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Cerebrovascular Accident

Page 621-625
occurs when the brain is damaged by a sudden disruption in the flow of blood to a part of the brain (embolic), or by bleeding inside the head (hemorrhagic)
also known as stroke (CVA)

Transient Ischemic Attack

Page 625-626
temporary episodes with a duration of less than 24 hours of impaired neurologic functioning caused by an inadequate flow of blood to a portion of the brain;
often referred to as "little strokes" or "mini strokes" (TIA)

Arteriovenous Malformations

Page 624 (Enrichment Box)
formed during fetal development is abnormal structures of the blood vessels; an abnormal connection is noted in which the capillaries are lacking; usually found in the brain but may be located in any vascular structure

Epidural Hematoma

Page 626-627
a collection or mass of blood that forms between the skull and dura mater. the outermost of the three meningeal layers covering the brain

Subdural Hematoma

Page 626-627
a collection or mass of blood that pools between the dura mater and the arachnoid membrane, the second meningeal membrane

Cerebral Concussion

Page 627-628
a possible bruising of the cerebral tissue that is caused by back and forth movement of the head, as in an acceleration-deceleration insult; can also result from blunt force trauma

Cerebral Contusion

Page 628-629
an injury to the brain that involves bruising of the tissue along or just beneath the surface of the brain; etiology may be blunt force trauma to the head, as occurs in an auto accident may also be caused by subdural or epidural hematoma; is often associated with skull fracture
also known as a contra-coup insult

Depressed Skull Fracture

Page 630-631
occurs when a break or fracture occurs in one of the bones of the cranium; when the skull bones are depressed or torn loose, they are pushed below the normal surface of the skull and in on the brain; epilepsy is a common complication; direct impact on the skull with a blunt object is the most common cause

Basilar Skull Fracture

Page 630 (Enrichment Box)
a fracture of the bones of the floor of the cranial vault, resulting from a massive insult to the cranium during MVA or other violent trauma in which the head is struck anteriorly or laterally in the midportion; raccoon eyes and battle signs are manifestations, CSF flowing from the ears or nares may also be associated; occasionally, the severity of the fracture causes severing of the pituitary stalk, resulting in panhypopituitarism


Page 631-632
the loss of nerve function below the waist and paralysis of the lower trunk and legs


Page 631-632
a loss of nerve function at the cervical region resulting in paralysis of the arms, hands, trunk, and legs

Spinal Cord Injuries

Page 631-632
affect the innervation of any spinal nerves distal to the point of insult, The extent of the injury and consequential edema often results in the failure of spinal nerve function with resulting loss of motor and sensory function; usually results from vertebral fractures or vertebral dislocations

Degenerative Disk Disease

Page 632-634
the degeneration or deterioration of an intervetebral disk that may result in pain in the areas served by the spinal nerves of the involved disk space; a natural part of aging that occurs in almost everyone over time; commonly results in footdrop and dragging of the leg

Herniated Disk (Severe or Noncontained)

Page 636-637
the rupture of the nucleus pulposus (a gelantinous center) through the both the inner and outer annular walls (circular structure that surrounds the pulposus) of the disk into the spinal canal; usually result from accumulated trauma such as improper body mechanics when lifting or sudden impact, poor posture or the aging process can also be causative factors

Bulging Disk and Contained Disk Herniation

Page 636-637
the rupture of the nucleus pulposus through the inner but not the outer annular wall; usually result from accumulated trauma such as improper body mechanics when lifting or sudden impact, poor posture or the aging process can also be causative factors

Sciatic Nerve Injury (Spinal Stenosis)

Page 638-639
a pathologic condition brought on by trauma, degeneration, or rupture of the nucleus pulposus within intervertebral disks L4 through S3.rupture of one or more disks or their nuclei produces severe, constant or intermittent, sharp pain radiating from the sciatic nerve down the leg and to the foot
(Spinal Stenosis) a narrowing of the spinal canal or nerve root foramen is often termed sciatica because of the compression on the spinal cord and spinal nerve roots;


