Brain has widespread degeneration and protein deposits
Meningitis
Meningitis is acute inflammation of the meninges
Infection may be introduced through body infection or outside
agent entering skull
Drowsiness, confusion, irritability, problems with concentration,
memory defects, and sensory impairments are symptoms
Neurosyphilis
Neurosyphilis is deterioration of brain tissue due
to syphilis
Degenerative disorder called general paresis linked
to syphilis in late 19th century
Incidence of syphilis has dramatically decreased
AIDS Dementia
AIDS dementia seen in 15% of those diagnosed with AIDS
Appears in late stages of AIDS
Early symptoms often go unnoticed or mistaken for other problems
First signs are cognitive changes such as forgetfulness; later
confusions, disorientation, and poor coordination
AIDS dementia often caused by other infectious agents
Damage to brain is often diffused
Groups at Risk for Cerebral Infections
Common illnesses may be related to encephalitis
People at risk for herpes infection also at risk for encephalitis
Organisms that cause cerebral infections are transmitted through
insect and rodent bites
People living in different locations are at risk for different
types of cerebral infections
Treatment of Cerebral Infections
Treatment depends on type of infection
Bacterial and fungal infections are treatable
Viral infections are more challenging to treat
Some argue that HIV infection may be reversible in early stages;
secondary infections that may lead to AIDS dementia may be eliminated
Family support and memory aids are important
Traumatic Brain Trauma
Brain trauma is injury to brain due to jarring, bruising, or cutting
Traumatic head injury is leading cause of disability and death
in children and young adults
Most victims show long-term disabilities
Concussion
A concussion results from blow to head that momentarily
disrupts brain function
Temporary loss of consciousness and subsequent amnesia prior
to injury is usual result
The longer unconsciousness lasts, the more severe the symptoms
and less likely person will recover completely
Aftereffects may be experienced months or years later
Contusion
A contusion is injury that occurs when brain is bruised
Person lapses into coma for hours or even days
Victim may experience traumatic delirium, which disappears
within a week
More severe injury leads to permanent instability and intellectual
impairment
Repeated head injuries can result in cumulative damage
Boxers may be susceptible to ementia pugilistica and other
structural changes in brain
Laceration
In a laceration, an object ruptures and destroys brain tissue
Most serious form of brain trauma
Damage may result in death, extreme disability, or minor disability,
but depends on site of damage
Typically results in physical impairment or personality change
Groups at Risk
Two-thirds of victims are males in highest risk age group,
15- to 24-year-olds
Falls are second most common cause of head injury
Most common cause is automobile and motorcycle accidents
Treatment of Brain Trauma
Many head injuries are devastating
Rehabilitation can range from intensive inpatient treatment
to periodic outpatient treatment
Cerebrovascular Accidents (CVA): Strokes
Cerebrovascular accidents are known as strokes and
involve blockage or breaking of blood vessel in brain, damaging tissue
Third leading cause of death
Marked by stroke syndrome, which is acute onset of specific disabilities
involving the CNS
Many people have small CVAs that occur in less critical areas
of brain; less noticeable effects on behavior occur
Infarction occurs when supply of blood to brain is
cut off leading to death of brain tissue
An embolism is a ball of fat, air, or clot that
breaks off from side of vessel and clogs vessel too narrow
to let it pass
Thrombosis involves fatty material that gradually
builds up and blocks flow of blood in vessel
Hemorrhage occurs when blood vessel in brain ruptures
causing blood to spill out into brain tissue
Often caused by hypertension
In brain, hemorrhage is usually due to aneurysms
The Effects of a Stroke
Aftereffects depend on nature of stroke, extent of damage,
and location of damage
Typical effects are aphasia, agnosia, apraxia, and paralysis
Most common stroke is due to infarction due to thrombosis
in left-middle cerebral artery causing aphasia and impairment
on right side of body
Emotional disturbances usually accompany CVAs either as part
of injury or reaction to impairment
In some patients, behavioral symptoms may disappear while
others are remedied through rehabilitation
In general, the younger the person and the smaller the damaged
area, the better the chance of recovery
Groups at Risk
Clearest risk factor for CVA is age
Men are more vulnerable than women
