clinic Internal Medicine Review 2006-2007. Chapter 18. Editor-in-Chief Thomas M.
Habermann, MD