Disorders and Diseasesof the Neuroskeletal System

and the Central Nervous SystemBy: Andrea Bonde

Segmental Vs. Axonal Demyelination

Demyelination is the root cause of the symptoms that people with MS experience. When it occurs the speed at which messages pass along the nerves is slower than normal. Even

when the patches of scarring caused by demyelination have healed and re-myelination has occurred, the response time of the nerve endings tends to remain slower.

Segmentaloriginally described in

experimental lead poisoning, is characterized by

breakdown and loss of myelin over a few segments. The

axon remains intact and there is no change in the neuronal body. The loss of saltatory

conduction that results from segmental demyelination

leads to decrease of conduction velocity and

conduction block.

AxonalClinically, neuropathy causes

weakness and atrophy of muscle, loss of sensation or

altered sensation (pain, paresthesias), and weak or

absent tendon reflexes. Nerve conduction studies can

distinguish demyelinative neuropathy (slowing of conduction velocity or conduction block) from

axonal neuropathy (low-action potential amplitudes).

Re-innervation

Restoration of nerve function to a part from

which it was lost; it may occur

spontaneously or be achieved by nerve

grafting.

Study• 77 heart transplant recipients• 1-5 years after transplantation• Partial reinnervation was observed in 52 patients at

various times after transplantation

• Reinnervation extent correlated with time after

surgery but also inversely with donor age and recipient age

Guillain-Barre Syndromea serious disorder that occurs when the body's defense immune system

mistakenly attacks part of the nervous system. This

leads to nerve inflammation that causes muscle

weakness and other symptoms.

www.gbs-cidp.org – Support Group

Hydrocephalus

The term hydrocephalus is derived from the Greek words "hydro" meaning water and "cephalus"

meaning head. As the name implies, it is a condition in which the primary characteristic is

excessive accumulation of fluid in the brain.

Vasogenic Vs. CytoxicCerebral Edema

Cerebral edema is an excess

accumulation of water in the

intracellular and/or extracellular spaces

of the brain.

Vasogenic edema: occurs due to the

failure of tight junctions and

astrocyte processes which normally

maintain an adequate blood-brain barrier.

Epidural Vs. SubduralHematoma

Epidural Vs. SubduralHematoma

Epidural(EDH) is the

accumulation of blood in the

potential space between brain dura

and bone.

SubduralA collection of blood on the surface of the

brain. Accumulation of

blood between the the dura and the

brain.

IntraparnchymalHematoma

Traumatic Intraparenchymal hemorrhage is bleeding into the tissue of the brain caused by trauma to the head. This type of

bleeding can cause a hematoma which expands inside the brain, pushing aside adjacent brain tissue and compressing it. The term

intraparenchymal basically means "within the brain tissue".

Slit hemorrhageA small tear within the

brain that starts to hemorrhage.

Lacunar infarctsLacunar infarcts are small (0.2 to 15 mm in diameter)

noncortical infarcts caused by occlusion of a single penetrating branch of a large cerebral artery. These

branches arise at acute angles from the large arteries of the circle of Willis, stem of the middle cerebral artery (MCA), or the basilar artery. Although this

definition implies that pathological confirmation is necessary, diagnosis in vivo may be made in the

setting of appropriate clinical syndromes and radiological tests.

Bacterial vs. ViralMeningitis

Meningitis is an inflammation of the

tissue around the spinal cord and brain.

There are three (3) types of bacteria (germs) that

cause the disease: H. Influenzae (Hib), Strep

pneumoniae, and Neisseria meningitidis.

Viral meningitis is relatively common and

can be caused by different viruses. The

most common cause is from a group of viruses

known as enteroviruses.

Cerebral ToxoplasmosisToxoplasmosis is

an infectious disease caused by

the one-celled protozoan parasite Toxoplasma gondii.

Cats, the primary carriers of the organism,

become infected by eating rodents and birds

infected with the organism. Once

ingested, the organism reproduces in the intestines of cats,

producing millions of eggs known as oocysts,

which are excreted in cat feces daily for

approximately two weeks.

In the United States, it is estimated that

approximately 30% of cats have been infected by T.

gondii.

Myotonia

Tennessee Fainting goats have myotonia as well as humans.

