Lekcja 7: Kliniczne aspekty chorób układu nerwowego 2 | Clinical Aspects of Nervous System Diseases 2

Lekcja 7: Kliniczne aspekty chorób układu nerwowego 2 | Clinical Aspects of Nervous System Diseases 2

3. Infectious Diseases of the Nervous System

A. Meningitis

Overview: Meningitis is an infection of the meninges, the protective membranes covering the brain and spinal cord. It can be caused by bacterial, viral, or fungal pathogens, each with distinct clinical presentations.

Causes:

  • Bacterial Meningitis: Often caused by Neisseria meningitidis, Streptococcus pneumoniae, or Haemophilus influenzae. It is the most severe form and requires prompt treatment.
  • Viral Meningitis: Usually less severe, commonly caused by enteroviruses. It often resolves without specific treatment.
  • Fungal Meningitis: Rare and typically affects immunocompromised individuals, caused by fungi like Cryptococcus neoformans.

Risk Factors:

  • Bacterial Meningitis: Age (infants and elderly), close living quarters (e.g., dormitories), weakened immune system, recent respiratory infection.
  • Viral Meningitis: Young age, weakened immune system, recent viral infection.
  • Fungal Meningitis: Immunocompromised states (e.g., HIV/AIDS, cancer treatment).

Symptoms:

  1. Sudden Onset of Fever:
    • Fever associated with meningitis is often high and sudden. In bacterial meningitis, fever can rise quickly and may be accompanied by chills and profuse sweating. The fever is often persistent and can be resistant to typical antipyretic medications.
  2. Severe Headache:
    • The headache is intense and may be described as the worst headache ever experienced. It is often diffuse but can be localized. The pain is usually severe and unrelenting, exacerbated by movement or bright light, and not relieved by usual headache treatments.
  3. Stiff Neck:
    • Patients experience significant neck stiffness, which can make it painful and difficult to move the neck. This symptom results from the inflammation of the meninges and surrounding structures. The inability to touch the chin to the chest is a common manifestation.
  4. Nausea and Vomiting:
    • Nausea is often severe and persistent, not necessarily related to food intake. Vomiting can occur frequently and is often accompanied by a feeling of discomfort and malaise, stemming from increased intracranial pressure.
  5. Sensitivity to Light (Photophobia):
    • Sensitivity to light causes discomfort or pain in the eyes when exposed to light. This may result in avoidance of bright environments, squinting, or covering the eyes to reduce light exposure.
  6. Confusion or Altered Mental Status:
    • Patients may exhibit confusion, agitation, or drowsiness. This can range from mild disorientation to severe mental status changes, including delirium or coma, affecting the ability to recognize familiar people or respond to stimuli.

Additional Symptoms:

  • Rash: In cases of bacterial meningitis caused by Neisseria meningitidis, a petechial or purpuric rash may develop. This rash is often non-blanching and can spread rapidly.
  • Seizures: Seizures, either generalized tonic-clonic or focal, may occur due to irritation of the cerebral cortex. This is more common in severe cases.
  • Cold Hands and Feet: Indicates poor peripheral circulation, especially in severe or advanced cases of bacterial meningitis.

Diagnosis:

  • Lumbar Puncture (Spinal Tap): To analyze cerebrospinal fluid (CSF) for infection markers.
  • Blood Cultures: To identify the causative pathogen.
  • Imaging (CT, MRI): To assess for complications.

Treatment:

  • Bacterial Meningitis: Immediate antibiotics (e.g., ceftriaxone, vancomycin) and corticosteroids.
  • Viral Meningitis: Supportive care including hydration and pain management; antivirals if indicated.
  • Fungal Meningitis: Antifungal medications (e.g., fluconazole) for immunocompromised patients.

Prognosis:

  • Bacterial Meningitis: Can be severe with outcomes ranging from full recovery to long-term complications or death. Prompt treatment improves prognosis.
  • Viral Meningitis: Generally good; most recover fully with supportive care.
  • Fungal Meningitis: Requires prolonged treatment; prognosis depends on the underlying condition and response to treatment.

B. Encephalitis

Overview: Encephalitis is inflammation of the brain tissue, usually caused by viral infections. It can also result from bacterial infections or autoimmune reactions.

Causes:

  • Viral Causes: Commonly caused by Herpes Simplex Virus (HSV) or West Nile Virus. Other viruses such as mumps, measles, or varicella-zoster can also cause encephalitis.
  • Bacterial Causes: Rarely, bacterial infections such as Mycobacterium tuberculosis can lead to encephalitis.
  • Autoimmune Reactions: Conditions like anti-NMDA receptor encephalitis, where the immune system attacks brain tissue.

Risk Factors:

  • Viral Encephalitis: Recent viral infections, age (young and elderly), immunocompromised status.
  • Bacterial Encephalitis: Recent bacterial infections or history of tuberculosis.
  • Autoimmune Encephalitis: Autoimmune diseases, certain cancers.

