Nervous System Disorders

Nervous System Disorders

Introduction

·        The nervous system is a complex network responsible for controlling and coordinating body activities. It consists of the Central Nervous System (CNS)—brain and spinal cord, and the Peripheral Nervous System (PNS)—cranial nerves, spinal nerves, and peripheral nerves.

·        Disorders of the nervous system may affect motor functions, sensory perception, cognition, memory, or autonomic functions.

·        They may arise due to genetic defects, congenital anomalies, infections, trauma, ischemia, degenerative changes, toxins, or autoimmune responses.

·        Nervous system disorders can be acute, chronic, progressive, or reversible depending on the cause.

Neuropathy

• Definition: Damage or dysfunction of peripheral nerves causing weakness, numbness, or pain.
• Types:
• Peripheral neuropathy – affects hands/feet.
• Autonomic neuropathy – affects involuntary functions (BP, digestion).
• Focal neuropathy – affects specific nerves.
• Causes: Diabetes (most common), alcoholism, vitamin deficiencies, toxins, autoimmune diseases, infections, trauma.
• Symptoms: Tingling, burning, numbness, muscle weakness, loss of coordination, autonomic dysfunction (e.g., hypotension, gastroparesis).
• Diagnosis: Nerve conduction studies, EMG, blood tests, nerve biopsy.
• Treatment: Control underlying cause (e.g., diabetes), physiotherapy, neuropathic pain medications (gabapentin, duloxetine), vitamin supplements.

Hydrocephalus

• Definition: Abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain leading to raised intracranial pressure (ICP).
• Types:
• Communicating hydrocephalus – impaired CSF absorption.
• Non-communicating (obstructive) – blockage in ventricular pathways.
• Normal-pressure hydrocephalus (NPH) – occurs in elderly, triad of gait disturbance, dementia, urinary incontinence.
• Causes: Congenital malformations, tumors, meningitis, hemorrhage, trauma.
• Symptoms:
• Infants – enlarged head, bulging fontanelle, irritability, developmental delay.
• Adults – headache, nausea, papilledema, gait disturbance, memory loss.
• Diagnosis: CT/MRI brain, CSF pressure measurement.
• Treatment: Surgical CSF diversion (ventriculo-peritoneal shunt, endoscopic third ventriculostomy), treat cause.

Intracranial Haemorrhage

• Definition: Bleeding inside the brain or skull.
• Types:
• Epidural hematoma – arterial bleed between dura and skull.
• Subdural hematoma – venous bleed between dura and arachnoid.
• Subarachnoid hemorrhage (SAH) – bleeding into CSF space.
• Intracerebral hemorrhage (ICH) – bleeding within brain tissue.
• Causes: Head trauma, hypertension, aneurysm rupture, anticoagulants, arteriovenous malformations.
• Symptoms: Sudden severe headache, vomiting, altered consciousness, focal neurological deficits.
• Diagnosis: CT scan (gold standard), MRI, angiography.
• Treatment: Emergency stabilization, surgical evacuation, BP control, reversal of anticoagulation, neurocritical care.

Seizures & Epilepsy

• Definition:
• Seizure: Sudden, abnormal, excessive electrical activity in brain.
• Epilepsy: Recurrent unprovoked seizures.
• Types of seizures:
• Generalized (tonic-clonic, absence, myoclonic).
• Focal (partial) seizures – simple or complex.
• Causes: Genetic, trauma, infections (meningitis, encephalitis), metabolic (hypoglycemia, hypocalcemia), tumors, idiopathic.
• Symptoms: Convulsions, loss of consciousness, aura, automatisms, confusion postictally.
• Diagnosis: EEG, MRI/CT brain, metabolic workup.
• Treatment: Antiepileptic drugs (phenytoin, valproate, levetiracetam), ketogenic diet, vagus nerve stimulation, surgery for refractory cases.

Cerebrovascular Disease (CVD)

• Definition: Group of brain disorders caused by abnormality of blood vessels supplying the brain.
• Includes: Ischemic stroke, hemorrhagic stroke, transient ischemic attack (TIA).
• Risk Factors: Hypertension, diabetes, smoking, hyperlipidemia, atrial fibrillation, age.
• Symptoms: Sudden weakness/paralysis, facial droop, speech disturbance, vision loss, dizziness.
• Diagnosis: CT/MRI brain, carotid Doppler, angiography.
• Treatment:
• Ischemic stroke – thrombolysis (tPA), thrombectomy.
• Hemorrhagic stroke – surgery, BP control.
• Long-term – antiplatelets, anticoagulants, statins, lifestyle changes.

Spina Bifida

• Definition: Congenital neural tube defect where spinal cord and vertebrae do not develop properly.
• Types:
• Spina bifida occulta – mild, hidden defect.
• Meningocele – meninges protrude.
• Myelomeningocele – spinal cord + meninges protrude (most severe).
• Causes: Folate deficiency in pregnancy, genetic predisposition.
• Symptoms: Visible spinal defect, weakness, paralysis, bladder/bowel dysfunction, hydrocephalus (associated).
• Diagnosis: Prenatal ultrasound, maternal alpha-fetoprotein screening, postnatal exam.
• Treatment: Surgical correction, physiotherapy, management of complications, folic acid supplementation for prevention.

