Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2952_Библиотеки_им_академика_М_И_Перельмана
.pdf
Nervous System Diseases and Disorders 307
■ Alteration in mental alertness or cognitive function,
including:
1. Extreme or prolonged drowsiness
2. Stupor, unconsciousness, or coma
3. Amnesia or extreme forgetfulness
Diagnostic Tests
A neurologic examination includes testing motor, sen
sory, and mental function. This examination is often
performed on any individual presenting with an injury
to the head, neck, or spinal column, or exhibiting neu
rologic symptoms. Motor testing includes checking
reflexes, gait, and posture. The examiner may ask the
individual to walk a straight line, touch the nose with
the eyes closed, or place one foot directly in front of
the other while walking slowly. This tests for balance
and coordination. Sensory testing includes checking
the ability to feel, using pinprick or application of
heat, cold, or vibration. The ability to see and smell
also can be part of sensory testing. The cranial nerves
are also tested depending on the symptoms presented.
Testing of mental or cognitive function includes ask
ing simple questions related to name, occupation, and
location. Further testing might include simple math
problems or questions about current events. The
examiner may also ask the individual to remember a
short list of words, name specific objects in the room,
or draw shapes.
One of the most important laboratory tests in a
neurologic examination is the analysis of cerebro
spinal fluid (CSF). The fluid is examined under a
microscope to determine the presence of bacteria,
leukocytes, red blood cells, neoplastic cells, and other
microorganisms.
To obtain this fluid, a lumbar puncture must be
performed, a procedure that consists of positioning the
affected individual on his or her side in a knee-chest
position to widen the vertebral disk space, inserting a
spinal needle into the meningeal space around the spi
nal cord, and withdrawing CSF. During the procedure,
a special manometer might be connected to the spinal
needle so intracranial pressure (ICP) can be measured.
Other laboratory tests include blood and urine
tests. Genetic testing of people with a family history of
neurological disorders is becoming common practice to
Pharmacology
Common Drugs for Neurologic Disorders
■ ■ ■ Bill ^^1 f
Highlight
Category Examples of Medications
Anticonvulsants
/ ' -
Drugs used to treat
convulsive disorders
Aldehydes Paraldehyde
Barbiturates Phenobarbital or barbexaclone
Benzodiazepines Clonazepam, diazepam, or lorazepam
Carbamates Felbamate
Carbozamides Carbamazepine or eslicarbazepine
Fatty acids Progabide, tiagabine, or valproic acid
Fructose based Topiramate
GABAs Gabapentin or pregabalin
Hydantoins Phenytoin, mephenytoin, or fosphenytoin
Pyrrolidines Levetiracetam
Triazines Lamotrigine
Ureas Pheneturide or phenacemide
Others Beclamide, primidone, sultiame, or mesuximide
Antibiotics
Drugs used to prevent or Ampicillin, amoxicillin, ciprofloxacin, doxycycline,
stop bacterial infections erythromycin, penicillin, or tetracycline
(continued)
308 Chapter 15
Common Drugs for Immune Disorders (continued)
Category Examples of Medications
Anticoagulants
Drugs used to
prevent clotting
Tissue plasminogen activator, warfarin, heparin, or
dabigatran
Antipyretics/Analgesics
Drugs used to reduce
fever and pain
Acetaminophen, aspirin, ibuprofen, or naproxen
Anti-inflammatories
Drugs used to reduce
inflammation
Steroids Hydrocortisone, beclomethasone, or amcinonide
Nonsteroids Aspirin or ibuprofen
Antidementias
Drugs used to treat
dementia disorders by
maintaining mental
function or controlling
moods or behaviors
Cholinesterase inhibitors Donepezil hydrochloride, memantine hydrochloride
with donepezil hydrochloride, galantamine, or
rivastigmine
Antipsychotics Risperidone or olanzapine
Antidepressants Amitriptyline, amoxapine, doxepin, imipramine, or
sertraline
Dopamine agonists
Drugs used for Parkinson’s
disease and restless leg
Pramipexole, ropinirole, or rotigotine
Levodopa based
Drugs used to treat
Parkinson’s disease
Co-careldopa, co-beneldopa, or duodopa
Skeletal Muscle Relaxants
Drugs used to treat Baclofen, botulinum toxin type B, or onabotulinum
dystonia toxin A
Others Benzodiazepine, divalproex, guanidine, memantine,
tacrine, tetrabenazine
determine if the individual is carrying one of the genes
known to cause the disorder.
