Neurological Disorder: Neuron
Neurological Disorder: Neuron
Neurological Disorder: Neuron
Acetylcholine *BOTH*
ANATOMY AND PHYSIOLOGY (Excitatory and inhibitory)
● (major transmitter of PNS)
1. Central Nervous System (CNS) ● Usually excitatory;
• Brain - parasympathetic effect
•Spinal cord sometimes inhibitory
2. Peripheral Nervous System (stimulation of heart by vagal
(PNS) nerve)
• Cranial nerves ● Excitatory // Inhibitory
•Spinal nerves ● Controls sleep and wakefulness
• Autonomic nervous system cycle
Neuron ● Signals muscles to become alert
• Basic functional unit of the brain
2. Serotonin (*INHIBITORY*)
• Dendrites – receives electrochemical
● Inhibitory
messages
● Controls fluid intake, sleep and
- Extensions that carry impulses
wakefulness temperature
toward the cell body.
regulation pain control, sexual
• Axon – carries electrical impulses
behaviours regulation of
away from the cell
emotions
• Myelin sheath – increases speed of
● Mood control and sleep
conduction
● Inhibits pain pathways
- oligo - gumagawa ng myelin
3. Dopamine (*EXCITATORY*)
TYPES OF NEURONS
● excitatory
Sensory Neurons
● Usually inhibitory??
- Also knowns as afferent neurons
● Affects behaviour (attention and
- Transmit impulses from
emotion) fine movements
receptors to the cns
● Controls complex movements,
Motor Neurons
motivation, cognition.
- Also termed as Efferent Neurons
● Regulates emotional response
- Transmits impulses from the
central nervous system to the
4. Norepinephrine
effectors (Muscle, Glands)
(*EXCITATORY*)
Interneurons
● (major transmitter of SNS)
- Found entirely within the
● Usually excitatory
central nervous system
● Affects mood and overall action
- Specialized to transmit sensory
● Causes changes in attention,
motor impulses.
learning and memory sleep and
Neurotransmitters
wakefulness. mood.
● Communicate messages from
one neuron to another or from a
5. Gamma-aminobutyric acid
neuron to specific target tissue.
(GABA) (*INHIBITORY*)
● Potentiate or modulate a
● Inhibitory - Patulugin
specific action and can either
● Modulates other
excite or inhibit the target cell's
neurotransmitters.
activity.
6. Enkephalin, Endorphins
● Manufactured and stored in
(*BOTH*)
synaptic vesicles
● Excitatory
● Diffuses/transported across the
● Pleasurable sensations
synapse, binding to receptors in
● Inhibits transmission
the postsynaptic cell membrane
● Controls fight to fight response.
Action:
7. GLUTAMINE (*EXCITATORY*)
• Potentiates
● Excitatory
• Terminates
● Results in neurotoxicity are too
• Modulates
high.
• Excite
• inhibit
Potentiates - nagpapabilis 3. MEDULLA
Terminates - - Contains Cardiac centers,
Modulates respiratory centers, vasomotor
Excite - centers and reflex centers
Inhibit (Coughing sneezing, swallowing
and vomiting)
Serotonin - Mood control
Dopamine 4. PONS
- Decrease (Parkinson, due to lack - Anterior to the cerebellum and
of dopamine. superior to the medulla
Norepinephrine - Contains two respiratory centers
- Decrease or increase ( Anxiety) (apneustic & pneumotaxic)
Gaba responsible to produce normal
- Inhibitory breathing rhythm.
- At evening
Enkephalin 5. MIDBRAIN
- Excitement - Regulates Visual reflexes,
Auditory reflexes and righting
CENTRAL NERVOUS SYSTEM reflexes.
1. CEREBRUM
Frontal Lobe 6. HYPOTHALAMUS
- Largest Lobe FUNCTIONS
- Major Function concentration - Productions of hormones
abstract thought information - Regulation of body temperature
storage and memory function. - Regulation of food and fluid
- Contains Broca’s Area (Motor intake
Control of speech.) - Integration of the functioning to
- Generates the impulses that the autonomic nervous system.
bring about voluntary
movement. 7. THALAMUS
Parietal Lobes - Functions are primarily
- sensory functions concerned with sensation
- Touch. Taste, temperature - Capable of suppressing minor
- This sensation is felt. sensations.
