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Nervous System Diseases and Disorders 317
foods that trigger migraines are chocolate, wine, and
cheese. It is also thought that these are vascular head
aches caused by altered arterial blood flow.
■ Diagnosis. Diagnosis of the cause of headache
depends on individual history and physical examina
tion. Testing can include X-ray, EEG, and MRI and
CT scans.
■ Treatment. Headache treatment depends on the
cause, severity, and frequency of occurrence. Often,
lifestyle changes, such as improvements in diet, sleep,
and exercise, help. Pain medications may be over-the-
counter, such as acetaminophen (Tylenol
®
) or ibuprofen.
Prescription pain medication and anti-nausea medica
tions might also be needed.
■ Prevention. Diet and lifestyle changes and stress
reduction are measures that can help prevent head
aches. Severe headaches might require prescription
medication.
Epilepsy
■ Description. Epilepsy is a chronic disease of the brain,
characterized by intermittent episodes of abnormal
electrical activity in the brain, activity that might be
compared to an arrhythmia of the heart.
■ Etiology. The cause of epilepsy can be due to brain
tumors, neurologic disease, or scar tissue in the brain
due to trauma or stroke. More commonly, the cause
cannot be determined during the individual’s life or
even on autopsy.
■ Symptoms. The most noted symptom of epilepsy is a
convulsive seizure. A convulsion is an abnormal muscle
contraction. A seizure is actually a sudden attack, but it
is commonly used to indicate a convulsive seizure. Not
all seizures are characterized by convulsions, and not all
convulsions are due to epilepsy. Convulsions can occur
in a nonepileptic individual due to conditions such as
excessive temperature (hyperpyrexia), hypoglycemia,
hypocalcemia, and drug or alcohol toxicity.
For decades, seizures have been described as petit
mal (small) and grand mal (large). Terms such as par
tial and generalized have also been used. These terms
have worked well, but fail to capture the many types of
seizures. More recently, the Epilepsy Foundation has
developed a new classification system.
The new classification system for seizures is:
■ Focal onset seizures (formerly petit mal/partial)
These seizures are also called absence seizures
and commonly occur in children; they are often
outgrown during puberty, but they can last a life
time. These seizures consist of a brief change in
the level of consciousness without convulsions.
The involved individual might show symptoms of
blank staring, blinking, and twitching of the eyes
or mouth, or all of these. The individual might
remain seated or standing with loss of awareness
of surroundings. Often, the seated individual
appears to have only a loss of attention or absent
mindedness. Episodes often last only a few sec
onds, but can occur multiple times during the day.
■ Generalized onset seizures (formerly grand mal/
generalized) These seizures are the type most often
thought of as epilepsy. They are characterized by
convulsions, loss of consciousness, urinary and fecal
incontinence, and tongue biting. Epileptic individuals
often perceive an aura with grand mal seizures, allow
ing time to lie down or call for support. Auras can
include tingling of the fingers, ringing in the ears, and
visual disturbances. These seizures may begin with a
crying out as the contraction of the respiratory mus
cles forces exhalation, followed by generalized rhyth
mic contractions of the skeletal muscles of the body,
arms, and legs. Contractions can last one to two min
utes, but consciousness will return more slowly. The
involved individual is often weak, drowsy, and con
fused, and has no memory of the seizure event.
■ Status epilepticus is a life-threatening event, a state
of continued convulsive seizure with no recovery of
consciousness. This is a medical emergency because
treatment is needed to prevent cerebral anoxia and
possible death.
■ Diagnosis. Diagnosis of epilepsy is made on the basis
of EEG, CT, and cerebral angiograms. EEG can reveal
altered brain activity; CT can indicate alteration in brain
structure, including tumors; and cerebral angiograms
can reveal alteration in blood flow. Blood tests can be
performed to indicate disorders of hypoglycemia and
drug or alcohol toxicity.