Other high-risk groups include those with diabetes, family
history, African-Americans
High cholesterol, obesity, smoking, and hypertension increase
risk
Treatment of Stroke
People often ignore first signs of stroke
Important to seek treatment at first sign of symptoms
Medications can limit effects of stroke if given in a timely
manner
Brain Tumors (neoplasms)
Brain tumors classified in two ways
Metastic brain tumors originate in different part of
body and spread (metatasize) to brain
Primary brain tumors originate in brain; may be intracerebral
and extracerebral
First signs of brain tumor are subtle and insidious
Progressive destruction, patient develops at least one of several
symptoms
Symptoms related to location of tumor in brain; as tumor grows,
adjacent areas of brain and their functions are affected
Groups at Risk
Not much is known about risk factors
Some cancers metastasize to brain
Smoking increases risk for lung cancer
Treatment of Brain Tumors
Some tumors are surgically removed
Radiation treatment may be used if surgery would destroy language
and major motor areas
Surgery, chemotherapy, and radiation are used in combination
Degenerative Disorders
Degenerative disorders consist of syndromes characterized
by general deterioration of intellectual, emotional, and motor functioning
due to progressive pathological change in brain
Symptoms vary depending on site of damage
Aging and Dementia
Dementia is severe mental deterioration and was believed to
be a natural part of aging
Dementia is result of degenerative brain disorders
Almost all old people show some psychological changes due
to normal aging
Dementias are pathological and result of organic deterioration
of brain
Diagnosis of syndromes is difficult
Many other problems mimic symptoms of dementia
Alzheimer's disease difficult to distinguish from other
dementias
There is considerable overlap of symptoms
Symptoms often related to person's premorbid personality
and psychosocial history
Alzheimer's Disease
Alzheimer's disease is most common form of dementia
Autopsies reveal neurofibrillary tangles and senile plaques
Primary symptoms are cognitive deficits, especially loss of
memory
Early signs include irritability and failure of concentration
and memory
Symptoms create difficulties for families of Alzheimer's patients
Rate of progression is highly variable
Research suggests a genetic role and may involve several genetic
abnormalities
May be related to Down syndrome and chromosome 21
Production of amyloid may be controlled by genes on chromosome
21
Other chromosomes may be implicated as well
Buildup of beta amyloid may be caused by breakdown of
several regulatory mechanisms each controlled by a different
gene
Research suggests that Alzheimer's may have multiple contributing
factors
Lewy Body Disease
Lewy body disease may be second most common degenerative
brain disease
Rounded structures in neurons throughout brain are found
Clinicians must rely on analysis of patient's symptoms for
diagnosis
Symptoms of Lewy body disease are similar to those of Alzheimer's
disease
Fluctuations in day-to-day functioning seen in Lewy body disease
Most cases involve memory impairment followed by symptoms
of Parkinson's disease
Vascular Dementia
Vascular dementia is cumulative effect of several CVAs
Common symptoms include blackouts, heart problems, kidney
failure; psychological symptoms include language and memory defects,
emotional lability, and depression
Huntington's Chorea
Huntington's chorea is genetically transmitted
The basal ganglia is damaged; area is responsible for posture,
muscle tonus, and motor coordination
Early signs include vague behavioral and emotional changes
Involuntary, spasmodic jerking of limbs characterize disorder
Increasingly bizarre behavior is seen in patients
Parkinson's Disease
Parkinson's disease involves damage to basal ganglia,
especially substantia nigra
Cause is unknown, but may be related to heredity, viruses,
toxins, head trauma
Primary symptom is tremors that are present during rest, but
diminish or cease when person is sleeping
Another symptom is an expressionless, masklike countenance
Patients walk in a distinctive slow, stiff gait
Many patients also experience psychological disturbances such
as memory, learning, judgment and concentration problems, and
dementia
Groups at Risk
Since women live longer, more women will experience dementia
Percentage of men who will develop dementia is same
Age and gender related to type dementia an individual is likely
to develop
Educational level may affect incidence or rate of diagnosis
of Alzheimer's disease
Some stroke patients developed vascular dementia with high
blood pressure, a risk factor
A test now exists to identify defective gene that causes Huntington's
chorea
