DISORDERS OF NERVOUS SYSTEM
Dr. zameer pasha
Introduction
• Divisions of the nervous system:
– Central Nervous System
• Brain and spinal cord
– Peripheral Nervous System
• Peripheral nerves
Autonomic Nervous System
• Symphathetic nervous system
• Parasympathetic nervous system
Common disorders
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Headaches (Migraine)
Alzheimer’s disease
Cerebrovascular accident – stroke
Epilepsy
Meningitis
Poliomyelitis
Neuralgias
Tumors
Headaches
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Any pain occurring in the head
Acute or chronic
Numerous etiologies
Very common condition
– May be a symptom of other diseases
• Infections, neoplasms, inflammatory diseases, etc
• Due to irritation, inflammation of any pain-sensitive structure
• Brain itself is not a source of headache
Migraine Headache
• Migraine is a term applied to certain headaches with a
vascular quality, characterized by varying degrees of recurrent
vascular headache, photophobia, sleep disruption, and
depression.
• mechanisms of migraine are not completely understood.
• Migraine usually begins during the second decade of life and
is especially common in professional persons.
• The frequency of attacks is extremely variable. They may
occur at frequent intervals over a period of years or on only a
few occasions during the lifetime of the patient.
• A prodromal stage (preheadache phenomenon) is noted by some patients,
consisting of lethargy and dejection several hours before the headache.
Visual phenomena such as scintillations, hallucinations are often
described
• The headache phase consists in severe pain in the temporal, frontal and
retro-orbital areas.
• The pain is usually unilateral
• The pain is usually described as a deep, aching, throbbing type.
• Anorexia and vomiting may occur, as well as a variety of visual
disturbances. Prolonged and painful contraction of head and neck muscles
is found in some patients.
• Treatment: The treatment of migraine includes a wide variety of drugs
ranging from acetylsalicylic acid and codeine to ergotamine, methysergide
and norepinephrine.
Neuralgia
• Neuralgia is pain in one or more nerves that
occurs without stimulation of pain receptor
(nociceptor) cells.
• Examples:
– Trigeminal neuralgia
– Sphenopalatine neuralgia
Trigeminal neuralgia
• Trigeminal neuralgia (“tic douloureux”) follows the anatomical distribution
of the fifth cranial nerve. It mainly affects the second and third divisions
of the trigeminal nerve.
• Most cases are idiopathic, but compression of the trigeminal roots by
tumors or vascular anomalies may cause similar pain
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• The pain itself is of a searing, stabbing, or lancinating type which many
times is initiated when the patient touches a “trigger zone” on the face.
• Each attack of excruciating pain persists for only a few seconds to several
minutes and characteristically disappears as promptly as it arises.
• the pain may be so severe that the patient lives in constant fear of an
attack, and many sufferers have attempted suicide to put an end to their
torment.
• The “trigger zones,” which precipitate an attack when touched, are
common on the vermilion border of the lips, the alae of the nose, the
cheeks, and around the eyes. Usually any given patient manifests only a
single trigger zone.
• Treatment:
• One of the earliest forms of treatment was peripheral neurectomy,
• Injection of alcohol either into a peripheral nerve area or centrally into the
gasserian ganglion.
• Carbamazepine is the drug of choice in recent times
• microsurgical decompression of the trigeminal root
Sphenopalatine Neuralgia
• Sphenopalatine ganglion neuralgia, or periodic migrainous neuralgia, is
characterized by unilateral paroxysms of intense pain in the region of the
eyes, the maxilla, the ear and mastoid, base of the nose, and beneath the
zygoma.
• These paroxysms of pain have a rapid onset, persist for about 15 minutes
to several hours, and then disappear as rapidly as they began. There is no
“trigger zone.”
• Interestingly, in some patients the onset of the paroxysm occurs at exactly
the same time of day and, for this reason, the disease has been referred to
as “alarm clock” headache.
Auriculotemporal Syndrome
• Frey’s Syndrome
• which arises as a result of damage to the auriculotemporal nerve and
subsequent reinnervation of sweat glands by parasympathetic salivary
fibers.
• The patient typically exhibits flushing and sweating of the temporal area
during eating.
• similar condition known as “crocodile tears”
• The syndrome is a possible complication of parotitis, parotid abscess,
parotid tumor and ramus resection
Bell’s Palsy
• Bell’s palsy is paralysis of the facial musculature, usually unilaterally.
• The muscular paralysis manifests itself by the drooping of the corner of
the mouth, from which saliva may run, the watering of the eye, and the
inability to close or wink the eye.
• . When the patient smiles, the corner of the mouth does not rise. The skin
of the forehead does not wrinkle. The patient can not raise his/her
eyebrow.
• The patient has a typical masklike or expressionless appearance. Speech
and eating usually become difficult.
• Sometimes the taste sensation on the anterior portion of the tongue is
lost or altered.
• Usually idiopathic but facial nerve paralysis may be seen as a complication
of inferior alveolar nerve block.
• Melkersson-Rosenthal syndrome
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Alzheimer’s disease
• Alzheimer’s disease is a brain disease that slowly destroys
memory and thinking skills and, eventually, the ability to carry
out the simplest tasks. It begins slowly and gets worse over
time. Currently, it has no cure.
• Dementia is a loss of thinking, remembering, and reasoning
skills that interferes with a person’s daily life and activities.
• Alzheimer’s disease is the most common cause of dementia
Disorders that cause paralysis
• Hemiplegia
– Loss of muscle control & sensation on one side of the body
(Lefr or Right)
• Paraplegia
– Loss of muscle control & sensation on the lower part of the
trunk and lower extremities
• Quadriplegia
– Paralysis of all four extremities
Cerebrovascular Accident (CVA)
• Focal neurological impairment due to lack of blood supply to an area of
the brain lasting more than 24 hours
• Clinical condition is called stroke
• 2 types of stroke:
– Ischemic: embolic or thrombotic, 75% CVA’s
– Hemorrhagic: 25% CVA’s
• Risk factors: same as for cardiovascular disease, smoking, HTN,
hyperlipidemia, diabetes, oral contraceptives
• Clinical features: hemiplegia or hemiparesis, dysphagia, speech
impairment, diplopia & loss of visual fields, lack of coordination,
confusion, sensory impairment
Thank you