■ Treatment. Anticonvulsive medications are the treat
ment of choice for epilepsy. Close monitoring and
adjustment of medications are needed to get the best
effect. Medications are effective in preventing or reduc
ing seizures 80% of the time. Education and emotional
support of the affected individual and family members
are necessary because this disease is often feared due
to lack of education. The goal for epileptic individuals
should be maintenance of a normal lifestyle.
318 Chapter 15
Healthy Highlight
First Aid for
Seizures
A
seizure is a sign of a malfunction of some part of the brain’s electrical system.
Most seizures in individuals diagnosed with epilepsy are not emergencies, but
they could be in others. It is always wise to call for assistance (medical personnel) when
unsure.
■
■
■
■
■
■
■
■
■
In the event of a seizure, complete the following steps:
Look for a medical ID.
Loosen tight clothing.
Protect the individual from harm or nearby hazards.
Protect the head by placing a cushion or padding under it.
Do not attempt to place a tongue blade, any hard object, or your fingers in the indi
vidual’s mouth.
Turn the individual to a side-lying position.
Avoid tightly restraining the individual.
Stay with the individual until other assistive personnel arrive.
Reassure the individual and offer assistance as consciousness returns.
■ Prevention. Because the cause of epilepsy in many
cases is not clear, it is not possible to prevent it. In the
case of epilepsy brought on by head injury, prevention
measures include wearing a seat belt in the car and a
helmet when riding a motorcycle, ATV, bike, or horse
or while skating or skiing.
Bell’s Palsy
■ Description. Bell’s palsy is a disease affecting the facial
nerve (seventh cranial nerve), causing unilateral (one
sided) paralysis of the face. It commonly occurs in indi
viduals 20 to 60 years of age. Bell’s palsy can affect either
side of the face, and both genders are affected equally.
There appears to be an increased risk for pregnant
women and those with an upper respiratory infection,
influenza, and diabetes.
■ Etiology. This disease is idiopathic, but possible
causes include autoimmune problems and viral disease.
■ Symptoms. Symptoms include a drooping weakness
of the eye and mouth, with inability to close the affected
eye and drooling of saliva. The affected individual is
unable to whistle or smile and has a distorted facial
appearance (Figure 15-8).
■ Diagnosis. Diagnosis is made on the basis of clin
ical history and symptoms. An electromyography can
be completed to measure voluntary muscle movement
and determine the extent of nerve weakness. An MRI
scan is helpful also.
Figure 15-8 Facial appearance of Bell’s palsy.
■ Treatment. Treatment includes analgesics and
anti-inflammatory medications. If the individual is
unable to close the affected eye, protection of the eye
with a patch and artificial tear medication might be
needed. Warm, moist heat, electrical nerve stimulation,
and massage can be prescribed to prevent facial muscle
atrophy. Prognosis for Bell’s palsy is good, with most
cases resolving spontaneously in two to eight weeks.
Plastic surgery might be prescribed to correct the facial
deformities caused by chronic disease.
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PARKINSON’S DISEASE
NORMAL NEURON
Transmiting Neuron
Dopamine Receptor
Dopamine
STRIATUM —
Caudate Nucleus —■
Putamen —•
Subsntia Nigra —
VentralTegmental —
Area
Doparmine Essential
Frontal Lobe for Motor Skills
PARKINSON’S REDUCED DOPAMINE
Figure 15-9 Parkinson’s disease.
■ Prevention. Since the cause of Bell’s palsy is unknown,
there are no known preventive measures.
Parkinson’s Disease
■ Description. Parkinson’s disease is a slow, progressive
brain degeneration, usually developing in individuals
in their late 50s and 60s (Figure 15-9). Parkinson’s
affects men more often than it does women.
■ Etiology. The cause is unknown, but individuals with
Parkinson’s have been found to have a deficiency of the
neurotransmitter dopamine in the brain.
