Download Diseases of the Nervous System

Diseases of the Nervous System
Meningitis
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Haemophilus influenzae meningitis:
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leading cause of bacterial meningitis in children
under 5 years of age. It occurs most frequently
in children from 1 month up to 4 years with a
peak at 6 to 9 months.
The infection usually spreads from somewhere
in the respiratory tract to the bloodstream and
then to the meninges (the membranes that
cover the brain). At the meninges, the bacteria
produce infection and inflammation causing
serious illness and sometimes death
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Symptoms
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Irritability, poor feeding in infants
Fever (in young infants the temperature
may actually be below normal)
Severe headache (older children)
Nausea and vomiting
Stiff neck or pain in neck when flexed
Pain in back when neck is flexed
foreward and chin brought toward chest
(older children)
Unusual body posturing
Photophobia
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Complications
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Roughly 20% of patients may experience
some hearing loss.
Some patients will have brain damage,
which can include seizures, mental
retardation, hydrocephalus ("water on the
brain"), learning disorders, abnormalities
in speech and language development,
and behavioral problems
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Meningococcal Menigitis:
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infection caused by the bacterium
Neisseria meningitidis that causes
inflammation of the membranes covering
the brain and spinal cord.
The death rate ranges from 5% to 15%,
with young children and adults over 50
having the highest risk of death.
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Symptoms:
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Rash, pinpoint red spots
(petechiae)
Complications :
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Brain damage
Shock
Increased spinal fluid
pressure
Myocarditis (inflammation
of the heart)
Hydrocephalitis (blockage
of spinal fluid in brain)
Deafness
Paralysis of various muscles
Mental retardation
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Pneumococcal meningitis:
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Streptococcus pneumoniae is the most common
cause of meningitis in adults, and the second
most common cause of meningitis in children
older than 6 years old.
Prevention
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Early treatment of pneumonia and ear infections
caused by pneumococcus may decrease the risk of
meningitis. There are also two effective vaccines on
the market to prevent pneumococcus infection.
The current recommendations are for people at high
risk for pneumonia, children, and everyone over the
age of 55 to be vaccinated.
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Treatment
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Antibiotic therapy should be started as soon as
possible. Ceftriaxone is one of the most commonly
used antibiotics.
If antibiotic resistance is suspected, vancomycin or
rifampin are used.
Prognosis
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With early treatment, the outcome is better. However,
20% of people who contract this disease will die of it
and 50% have serious long-term complications
Leprosy
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Alternative names: Hansen's disease
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An infectious disease, known since Biblical times, which is
characterized by disfiguring skin lesions, peripheral nerve
damage, and progressive debilitation.
Causes, incidence, and risk factors
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Leprosy is caused by the organism Mycobacterium leprae.
It is a difficult disease to transmit and has a long
incubation period, which makes it difficult to determine
where or when the disease was contracted.
Children are more susceptible than adults to contracting
the disease.
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2 common forms
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tuberculoid and lepromatous,
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Both forms produce lesions on the skin
lepromatous form is most severe, producing large disfiguring
nodules.
All forms of the disease eventually cause peripheral
neurological damage (nerve damage in the extremities)
manifested by sensory loss in the skin and weakness of the
muscles.
People with long-term leprosy may lose the use of their
hands or feet due to repeated injury which results from
absent sensation.
Leprosy is common in many countries in the world, and in
temperate, tropical, and subtropical climates.
Approximately 100 cases per year are diagnosed in the
United States. Most cases are limited to the South,
California, Hawaii, and U.S. island possessions.
Effective medications exist, and isolation of victims in "leper
colonies" is unnecessary.
The emergence of drug-resistant Mycobacterium leprae, as
well as increased numbers of cases worldwide, have led to
global concern about this disease.
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Symptoms include:
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one or more hypopigmented skin lesions that
have decreased sensation to touch, heat, or
pain
skin lesions that do not heal after several weeks
to months
numbness or absent sensation in the hands and
arms, or feet and legs
Muscle weakness resulting in signs such as foot
drop (the toe drags when the foot is lifted to take
a step)
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Treatment
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Medications used to eliminate the
microorganism and to reduce symptoms
include:
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Expectations (prognosis)
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Dapsone
Rifampin
Clofazimine
Ethionamide
Aspirin, prednisone, or thalidomide are used for the
control of inflammation (e.g., "erythema nodosum
leprosum") that may occur with therapy
Early recognition is important. Early treatment
limits damage by the disease, renders the
person noninfectious, and allows for a normal
lifestyle.
Complications
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permanent nerve damage
Polio
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Symptoms
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There are three basic patterns of polio infection:
subclinical infections, nonparalytic, and paralytic.
Most (95%) are subclinical infections, which may go
unnoticed.