• Relaxation of muscle is impaired• Can affect any muscle group

• Repeated effort needed to relax•Trouble releasing grip on objects, rising from a seated position and many other

problems• Abnormality in the muscle membrane• Often associated with inherited

neurological disorders

Dermatomyositisis a muscle disease

characterized by inflammation and a

skin rash. It is a type of

inflammatory myopathy.

The disease is treated with anti-inflammatory medicines called corticosteroids and drugs that

suppress the immune system.

Cerebral HemorrhagicInfarctionHappens

when blood flow to a part of the brain

stops.

AKACerebrovascular disease

CVACerebral infarction

Cerebral hemorrhageIschemic stroke

Stroke – ischemicCerebrovascular accident

Stroke - hemorrhagic

Cerebrospinal FluidThe cerebrospinal fluid (CSF) is

produced from arterial blood by the choroid plexuses of the lateral and

fourth ventricles by a combined process of diffusion, pinocytosis and

active transfer. A small amount is also produced by ependymal cells

CSF from the lumbar region contains 15 to 45 mg/dl protein (lower in

childen) and 50-80 mg/dl glucose (two-thirds of blood glucose).

Lumbar Puncture

A lumbar puncture (also called a spinal tap) is a procedure to collect and look at the fluid

(cerebrospinal fluid, or CSF) surrounding the brain and spinal cord.

Types of brain herniation1. Uncinate/Uncal

rranstentorial herniation2. Central transtentorial

herniation3. Subfalcine (cingulate)

herniation4. Extracranial

(transcalvarial) herniation5. Upward cerebellar

herniation6. Tonsillar (downward cerebellar) herniation

is when the brain tissue is pushed from its normal position and protrudes into adjacent compartments or may even push out of the skull if there is an opening present.

Axonal InjuryDAI involves

massive loss of neuronal function

towards the central area of the brain,

well away from any areas of direct

trauma with the skull.

Vascular InjuryPeripheral vascular injuries may result from penetrating or blunt

trauma to the extremities. If not recognized and treated

rapidly, injuries to major arteries, veins, and nerves may have disastrous consequences resulting in the loss of life and

limb.

Embolisma blockage in one of the

arteries of the body due to a blood clot that has broken

off from another location in the body (embolus) and

traveled through the bloodstream to lodge in a

small blood vessel. The blockage may limit or stop

blood flow. An embolism is a clot that

travels from the site where it formed to another location

in the body.

ThrombusA thrombus is a blood clot that forms in a vessel and remains

there. This can result in damage, destruction (infarction), or even death of the tissues (necrosis) in

that area.

Event Community(fatal)

Hospital(fatal) Total

DVT (Deep Vein Thrombosis) 108,889 (649) 269,734 (1,609) 378,623 (2,258)

According to the US Census data of 2000

“Brain Dead”It is now considered by the medical profession

and supported by legal and some ethical consensus that if a person's entire brain is

dead, the person is dead.

“Respirator Brain”A swollen and congested brain with necrotic and

autolytic changes seen in patients who have been

on a respirator.

Brain AutolysisIn 1993 conducted a clinico-

neuropathological study on 60 cases of brain death. The average duration

of brain death was 99 hours. Autolysis of the cerebellar granular

layer and the pituitary gland was evident in all cases.

Autolysis – is a breakdown of a part or whole cell or tissue by self-produced enzymes

ConcussionAn alteration of conscious

awareness after head trauma. The collection of symptoms following a

concussion is called the postconcussion syndrome (PCS),

and include dizziness, nausea, vomiting, headache,

disorientation, forgetfulness, irritability, depression, mood swings, insomnia, and loss of

libido. Most cases of PCS resolve after a few months, but

approximately 20% of cases can involve longer term problems.

Coup Vs. CountrecoupInjury

Coup Vs. ContrecoupInjuryA "coup" injury is the

initial site of impact.

A contrecoup injury happens at the opposite side as the site of injury,

so if you struck your forehead, the brain

injury would be at the back of the brain.

Global vs. FocalCerebral ischemia

Global ischemia in man develops after transient circulatory arrest with resuscitation or after near-

drowning

Focal ischemia follows transient or permanent flow reduction in the territory of a

cerebral artery.

Due to:• Hanging

•Circulatory arrest• Drowning

Due to:•Hemispheral stroke• Transient ischemic

attack

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