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Samenvatting Basiswetenschappen 2: Neuro-Anatomie
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Complete samenvatting van de lessen en cursus Bevat 5 delen: - Neuro-Anatomie - Neuro-Fysiologie - Neuro-Pathologie - Psychiatrie - Geriatrie
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Hogeschool GentBasiswetenschappen 2
Neuro-anatomie, -fysiologie, -pathologie, geriatrie en psychiatrie
2021-2022
,Inhoud
1 HET ZENUWSTELSEL ONTVANGT, INTEGREERT EN BEANTWOORDT INFORMATIE .......................................................... 15
1.1 DE ANATOMISCHE OPDELING VAN HET ZENUWSTELSEL ..................................................................................................... 16
1.2 HET PERIFEER ZENUWSTELSEL KUNNEN WE VERDER OPDELEN IN EEN SOMATISCH EN EEN AUTONOOM
ZENUWSTELSEL. ............................................................................................................................................................................................... 16
1.3 DE NEUROLOGISCHE REACTIE ...................................................................................................................................................... 17
2 ZENUWWEEFSEL...................................................................................................................................................................................... 18
2.1 ZENUWWEEFSEL ................................................................................................................................................................................. 18
2.2 NEURONEN ............................................................................................................................................................................................ 18
ALGEMENE BOUW VAN EEN NEURON ..................................................................................................................................................... 18
ACTIEPOTENTIALEN REIZEN LANGS HET AXON ....................................................................................................................................... 19
NEURONEN STAAN VIA SYNAPSEN MET ELKAAR IN CONTACT ................................................................................................................. 19
ER BESTAAN 3 TYPES NEURONEN, MET TELKENS EEN VERSCHILLENDE FUNCTIE .................................................................................. 20
REGENERATIE VAN NEURONEN ............................................................................................................................................................. 22
2.3 NEUROGLIA........................................................................................................................................................................................... 22
NEUROGLIA IN HET CZS ....................................................................................................................................................................... 23
NEUROGLIA IN HET PZS = CELLEN VAN SCHWANN ............................................................................................................................... 24
2.4 GRIJZE EN WITTE STOF .................................................................................................................................................................... 25
GRIJZE STOF ......................................................................................................................................................................................... 26
WITTE STOF .......................................................................................................................................................................................... 27
3 PRIKKELGELEIDING EN PRIKKELOVERDRACHT ........................................................................................................................... 28
3.1 PRIKKELGELEIDING BINNEN EEN NEURON................................................................................................................................ 28
DE CELMEMBRAAN ................................................................................................................................................................................ 29
RUSTTOESTAND .................................................................................................................................................................................... 30
DEPOLARISATIE .................................................................................................................................................................................... 30
REPOLARISATIE .................................................................................................................................................................................... 31
HYPERPOLARISATIE .............................................................................................................................................................................. 31
3.2 DE SYNAPS: DE PLAATS VOOR PRIKKELOVERDRACHT VAN NEURON NAAR EEN VOLGENDE CEL ...................... 32
BOUW VAN EEN SYNAPS ........................................................................................................................................................................ 32
ENKELE BEGRIPPEN .............................................................................................................................................................................. 33
VERLOOP VAN PRIKKELOVERDRACHT TER HOOGTE VAN SYNAPS .......................................................................................................... 33
HET TYPE NEUROTRANSMITTER BEPAALT HET EFFECT IN DE POSTSYNAPTISCHE CEL . .......................................................................... 34
3.2.4.1 Exciterende neurotransmitters ............................................................................................................................................... 34
1
, 3.2.4.2 Inhiberende neurotransmitters ............................................................................................................................................... 35
4 HET CENTRAAL ZENUWSTELSEL ....................................................................................................................................................... 35
4.1 BELANGRIJKSTE HERSENGEBIEDEN ........................................................................................................................................... 35
4.2 DE VENTRIKELS ................................................................................................................................................................................... 36
4.3 CEREBRUM OF GROTE HERSENEN ............................................................................................................................................... 37
CEREBRALE CORTEX............................................................................................................................................................................. 38
4.3.1.1 De hersenkwabben .................................................................................................................................................................. 39
4.3.1.2 Algemene functies van de cerebrale cortex ......................................................................................................................... 40
4.3.1.3 Motorische gebieden ............................................................................................................................................................... 40
oefening ........................................................................................................................................................................................................ 42
4.3.1.4 Sensorische gebieden ............................................................................................................................................................. 42
CEREBRALE WITTE STOF ....................................................................................................................................................................... 44
BASALE KERNEN ................................................................................................................................................................................... 44
4.4 DIENCEPHALON (TUSSENHERSENEN) ......................................................................................................................................... 46
EPITHALAMUS ....................................................................................................................................................................................... 46
THALAMUS ............................................................................................................................................................................................ 47
HYPOTHALAMUS ................................................................................................................................................................................... 47
HET LIMBISCH SYSTEEM ........................................................................................................................................................................ 49
4.5 HERSENSTAM (TRUNCUS CEREBRI) ............................................................................................................................................. 50
MIDDENHERSENEN (MESENCEPHALON) ................................................................................................................................................ 51
PONS .................................................................................................................................................................................................... 51