Brain scans include several types used to diagnose
tumors, blood vessel malformations, strokes, and hem
orrhages. These include computed tomography (CT),
magnetic resonance imaging (MRI), Positron Emis
sion Tomography (PET) and single photon emission
computed tomography (SPECT) scans. Angiography,
electroencephalography (EEG), electromyography
(EMG), electronystagmography (ENG), myelography,
thermography, ultrasound imaging, X-rays, and biop
sies may also be performed.
Because the skull is a rigid structure, any increase
in the size of the brain tissue by swelling, tumor, infec
tion, or hematoma will cause an increase in ICP. If pres
sure becomes too high, the brain will herniate or move
downward through the foramen magnum, the only
opening available. When this occurs, coma and rapid
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Nervous System Diseases and Disorders 309
death can occur because this places pressure on vital
centers in the brain stem.
Radiologic examinations include X-rays of the skull
and vertebral column for fractures and other abnormal
ities. A myelogram, or picture of the spinal cord, might
be used for diagnosis of a tumor, nerve root compres
sion, herniated nucleus pulposus (HNP), or herniated
disk. Angiograms can help determine vessel occlusion
and hematomas in individuals exhibiting symptoms of
cerebrovascular accident or stroke.
Electroencephalography (EEG) measures electri
cal brain activity. A damaged area of the brain might
exhibit abnormal electrical activity as might occur with
cerebrovascular accident and epilepsy. EEG is also used
to determine brain death.
Computerized tomography (CT) and magnetic res
onance imaging (MRI) scanning are both valuable tools
to assess the anatomy of the brain and spinal cord.
Common Diseases of the
Nervous System
The diseases of the nervous system can range from
mild to severe, depending on the particular condition.
Age-related factors can influence the severity of the dis
ease, but many nervous system disorders can affect the
individual at any age.
Infectious Diseases
Infections of the nervous system are more common in the
young but can be found in older adults as well. Early diag
nosis and treatment are essential to reduce the permanent
neurologic deficits that can result from the infection.
Encephalitis
■ Description. Encephalitis is an inflammation of the
brain tissue.
■ Etiology. Encephalitis is caused by a variety of micro
organisms, including bacteria and viruses, or as a com
plication of measles, chicken pox, or mumps. Such
viruses can be spread also by mosquitoes and carried
from animal to human or from human to human.
■ Symptoms. Symptoms include headache, elevated
temperature, and a stiff neck and back but can progress
to lethargy, mental confusion, and even coma.
■ Diagnosis. Encephalitis is usually diagnosed by find
ing the causative agent in spinal fluid obtained by lum
bar puncture.
■ Treatment. Treatment is supportive. Antiviral med
ication might be effective in some types of encepha
litis, but prognosis is guarded because some forms of
encephalitis have a high mortality rate. Severe encepha
litis can leave the individual with permanent neurologic
impairment.
■ Prevention. Prevention is related to avoiding trans
mission of the disease by mosquitoes. Activities include
avoiding outdoor activity when mosquitoes are active—
usually near or after dark—wearing protective clothing
with long sleeves and long pants, and using repellents
that contain DEET.
Consider This...
The female mosquito is the only one that
bites. The male mosquito feeds on flower
nectar, but the female needs blood proteins
in order to produce fertile eggs. The pierc
ing bite mixed with the mosquito saliva
creates the stinging skin irritation associated
with a mosquito bite.
Meningitis
■ Description. Meningitis is inflammation of the
meninges, the covering of the brain and spinal cord.
■ Etiology. Meningitis can be caused by anything that
causes an inflammatory response, including bacteria,
viruses, fungi, and toxins such as lead and arsenic. Some
forms of meningitis are more contagious and more lethal
than other forms of the disease. The most common cause
of meningitis is bacterial invasion by Neisseria meningiti-
des. Bacteria and viruses usually reach the meninges after
invading and infecting other parts of the body such as the
middle ear, sinuses, and upper respiratory tract; or they can
be carried to the meninges in the blood, as in septicemia.