Clinical poliomyelitis affects the central nervous
system (brain and spinal cord) and is divided into
nonparalytic and paralytic forms.
It may occur after recovery from a subclinical
infection.
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SUBCLINICAL INFECTION: no symptoms, or
symptoms lasting 72 hours or less
Slight fever
headache
general discomfort or uneasiness (malaise)
Sore throat
red throat
vomiting
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NONPARALYTIC POLIOMYELITIS
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symptoms last 1 to 2 weeks
Moderate fever
headache
Stiff neck
vomiting
diarrhea
Excessive tiredness, fatigue
irritability
pain or stiffness of the back, arms, legs, abdomen
muscle tenderness and spasm in any area of the body
Neck pain
pain front part of neck
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Neck stiffness
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Back pain or backache
Leg pain (calf muscles)
Skin rash or lesion with pain
muscle stiffness
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PARALYTIC POLIOMYELITIS
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fever, occurring 5 to 7 days before other symptoms
headache
stiff neck and back
Muscle weakness, asymmetrical
Abnormal sensations (but not loss of sensation) of an area
sensitivity to touch, mild touch may be painful
Difficulty beginning to urinate
constipation
Bloated feeling of abdomen
Swallowing difficulty
Muscle pain
Muscle contractions or muscle spasms, particularly in the calf, neck, or
back
drooling
Breathing difficulty
irritability or poor temper control
positive Babinski’s reflex
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Treatment
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The goal of
treatment is to
control symptoms
while the infection
runs its course.
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Tetanus: A disease caused by the toxin of the
bacterium Clostridium tetani that affects the
central nervous system, sometimes resulting in
death.
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Infection begins when the spores are introduced into
an injury or wound.
The spores germinate, releasing active bacteria that
multiply and produce a neurotoxin, called
tetanospasmin.
Tetanospasmin selectively blocks inhibitory nerve
transmission from the spinal cord to the muscles,
allowing the muscles to go into severe spasm.
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Prevention
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Tetanus is completely preventable by active tetanus
immunization (vaccine).
Tetanus immunizations are begun in infancy as a
series of DPT shots (D = diptheria, P = pertussis or
whooping cough, and T = tetanus).
Boosters are given to teenagers and older adults as
Td shots (adult tetanus and diphtheria) or singly as
just tetanus.
Immunization is considered to provide protection for
ten years.
Studies in the army suggest that good protection
persists up to 12 years after the last immunization.
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Symptoms
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spasms and tightening of the jaw muscle (hence the
name lockjaw)
Stiffening of the neck and other muscles
Spasms of the neck and other muscles
Stiffness of the chest muscles
Stiffness of the abdominal muscles (abdominal
stiffness)
Spasms and stiffness of the back muscles, often
causing arching (opisthotinosis)
Tetanic seizures (painful, powerful bursts of muscle
contraction)
Irritability
fever
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Treatment
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Control and reverse the tetany with antitoxin, tetanus immune
globulin.
Penicillin can be given to kill the Clostridium tetani; other
antibiotics such as clindamycin, erythromycin, or metronidazole
can be used in patients who are allergic to penicillin.
Remove and destroy the source of the toxin through surgical
exploration and cleaning of the wound (debridement).
Treat symptoms with supportive therapy.
Muscle spasms can be treated with muscle relaxants such as
diazepam.
Bedrest with a non-stimulating environment is also
recommended (dim light, reduced noise, and stable
temperature).
Sedation may be necessary to keep the affected person quiet.
Respiratory support with oxygen, endotracheal tube, and
mechanical ventilation may be necessary.
Botulism
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Signs and Symptoms:
Infant botulism is usually seen in children
under 6 months of age. The children may
receive medical attention because of
symptoms such as constipation, poor sucking
action, a weak cry, and a general, progressive
muscle weakness.
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Description:
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Infant botulism is caused by Clostridium bacteria that
live in soil and dust.
These bacteria may also contaminate foods,
especially honey.
Clostridium bacteria produce a toxin (poison) called
botulinum toxin, which blocks the normal messages
between muscles and nerves and affects muscles
everywhere in the body.
The toxin usually affects intestinal muscles first.
Infant botulism occurs worldwide, and 98% of cases
occur in infants between 1 to 6 months of age.
In the United States, most cases of infant botulism
cannot be prevented, since the spores of Clostridium
bacteria are found in soil everywhere.
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Duration:
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Contagiousness:
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Infants with infant botulism may require hospitalbased support for an extended period.
In severe cases of infant botulism, the child may
require several weeks of hospitalization and even
respiratory support.
No special isolation or precautions are needed since
this infection is not transmitted from person to
person.
Prevention:
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Most cases of infant botulism cannot be prevented.
Parents can eliminate one risk factor by not feeding
honey to children under age 1 year.