Symptoms:

  1. Fever:
    • A high, persistent fever is common. It often occurs suddenly and can be accompanied by chills. The fever reflects systemic infection and may be associated with other symptoms like fatigue and malaise.
  2. Headache:
    • The headache is usually severe and persistent. It can be localized or diffuse and is often accompanied by neck stiffness and photophobia.
  3. Confusion and Disorientation:
    • Patients may experience significant cognitive impairment, ranging from mild confusion to severe disorientation. They may have difficulty recognizing familiar people, understanding their surroundings, or responding to questions.
  4. Seizures:
    • Seizures are a frequent complication of encephalitis, which can present as generalized tonic-clonic seizures or focal seizures, depending on the affected brain regions.
  5. Difficulty with Speech or Movement:
    • Speech may become slurred or incoherent, and patients might have difficulty with motor coordination. This can range from mild difficulty to significant impairments in controlling voluntary movements.

Additional Symptoms:

  • Altered Consciousness: Ranging from lethargy to coma, depending on the severity of inflammation.
  • Behavioral Changes: Patients may display unusual behavior, agitation, or personality changes.

Diagnosis:

  • Clinical Evaluation: Based on symptoms and neurological examination.
  • Brain Imaging (MRI): Identifies inflammation and abnormalities.
  • CSF Analysis: Lumbar puncture to assess for infection markers and possibly viral DNA/RNA.
  • Serological Testing: Identifies specific viral or bacterial pathogens.

Treatment:

  • Antiviral Medications: For viral causes (e.g., acyclovir for HSV).
  • Antibiotics: If a bacterial cause is identified.
  • Corticosteroids: To reduce inflammation.
  • Supportive Care: For symptom management.

Prognosis:

  • Viral Encephalitis: Variable; some recover fully while others may have lasting neurological deficits.
  • Bacterial Encephalitis: Depends on promptness of treatment; can lead to significant complications if not treated early.
  • Autoimmune Encephalitis: Prognosis varies; treatment of the underlying autoimmune condition can improve outcomes.

4. Traumatic Nervous System Injuries

A. Traumatic Brain Injury (TBI)

Overview: Traumatic Brain Injury (TBI) results from a blow or jolt to the head that disrupts brain function. The severity can range from mild (concussion) to severe, potentially leading to long-term disabilities.

Risk Factors:

  • Age: Young children and elderly individuals are at higher risk.
  • Substance Abuse: Increased risk of accidents.
  • Previous TBI: History of previous injuries increases risk of further damage.

Symptoms:

  1. Headache:
    • Post-traumatic headaches can be severe and persistent. They might resemble tension-type headaches or migraines and can be accompanied by nausea or dizziness.
  2. Confusion or Disorientation:
    • Patients may experience disorientation to time, place, or identity. This can include difficulty recalling recent events, confusion about surroundings, or impaired attention.
  3. Dizziness and Loss of Balance:
    • Dizziness may be accompanied by a sensation of spinning (vertigo) or unsteadiness. Patients may have trouble maintaining balance, leading to falls or difficulty walking.
  4. Nausea or Vomiting:
    • Nausea and vomiting are common, especially if the injury results in increased intracranial pressure or concussive symptoms.
  5. Loss of Consciousness:
    • Some patients may lose consciousness at the time of the injury. The duration can vary from a few seconds to several minutes or longer, depending on the severity of the trauma.
  6. Cognitive Difficulties:
    • Problems with memory, concentration, or executive functions are common. Patients might struggle with problem-solving, planning, or organizing tasks.

Additional Symptoms:

  • Sensitivity to Light or Noise: Increased sensitivity can occur, leading to discomfort in bright environments or loud sounds.
  • Sleep Disturbances: Patients may experience insomnia, excessive sleepiness, or changes in sleep patterns.

Diagnosis:

  • CT Scan or MRI: Identifies structural brain damage or hemorrhages.
  • Cognitive Tests: Assesses the extent of cognitive impairment.

Treatment:

  • Acute Care: Rest, monitoring for worsening symptoms, surgical intervention if needed.
  • Rehabilitation: Physical, occupational, and cognitive therapy.

Prognosis:

  • Mild TBI (Concussion): Often fully recover with appropriate management.
  • Severe TBI: Recovery can be lengthy and may result in long-term impairments or disability.

B. Spinal Cord Injury

Overview: Spinal cord injuries result from trauma that damages the spinal cord, leading to loss of motor function and sensation below the injury site.

Risk Factors:

  • Age: Risk increases with age.
  • Gender: Males are more likely to sustain spinal cord injuries.
  • High-Risk Activities: Participation in contact sports or high-risk occupations.

Symptoms:

  1. Loss of Movement or Sensation:
    • Patients may experience complete or partial paralysis below the level of injury. This can include loss of voluntary movement and sensory perception (touch, pain, temperature).
  2. Loss of Bowel or Bladder Control:
    • Damage to the spinal cord can affect autonomic functions, leading to incontinence or difficulty controlling bowel and bladder functions.
  3. Muscle Weakness:
    • Weakness in the limbs, trunk, or other areas of the body depending on the injury level. This weakness can range from mild to severe and may affect daily activities.
  4. Breathing Difficulties:
    • Injuries at higher levels (e.g., cervical spine) may impact respiratory muscles, leading to difficulties in breathing or the need for mechanical ventilation.