■ Symptoms. Symptoms of meningitis often include a
sudden onset of high fever, severe headache, photopho
bia (fear of light), and a stiffness in the neck that resists
bending the neck forward or sideways (nuchal rigidity).
As the disease progresses, drowsiness, stupor, seizures,
and coma might occur.
■ Diagnosis. Diagnosis is usually confirmed by finding
the causative agent in the spinal fluid obtained by lum
bar puncture.
310 Chapter 15
■ Treatment. Antibiotic treatment of bacterial menin
gitis is usually quite effective. Other treatments include
antipyretics; anticonvulsive medications; and a quiet,
dark environment. If untreated, meningitis can be fatal,
especially in infants, children, and older individuals. It
can cause permanent neurologic damage in children,
leading to hearing loss, learning and developmental
challenges, and epilepsy. Good handwashing practices
can help prevent the spread of the disease.
■ Prevention. Good handwashing helps reduce expo
sure to infectious organisms. Avoiding those who are
infected is also a preventive activity.
Poliomyelitis
■ Description. Poliomyelitis, or polio, is a viral infection
affecting the brain and spinal cord. Polio was a major
crippling and life-threatening disease affecting chil
dren prior to the development of a vaccine in the 1950s.
Immunization programs since that time have virtually
eliminated the disease in the United States.
■ Etiology. The poliomyelitis virus enters the body
through the mouth and nose. It crosses the gastrointes
tinal tract into the blood and then travels to the brain
and spinal cord. The virus is spread by oropharyngeal
secretions and by infected feces.
■ Symptoms. Symptoms of polio include muscle weak
ness, neck stiffness, and nausea and vomiting. As the
disease progresses, muscles atrophy and deteriorate.
Muscles of the arms, legs, and respiratory system can
become paralyzed.
■ Diagnosis. Diagnosis is made by clinical examination
and confirmed by culturing the virus from the throat,
feces, or spinal fluid.
■ Treatment. Treatment is supportive and includes
analgesics and bed rest during the acute phase. Long
term physical therapy and limb braces might be needed.
If the respiratory system is involved, mechanical venti
lation might be necessary.
Ten to 40 years after the initial polio attack, many
survivors experience postpolio syndrome (PPS),
characterized by further weakening of muscles that
were previously affected by the polio infection. Symp
toms can include joint pain, fatigue, and increasing
skeletal deformities such as scoliosis. The problems
caused by PPS usually mirror the severity of the orig
inal polio attack. If the original attack was not severe,
the PPS condition is usually not bad. PPS tends
to affect females more often than it does males.
This is not an infectious condition, and it is rarely
life-threatening.
■ Prevention. The most effective prevention is with the
polio vaccine.
Tetanus
■ Description. Tetanus is a highly fatal infection of
nerve tissue.
■ Etiology. Tetanus disease is caused by the Clostridium
tetani bacterium. The effects of the toxin produced by
this bacterium on the CNS lead to voluntary or skeletal
muscle contraction.
■ Symptoms. The first symptom is typically a stiffness
of the jaw, commonly called lockjaw, and is due to strong
jaw muscle contractions. This disease affects both the
musculoskeletal system and the nervous system.
More detailed information about tetanus is found
in Chapter 6, “Musculoskeletal System Diseases and
Disorders.”
Rabies
■ Description. Rabies is an often fatal encephalomyelitis.
■ Etiology. Rabies is caused by a virus and primar
ily affects animals such as dogs, cats, foxes, raccoons,
squirrels, and skunks but can be transmitted to humans
through a bite by an infected animal. Like tetanus, this
virus travels slowly to the spinal cord and brain, so the
location of the bite is significant. Incubation time is
from one to three months. Shorter incubation times are
related to the position of the bite, making bites to the
face and neck more serious than those to the extremities.
■ Symptoms. Symptoms of rabies include fever, pain,
paralysis, convulsions, and rage. In animals, a change
in temperament is often noticed. Wild animals can
become friendly, and family pets can become aggressive.
Another classic symptom is spasm and paralysis of the
muscles of swallowing. The sight of water or attempt
ing to drink water causes throat spasms, leading to
hydrophobia (hydro = water, phobia = fear). Inability
to swallow also causes a drooling of frothy saliva, an
identifying symptom in animals.