Treatment of Degenerative Disorders
Drugs that increase levels of acetylcholine have been used
to treat Alzheimer's disease
There is no cure and little treatment for Alzheimer's disease
Behavioral therapy may suppress some symptoms
Most common treatment is custodial care
Many patients are able to remain at home with their
families, especially if family can receive support services
High blood pressure, diabetes, obesity, and smoking are risk
factors for vascular dementia; after damage, decline is irreversible
Drugs that increase amount of dopamine among Parkinson's disease
patients can control tremor but do not cure it
Nutritional (and vitamin) Deficiencies
Insufficient intake of essential vitamins can result in neurological
damage and psychological disturbances
Beriberi and pellagra are two common syndromes in less industrial
countries
Korsakoff's Syndrome--a psychosis related to alcoholism
Primary pathological is deficiency of B12 or thiamine
There are two classic behavioral signs of Korsakoff's psychosis
Anterograde amnesia is inability to incorporate new memories
Confabulation is tendency to fill in memory gaps with
invented stories
Suggests a psychotic impairment of judgment and spreads to
other aspects of psychological impairment
Endocrine Disorders
Endocrine glands produce hormones that affect bodily mechanisms
Thyroid Syndromes
Hyperthyroidism involves excessive secretion of thyroxin,
which leads to physical and psychological difficulties
Hypothyroidism involves deficient secretion of thyroxin, which
leads to physical and psychological difficulties
Adrenal Syndromes
Addison's disease refers to chronic underactivity of adrenal
glands, which leads to physical and psychological changes
Cushing's syndrome refers to adrenal cortex overactivty leading
to physical and psychological changes
Toxic Disorders
Lead
Excessive ingestion of lead causes lead encephalopathy,
leading to extreme pressure in the brain
Most common victims are children and may be related to mental
retardation
There are a number of sources of lead contamination
Other Heavy-Mental Toxins
Victims of toxins typically have jobs where they come into
contact with mercury and manganese
Other victims come into contact in other ways such as food
or air contamination--for example, fish from water polluted by
mercury wastes
Mercury poisoning causes memory loss, irritability, and difficulty
in concentration
Later, it causes tunnel vision, motor problems, coma, and
death
Psychoactive Drugs
Alcohol, opiates, and amphetamines can cause severe psychological
disturbances
Inhalation of aerosol gases and glues has become more popular
way to get high
Carbon Monoxide
Carbon monoxide combines with hemoglobin to prevent blood
from absorbing oxygen
Often results in death; those who survive have a number of
psychological consequences such as apathy, confusion, and memory
defects
The Epilepsies
Epilepsy is broad term for disorders that have spontaneous seizure
caused by disruption of electrical and physiological activity of brain
cells
Abnormal activity disrupts functions controlled by affected part
of brain
Causes of Epilepsy
Any condition that interferes with brain function can cause epilepsy
Most common cause is brain injury
If epilepsy beings in middle age, most likely cause is brain
tumor
If epilepsy begins in older age, cause is most likely to be
cerebral vascular disease such as stroke or cerebral arteriosclerosis
When a cause can be identified, it is known as symptomatic
epilepsy
When cause is unknown, it is idiopathic epilepsy
Types of Seizure
Partial seizures originate in one part of brain
In simple partial seizure, cognitive functioning remains
intact; person may have sensory changes or minor psychological
changes
In complex partial seizure, cognitive functioning is
interrupted; an aura may precede seizure; person is not able to
engage in purposeful activity and does not respond normally
Generalized seizure involves entire brain at outset or
soon spreads from one part
Absence seizures involve spaced-out look and sense
of being absent from the surroundings
Tonic-clonic seizures begin with a tonic or rigid extension
of limbs followed by clinic or jerking movements through body
Each type of seizure requires different kind of drug; therefore,
accurate diagnosis is important
Psychological Factors in Epilepsy
Most common complaint is poor memory, since most epilepsies involve
temporal lobes
Once thought there was an epileptic personality, but no data support
that view
Treatment of Epilepsy
Most people take antiepileptic drugs, which suppress seizures
in 80% of patients
Some report side effects of being drugged down
Surgery involves removal of focal epileptic area and is becoming
more common
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