4.5.2.1 Formatio reticularis .................................................................................................................................................................. 52
MEDULLA OBLONGATA .......................................................................................................................................................................... 52
4.6 KLEINE HERSENEN ............................................................................................................................................................................. 53
4.7 DE MENINGES....................................................................................................................................................................................... 53
DURA MATER ........................................................................................................................................................................................ 54
ARACHNOÏD MATER ............................................................................................................................................................................... 55
PIA MATER ............................................................................................................................................................................................ 55
4.8 HET CEREBROSPINAAL VOCHT ..................................................................................................................................................... 56
4.9 HET RUGGENMERG ............................................................................................................................................................................ 57
4.10 SPINALE REFLEXEN ........................................................................................................................................................................... 60
5 NEURO- ANATOMIE: HET PERIFEER ZENUWSTELSEL ................................................................................................................. 61
2
,5.1 INTRODUCTIE ....................................................................................................................................................................................... 61
5.2 DE SPINALE ZENUWEN...................................................................................................................................................................... 61
PLEXUSSEN .......................................................................................................................................................................................... 62
5.3 DE HERSENZENUWEN (BELANGRIJK VOOR EXAMEN) ........................................................................................................... 62
NERVUS OLFACTORIUS (N. I) ................................................................................................................................................................ 64
NERVUS OPTICUS (N. II) ....................................................................................................................................................................... 64
NERVUS OCULOMOTORIUS (N. III) ........................................................................................................................................................ 65
NERVUS TROCHLEARIS (N. IV) ............................................................................................................................................................. 65
NERVUS TRIGEMINUS (N. V) ................................................................................................................................................................. 65
NERVUS ABDUCENS (N. VI) .................................................................................................................................................................. 66
NERVUS FACIALIS (N. VII) .................................................................................................................................................................... 67
NERVUS VESTIBULOCOCHLEARIS (N. VIII) ............................................................................................................................................ 68
5.3.8.1 Radix cochlearis ......................................................................................................................................................................... 69
5.3.8.2 Radix vestibularis....................................................................................................................................................................... 70
NERVUS GLOSSOPHARYNGEUS (N. IX)................................................................................................................................................. 71
NERVUS VAGUS (N. X) ..................................................................................................................................................................... 72
NERVUS ACCESSORIUS (N. XI) ........................................................................................................................................................ 73
NERVUS HYPOGLOSSUS (N. XII) ...................................................................................................................................................... 74
OVERZICHT HERSENZENUWEN ......................................................................................................................................................... 75
5.4 CENTRALE SYSTEMEN (LEZEN) ..................................................................................................................................................... 76
VESTIBULAIR SYSTEEM ......................................................................................................................................................................... 76
5.4.1.1 Het perifere deel van de radix vestibularis ........................................................................................................................... 76
5.4.1.2 Binnenkomen van de radix vestibularis in de hersenstam ................................................................................................. 77
5.4.1.3 Secundaire vestibulair systeem ............................................................................................................................................. 77
5.4.1.4 Samenwerking van oogspieren, halsspieren en evenwichtsorgaan ................................................................................. 78
AKOESTISCH SYSTEEM.......................................................................................................................................................................... 78
5.4.2.1 Nuclei cochleares..................................................................................................................................................................... 79
5.4.2.2 Colliculi inferiores ..................................................................................................................................................................... 80
5.4.2.3 Auditieve schors ....................................................................................................................................................................... 80
6 HET AUTONOOM ZENUWSTELSEL ..................................................................................................................................................... 81
6.1 AUTONOOM ZENUWSTELSEL = ONWILLEKEURIG ZENUWSTELSEL. ................................................................................. 81
BOUW: .................................................................................................................................................................................................. 81
3
, BESTAAT UIT 2 GROTE SUBEENHEDEN: ................................................................................................................................................. 82
7 NEUROPATHOLOGIE ............................................................................................................................................................................... 83
7.1 NAH .......................................................................................................................................................................................................... 83
7.2 TRAUMATISCH HERSENLETSEL (THL) ......................................................................................................................................... 84
EPIDEMIOLOGIE .................................................................................................................................................................................... 84
OORZAKEN............................................................................................................................................................................................ 84
PATHOFYSIOLOGIE ................................................................................................................................................................................ 84
7.2.3.1 Primair hersenletsel ................................................................................................................................................................. 85
7.2.3.2 Secundair hersenletsel ............................................................................................................................................................ 85
ERNST VAN LETSEL ............................................................................................................................................................................... 86
7.2.4.1 GCS (= glascow coma scale) ................................................................................................................................................. 86
7.2.4.2 Duur van de coma of bewustzijnsdaling ............................................................................................................................... 87