■ Symptoms. Classic symptoms include the following:
■ Rigidity and immobility of the hands and a very
slow speech pattern
■ A fine tremor in the hands described as a pill-rolling
motion of the fingers
■ An expressionless facial appearance with a fixed stare
and infrequent blinking called Parkinson’s facies
(fay-SHEEZ)
■ An abnormal bent-forward posture that includes a
bowed head and flexed arms (Figure 15-10)
■ A peculiar gait of short, fast-running steps due to the
abnormal posture that makes the individual tend to
stumble forward, leading to frequent falls
Figure 15-10 Classic posture in Parkinson’s disease.
320 Chapter 15
Meditation for
Dementia
Complementary and Alternative Therapy
D
ementia is a growing problem in the health care arena. There are several types of
dementia but all types cause frustration to the affected individual and the families
who are caring for those affected. One study reviewed the research incorporating medi
tation into the routine interventions used for the individuals with dementia. The results
suggested that meditation was beneficial for individuals with dementia. The meditation
based interventions helped improve the quality of life for the affected individuals and
even improved their cognition some. More research needs to be done before this is con
sidered a cost-effective and evidence-based treatment for therapists to use with individ
uals with dementia.
Source: Hoffman et al. (2020)
■ Diagnosis. Diagnosis is usually easy to make after a
thorough history and physical exam. Criteria for Par
kinson’s disease are bradykinesia and at least one of the
following: muscle rigidity, resting tremor, and/or pos
tural instability.
■ Treatment. Treatment of Parkinson’s is symptom
atic. Dopamine replacement medications can be
used; they do not stop the progression of the disease,
but they might help with symptoms. Psychological
support and physical therapy for muscle soreness are
also helpful.
■ Prevention. There is no known prevention for Par
kinson’s disease.
Dementias
Dementia (dee-MEN-she-ah) is a loss of mental abil
ity due to the loss of neurons or brain cells caused in
Healthy Highlight
Hand Tremors
H
and tremors are often seen in Parkinson’s disease but can occur for many other
reasons. There are many categories of tremors including essential, physiologic,
orthostatic, psychogenic, cerebellar, and dystonic. Causes of hand tremors include dis
orders such as Parkinson’s disease, but they can also be caused by drugs, alcohol abuse,
hyperthyroidism, and liver failure. Some tremors are inherited and others are just
familial. Tremors are most common at mid-life and older but can occur at any age.
The most common tremor type is the essential tremor. This type of tremor usually
affects the hands and arms, but can affect the voice, legs, and head. About 50% of essential
tremors are thought to be inherited, but they can also be of unknown cause. This tremor
usually occurs when an individual holds a posture such as holding a fork or holding the
arms outstretched. It usually does not occur at rest. Beta-blocker and anticonvulsant
medications may be of some help if the tremors worsen to the point of making day-to
day tasks difficult to perform.
Short-lived physiologic tremors may occur due to stress, anxiety, low blood sugar,
thyroid problems, or withdrawal from caffeine or alcohol. The cause and treatment of
physiologic tremors should be addressed by a physician. Treatment may include medi
cations, focused ultrasound, surgery, or lifestyle adjustments.
Source: NIH: National Institute of Neurological
Disorders and Stroke (2020)
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Nervous System Diseases and Disorders 321
several ways. One of the most common dementias is senile
(old) dementia and is related to degeneration of cells
with aging. The most common cause of senile dementia
is Alzheimer’s disease. Therefore, Alzheimer’s and senile
dementia are often used synonymously, but in reality, an
individual can have senile dementia without Alzheimer’s.
Vascular dementia also can be considered a form of senile
dementia because it tends to occur in older individuals.
Alzheimer’s Disease
■ Description. Alzheimer’s (ALTZ-high-merz) disease
is a form of dementia characterized by the death of neu
rons and replacement of these neurons by microscopic
plaques (Figure 15-11). It is the most common cause
of dementia among older people. The disease usually
affects individuals 60 years of age and older. The num
ber of cases increases with age, with an estimated 33%
of individuals over age 85 affected.
