NEUROLOGICAL DISEASES

Parkinson disease
► Parkinson’s disease (PD) is a type of movement disorder that can affect
the ability to perform common, daily activities.
► Symptoms are typically divided into those that affect movement (motor
symptoms) and those that do not (non-motor symptoms)
► Motor and Related Symptoms of PD:
► Tremor: The characteristic tremor in PD is a slow, rhythmic tremor that
typically starts in one hand, foot, or leg and can eventually affect both
sides of the body.
► Tremor can also occur in the jaw, chin, mouth, or tongue.
► Rigidity: Rigidity refers to a tightness or stiffness of the limbs.
► Bradykinesia: Greek for “slow movement,” bradykinesia is a frequent
symptom of PD and related movement disorders.
► In addition to a general slowness of movement, the bradykinesia of PD is
typically demonstrated by a reduced or mask-like expression of the face
(hypomimia), a decreased blink rate of the eyes, and problems with fine
motor coordination (for example, difficulties buttoning a shirt).
► Postural Instability: More pronounced in the later stages of PD, postural
instability includes the inability to maintain a steady, upright posture or
to prevent a fall.
► Walking or Gait Difficulties: Bradykinesia and postural instability both
contribute to walking, or gait, difficulties in PD, particularly as the
disease progresses.
► Vocal Symptoms: In addition to the core motor symptoms of PD, changes
in the voice are common. Generally, these are believed to be at least
partly due to bradykinesia.
► In PD, the voice may become softer, or it may start off strong and then
fade away. There may be a loss of the normal variation in volume and
emotion in the voice, so that the individual may speak in a monotone.
► Non-Motor Symptoms of PD
► Disturbances in the Sense of Smell: A reduced sensitivity to odors
(hyposmia) or a loss of smell (anosmia) is often an early symptom of PD.
► Sleep problems: are commonly experienced by people with PD. The
inability to fall asleep, or primary insomnia, is less common than the
inability to stay asleep, or secondary insomnia.
► Depression and Anxiety: Depression as well as anxiety is a fairly common
non-motor symptom of PD. It can range in severity and may improve
with PD treatment.
► Fatigue: Fatigue is a complex symptom of PD that is not fully understood.
It is known, however, that fatigue is significantly associated with
depression and sleep disorders.
► Cognitive Decline: Particularly in more advanced PD or in older people
with PD, problems with thinking, word finding, and judgment are
common.
► Weight Loss: Loss of weight is a common symptom of PD, particularly in
the later stages of the illness.
► How PD Affects the Brain
► PD is a neurodegenerative disease. There is a loss of neurons (nerve cells)
in certain areas of the brain, including a region called the substantia
nigra.
► The neurons in this region (which appear dark under a microscope)
produce a neurotransmitter (a chemical messenger that allows neurons
to communicate) called dopamine.
► Dopamine helps to regulate movement. As the number of cells in the
substantia nigra decreases, there is less dopamine available in the brain.
► Loss of neurons in other parts of the brain also occurs in PD, and
accounts for some of the non-motor symptoms of the disease.
 Theories About Cause

► Genetic Factors: There are several genes that, when mutated, can
increase the risk of PD.
► Environnemental Factor: Certain environnemental factor, such as
significant exposure to pesticides or solvents and repeated head injuries,
can increase the risk of PD.
► It seems likely that environmental factors do influence the development
of PD, perhaps particularly in people who also have a genetic
susceptibility.
► Other Risk Factors There are other things that put an individual at higher
risk for developing PD.
► The main risk factor is age, because PD is more common in older adults
(>50 years of age).
► Men also have a higher risk of PD than women.
► The actual links between any of these factors and PD are not completely
understood.
 Guillain–Barré syndrome

► In Guillain-Barré syndrome, the body's immune system attacks part of

the peripheral nervous system.
► The syndrome can affect the nerves that control muscle movement as
well as those that transmit pain, temperature and touch sensations.
► This can result in muscle weakness and loss of sensation in the legs and/
or arms.
► It is a rare condition, and while it is more common in adults and in males,
people of all ages can be affected.
► These sensations can quickly spread, eventually paralyzing your whole
body.
► Symptoms
► Signs and symptoms of Guillain-Barré syndrome may include:
► Prickling, pins and needles sensations in your fingers, toes, ankles or
wrists
► Weakness in your legs that spreads to your upper body
► Unsteady walking or inability to walk or climb stairs
► Difficulty with eye or facial movements, including speaking, chewing or
swallowing
► Severe pain that may feel achy and may be worse at night
► Difficulty with bladder control or bowel function
► Rapid heart rate
► Low or high blood pressure
► Difficulty breathing
 Causes and risk factors