■ Diagnosis. Diagnosis is based on a history and phys
ical exam, observing for symptoms of muscle spasms,
stiffness, and pain. Laboratory tests are not helpful with
diagnosis.
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Nervous System Diseases and Disorders 311
Healthy Highlight
Polio Vaccine
Precautions
T
here are three distinct polioviruses, designated as types 1, 2, and 3. Dr. Jonas Salk
developed an injectable vaccine against only one form of polio, so that vaccine is
called a monovalent vaccine. It used dead virus to stimulate the production of antibod
ies against polio. Dr. Albert Sabin later developed an oral vaccine (trivalent oral polio
vaccine [TOPV]) against all three forms of the virus; that vaccine is, therefore, called
a trivalent vaccine and is a live vaccine using weakened virus to stimulate antibody
production.
Immunosuppressed individuals must follow precautions with polio vaccines. Immu
nosuppressed individuals include those who are:
■
■
■
■
■
■
■
■
Affected with chronic disease.
Taking chemotherapy.
Receiving radiation treatments.
Taking immunosuppressive medications for organ transplants.
On long-term steroid treatment.
Precautions for immunosuppressed individuals include the following:
Do not take the live trivalent vaccine because this can lead to contracting polio.
Do not change diapers or come in contact with feces of children recently treated with
TOPV.
Do not come in contact with nasal secretions or vomitus of children recently treated
with TOPV.
■ Treatment. Treatment of rabies includes immediate
washing of the area with soap and water, followed by
medical attention. A series of anti-rabies injections
must be given before the virus has had time to reach
the brain. Any animal bite needs to be investigated
immediately. The biting animal should be confined and
placed under observation for symptoms of rabies, and
viral cultures should be obtained. If the animal cannot
be captured and must be killed, care should be taken not
to destroy the head because the brain must be examined
Healthy Highlight
Tdap for Adults
T
he Centers for Disease Control and Prevention (CDC) recommends the Tdap (tet
anus, diphtheria, and acellular pertussis) shot be given to adults age 65 and older.
A one-time dose of Tdap should be given for the Td booster and then they should just
receive a Td booster every 10 years. Previously, the recommendation was for older
adults only if they had close contact with infants under age 1 and if they had not been
vaccinated with Tdap before. Pertussis cases have been increasing during the last
30 years. Individuals may not be able to receive the vaccine if a high fever is present,
or if they have a neurologic disease, a previous reaction to the vaccine, a history of
seizures, or are immunocompromised. There are two Tdap vaccines on the market, but
only one (Boostrix®) is recommended by the Food and Drug Administration for older
adults.
Source: Centers for Disease Control and Prevention (CDC) (2019)
312 Chapter 15
for presence of disease. If the animal cannot be found,
the injured individual will need to take the series of
injections immediately.
There is no cure for rabies. Treatment is palliative
and includes strong muscle relaxants to reduce convul
sions. Untreated cases end with severe convulsions and
respiratory arrest. Death usually occurs within two to
five days after the onset of symptoms.
■ Prevention. Prevention of rabies begins with vacci
nation of family pets and education of children in rec
ognizing and avoiding animals with rabid symptoms.
Shingles
■ Description. Shingles is an acute viral disease.
Approximately one in three people will develop shin
gles in their lifetime. It is more common as people get
older, with 50% of cases developing in men and women
over the age of 60.
■ Etiology. Shingles is caused by herpes zoster, the
same virus that causes chicken pox. The only differ
ence between chicken pox and shingles is the level of
the affected individual’s immunity. Chicken pox usu
ally appears in children with little or no immunity, and
shingles occurs in adults with limited immunity. It is
thought that the herpes zoster virus is a chicken pox
virus that has been dormant, usually for years, after
recovery from chicken pox. This virus tends to flare up
or become active during periods of stress or immuno
suppression caused by other disease processes, trauma,
and aging.
■ Symptoms. Shingles is characterized by an itching,
painful, red rash, and small vesicles or blisters that fol
low the course of a sensory nerve (Figure 15-4). The
resulting neuritis or inflammation of the nerve results
in a stabbing, sharp pain that usually is more severe at
night. Symptoms can last from 10 days to several weeks.