■ Etiology. The cause of Alzheimer’s disease is
unknown. Experts now believe that a variety of factors
may interact to cause this problem. Age is the greatest
known risk factor; as one ages, the risk of Alzheimer’s
increases dramatically. Other risk factors include hered
ity, heart disease, poor general health, and possibly a
link in those with a history of head trauma.
■ Symptoms. Symptoms of the disease begin with mild
mental impairment characterized by loss of short-term
memory, inability to concentrate, and slight changes
in personality. As the disease progresses, the affected
individual struggles with communication skills, uses
meaningless words, and cannot form sentences.
Increased forgetfulness and difficulties in communica
tion lead to irritability and agitation. In the final stages,
which can take 5 to 10 years to develop, the affected
individual’s mental and physical capabilities are severely
affected. The affected individual becomes restless, dis
oriented, incontinent, hostile, and combative and is
totally dependent on a caregiver. Death is usually due
to a secondary cause such as infection.
■ Diagnosis. Diagnosis cannot be positively made
except from autopsy. Initially, a diagnosis can be made
on the basis of symptoms after ruling out other brain
diseases. In the final stage of the disease, CT or MRI
scans might reveal the characteristic brain atrophy and
microscopic plaques.
■ Treatment. Treatment is supportive because there
is no known cure for Alzheimer’s disease. As the indi
vidual’s capabilities decline, care is focused on safety
and maintaining adequate nutrition, hydration, and
personal hygiene. Mobility and mental capabilities are
supported for as long as possible. Emotional support of
family members and caregivers is of primary concern.
■ Prevention. The Alzheimer’s Research and Preven
tion Foundation has developed four “Pillars of Preven
tion” that include:
■ Diet and supplements—eating a healthy diet,
including lean proteins, fruits and vegetables,
Alzheimer’s
disease
Healthy
— Normal
neuron
Amyloid —
plaques
Figure 15-11 Alzheimer’s disease.
322 Chapter 15
omega-3 fats, supplements of folic acid, magnesium,
fish oil, and vitamins B
12
, D, E, and C, while avoid
ing trans fats and excessive alcohol consumption.
■ Stress management—including meditation, deep
breathing, massage, and prayer.
■ Exercise and brain aerobics—physical exercise
can reduce the development of Alzheimer’s by 50%,
while mental exercise can reduce the development by
70%! Physical exercise should include approximately
150 minutes a week of cardio and strength training.
Brain aerobics includes anything that stimulates your
brain such as reading, writing, playing board games,
or working crossword puzzles.
■ Spiritual fitness—maintaining individual spiritual
ity, socializing with others in clubs or organizations,
and volunteering.
Since some research indicates there may be a strong
relationship between the development of Alzheimer’s
and head trauma, preventive activities also include
wearing seat belts and helmets as indicated.
Vascular Dementia
■ Description. Vascular dementia is caused by atrophy
and death of brain cells due to decreased blood flow.
■ Etiology. Atherosclerotic plaque is the common cause
of decreased blood flow and is common with aging.
■ Symptoms. Because the atherosclerotic plaques
develop slowly, so do symptoms, which progress so
slowly that they often go unnoticed by family mem
bers until they become quite severe. Symptoms include
changes in memory, personality, and judgment.