► The exact cause of Guillain-Barré syndrome isn't known. The disorder

usually appears days or weeks after a respiratory or digestive tract
infection. Rarely, recent surgery or immunization can trigger Guillain-
Barré syndrome.
► In the disease the nerves' protective covering (myelin sheath) is damaged.
The damage prevents nerves from transmitting signals to your brain,
causing weakness, numbness or paralysis.
 Meningitis

► Meningitis is an inflammation of the meninges.

► The meninges are the three membranes that cover the brain and spinal
cord. Meningitis can occur when fluid surrounding the meninges
becomes infected.
► A bacterial or viral infection of the fluid surrounding the brain and
spinal cord usually causes the inflammation.
► However, injuries, cancer, certain drugs, and other types of infections
also can cause meningitis. It is important to know the specific cause of
meningitis because the treatment differs depending on the cause
 Bacterial Meningitis

► Bacterial meningitis is very serious and can be deadly. Death can occur in as
little as a few hours. Most people recover from meningitis. However,
permanent disabilities (such as brain damage, hearing loss, and learning
disabilities) can result from the infection.
► Viral Meningitis
► Viral meningitis is the most common type of meningitis, an inflammation of the
lining of the brain and spinal cord. It is often less severe than bacterial
meningitis, and most people get better on their own (without treatment).
► Babies younger than 1 month old and people with weakened immune systems
► are more likely to have severe illness from viral meningitis.
► Fungal Meningitis
► Fungal meningitis is rare in the United States. It can develop after a fungus
spreads from somewhere else in the body to the brain or spinal cord.
► People get it by inhaling fungal spores from the environment.
► Parasitic Meningitis
► Various parasites can cause meningitis or can affect the brain or nervous
system in other ways. Overall, parasitic meningitis is much less common
than viral and bacterial meningitis.
► Amebic Meningitis
► Primary amebic meningoencephalitis (PAM) is a rare brain infection that
is usually fatal and caused by Naegleria fowleri. Naegleria fowleri is a free-
living ameba* (a single-celled living organism that is too small to be seen
without a microscope.) it is very rare.
► Non-Infectious Meningitis
► Sometimes cancers, certain drugs, head injury and brain surgery can
cause meningitis
► Symptoms
► The early symptoms of meningitis may include fever, headache, body
aches, fatigue & sleepiness. Later symptoms that may occur are nausea,
vomiting, confusion, stiff neck, and sensitivity to light.
► In babies, the symptoms include fever, fussiness, refusal to eat, difficulty
waking up, and swelling of the soft spot on the baby’s head.
 Causes and risk factors

► Each type of meningitis has a slightly different cause, but each ultimately
acts in the same way: A bacterium, fungus, virus, or parasite spreads
through the bloodstream until it reaches the brain, or spinal cord.
► There, it sets up in the lining or fluids around these vital body parts and
starts developing into a more advanced infection.
► Non-infectious meningitis is the result of a physical injury or other
condition; it doesn’t involve an infection.
► Meningitis occurs in people of all ages, but it is more common in children
and people over 65. Additionally, people with weak immune systems are
more at risk for meningitis. Smoking, secondhand smoke and crowded
living conditions also increase the risk for some kinds of meningitis.
 Encephalitis