Page 640-641
primary or secondary; acute or chronic pain in the head that is not confined to any one specific nerve distribution; often caused by fatigue or tension

tension headache

Page 640
strain on facial, neck, and scalp muscles resulting from tension

vascular headache

Page 640
edema within the blood vessels of the head resulting in change in arterial size

cluster headache

Page 640
generally severe pain, developing around or behind one eye often accompanied by tearing of affected eye, abrupt onset and cessation, generally occurring at night and continuing for several weeks or months than disappearing for some time even years, more common in men; associated with nasal congestion and partial Horner's syndrome


Pages 641-642
periodic severe headaches that may be completely incapacitating and almost always are accompanied by other symptoms, such as nausea and vomiting, anorexia, intense hemicranial or bilateral throbbing pain, and visual signs and symptoms; photophobia orvisual auras (flashing lights, zigzagging lines, or areas of total darkness) may precede the onset; tends to appear in families, certain foods may trigger, biological cause may be change in cerebral blood flow attributable to vasoconstriction followed by vasodilation of the cerebral and cranial arteries


Pages 642-643
a chronic brain disorder characterized by sudden episodes of abnormal intense electrical activity in the brain which usually results in seizure activity; may be inclusive of petit mal epilepsy (also called petit mal seizures and absence seizure) or Tonic-clonic seizures (grand mal epilepsy)

Parkinson's disease

Pages 643-644
a common, slowly progressive neurologic disorder characterized by the onset of recognizable disturbances such as a 'pill-rolling" tremor of the thumb and forefinger, muscular rigidity, slowness of movement, and postural instability; a deficiency in dopamine is demonstrated;

Huntington's chorea

Pages 645-646
(ceaseless, uncontrolled, involuntary movements) a hereditary degenerative disease of the cerebral cortex and basal ganglia and progressive atrophy or the brain;
insidious onset, with loss of musculoskeletal control exhibited by subtle, semipurposeful movements typically affecting the arms and face first; transmitted by autosomal-dominant traits that can be inherited by either sex; familial tendensiy

amyotropic lateral sclerosis

Pate 646-647
a progressive, destructive motor neuron disease that results in muscular atrophy; fasciculations (small local involuntary muscular contractions) and accompanying atrophy and weakness are noted in the forearms and hands, difficulties in speech, chewing, swallowing, and breathing are noted; may be caused by autosomal inherited traits
also known as Lou Gehrig disease

transient global amnesia

Pages 647-648
a transient or temporary event having a duration of 1-6 sometimes up to 12 hours, considered to be global in nature because it encompasses the entire memory of current events, the amnesia manifest as total loss of recent memory, the learning process is completely blocked; patient has recall of personal identity and orientation to place as long as is in a normal environment; although memory usually returns withing 6-12 hours, period of amnesic experience will remain unavailable to any recall; etiology unknown , evidence points to the precursors of experiencing stress or emotional events, swimming or immersion in cold water, driving, or having sexual intercourse; patient may have history of migraine usually without nausea, vomiting, or photosensitivity

peripheral neuritis/neuropathy

Page 648
a degeneration of the peripheral nerves affecting the distal muscles of the extremities; precipitating factors include severe infection or chronic alcohol intoxication, onset is insidious, clumsiness and loss of sensation in the hands and feet are followed by a flaccid paralysis and a wasting of muscles, with pain or tenderness, in these areas, deep tendon reflexes are diminished, skin takes on glossy, red appearance; sweating is decreased; foot drop may be experienced

trigeminal neuralgia (Tic Douloureux)

Page 648-649
severe pain in the area innervated by the fifth cranial nerve, (trigeminal nerve) pain experienced is dependent on which of the three firth cranial nerve branches is affected; pain is always unilateral; duration is of seconds to minutes; occasionally, is a sequela to MS or HZ

