Cns Disorders

ALZHEIMER’S DISEASE >Definition progressive, irreversible, degenerative, neurologic diease that begins indiously and is characterized by gradual losses of cognitive function and disturbances in behavior and affect >etiology genetic/familial >Risk factors >Complications: injury, malnutrition female gender advanced age viruses environmental toxins silent brain infarcts previous head injury >S/Sx Early: short term memory impairment Mild anomia Poor abstract reasoning and orientation Topographic disorientation Visual and spatial disorientation Middle:Apraxia Perseveration Nocturnal restlessness Apraxia Aphasia Agraphia Advanced: progression of sign and symptoms Dysarthria Paranoid delusions Short attention span Wandering Hyperactivity Pacing Restlessness Agitation Hallucinations Los of spontaneity and social inhibitions Urinary and fecal incontinence Emaciation Increased irritability Unresponsiveness >Diagnostics: Detailed patient history Noncontrast computed tomography Magnetic resonance imaging Single Photon emission computed tomography Neuropsychological evaluation Complete blood count Commercial assasys for CSF >medical mgt: Cholinesterase inhibitors Donepezil ( Aricept) antidepressant Galantamine ( Reminyl) Memantine (Namenda)

MYASTHENIA GRAVIS >Definition: chronic autoimmune disorder affecting the neuromuscular transmission of impulses in the voluntary muscles if the body , characterized by varying degrees of weakness. >Etiology: unknown depletion of acetylcholine receptors at neuromuscular junctions brought about by an autoimmune attack >Risk factors: genetic environmental factors women >S/Sx: extreme muscular weakness easy fatigability diplopia ptosis masklike facial expression dysarthria dysphagia dysphonia sudden respiratory distress tachycardia anxiety >diagnostic: serum test for acetylcholine receptor antibodies Edrophonium (Tensilon) test Electrophysiologic testing CT Scan >Medical: oral anticholinesterase- neostigmine bromide (Prostigmin), pyridostigmine (Mestinon, Regonol) immunosuppressive drugs- prednisone, azathioprine (Imuran) Palsmapheresis- removes antibodies from blood Thymectomy Edrophonium (tensilon) >Complication: Aspiration Respiratory failure Complications of decreased physical mobility >Nursing Mgt: Monitor respiratory status Monitor speech and swallowing activities Administer medications as prescribed Provide rest periods Instruct to avoid muscle stress

PARKINSON’S DISEASE >definition: chronic, progressive neurologic disease affecting the brain centers responsible for control and regulation of movement >etiology: unknown deficiency of dopamine, due to degenerative changes in the substantia nigra of the brain >risk factors: genetic atherosclerosis head trauma toxicity from pesticides, herbicides, methylphenyl-tetrahydropyridine or welding fumes >S/Sx: Bradykinesia Tremors Rigidity Resting “pill-rolling” tremors Poor balance Autonomic disorders- sleeplessness, salivation, orthostatic hypotension, dizziness Depression Dementia Gait difficulties Micrographia Head bent forward Masklike expressions Drooling Losss of postural reflexes Bone demineralization >diagnostics: Positron Emission Tomography Physical examination Sensorimotor assessment >Medical: anticholinergics-trihexyphenidyl(Artane), benztropine(Cogentin), NS procyclidine(Kemadrin) Amantadine (Symmetrel) – reduce transmission of cholinergic pathways Levadopa -carbidopa (Sinemet)-inhibit destruction of levadopa in the bloodstream Levadopa Bromocriptine(Parlodel), pergolide(Permax), pramipexole(Mitrapex), ropinirole(Requip) Monoamine oxidase inhibitor- selegiline, deprenyl(Eldepryl) Tolcapone(Tasmar), entacapone(Comtan) >Surgical: Medial Pallidotomy- electrode destroys cells in the globus pallidus and improves longstanding symptoms chronic deep brain stimulation of the thalamus, electrodes implanted in the thalamus or globus pallidus brain tissue transplant >Complication: dementia, aspiration, injury from falls >nursing mgt: encourage patienty to participate in daily exercises advise stretching and postural exercises encourage to take warm baths and receive massages suggest smaller meals and additional snacks encourage compliance to medications exercise facial muscles encourage open medications encourage foods with moderate fiber content and increase water

MULTIPLE SCLEROSIS >definition: chronic, immune-mediated neurologic demyelinating disease of the CNS. Characterized by the occurrence of small patches of demyelination of the white matter of the optic nerve, brain , spinal cord >classification: 1. relapsing remitting(RR)-clearly defined acute attacks, frequency of attacks once every two years 2. secondary progressive (SP)- always begins as RR but clinical course changes with declining attack rate with steady deterioration in neurologic function unrelated to original attack 3. primary progressive(PP)- steady progression of disability from onset without exacerbations and remissions 4. progressive relapsing(PR)- same as PP except that patients experience acute exacerbations along with a steadily progressive course >etiology: unknown >risk factors: autoimmune dysfunction, genetic susceptibility, infectious process >S/Sx: fatigue and weakness Abnormal reflexes- absent or exaggerated Vision disturbances-diplopia, nystagmus Motor dysfunction- weakness, tremor, incoordination Sensory disturbances- paresthesia, impaired deep sensation, impaired vibratory and position sense Impaired speech- slurring, scanning(dysarthria) Urinary dysfunction- hesitancy, frequency, urgency, retention, incontinence, upper UTI Neurobehavioral syndromes- depression, cognitive impairment, emotional lability >diagnostic: magnetic resonance imaging – visualizing plaques electrophoresis of CSF- shows abnormal IgG antibodies magnetic resonance spectropy visual, auditory, and somatosensory evoked potentials- slowed conduction is evidence of MS >complication: respiratory dysfunction, Infections-bladder, respiratory, sepsis, complications from immobility,speech, voice and language disorders >medical mgt: corticosteroid or adrenocorticotropic hormone- decrease inflammation, shorten duration of relapse immunosuppressive agents- stabilize the course of treatment interferon beta-1a(Rebif, Avonex) and interferon beta 1b(Betaseron) copolymer-1