► Encephalitis
► Encephalitis is an inflammation of the brain tissues. The most common
cause is viral infections. In rare cases it can be caused by bacteria or even
fungi.
► There are two main types of encephalitis: primary and secondary.
Primary encephalitis occurs when a virus directly infects the brain and
spinal cord. Secondary encephalitis occurs when an infection starts
elsewhere in the body and then travels to your brain.
► Encephalitis is a rare yet serious disease that can be life-threatening.
► Symptoms of encephalitis
► Encephalitis sometimes starts off with flu-like symptoms, such as a high
temperature and headache.
► More serious symptoms come on over hours, days or weeks, including:
confusion or disorientation
► Seizures or fits
► Changes in personality and behavior
► Difficulty speaking
► Weakness or loss of movement in some parts of the body
► Loss of consciousness
► Causes of encephalitis
► It's not always clear what causes encephalitis, but it can be caused by:
► viral infections – several common viruses can spread to the brain and
cause encephalitis in rare cases, including the herpes simplex virus
(which causes cold sores and genital herpes) and the chickenpox virus
► A problem with the immune system, the body's defense against infection
– sometimes something goes wrong with the immune system and it
mistakenly attacks the brain, causing it to become inflamed
► Bacterial or fungal infections – these are much rarer causes of
encephalitis than viral infections
► Risk factors for encephalitis
► The groups most at risk of encephalitis are:
► older adults
► children under the age of 1
► people with weak immune systems
► You may also have a higher risk of getting encephalitis if you live in an
area where mosquitos or ticks are common. Mosquitos and ticks can
carry viruses that cause encephalitis.
► You’re more likely to get encephalitis in the summer or fall when these
insects are most active.
► Although the MMR (measles, mumps, rubella) vaccine has a long history
of being safe and effective, in rare cases it has caused encephalitis.
► Complications associated with
► encephalitis
► Most people who are diagnosed with severe encephalitis will experience
complications. Complications resulting from encephalitis can include:
► loss of memory
► behavioral/personality changes
► epilepsy
► fatigue
► physical weakness
► intellectual disability
► lack of muscle coordination
► vision problems
► hearing problems
► speaking issues
► coma
► difficulty breathing
► death
► Complications are more likely to develop in certain groups, such as:
► older adults
► people who have had coma-like symptoms
► people who didn’t get treatment right away
 Stroke

► A stroke occurs when a blood vessel in the brain ruptures and bleeds, or
when there’s a blockage in the blood supply to the brain. The rupture or
blockage prevents blood and oxygen from reaching the brain’s tissues.
► Without oxygen, brain cells and tissue become damaged and begin to die
within minutes.
► A stroke is a medical emergency, and prompt treatment is crucial. Early
action can reduce brain damage and other complications.
► Symptoms of a stroke show up in the body parts controlled by the
damaged areas of the brain.
► Stroke symptoms can include:
► Paralysis
► Numbness or weakness in the arm, face, and leg, especially on one side of
the body
► Trouble speaking or understanding speech
► Confusion
► Slurring speech
► Vision problems, such as trouble seeing in one or both eyes with vision
blackened or blurred, or double vision
► Trouble walking
► Loss of balance or coordination
► dizziness
► severe, sudden headache with an unknown cause
► Prompt treatment is key to preventing the following
► outcomes:
► brain damage
► long-term disability
► death
► Types of stroke
► During an ischemic stroke, the arteries supplying blood to the brain
narrow or become blocked. These blockages are caused by blood clots or
blood flow that’s severely reduced.
► Ischemic stroke: The two most common types of ischemic strokes are
thrombotic and embolic.
► A thrombotic stroke happens when a blood clot forms in one of the
arteries supplying blood to the brain. The clot passes through the
bloodstream and becomes lodged, which blocks blood flow.
► An embolic stroke is when a blood clot or other debris forms in another
part of the body and then travels to the brain
► Transient ischemic attack (TIA): A transient ischemic attack, often
called a TIA or ministroke, occurs when blood flow to the brain is
blocked temporarily.
► Symptoms, which are similar to those of a full stroke, are typically
temporary and disappear after a few minutes or hours.
► A TIA is usually caused by a blood clot. It serves as a warning of a future
stroke.
► Hemorrhagic stroke: A hemorrhagic stroke happens when an artery in
the brain breaks open or leaks blood. The blood from that artery creates
excess pressure in the skull and swells the brain, damaging brain cells
and tissues.
► Risk factors for stroke
► Risk factors for stroke include:
► Diet
► An unhealthy diet that increases your risk of stroke is one that’s high in:
► Salt
► Saturated fats
► Trans fats
► Cholesterol
► Inactivity
► Inactivity, or lack of exercise, can also raise your risk for stroke.
► Alcohol consumption
► Your risk for stroke also increases if you drink too much alcohol. Alcohol
consumption should be done in moderation.
► Tobacco use
► Using tobacco in any form also raises your risk for stroke, since it can
damage your blood vessels and heart.
► Personal background There are certain personal risk factors for stroke
that you can’t control.
► Stroke risk can be linked to your:
► Family history. Stroke risk is higher in some families because of genetic
health issues, such as high blood pressure.
► Gender. While both women and men can have strokes, they’re more
common in women than in men in all age groups.
► Age. The older you are, the more likely you are to have a
► stroke.
► Race and ethnicity. Caucasians, Asian Americans, and Hispanics are less
likely to have a stroke than African- Americans, Alaska Natives, and
American Indians.
 Seizures