Bell's palsy

Pages 649-650
a disorder of the facial nerve (seventh cranial nerve) that causes a sudden onset of weakness or paralysis of facial muscles, often develops overnight, patient may be aware of pain or a drawing sensation behind the ear, followed by an inability to open or close the eye and drooping of the mouth and drooling of saliva; may be unable to smile, whistle, or grimace, and the facial expression is distorted; taste perception may be diminished contributing to loss of appetite; usually unilateral, may be transient or permanent


Page 650-651
an inflammation of the meninges, the membranous coverings or the brain, and spinal cord; early symptoms include vomiting and a headache that increases in intensity with movement or shaking of the head, nuchal rigidity (stiff neck that resists any sideways or flexion-extension movements of the head); positive Kernig's sign (resistance to leg extension after flexing the thigh on the body) and Brudzinski's sign (neck flexion causing flexion of the hips from a supine position) are indications of meningeal irritation; origin may be bacterial or viral


Pages 651-652
an inflammation of brain tissue with an insidious or sudden onset; symptoms include headache, elevated temperature, stiffness in the neck and back, muscular weakness, restlessness, visual disturbances, and lethargy, mental confusion progresses to disorientation and even coma; caused by viruses or the toxins from chickenpox, measles, or mumps, most cases originate from the bite of an infected mosquito

Guillain-Barre Syndrome

Page 652-653
an acute, rapidly progressive disease of the spinal nerves including demyelination of the nerves; symptoms include numbness and tingling of the feet and hands at onset followed by increasing muscle pain and tenderness, progressive muscle weakness and paralysis usually start in the lower extremities and move up the body in 24-72 hours, (descending weakness and paralysis is possible) respiratory insufficiency and difficulty swallowing are possible; etiology is thought to have an autoimmune basis, has been known to follow respiratory infection or gastroenteritis

brain abscess

a collection of pus occurring anywhere in the brain; may result from local or or be secondary to an infection elsewhere in the body, head trauma or craniotomy wound may be the portal of entry for common causative organisms such as staphylococci, streptococci, or pneumococci; primary symptom is headache; nausea and vomiting, visual disturbances, unequal pupil size, and seizures may occur; many times eyes look toward the insult, moving to the side of the head where the abscess is located, nuchal rigidity may be noted.; lumbar puncture is contraindicated because it can cause increased intracranial pressure which may cause the brain stem to herniate and result in death


Pages 654-655
a highly contagious, viral infection of the anterior horn cells of the gray matter of the spinal cord causing a selective destruction of motor neurons; symptoms include low grade fever, profuse discharge from the nose, and malaise followed by a progressive muscle weakness, stiff neck, nausea, vomiting, and a flaccid paralysis of the involved muscles; atrophy of the muscles follows, with decreased tendon reflexes, then muscle and joint deterioration; when involves muscles supplied by spinal nerves is termed spinal, and when involves muscles supplied by cranial nerves is termed bulbar; poliovirus enters through nose and throat and crosses into gastrointestinal tract progressing to CNS by way of bloodstream; transmission is by oropharyngeal secretions or feces that contain the virus; immunization with the Sabin trivalent oral vaccine affords immunity to all three types, immunization with monovalent Sabin vaccine grants immunity to only one form as does Salk vaccine; trivalent vaccine is contraindicated for persons with immunosuppressive conditions because it puts them at risk of developing the disease; two poliovirus vaccines are currently licensed in the US, inactivated poliovirus vaccine (IPV) oral poliovirus vaccine (OPV)

postpolio syndrome

Page 655
occurs later in life in persons who have previously had poliomyelitis; functional deterioration of muscles is accompanied by loss of strength, the progressive weakness begins 30 years or more after the initial attack and involves already affected muscles, fasciculations and muscular atrophy may accompany the weakness

intracranial tumors

Pages 655-656
can be primary tumors (neoplasms originating in the brain and arising from any cell within the cranium), or secondary tumors, cancer that has metastasized from another area of the body, named according to the tissue in which they originate; symptoms include headache (usually dull, constant, and worse at night or in the morning), focal or generalized seizures, nausea and vomiting, loss of consciousness, cognitive dysfunction, muscle weakness, sensory loss, aphasia, gait disturbance and visual dysfunction

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