Additional Symptoms:

  • Spasticity: Increased muscle tone or spasms below the injury site, affecting movement and coordination.
  • Autonomic Dysreflexia: In injuries above the T6 level, a potentially life-threatening condition characterized by sudden high blood pressure, sweating, and headache.

Diagnosis:

  • Imaging Tests (MRI or CT Scan): Visualizes spinal cord damage and associated fractures or dislocations.

Treatment:

  • Acute Care: Stabilization, surgical intervention to prevent further damage.
  • Rehabilitation: Physical therapy, occupational therapy, and support for daily living activities.

Prognosis:

  • Incomplete Injuries: Potential for partial recovery; some regain function.
  • Complete Injuries: Generally stable level of impairment; rehabilitation focuses on maximizing independence.

5. Demyelinating Diseases

A. Multiple Sclerosis (MS)

Overview: Multiple Sclerosis (MS) is an autoimmune disease where the immune system attacks the myelin sheath surrounding nerve fibers in the central nervous system (CNS), leading to impaired nerve impulse transmission.

Risk Factors:

  • Age: Most commonly diagnosed between 20 and 40 years old.
  • Gender: More common in females.
  • Geographic Location: Higher prevalence in temperate regions.
  • Family History: Increased risk if a close family member has MS.

Symptoms:

  1. Fatigue:
    • Fatigue in MS is often profound and debilitating, not necessarily related to physical activity. It can impact daily functioning and quality of life.
  2. Numbness or Tingling in the Limbs:
    • Sensory disturbances, such as numbness, tingling, or a “pins and needles” sensation, often affect the arms, legs, or face.
  3. Difficulty with Coordination and Balance:
    • Patients may experience unsteady gait, difficulty with fine motor skills, or problems with balance, increasing the risk of falls.
  4. Vision Problems:
    • Visual disturbances such as blurred vision, double vision, or partial loss of vision can occur due to optic neuritis, inflammation of the optic nerve.
  5. Muscle Weakness:
    • Muscle weakness can be focal or diffuse, affecting the arms, legs, or other parts of the body. It may lead to difficulty with tasks requiring strength.
  6. Cognitive Changes:
    • Cognitive impairment can include difficulties with memory, concentration, and problem-solving. This can affect work and daily activities.

Additional Symptoms:

  • Bladder and Bowel Dysfunction: Problems such as frequent urination, urgency, or incontinence.
  • Sexual Dysfunction: Difficulty with sexual arousal or function due to autonomic nervous system involvement.

Diagnosis:

  • MRI: Identifies demyelinating lesions in the brain and spinal cord.
  • Lumbar Puncture: Analyzes cerebrospinal fluid for oligoclonal bands and other MS markers.

Treatment:

  • Disease-Modifying Therapies: Medications to reduce disease activity (e.g., interferons, glatiramer acetate).
  • Symptom Management: Medications and therapies for specific symptoms.
  • Rehabilitation: Physical therapy and occupational therapy to improve function and quality of life.

Prognosis:

  • Variable: Disease progression and disability vary among individuals; early treatment can improve long-term outcomes.

B. Guillain-Barré Syndrome (GBS)

Overview: Guillain-Barré Syndrome (GBS) is an acute, autoimmune polyneuropathy that often follows an infection. It involves rapid-onset muscle weakness due to peripheral nerve damage.

Risk Factors:

  • Recent Infection: Especially gastrointestinal or respiratory infections.
  • Age: Can occur at any age but slightly higher incidence in adults.

Symptoms:

  1. Progressive Muscle Weakness:
    • Weakness typically starts in the legs and ascends to the upper body and arms. It can rapidly progress, potentially leading to paralysis.
  2. Numbness or Tingling:
    • Sensory abnormalities such as numbness, tingling, or a “pins and needles” sensation often precede or accompany muscle weakness.
  3. Difficulty Breathing:
    • In severe cases, muscle weakness can affect the respiratory muscles, leading to respiratory distress and the need for ventilatory support.
  4. Autonomic Dysfunction:
    • Symptoms such as irregular heart rate, blood pressure fluctuations, and sweating abnormalities can occur due to autonomic nerve involvement.

Additional Symptoms:

  • Pain: Often described as aching or cramping, particularly in the lower back or legs.
  • Facial Weakness: May affect facial muscles, leading to difficulty with facial expressions or swallowing.

Diagnosis:

  • Nerve Conduction Studies: Evaluates nerve function and identifies demyelination or axonal damage.
  • Lumbar Puncture: Assesses cerebrospinal fluid for elevated protein levels without increased white blood cells.

Treatment:

  • Intravenous Immunoglobulin (IVIG) or Plasmapheresis: Reduces immune system activity.
  • Supportive Care: Monitoring and managing respiratory function, rehabilitation.

Prognosis:

  • Variable: Many individuals experience significant recovery, though some may have residual weakness or long-term effects. Early treatment improves outcome