► Seizures are symptoms of a brain problem. They happen because of

sudden, abnormal electrical activity in the brain.
► When people think of seizures, they often think of convulsions in which a
person's body shakes rapidly and uncontrollably. Not all seizures cause
convulsions.
► The symptoms of a severe seizure include violent shaking and a loss of
control. However, mild seizures can also be a sign of a significant
medical problem, so recognizing them is important.
► Because some seizures can lead to injury or be a sign of an underlying
medical condition.
 Symptoms that indicate a seizure is in
progress include:
► Losing consciousness, followed by confusion
► Having uncontrollable muscle spasms
► Drooling or frothing at the mouth
► Falling
► Having a strange taste in your mouth
► Clenching your teeth
► Biting your tongue
► Having sudden, rapid eye movements
► Making unusual noises, such as grunting
► Losing control of bladder or bowel function
► Having sudden mood changes
 What causes seizures

► Seizures can stem from a number of health conditions. Anything that

affects the body also may disturb the brain and lead to a seizure.
► Some examples include:
► alcohol withdrawal
► a brain infection, such as meningitis
► a brain injury during childbirth
► a brain defect present at birth
► choking
► drug abuse
► drug withdrawal
► electric shock
► epilepsy
► extremely high blood pressure
► a fever
► head trauma
► kidney or liver failure
► low blood glucose levels
► a stroke
► a brain tumor
► vascular abnormality in the brain
 Pain

► Pain
► Pain is an unpleasant sensation and emotional experience that links to
tissue damage. It allows the body to react and prevent further tissue
damage.
► People feel pain when a signal travels through nerve fibers to the brain
for interpretation.
► The experience of pain is different for every person, and there are
various ways to feel and describe pain. This variation can, in some cases,
make it challenging to define and treat pain.
► Pain can be short- or long-term and stay in one place or spread around
the body
 Causes

► People feel pain when specific nerves called nociceptors detect tissue
damage and transmit information about the damage along the spinal
cord to the brain.
► For example, touching a hot surface will send a message through a reflex
arc in the spinal cord and cause an immediate contraction of the muscles.
► This contraction will pull the hand away from the hot surface, limiting
further damage.
► The brain’s interpretation of these signals and the efficiency of the
communication channel between the nociceptors and the brain dictate
how an individual experiences pain.
► The brain may also release feel-good chemicals, such as dopamine, to try
to counter the unpleasant effects of pain.
► Types
► Pain can be either acute or chronic.
► Acute pain
► This type of pain is generally intense and short-lived. It is how the
► body alerts a person to an injury or localized tissue damage.
► Treating the underlying injury usually resolves acute pain.
► Acute pain triggers the body’s fight-or-flight mechanism, often resulting in
faster heartbeats and breathing rates.
► There are different types of acute pain:
► Somatic pain: A person feels this superficial pain on the skin or the soft tissues
just below the skin.
► Visceral pain: This pain originates in the internal organs and the linings
of cavities in the body.
► Referred pain: A person feels referred pain at a location other than the
source of tissue damage. For example, people often experience shoulder
pain during a heart attack.
► Chronic pain
► This type of pain lasts far longer than acute pain, and there is often no
cure. Chronic pain can be mild or severe. It can also be either continuous,
such as in arthritis, or intermittent, as with migraines.
► Intermittent pain occurs on repeated occasions but stops in between
flares.
► There are other, more specialized ways of describing pain.
► These include:
► Neuropathic pain: This pain occurs following injury to the peripheral
nerves that connect the brain and spinal cord to the rest of the body.
► It can feel like electric shocks or cause tenderness, numbness, tingling, or
discomfort.
► Phantom pain: Phantom pain occurs after the amputation of a limb and
refers to painful sensations that feel as though they are coming from the
missing limb.
► Central pain: This type of pain often occurs due to infarction, abscesses,
tumors, degeneration, or bleeding in the brain and spinal cord. Central
pain is ongoing, and it can range from mild to extremely painful. People
with central pain report burning, aching, and pressing sensations.
 Polio