7.2.4.3 PTA (post traumatische amnesie) ......................................................................................................................................... 87
ZIEKTEBEELDEN .................................................................................................................................................................................... 88
PROGNOSE ........................................................................................................................................................................................... 88
VEGETATIEVE TOESTAND ...................................................................................................................................................................... 89
GEVOLGEN............................................................................................................................................................................................ 90
7.2.8.1 Sensomotorische problemen.................................................................................................................................................. 90
7.2.8.2 Epilepsie .................................................................................................................................................................................... 91
7.2.8.3 Zenuwschade ........................................................................................................................................................................... 91
7.2.8.4 Intellectuele schade ................................................................................................................................................................. 91
7.2.8.5 Gestoord geheugen ................................................................................................................................................................. 91
7.2.8.6 Gedragsproblemen .................................................................................................................................................................. 92
7.2.8.7 Ataxie ......................................................................................................................................................................................... 92
7.2.8.8 Spasticiteit ................................................................................................................................................................................. 92
7.2.8.9 Praxiestoornissen .................................................................................................................................................................... 92
7.2.8.10 Perseveratie.............................................................................................................................................................................. 93
7.2.8.11 Spraak- en taalstoornissen ..................................................................................................................................................... 93
7.2.8.12 Agnosie...................................................................................................................................................................................... 93
7.2.8.13 Attentiestoornissen .................................................................................................................................................................. 94
7.3 CVA .......................................................................................................................................................................................................... 95
DEFINITIE .............................................................................................................................................................................................. 95
4
, FYSIOLOGIE VAN DE HERSENENDOORBLOEDING ................................................................................................................................... 96
INCIDENTIE ............................................................................................................................................................................................ 96
CLASSIFICATIE ...................................................................................................................................................................................... 97
ISCHEMISCHE CVA ............................................................................................................................................................................... 97
7.3.5.1 Risicofactoren ........................................................................................................................................................................... 97
7.3.5.2 Prognose ................................................................................................................................................................................... 98
7.3.5.3 Gevolgen en stoornissen op lichamelijk vlak ....................................................................................................................... 99
a. Splitsing van het lichaam .................................................................................................................................................................. 99
b. Asymmetrie......................................................................................................................................................................................... 99
c. Pushen .............................................................................................................................................................................................. 100
d. Hemianopsie .................................................................................................................................................................................... 100
e. Incontinentie en obstipatie (= constipatie).................................................................................................................................... 100
f. Stoornissen in denken, emoties en gedrag ................................................................................................................................. 100
7.3.5.4 Behandeling ............................................................................................................................................................................ 101
7.3.5.5 Behandeling in ziekenhuis (Ischemische CVA) ................................................................................................................. 102
a. Fase 1: de hyperacute fase............................................................................................................................................................ 102
b. Fase 2: de acute fase ..................................................................................................................................................................... 102
c. Fase 3: de herstelfase .................................................................................................................................................................... 103
d. Fase 4: de revalidatiefase .............................................................................................................................................................. 103
HERSENBLOEDINGEN .......................................................................................................................................................................... 103
7.4 EPILEPSIE ............................................................................................................................................................................................ 104
DIAGNOSE ........................................................................................................................................................................................... 104
BEHANDELING ..................................................................................................................................................................................... 104
GEGENERALISEERD BEGIN .................................................................................................................................................................. 105
7.4.3.1 Tonisch clonisch..................................................................................................................................................................... 105
7.4.3.2 Absence .................................................................................................................................................................................. 105
FOCALE BEGIN .................................................................................................................................................................................... 105
7.5 EXTRAPIRAMIDALE ZIEKTEN ........................................................................................................................................................ 105
HET EXTRAPIRAMIDAAL SYSTEEM (EPS) ............................................................................................................................................ 105
DE ZIEKTE VAN PARKINSON ................................................................................................................................................................ 106
7.5.2.1 Definitie.................................................................................................................................................................................... 106
7.5.2.2 Etiologie................................................................................................................................................................................... 107
5