The pattern of rash and blisters usually appears on the
body trunk and runs toward the midline but also can
appear on the face, causing severe conjunctivitis. A rarer
form of shingles is Zoster san herpes, or shingles with
out the typical rash. Pain may run more front to back
and is often mistaken for a heart attack.
■ Diagnosis. Diagnosis is made on the basis of the
appearance of lesions. A viral culture or blood test
for the herpes virus can be performed to confirm the
diagnosis.
■ Treatment. There is no cure for shingles. Treatment
is symptomatic and involves administration of antiviral
Figure 15-4 Shingles: vesicles follow a nerve pathway.
medication (acyclovir, valacyclovir, famciclovir), anal
gesics (acetaminophen, aspirin, ibuprofen, and opioids,
like codeine, for severe pain), topical antibiotics applied
to prevent infections of the open blisters, and antipru
ritics (medications to reduce itching).
■ Prevention. Zostavax
®
and Shingrix are vaccines used
to prevent shingles. Both are approved for adults age
50 and older and are approved by the Food and Drug
Administration. People who have had shingles can still
receive the vaccine to help prevent further outbreaks.
The vaccine is not a treatment for shingles.
Vascular Disorders
Vascular disorders of the nervous system can be quite
severe, causing long-term debility. Some vascular disor
ders can be prevented or reduced in severity by lifestyle
changes.
Cerebrovascular Accident (CVA)
■ Description. CVA is commonly called a stroke. For
Americans, it is the fifth leading cause of death and the
leading cause of serious long-term disability.
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Consider This...
On average, every 40 seconds someone in
the United States suffers a stroke, and every
4 minutes someone dies from a stroke.
■ Etiology. CVA is due to poor blood supply to the
brain. A common causative factor is arteriosclerosis. A
CVA is to the brain what a heart attack is to the heart—
lack of blood flow to the brain causes brain tissue death.
The three common causes of poor blood supply or lack
of blood flow are:
■ Cerebral thrombus—a clot in a brain artery and the
most common cause of vessel occlusion. Thrombus
formation usually occurs in an area where the vessel
is narrowed by arteriosclerosis. Symptoms usually
appear gradually until blood flow is inadequate.
■ Cerebral embolism—usually due to a small piece
of a thrombus or arterial plaque breaking loose and
traveling in the artery until it wedges and occludes
the vessel. Symptoms usually appear quite suddenly.
■ Cerebral hemorrhage—the rupture of an artery, fill
ing the surrounding brain tissue with blood. Cerebral
hemorrhage is usually due to hypertension and arte
riosclerosis (see “Arteriosclerosis and Atherosclero
sis” section in Chapter 8, “Cardiovascular System
Diseases and Disorders”), which cause the vessel
to tear and hemorrhage. Another cause of cerebral
hemorrhage is a weakened artery due to an aneu
rysm. Symptoms are very sudden with hemorrhage.
■ Symptoms. When an area of the brain loses blood
supply, the individual suddenly loses consciousness and
can die or have permanent neurologic disability. About
one-third of individuals with a CVA die. Some survive
without functional disability, and others might have
mild, moderate, or severe disability. The symptoms of
CVA are numerous, depending on the area of the brain
affected and the severity of the occlusion or hemorrhage
(Figure 15-5).
Common symptoms include dysphasia (dis-FAY-
zee-ah; dys = difficulty, phasia = speaking), dysphagia
(dis-FAY-jee-ah; dys = difficulty, phagia = swallow
ing), hemiparesis (HEM-ee-par-EE-sis; hemi = one
half, paresis = paralysis), confusion, and poor coordi
nation (Figure 15-6).
■ Diagnosis. Diagnosis of CVA is made and confirmed
by physical examination, EEG, and CT or MRI scan.
One indicator of the location of brain damage is shown
by the pattern of hemiparesis, if present. Hemiparesis
BE FAST
BALANCE EYES
Loss of Balance, Blurred Vision
Headache or Dizziness
FACE
One Side of the Face
Drooping
ARMS
Arm or Leg
Weakness
SPEECH
Speech Difficulty
TIME
Time to Call for
Ambulance Immediately
Figure 15-5 Stroke symptoms.