► Polio
► Poliomyelitis is a crippling disease that results from infection with any
one of the three related poliovirus types (referred to as types P1, P2, and
P3)
► Two phases of acute poliomyelitis can be distinguished: a nonspecific
febrile illness (minor illness) followed, in a small proportion of patients,
by aseptic meningitis and/or paralytic disease (major illness).
► Following poliovirus exposure, viral replication occurs in the oropharynx
and the intestinal tract. Viremia follows, which may result in infection of
central nervous system cells.
► The virus attaches and enters cells via a specific poliovirus receptor.
► Replication of poliovirus in motor neurons of the anterior horn and
brain stem results in cell destruction and causes the typical clinical
manifestations of poliomyelitis.
► Depending on the site of infection and paralysis, poliomyelitis can be
classified as spinal, bulbar, or spino-bulbar disease.
► Progression to maximum paralysis is rapid (2–4 days); paralysis is usually
associated with fever and muscle pain, and rarely progresses after the
temperature has returned to normal.
► Non-paralytic polio symptoms
► Non-paralytic polio, also called abortive poliomyelitis, leads to flulike
symptoms that last for a few days or weeks. These include:
► fever
► sore throat
► headache
► vomiting
► fatigue
► back and neck pain
► arm and leg stiffness
► muscle tenderness and spasms
► meningitis, an infection of the membranes surrounding the brain
 Paralytic polio symptoms

► Paralytic polio affects only a small percentage of those invaded by the

polio virus. In these cases, the virus enters motor neurons where it
replicates and destroys the cells.
► These cells are in the spinal cord, brain stem, or motor cortex, which is
an area of the brain important in controlling movements.
► Symptoms of paralytic polio often start in a similar way to non-paralytic
polio, but later progress to more serious symptoms such as:
► A loss of muscle reflexes
► Severe muscle pain and spasms
► Loose or floppy limbs that are often worse on one side of the body
► Paralytic polio may also be classified as:
► Spinal polio: The virus attacks motor neurons in the spinal cord that
causes paralysis in the arms and legs, and breathing problems.
► Bulbar polio : The virus affects the neurons responsible for sight, taste,
swallowing, and breathing.
► Bulbospinal polio: The virus causes symptoms of both spinal and bulbar
polio.
► Causes and risk factors
► The polio virus usually enters the environment in the feces of someone
who is infected. In areas with poor sanitation, the virus easily spreads
from feces into the water supply, or, by touch, into food.
► In addition, because polio is so contagious, direct contact with a person
infected with the virus can cause polio.
► Individuals who carry the poliovirus can spread it via their feces for
weeks, even if they have shown no symptoms themselves.
► The virus stays within the intestines, before spreading to other areas of
the body. Eventually, the virus moves into the bloodstream where it can
spread to the entire body.
► As is the case with many other infectious diseases, people who get polio
tend to be some of the most vulnerable members of the population.
► This includes the very young, pregnant women, and those with immune
systems that are substantially weakened by other medical conditions.
► Anyone who has not been immunized against polio is especially
susceptible to contracting the infection.
 Alzheimer’s disease

► The deterioration of intellectual capabilities, memory, judgment, and

personality to the extent that daily functioning and quality of life are
seriously impaired.
► Generally occurs in the elderly impairing brain function, which can lead
to dementia.
► Named for German neurologist Alois Alzheimer in 1907.
► Statistics
► 4 million or more cases in U.S.
► 100,000 die each year.
► 4th major leading cause of death
► in U.S.
► 65 or older when symptoms can begin
 Clinical Features

► Loss of short-term memory and ability to create memories

► Concentration on past
► Loss of time
► Communication diminishes
► Personality changes
► Delusions
► Become immobilized and uncomprehending
► Death due to respiratory failure
► 65 and up disease lasts 8-20 years
► 65 and down disease lasts 5-10 years disease more rapid
► Histological Analysis
► 3 distinctive neuropathological features
► 1. Devastating losses of synapses and neurons within hippocampus
and entorhinal cortex.
► 2. Dense spherical structures, called senile plaques (SP),
► Prevalent outside the neurons of the hippocampus and other regions of
the brain.
► 3. Aggregations of fibrils (Neurofibrillary tangles, NFT)
► Accumulate within cell bodies and dendritic processes of the neurons of
the hippocampus, neuro-cortex, entorhinal cortex, and other brain parts.
► Diagnosis
► Only definitive way is to use brain scans (CT) to see plaques or tangles in brain
tissue.
► Tests used to exclude other diseases.
► Treatments
► No treatment can prevent Alzheimer’s
► Drugs for early stages
► Cognax, Aricept, Exelon, or Razadyne
► Severe stages
► Memantine (Namenda)
► Medicines used to control symptoms, allow
► Caregivers to provide easier care.