Temporal lobe
● Located on the side of the head
(temporal means “near the
temples”), and is associated
with hearing, memory, emotion,
and some aspects of
understanding Language and
music.
● Hearing and olfaction
Occipital lobe
● Located at the very back of the
brain, and contains the primary
visual cortex, which is
responsible for interpreting
incoming visual information.
2. CEREBELLUM
- Controls movement, balance
and position or
preprioconception.
AUTOIMMUNE DISORDERS OF ❖ CHARCOTTS TRIAD
THE NERVOUS SYSTEM *Scanning speech
- Pababain *Intentional Tremors
- Anti inflammatory *Nystagmus
- atelectasis do breath deep
breathing ❖ VISUAL DISTURBANCES
Optic nerve lesions or their
1. MULTIPLE SCLEROSIS
connection:
● Immune-mediated, progressive,
❑Blurring of vision
DEMYELINATING disease of the
❑Diplopia (double vision)
CNS resulting to impaired
❑Scotoma (patchy blindness)
transmission of nerve impulses
❑Total blindness
● *demyelination – destruction of
the myelin sheath’
❖ SENSORY NERVE
● Affects WOMEN than MEN
DISTURBANCES
● Degenerative disease
-Paresthesia
● Remission and exacerbation
- Proprioception Loss
- Pain
PATHOPHYSIOLOGY
❖ COGNITIVE DISTURBANCES
-Memory Loss
-Decreased Concentration
-Dementia
-Poor Abstract Reasoning
❖ CEREBELLUM / BASAL
INVOLVEMENT
-Ataxia
-Tremors
-Weakness of muscle in throat and
face
❖ OTHERS
-Bowel and Bladder dysfunction
- Impotence
-Muscle Hypertonically
CAUSES:
- Unknown
Spasticity (muscle hypertonicity)
- Post Viral Infection
❑Involvement of motor pathways
CLINICAL MANIFESTATION
Frontal and Parietal lobe
● Relapsing-Remitting Course
involvement
- S/sx depends on the location of
❑Cognitive and psychosocial
lesion (plaque)
involvement
PRIMARY symptoms:
DIAGNOSTIC FINDINGS
❑Fatigue
❑MRI
❑Depression
- Multiple plaques in CNS
❑Weakness
❑CSF electrophoresis
❑Numbness difficulty in coordination
- Presence of oligoclonal bonding
❑Ataxia (cerebellar and basal ganglia
(bands of IgG)
involvement)
❑Pain (lesion on sensory pathways)
MEDICAL MANAGEMENT
❑IV methylprednisolone 2. MYASTHENIA GRAVIS
❑Key agent for acute relapse ❑Autoimmune disease affecting the
❑Anti-inflammatory effect MYONEURAL junction that causes
❑Mitoxantrone (Novantrone) weakness of voluntary muscles
❑Check for cardiac toxicity ❑Women are more affected than men
● Myasthenia gravis (MG) is a
Symptom Mng: chronic autoimmune
❑Baclofen (Lioresal) – GABA agonist neuromuscular disease
characterized by varying
Medication of choice for SPASTICITY degrees of weakness of the
❑Amantadine (symmetrel) skeletal muscles of the body.
- Treatment of fatigue ● Purely motor disorder (no effect
❑Beta-blockers, antiseizure agents, on sensation and coordination)
benzodiazepines Cause: unknown but abnormal
- Ataxia thymus gland
❑UTI Pathophysiology: Destruction of
- Vitamin C (increases the acidity acetylcholine receptors at
of urine) neuromuscular junction.
NURSING MANAGEMENT
❑Promote physical mobility
- Walking (improves gait and
loss of position sense)
- Daily exercise
❑Minimize spasticity
- Warm packs
- NOT Hot baths (avoided:
risk of burn injury secondary
to sensory loss)
❑Minimize effects of immobility
- Coughing and deep
breathing exercises
❑Prevent injury
- Walking with feet apart
(widens the base)
❑Enhance bowel and bladder
function
- Encouraged scheduled
toileting rounds MANIFESTATION!!