314 Chapter 15
affecting the left side is indicative of right-sided brain
injury, whereas hemiparesis affecting the right side
is indicative of left-sided brain injury. Symptoms of
right- and left-sided brain damage vary to some degree
(Figure 15-7). The long-term outcome of a CVA is very
dependent on a rapid diagnosis and treatment.
■ Treatment. Treatment of CVA depends on the sever
ity of the stroke and the symptoms. Anticoagulant and
hypertensive medications can be given to control the
formation of clots and to lower blood pressure. For
those individuals with a physical disability, a rehabilita
tion program, including the needed services of physical
therapy and speech therapy, must be set up early and
continued until the individual has gained maximum
potential.
Right brain damage
Leading to:
• Left-side paralysis
• Memory deficits
• Impulsive behavior
Left brain damage
Figure 15-6 CVA: facial features.
Blue is affected side
Leading to:
Right-side paralysis
Memory deficits
Slow behavior
Speech impairment
Figure 15-7 Symptoms of right and left CVA vary to some degree.
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Nervous System Diseases and Disorders 315
Complementary and Alternative Therapy
Using Acupuncture ne of the common post-stroke problems is dysphagia, difficulty swallowing. A
stroke in several areas of the brain can leave the affected individual with trouble
loiyspagla swallowing. This can cause many other problems for the individual such as malnutri
tion, pneumonia, choking, and even death. Acupuncture is commonly used in Asian and
Pacific Island treatment programs with success. One study used acupuncture to manage
the post-stroke complication of dysphagia. The researchers found that acupuncture did
have benefits for individuals with dysphagia. It improved their swallowing ability and
thus their quality of life. Further research needs to be done to determine the value and
safety of acupuncture for individuals affected by post-stroke dysphagia.
Source: Chan et al. (2020)
■ Prevention. Prevention of stroke is directed toward
avoiding risk factors that include:
1. Smoking
2. High-fat diet
3. Obesity
4. Lack of exercise
These factors also play a role in arteriosclerosis, a
main cause of CVA.
Early detection and treatment of occluded arteries
can aid in prevention of some types of CVA. Carotid
artery screening involves a physician auscultating the
carotid arteries and listening for vessel narrowing. As
blood rushes through a narrowed vessel, a rushing
sound called a bruit (BREW-ee) can be heard. Ultra
sound imaging can also be performed to determine the
condition of the vessel. Surgical intervention to open
the vessel might prevent CVA and includes removal of
plaque in the carotid arteries to improve blood flow and
reduce the risk of a thrombus. This surgical procedure
is called a carotid endarterectomy.
Transient Ischemic Attack (TIA)
■ Description. TIAs are sudden, mild mini-strokes.
■ Etiology. TIAs are due to insufficient blood supply to
the brain. They can serve as a warning of an impending
stroke and are often due to artery narrowing by arterio
sclerotic plaque.
■ Symptoms. Symptoms, like those of CVA, depend
on the area of the brain that is affected. Some common
symptoms are weakness of an arm, leg, or both; dizziness;
slurred speech; and a mild loss of consciousness. Total
loss of consciousness usually does not occur. Symptoms
usually subside within a few minutes to an hour.
■ Diagnosis. Symptoms can be completely resolved
by the time medical advice is sought. The diagnosis is
made on the medical history and physical examination
including a neurologic exam. Blood pressure is also
checked for hypertension. A stethoscope may be placed
over neck veins (auscultation) to determine blood flow
irregularities. Arteriograms can locate suspected vessel
blockage or occlusion. A CT scan of the head might also
be part of the diagnostic testing.
■ Treatment. Arteriograms showing blocked blood
flow can be followed up with surgery to open vessels or
bypass blockage. Carotid endarterectomy is one of the
more common surgeries to correct blood flow for TIA.
■ Prevention. Quitting smoking is the best preventive
measure. Knowing risk factors and living a healthy life
style are also helpful preventive measures.
Functional Disorders
Functional disorders of the nervous system include
degenerative disk disease, headache, epilepsy, and Bell’s
palsy. These conditions, although varying in severity,
are some of the most common problems of the system.
The cause of the disorder might be found, but in many
cases, it is unknown. Treatment of structural disorders
is directed toward the relief of symptoms and assisting
the individual in maintaining maximum function in
activities of daily living.