Headache

• Types:
• Tension headache – dull, band-like pressure.
• Migraine – unilateral throbbing, nausea, photophobia, aura.
• Cluster headache – severe unilateral pain around eye, lacrimation, nasal congestion.
• Secondary headache – due to trauma, tumor, infection, sinusitis.
• Causes: Vascular, neurological, psychological, secondary causes.
• Diagnosis: Clinical, neuroimaging if red flags.
• Treatment:
• Tension – stress reduction, analgesics.
• Migraine – NSAIDs, triptans, prophylaxis (beta-blockers, topiramate).
• Cluster – oxygen therapy, triptans, verapamil prophylaxis.

Meningitis

• Definition: Inflammation of meninges due to infection.
• Types: Bacterial (most severe), viral, fungal, tubercular.
• Symptoms: Fever, headache, neck stiffness, photophobia, altered sensorium, seizures.
• Signs: Kernig’s sign, Brudzinski’s sign.
• Diagnosis: CSF analysis (lumbar puncture), CT/MRI.
• Treatment: Immediate antibiotics (ceftriaxone, vancomycin), antivirals, steroids, supportive care.

Encephalitis

• Definition: Inflammation of brain tissue, usually viral.
• Causes: HSV, arboviruses, Japanese encephalitis, autoimmune.
• Symptoms: Fever, headache, seizures, altered consciousness, focal deficits.
• Diagnosis: CSF PCR, MRI brain, EEG.
• Treatment: Antivirals (acyclovir for HSV), supportive care, anti-seizure drugs.

Myasthenia Gravis

• Definition: Autoimmune neuromuscular disorder with antibodies against acetylcholine receptors at neuromuscular junction.
• Symptoms: Muscle weakness that worsens with activity (fatigability), ptosis, diplopia, dysphagia, respiratory weakness.
• Diagnosis: Antibody tests, EMG, edrophonium test, CT chest (thymoma association).
• Treatment: Acetylcholinesterase inhibitors (pyridostigmine), immunosuppressants (steroids, azathioprine), plasmapheresis/IVIG, thymectomy.

Parkinson’s Disease

• Definition: Progressive neurodegenerative disorder due to loss of dopamine-producing neurons in substantia nigra.
• Symptoms: Resting tremor, bradykinesia, rigidity, postural instability, mask-like face, shuffling gait.
• Diagnosis: Clinical, MRI (to exclude other causes).
• Treatment: Levodopa-carbidopa, dopamine agonists, MAO-B inhibitors, physiotherapy, deep brain stimulation in advanced cases.

Bell’s Palsy

• Definition: Acute unilateral facial nerve (CN VII) paralysis.
• Causes: Idiopathic (most common), viral (HSV), cold exposure.
• Symptoms: Sudden facial weakness, drooping mouth, inability to close eye, loss of taste anterior 2/3 tongue, hyperacusis.
• Diagnosis: Clinical, exclude stroke.
• Treatment: Corticosteroids, antivirals, eye care, physiotherapy.

Stroke

• Definition: Sudden neurological deficit due to interrupted blood supply to the brain.
• Types:
• Ischemic stroke (thrombosis/embolism).
• Hemorrhagic stroke.
• Risk Factors: Same as CVD (HTN, DM, smoking, age).
• Symptoms: Hemiplegia, aphasia, facial droop, visual loss, altered consciousness.
• Diagnosis: CT/MRI brain (to differentiate ischemic vs hemorrhagic).
• Treatment: Thrombolysis (if ischemic, within window), surgery for hemorrhage, rehabilitation, secondary prevention.

Head Injuries

• Types: Concussion, contusion, skull fracture, hematomas.
• Causes: Trauma (accidents, falls, assaults).
• Symptoms: Headache, vomiting, loss of consciousness, confusion, seizures, neurological deficits.
• Diagnosis: CT brain, MRI, neurological exam.
• Treatment: Airway-breathing-circulation stabilization, surgery for hematoma, ICP control (mannitol, hyperventilation), rehabilitation.

Guillain-Barré Syndrome (GBS)

• Definition: Acute autoimmune demyelinating polyneuropathy often after infection.
• Causes: Campylobacter jejuni, CMV, EBV, influenza vaccination (rare).
• Symptoms: Ascending weakness, areflexia, paresthesias, respiratory muscle involvement, autonomic instability.
• Diagnosis: CSF (albuminocytologic dissociation: high protein, low cells), nerve conduction studies.
• Treatment: IVIG or plasmapheresis, supportive respiratory care, physiotherapy.

Dementia

• Definition: Progressive decline in memory, cognition, and daily functioning beyond normal aging.
• Types: Alzheimer’s disease (most common), vascular dementia, Lewy body dementia, frontotemporal dementia.
• Symptoms: Memory loss, disorientation, language difficulties, personality changes, impaired judgment.
• Diagnosis: Clinical, cognitive testing (MMSE), MRI/CT brain.
• Treatment: Supportive, cholinesterase inhibitors (donepezil, rivastigmine), memantine, psychosocial support.

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