Healthy Highlight
The MIND Diet for
Brain Health
T
he MIND diet is similar to the well-known Mediterranean diet that has been con
sidered to be a diet that promotes the maintenance of a healthy heart. It also con
tains components of the DASH (Dietary Approaches to Stop Hypertension) diet that is
supported by the American Heart Association. MIND stands for Mediterranean-DASH
Intervention for Neurodegenerative Delay. It takes the best of the other two diets and
focuses on foods that affect brain health. This diet limits some foods but highly pro
motes others. Researchers studied subjects eating the MIND diet and found the partic
ipants had brain functioning at the level of 7+ years younger than individuals who ate
diets that were not similar to the MIND diet. They also reported that the MIND diet
reduced their risk of developing Alzheimer’s disease by 35% for individuals that fol
lowed the diet moderately but by 53% for individuals that followed it rigorously. It was
concluded that the MIND diet was much better than the DASH or Mediterranean diets
for reducing the chance of developing cognitive losses. The eight power foods in the
MIND diet include the following:
■ Vegetables/leafy greens, one cup raw or % cup cooked greens and % cup of other
cooked vegetables per day
■ Nuts, five one-ounce servings per week
■ Berries, one cup twice per week
■ Beans, one-half cup cooked four times per week
■ Fish/poultry, three ounces of fish and six ounces of poultry per week
■ Olive oil, daily
■ Whole grains, one-half cup cooked grains or a slice of whole grain bread three times
per day
■ Wine, one four-ounce glass per day
There are pros and cons to the MIND diet but consuming this diet consistently
might improve mind functions and help keep the individual healthier overall.
Source: U.S. News Health (2021)
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Nervous System Diseases and Disorders 323
Irritability, depression, and sleeplessness also can occur.
Personal hygiene is lacking and is often the sign that
alerts family members to the condition. The affected
individual can become disoriented and lost in familiar
surroundings.
■ Diagnosis. Diagnosis is made on the basis of a history
and physical and blood flow testing. Arteriograms of
the carotid and cerebral arteries will reveal narrowing
of vessels, stenosis, and arteriosclerotic plaques.
■ Treatment. Treatment is aimed at increasing blood
flow to the brain. If the cerebral arteries are involved or
narrowed, medications may help improve blood flow.
Carotid artery plaques can be surgically cleaned by a
carotid endarterectomy (END-ar-ter-ECK-toh-me;
endo = inside, arter = artery, ectomy = excision of).
Prognosis depends on the effectiveness of treatment
and the amount of brain cell death. If treatment is not
possible or effective, or if a large amount of brain tissue
has been lost, the affected individual will become pro
gressively more demented and might need institution
alization for care.
■ Prevention. The best preventive measures are to
quit smoking, lead a healthy lifestyle, and control
hypertension.
Head Trauma Dementia
■ Description. Head trauma can damage any part of
the brain. This term fails to capture all the symptoms
and long-term disabilities that can be related to such
trauma. Males experience head injuries more often than
females, with the most injuries occurring in those age
14 to 24 years. Very young children commonly have the
worst outcomes.
■ Etiology. Head trauma dementia is due to death of
brain cells related to head trauma. One type is Boxer’s
dementia, caused by repeated blows to the head as in the
sport of boxing. Other types of trauma can be those sus
tained in accidents, especially motor vehicle accidents,
and sports-related activities. The death of brain cells can
be caused by the injury itself or by edema and increased
ICP, which decreases or halts blood flow to brain cells,
leading to cell death.
■ Symptoms. Symptoms of head trauma dementia
include a prolonged or permanent decrease in mental
intellect, cognitive function, or both. The affected indi
vidual might be unable to perform activities that were
easily completed prior to the injury. There are often
symptoms of loss of the ability to reason, remember,
and show appropriate emotions and behaviors follow
ing such injury. Changes in personality are not uncom
mon. Chronic psychological trauma can bring about
major life changes, mania, major depression, and post-
traumatic stress and anxiety disorders.
■ Diagnosis. Diagnosis is made on the basis of history,
cranial X-rays, and MRI and CT scans.
■ Treatment. Treatment is aimed at correcting the dam
age if possible, preventing further damage, and main
taining the existing healthy tissue. Dead brain cells
cannot be replaced, so damage is permanent. Ther
apy and rehabilitation are needed to regain as much
function as possible. Individuals suffering severe head
trauma might need institutionalization for long-term
care.
■ Prevention. Head injury is often easy to prevent with
proper use of protective equipment. Preventive activi
ties include the following:
■ Wearing seat belts in automobiles.