316 Chapter 15
Degenerative Disk Disease
■ Description. Degenerative disk disease is actually a
degeneration, or wearing away, of the intervertebral disk
of the musculoskeletal system, but the results so severely
affect the neurologic system that it will be considered in
this chapter.
■ Etiology. The wearing away of the disk between the
vertebrae of the back allows the vertebrae to bump or
rub against each other. As these vertebrae move closer
together, the opening for the spine and nerve roots
becomes smaller, causing pressure on the nerves. The
condition of narrowing of nerve root openings in the
spinal column is called spinal stenosis (stenosis =
narrowing).
■ Symptoms. Common symptoms include difficulty
walking and radiating pain in the back and in one or
both legs. This pain often follows the nerve path and
can be intractable (difficult to stop or control). Degen
erative disk disease usually affects older individuals,
but can be related to trauma or congenital defects in
younger individuals.
■ Diagnosis. Diagnosis is made on the basis of clinical
history, X-ray, myelography, CT, or MRI.
■ Treatment. Treatment initially involves resting the
back and legs. A back brace might be beneficial. Long
term treatment involves analgesics, anti-inflammatory
medications, and exercise to ease the pain. A laminec
tomy, surgery to remove part of the vertebrae and widen
the nerve root opening, can be the treatment of choice.
In severe cases, surgery to fuse the vertebrae and free the
nerve root can be performed. Often, older individuals
affected with degenerative disk disease and spinal steno
ses are not medically stable enough to endure surgery.
■ Prevention. Since degenerative disk disease primarily
affects the elderly due to the aging process, many cases
cannot be prevented. Moderate exercise, especially daily
walking programs, and good nutrition can help slow or
stop painful symptoms.
Headache
■ Description. Headache, or cephalalgia (SEF-ah-LAL-
jee-ah; cephal = head, algia = pain), is one of the most
common disorders of humans. It is usually a symptom
of another disease rather than a disorder in and of itself.
Disorders that typically have headaches as a symptom
can include sinusitis, meningitis, encephalitis, hyper
tension, anemia, constipation, premenstrual tension,
and tumors, to name only a few. Most headaches are
not related to disease, but are basically caused by two
mechanisms:
■ Tension on the facial, neck, and scalp muscles
■ Vascular changes in arterial size (dilation or constric
tion) of the vessels inside the head
■ Etiology. Many factors produce headaches, including
allergies, stress, noise, toxic fumes, lack of sleep, and
alcohol consumption.
■ Symptoms. Headaches can be acute or chronic and
can affect different areas of the head. The pain can range
from mild to unbearable and incapacitating; it can be
constant or intermittent and might be described as pres
sure, throbbing, or stabbing. Interestingly, brain tissue
does not contain sensory nerves, so the sense of pain
must come from the pain receptors in the meninges,
facial tissue, or scalp. Some of the more common types
of headaches include:
■ Tension headache—caused by stress, strain, and
tension on the facial, neck, and scalp muscles.
Pain is typically in the occipital area.
■ Cluster headache—can be caused by stress, emo
tional trauma, or unknown reasons. These headaches
occur at night after falling asleep. The pain is gen
erally a severe, throbbing pain behind the nose and
one eye. The skin in this area becomes reddened, and
the nose and eye water. The pain generally subsides
after one or two hours, but might recur several times
during the night.
■ Post-lumbar puncture headache—a severe head
ache affecting up to 40% of individuals, following a
lumbar puncture. It is thought to be due to leakage
of spinal fluid through the needle puncture site. This
type of headache is often prevented by positioning
the individual flat in bed without a pillow for two or
three hours following this procedure.
■ Migraine headache—a severe, incapacitating head
ache commonly accompanied by nausea, vomiting,
and visual disturbances. Individuals affected by
migraines can experience a visual aura, a sensation
that precedes the event, including flashing light, dim
vision, or photophobia. This type of headache can
begin in adolescence and diminish in intensity and
frequency with age. Migraine headaches occur in
women twice as often as they do in men. The cause is
still unknown, although they tend to run in families,
suggesting some type of inheritance pattern. Some
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Соседние файлы в папке Библиотека им академика М.И. Перельмана