❑Enhance communication and Muscle weakness
manage swallowing difficulties Double vision (diplopia)
- Suctioning weak eyelids (unilateral ptosis)
- Careful feeding Difficulty speaking or smiling
- Proper position for eating Difficulty chewing and swallowing
❑Vision problems (Diplopia) DIAGNOSTIC FINDING
- Patch one eye ❑Acetylcholinesterase inhibitor test
❑ Swimming and stationary ❑a.k.a TENSILON TEST
Bicycling are useful in treating muscle - Tensilon test- in Myasthenia
spasticity. gravis reveal improved muscle
❑ Strenuous exercise should be contractility after edrophonium
avoided because it may exacerbate chloride (tensilon)
symptoms ❑Stops acetylcholine breakdown
❑Bowel and bladder program making it available for binding in
❑ Instruct patient to avoid cuts and myoneural junction
burns
❑Respiratory distress precaution
Edrophonium Chloride (Tensilon) PLASMAPHERESIS (plasma
❑Fast acting anticholinesterase is exchange)
administered IV ❑Patient’s plasma and plasma
❑30 secs after injection: components are removed through a
❑Resolution of symptoms (facial centrally-placed large-bore
muscle weakness and ptosis) after 5 double-lumen catheter
mins CONFIRMS the diagnosis.
❑*ATROPINE (anticholinergic)
antidote for side effects ❑Blood cells and antibody is
Assessment of Labs/Diagnostics separated then plasma substitute are
- Arterial Blood Gas & Pulmonary reinfused
function tests For respiratory ❑Produces TEMPORARY reduction in
compromise circulating antibodies
- Electromyography (EMG)
Decreased amplitude when THYMECTOMY
motor neurons are stimulated ❑Antigen-specific
- Confirming diagnosis immunosuppression
- IV administration of edrophonium
NURSING MANAGEMENT
chloride (Tensilon)
❑Teaching strategies to conserve
- Allows acetylcholine to bind with
energy
its receptors and temporarily
❑Minimize risk of aspiration
improves symptoms
- Weakness returns after effects of ❑Mealtime coincides the PEAK effect
Tensilon are discontinued of medication
❑Rest before meals
MEDICAL MANAGEMENT ❑Sit upright when eating
❑Anticholinesterase medications ❑Soft diet
❑Pyridostigmine Bromide (first line of ❑Eye problems
therapy) ❑Tape the eyes
❑Increases acetylcholine availability ❑Artificial tears
❑Gradually adjusted - Maintain effective breathing
❑Myasthenic crisis (Underdosage) pattern and airway clearance
❑Cholinergic crisis (Overdosage) Assess for respiratory distress
Differentiate: - Monitor meals and teach client
❑Tensilon test to bend head slightly forward
❑Relief of symptom: MYASTHENIC while eating and drinking to
CRISIS improve swallowing
❑Pyridostigmine bromide - Teach client to avoid exposure to
(Neostigmine) infections
❑Exacerbation of symptom: - Teach client to effectively
CHOLINERGIC CRISIS coughing, use chest
❑Atropine (anticholinergic) physiotherapy and incentive
spirometry
- Provide adequate nutrition
IMMUNOSUPPRESSIVE THERAPY Schedule meds minutes before
❑Corticosteroid eating for peak muscle strength
❑Suppresses immune response - Offer food frequently in small
❑Decreasing amount of antibodies amounts that are easy to chew
❑IV immunoglobulin (IVIG) and swallow (soft or semisolid)
❑Azathioprine - Promote improved physical
❑Inhibits T lymphocytes and reduces mobility with referrals to
antibody level physical therapy and/or
❑Procaine is avoided occupational therapy
❑Dentist is informed of diagnosis - Provide eye care: instill artificial
tears; use a patch over one eye
for double vision; wear
sunglasses to protect eyes from - Common Illness: Viral infection
bright lights Cytomegalovirus