■ Wearing a helmet when riding bikes, ATVs, and
skateboards.
■ Wearing work-related safety equipment along with
hard hats when needed.
■ For older adults, altering the surroundings by remov
ing rugs or furniture that might slide easily and cause
falls.
Substance-Induced Dementia
■ Description. This type of dementia is often cured
because the cause of the dementia is curable. In some
cases of substance-induced dementia, the individual
might not have dementia at all but, rather, suffer from
severe depression.
■ Etiology. Substance-induced dementia is due to brain
cell death caused by toxicity from drugs and toxins. This
type of dementia can be caused by repeated exposure to,
or use or abuse of, certain substances. Commonly, those
substances include alcohol, cocaine, heroin, lead, mer
cury, and fumes of paints, paint thinners, and insecti
cides, to name only a few. Brain cell death often persists
long after the exposure to the substance ends.
■ Symptoms. Symptoms of mental impairment and
decreased cognitive ability can be permanent and often
worsen over a period of time.
■ Diagnosis. Substance abuse dementia is usually dif
ficult to diagnose. A history and physical exam along
324 Chapter 15
Complementary and Alternative Therapy
Aromatherapy for romatherapy has been shown to improve sleep quality in a variety of settings such
as hospitals and long-term care facilities. The most commonly used aromatherapy
elleleep is lavender essential oil. The use of lavender has been shown to reduce anxiety, depres
sion, insomnia, and some types of pain. It is an herb native to North Africa and regions
surrounding the Mediterranean. Lavender essential oil can be toxic when ingested so
caution is necessary if using it or having it in the house. It is most often used in diffus
ers. It is not approved by the Food and Drug Administration (FDA) as a medication for
insomnia or other conditions. More research is recommended to study the long-term
effects of lavender.
Source: Cooksley (2020)
with family and caregiver history of the individual’s
symptoms and history are helpful. A mental health
exam is often needed.
■ Treatment. Once properly diagnosed, treating the
dementia is usually a matter of removing the toxin
(drugs, alcohol, fumes, or insecticides). Depending on
the degree of dementia, removing the toxin might or
might not restore normal function.
■ Prevention. Avoiding the toxin prevents this type of
dementia.
Sleep Disorders
Sleep may be described as a necessary state of uncon
sciousness. It is thought that sleep is a period of time
during which the body is actively restoring and repair
ing itself because an increased amount of growth hor
mone is released during sleep. Sleep also provides a
time of recuperation of mental activities. It is believed
that there is an increase in metabolic rate in the brain
during sleep that allows it to be more alert and efficient
during waking hours.
Sleep deprivation of just one night can lead to
changes in personality, lack of muscle coordination,
and decreased coping ability. There is a great variability
in sleep requirements among individuals and different
ages: infants need 16 to 20 hours of sleep every 24 hours.
The need for sleep decreases into adulthood, with adults
generally requiring between six and nine hours of sleep
and older adults requiring even less sleep. Sleep disor
ders can be due to a variety of causes and can be tested
by polysomnography, a procedure measuring a variety
of physical variables related to sleep.
Consider This...
5
Humans can live longer without food than
without sleep. If water is provided, a per
son can live a month or two without food,
but the human body will shut down and
die after only 11 days or so of total sleep
deprivation.
Insomnia
■ Description. Insomnia is the most common sleep dis
order in the United States, with about one-third of the
adult population experiencing it at some time. Insomnia
is the perception or feeling of inadequate or poor sleep,
the inability to fall or stay asleep, or waking up too early in
the morning. The affected individual arises physically and
mentally tired, irritable, and anxious. Insomnia is more
common in females and occurs increasingly with age.
■ Etiology. The cause of insomnia can be related to
stress, pain, fear, depression, and cardiovascular or thy
roid disorders. Drugs such as caffeine, alcohol, nicotine,
and bronchodilators also can cause insomnia. Eventu
ally, the fear of being unable to fall asleep can become
a cause.
