Nervous System and
Related Disorders
The Nervous System: Overview
Nervous System (NS)
Central NS Peripheral NS Cranial and spinal nerves
Brain and the Sensory Division Motor Division
Spinal Chord
Receptors to CNS CNS to effector muscles
Somatic NS Autonomic NS
(Conducts impulses to (Conducts impulses to cardiac muscles,
skeletal muscles) smooth muscles, glands)
Sympathetic NS Parasympathetic NS
(Fight or Flight (Rest and Digest)
Response)
Neuron: Anatomy and Physiology
axon (transfers signals to other cells)
dendrites
(receive signal from
other neurons)
nucleus
(controls the entire axon terminal
neuron) myelin (forms junctions
sheath with other cells)
Node of Ranvier
cell body
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Cranial Nerves
Types, Functions, Abnormalities
Cranial Nerve Name Type Function Abnormal Finding
I Olfactory Sensory Sense of smell anosmia
II Optic Sensory Sight/vision blindness
III Oculomotor Motor Pupillary constriction; elevation of upper lid; Anisocoria
movement of extra ocular muscles (EOM)
IV Trochlear Motor Movement of Superior Oblique Muscle of the eye Nystagmus
(EOM)
V Trigeminal Mixed Sensory: sensation of entire face Trigeminal Neuralgia/
Motor: mastication Tic Douloureux
VI Abducens Motor Movement of Lateral Rectus Muscles of the eye Diplopia
(EOM)
VII Facial Mixed Sensory: sensation in the anterior 2/3 of the tongue Bell’s Palsy
Motor: Muscles for Facial Expression
VIII Acoustic (Vestibulocochlear) Sensory Vestibular branch : Balance/equilibrium Vertigo
Cochlear branch: permits hearing Tinnitus; hearing loss
IX Glossopharyngeal Mixed Sensory: posterior 1/3 of the tongue Loss of sense of taste at
Motor: Controls muscles of the throat the posterior 1/3
loss of gag reflex
X Vagus Mixed Stimulation of the abdominal and thoracic Increased HCl secretion;
bradycardia
organs
XI Accessory Motor Controls sternocleidomastoid and trapezius Inability to move head
and shoulders
muscles
XII Hypoglossal Motor Movement of Tongue Protrusion or deviation
of tongue to one side
Glasgow Coma Scale
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Increased Intracranial Pressure (ICP)
Manifestations, Pathophysiology, Collaborative Management
Components of the Cranium
Brain 85 %
Cerebrospinal fluid (CSF) 10 %
Blood 5%
Intracranial Pressure
(ICP)
* Monroe Kellie Hypothesis
- an increase in one component leads to compensatory
decrease in other components to maintain homeostasis
or equilibrium
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Collaborative Management:
1. Monitor ICP, VS, LOC
2. Positioning
3. Prevent Valsalva Maneuver
4. Administer meds as ordered
Laxatives
Corticosteroids
Diuretics – osmotic diuretics e.g. Mannitol (Osmitrol)
5. Avoid coughing
Parkinson’s Disease
- chronic, progressive, and degenerative disorder that involves the basal ganglia (substantia nigra)
Risk Factors:
• Viral infection
• Disequilibrium between Dopamine and Acetylcholine
• Trauma
• Carbon monoxide poisoning
S/Sx:
• Bradykinesia
• Muscle Rigidity
• Tremors – resting/pill rolling/ non intentional
• Akinesia
• Stooped posture
• Shuffling/festinating gait
• Mask-like expression of face
• Flattened affect
Collaborative Management
1. Thickened liquid diet
2. Aspiration precaution
3. Increased fiber in the diet
4. Administer meds as ordered
•anti-cholinergics
•dopaminergics
•dopamine agonists
Myasthenia Gravis
• cause is unknown but most cases are autoimmune
• destruction of Acetylcholine (Ach) receptors in the myoneural junction / neuromuscular junction
• weakness in muscles that control bodily function and movement
s/sx:
Ptosis (droopy eyelids)
Diplopia
Dysphagia
weakness in voluntary muscles
Dx Test :
Current: Blood Test - Anti-Acetylcholine receptor antibody test
Previous: Endrophonium (Tensilon) Test – short-acting drug
*muscle improvement in 30-60 sec. but effect wears off after 3-5 minutes
*rapid but transient symptomatic improvement
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Collaborative Management:
1. Administer drugs as ordered
- Anticholinesterase : inhibit Acetylcholinesterase enzyme in the myoneural junction
: Pyridostigmine (Mestinon)
: Neostigmin (Prostigmin)
: Antidote : Atropine sulfate
- Corticosteroids
- Immunosuppressant – Azathioprine (Imuran)
• Crises - Myasthenic crisis – most common cause: undermedication, drug: anticholinesterase
- Cholinergic crisis – most common cause: overmedication, drug: anticholinergics
2. Plasmapheresis: removes plasma proteins containing antibodies that destroy Ach receptors
3. Surgery - Thymectomy
Multiple Sclerosis – characterized by autoimmune destruction of the myelin sheath
s/sx:
• Charcot’s triad
Scanning speech
Intentional tremor
Nystagmus
• Tingling sensations
• Slurred speech
• Bowel problems, bladder incontinence
• Easy fatigability
Collaborative Management:
1. Administer drugs as ordered: Muscle relaxant – Baclofen (Lioresal); Coricosteroids
2. Plasmapheresis
3. Thymectomy
4. Physical therapy