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Professional Treatment:
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Doctors make the diagnosis of infant
botulism by checking the infant's stool for
Clostridium bacteria or
Clostridium botulinum toxin.
A child with infant botulism is treated in a
hospital, usually in an intensive care unit.
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Botox:
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Botulinum toxin type A (BOTOX®) and botulinum toxin type B
(MYOBLOC(™)) are purified substances derived from a bacteria
that blocks the nerve signals from the brain to the muscle. By
injecting very tiny amounts into a specific facial muscle, only the
impulse of that muscle will be blocked, causing a local relaxation
and weakness.
In this way, botulinum toxin acts as a muscle blockade to
immobilize the underlying cause of the unwanted lines and
prevent "wrinkly" expressions.
Botulinum toxin type A (BOTOX®) has been used since 1980 to
treat many muscle disorders, such as lazy eye, and uncontrolled
blinking.
It was pioneered by dermatologic surgeons for cosmetic use in
1987.
The FDA has granted approval to botulinum toxin type A
(BOTOX® COSMETIC) for the temporary improvement in the
appearance of moderate to severe glabellar vertical lines in adult
men and women 65 or younger.
The approval specifically applies to the vertical lines between
the eyebrows.
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Botulinum Toxin Therapy
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Treatment involves injection of very small amounts of
botulinum toxin into the underlying muscles to relax them.
The actual treatment is well tolerated and takes just a few
minutes with no "down time" or prolonged recovery period.
Botulinum toxin takes effect about 3 to 7 days after
treatment.
The improvement generally lasts about 3 to 4 months
before the effect gradually fades and muscle action
returns.
It is anticipated that the average patient will require
reinjection at various intervals.
With repeated treatments, atrophy (thinning) of the muscle
may occur which usually produces longer-lasting results.
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Other Applications
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Excessive sweating can be treated with
injections of a highly diluted form of botulinum
toxin directly into the underarm skin, or skin on
the palms of the hand and soles of the feet.
There it paralyzes the sweat glands of the skin,
which are responsible for excessive
perspiration.
A single treatment session can provide months
of relief, and experts believe that injections can
be repeated indefinitely once or twice a year to
maintain dryness.
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Are there any side effects?
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Side effects are minimal and typically relate to the local
injection.
Soreness or mild bruising, while uncommon, may occur
around the injection site.
Makeup may be worn after treatment, but care should be
taken to avoid pressing or massaging the area for several
hours.
A temporary headache is not uncommon after injections in
the forehead area, especially after the first treatment.
In rare instances, patients may develop temporary
weakness of the neighboring muscles, a temporary
droopy brow or eyelid.
All of these possible effects are likely to be mild and
temporary, and in most cases, do not significantly limit
routine activities.
Rabies: fatal encephalitis
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Caused by rabies virus
Contracted through bite of infected animal
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Bats, dogs, cats, rabbits, raccoons,
Once virus enters nerves it is not accessible to
immune system until destroys CNS cells
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Symptoms:
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Preliminary symp. Are mild and varied
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Resemble many other infections
When CNS becomes involved person
alternates between agitation and calm
Muscle spasms of mouth and pharynx
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2 forms of rabies:
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Furious rabies: restless, then become excitable and
snap at anything
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Humans will sometimes bite too
Paralysis sets in and flow of saliva increases
Nervous control is progressively lost
Paralytic rabies: only minimal excitability
Animal or person remains relatively quiet and
unaware of surroundings
A form of paralysis that is transient but sometimes
fatal
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Treatment: injections or immunoglobulin
and antirabies vaccine
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Cryptococcus
Meninigitis:
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A rare fungal infection
caused by inhaling the
fungus, Cryptococcus
neoformans
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Symptoms
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Chest pain
Dry cough
Headache
nausea
confusion
Blurred vision or double vision (diplopia)
Fatigue
Fever
Unusual and excessive sweating at night
Glands, swollen WITHOUT nearby areas appearing
infected (e.g., red, painful, swollen)
Prolonged bleeding, bruising easily
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Skin rash may be present
Skin rash or lesion pinpointed rash (petechiae)
Bleeding into the skin
Bruises
Unintentional weight loss
Appetite, loss
Abdominal fullness prematurely after meals
Abdominal pain
Abdomen, swollen
Weakness
Bone pain or tenderness of the breastbone (sternum)
Numbness and tingling
Nerve pain or pain along the path of a specific nerve
Pain along a nerve root (major pathway from the spinal cord
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Treatment
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Some infections require no treatment. However,
medical observation should continue for a year
to detect any progression of the disease. If
pulmonary lesions are present or the disease
spreads, antifungal medications are prescribed,
and treatment with these agents may be
prolonged.
Medications include:
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Amphotericin B
Flucytosine
Fluconazole