■ Symptoms. The symptom is sleeplessness, often lead
ing to fatigue and irritability. The diagnostic definition
of insomnia is sleeplessness for more than one month
that is interfering with the individual’s social or work
habits.
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Nervous System Diseases and Disorders 325
■ Diagnosis. Diagnosis is determined by taking a care
ful account of an individual’s sleep history. Referral to a
sleep lab might help if a breathing disorder is suspected.
■ Treatment. Treatment consists of identifying and
removing the cause(s). One can develop a sleep rou
tine with a scheduled bedtime and awakening time, and
counseling might be needed to assist the individual in
managing or reducing stress and anxiety. The affected
individual is encouraged not to worry about when and
how much he or she sleeps and to take naps and sleep
as they can rather than build up anxiety about sleeping
at night. The total amount of sleep in 24 hours is more
important than the sleeping schedule.
■ Prevention. Prevention centers on living a healthy
lifestyle, balancing rest, exercise, and recreation with
stress management and healthy diet.
Consider This...
Average pillows and mattresses contain
millions of fungi and dust mites. Mattresses
gain approximately a pound or more per
year from dust mites.
Sleep Apnea
■ Description. Sleep apnea (AP-nee-ah; a = without,
pnea = breathing) is a sleep disorder characterized by
periods of apnea or breathlessness.
■ Etiology. This condition occurs more frequently in
men and might be related to obesity, hypertension, and
airway obstruction. Alcohol ingestion and smoking also
can be causative factors.
■ Symptoms. The diagnostic definition of sleep apnea
is more than five periods of apnea lasting for at least
10 seconds each per hour of sleep. These breathless
periods are followed by sudden gasps or snorts for air.
Other symptoms can include (1) excessive daytime
sleepiness to the point of falling asleep during driving,
at work, or in the middle of a conversation; (2) extreme
snoring that might not awaken the affected individual
but easily awakens family members; and (3) personality
changes, depression, and impotence. Sleep apnea can be
divided into three categories:
■ Obstructive apnea, caused by nasal obstruction
■ Central apnea, caused by a disorder in the brain’s
respiratory control center
■ Mixed apnea, a combination of both obstructive and
central apnea
■ Diagnosis. Diagnosis is confirmed by monitoring the
affected individual during sleep for apnea and low blood
oxygen levels.
■ Treatment. Treatment is based on cause. Obstructive
types and mixed types are treated with weight-loss ther
apy and, if needed, surgery to correct nasal obstruction.
Individuals affected by obstructive apnea also might
benefit from oxygen administration, oral appliances,
adjustable airway pressure devices, and continuous
positive airway pressure (CPAP) devices during sleep.
Central apnea is more difficult to control and might be
treated with medications to stimulate breathing.
■ Prevention. Most cases of sleep apnea can be pre
vented by maintaining a healthy weight, avoiding alco
hol, not smoking, and avoiding environmental smoke.
Consider This...
Staying awake for 17 hours has the same
effect on your body as drinking two glasses
of wine.
Tumors
Tumors may be classified as benign and malignant (see
Chapter 3, “Neoplasms”). Benign tumors of the brain
often become malignant if surgical removal is not pos
sible. The growth of benign tumors in the confined
space of the skull places pressure on the brain tissue
and blood vessels, leading to loss of function and death
of normal tissue. Tumors can occur in any area of the
brain and at any age, although many are fairly age-spe
cific or commonly occur in a particular age group. Gli
omas and meningiomas are most common in adults.
Brain Tumor
■ Description. Brain tumors may be classified as pri
mary or secondary. Primary tumors start in the brain
tissue, whereas secondary tumors occur in other areas
and metastasize to the brain. Brain tumors in children
are commonly primary tumors. Secondary tumors are
not called brain tumors; they are named after the organ
326 Chapter 15
of origin. In other words, breast tumor that metastasizes
to the brain is still called breast cancer with metastasis
to the brain. Common sites of secondary tumors that
metastasize to the brain include breast and lung.
■ Etiology. The cause of primary tumors is unknown.
■ Symptoms. Symptoms are varied, depending on the
area involved, and include headache, vomiting, seizures,
mood and personality changes, visual disturbances, and
loss of memory.
■ Diagnosis. Diagnosis is made on the basis of clinical
history, symptoms, X-ray examinations, CT and MRI
scans, and biopsy. A biopsy is the most definitive study
to determine the type of tumor and the best study to
assist with treatment and prognosis. Further studies
might be needed to determine the primary location of
metastatic brain tumors.
■ Treatment. Treatment can include surgery, radiation,
and chemotherapy. Treatment and prognosis depend on
the type and location of the tumor.
■ Prevention. Reducing or avoiding exposure to radia
tion, certain medications, and head trauma can benefit
prevention.
Trauma
Injuries to the brain, neck, and spinal cord are a main
cause of disability and death. Trauma to the head can
cause edema, increased ICP, hemorrhage, and infec
tion, resulting in brain damage. Injury to the neck
and spinal cord can lead to temporary or permanent
paralysis.
Concussions and Contusions
■ Description. A concussion is the less serious of the
two conditions and does not involve injury to the brain.
A contusion, however, is a physical bruising of the brain
tissue. Brain contusions are often accompanied by skull
fractures.
■ Etiology. A blow to the head caused by an object, fall,
or other trauma such as an automobile accident can
cause a concussion or contusion.
■ Symptoms. Both concussions and contusions cause
a disruption of normal electrical activity in the brain,
which, in turn, causes immediate unconsciousness,
often described as being knocked out. This state of
unconsciousness can last from a few seconds to sev
eral hours, and the affected individual often awakens
with amnesia, or loss of memory. Other symptoms are
headache, blurred vision, and irritability. The individual
might suddenly draw up the knees and begin vomiting.
The physical bruising of a contusion can lead to
the development of a hematoma, increased ICP, and
permanent brain damage. If the bruised tissue is in the
area of the impact, it is referred to as a coup (COO)
lesion. Coup lesions often occur with direct injury
such as is incurred from a direct blow to the head. If
the injury occurs on the opposite side of the brain, it
is called a contracoup (CON-tra-coo) lesion, which
often occurs when the head is in motion and is stopped
suddenly, causing a rebound effect to the opposite side
(Figure 15-12), as is often found in automobile acci
dents. Contracoup injuries are commonly accompanied
by a coup injury at the point of impact.
■ Diagnosis. Diagnosis of both conditions is made on
the basis of a history of the injury, neurologic examina
tion, cranial X-ray, and CT or MRI scans.
■ Treatment. Treatment of a concussion consists of
bed rest in a quiet area under direct observation. The
individual should be awakened every two to four hours
and observed for changes in consciousness, eye pupil
size, mood, and behavior. An individual suffering with
a contusion should be hospitalized for continuous mon
itoring. Analgesic, sedative, and stimulant medications
should not be given to individuals with head injuries
because these medications can mask symptoms and
make assessment difficult.
■ Prevention. Head injury prevention includes activi
ties such as wearing a seat belt in an automobile, wear
ing helmets with recreational activity, and preventing
falls by removing clutter and slippery rugs.
Skull Fractures
■ Description. A skull fracture is a break in a cranial
(skull) bone. The greatest danger of a skull fracture is
the resulting brain tissue damage (Figure 15-13). Bony
fragments can cut into the brain tissue, severing a vessel
and causing a hematoma. Brain damage from a fracture
can be temporary or permanent.
■ Etiology. A fracture can occur with head injuries
from falls, a severe blow to the head, automobile acci
dents, or sports injuries.
■ Symptoms. The position of the fracture will cause a
variety of symptoms. For instance, a fracture near the
base of the skull might injure the respiratory center
of the brain, causing the individual to stop breathing.
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