, 7.5.2.3 Epidemiologie ......................................................................................................................................................................... 107
7.5.2.4 Fysiopathologie ...................................................................................................................................................................... 107
7.5.2.5 Klinisch beeld ......................................................................................................................................................................... 108
7.5.2.6 Behandeling ............................................................................................................................................................................ 109
a. Medicamenteus................................................................................................................................................................................ 109
b. Chirurgie: deep brain stimulation (= DBS) ................................................................................................................................... 111
7.5.2.7 Prognose ................................................................................................................................................................................. 111
7.6 MULTIPLE SCLEROSE (MS) ............................................................................................................................................................ 112
DEFINITIE ............................................................................................................................................................................................ 112
DE MYELINE-SCHEDE: EVEN OPFRISSEN ............................................................................................................................................. 112
EPIDEMIOLOGIE .................................................................................................................................................................................. 113
ETIOLOGIE .......................................................................................................................................................................................... 113
VERLOOP ............................................................................................................................................................................................ 114
7.6.5.1 Klinische subtypes ................................................................................................................................................................. 114
a. Recidiverende-remitterende multipele sclerose (RRMS):.......................................................................................................... 115
b. Secundair progressieve multiple sclerose (SPMS)..................................................................................................................... 115
c. Primair progressief (PPMS) ........................................................................................................................................................... 115
d. Progressief-remitterende multipele sclerose (PRMS). ............................................................................................................... 115
SYMPTOMEN ....................................................................................................................................................................................... 115
7.6.6.1 Klinisch beeld ......................................................................................................................................................................... 115
7.6.6.2 Beginsymptomen ................................................................................................................................................................... 116
7.6.6.3 Motorische stoornissen van de piramidale baan ............................................................................................................... 116
7.6.6.4 Cerebellaire symptomen en hersenstam symptomen ...................................................................................................... 117
7.6.6.5 Visusstoornissen .................................................................................................................................................................... 117
7.6.6.6 Darm-en blaas stoornissen................................................................................................................................................... 117
7.6.6.7 Sensibiliteitsstoornissen ........................................................................................................................................................ 117
7.6.6.8 Andere ..................................................................................................................................................................................... 118
PROGNOSE ......................................................................................................................................................................................... 118
DIAGNOSE ........................................................................................................................................................................................... 118
THERAPIE............................................................................................................................................................................................ 119
7.7 INFECTIES VAN HET ZENUWSTELSEL ........................................................................................................................................ 120
MENINGITIS ......................................................................................................................................................................................... 120
6
, MENINGO-ENCEFALITIS ....................................................................................................................................................................... 121
7.8 INTRACRANIËLE TUMOREN ........................................................................................................................................................... 121
VERSCHILLENDE TYPES ...................................................................................................................................................................... 122
BEHANDELING ..................................................................................................................................................................................... 123
PROGNOSE ......................................................................................................................................................................................... 123
7.9 AMYOTROFE LATERALE SCLEROSE .......................................................................................................................................... 123
DEFINITIE ............................................................................................................................................................................................ 123
EPIDEMIOLOGIE .................................................................................................................................................................................. 124
KLINISCH BEELD .................................................................................................................................................................................. 124
DIAGNOSE ........................................................................................................................................................................................... 124
BEHANDELING ..................................................................................................................................................................................... 125
7.10 HOOFDPIJN ......................................................................................................................................................................................... 125
CLASSIFICATIE ............................................................................................................................................................................... 125
GERIATRIE ........................................................................................................................................................................................................ 127
1 BEGRIPPEN .............................................................................................................................................................................................. 127
1.1 GERONTOLOGIE ................................................................................................................................................................................ 128
1.2 GERIATRIE ........................................................................................................................................................................................... 129
2 NORMALE VEROUDERING ................................................................................................................................................................... 130
2.1 DEMOGRAFISCHE ASPECTEN....................................................................................................................................................... 130
LEVENSVERWACHTING ........................................................................................................................................................................ 130
VERGRIJZING ...................................................................................................................................................................................... 132
LANGER LEVEN OF BETER LEVEN? ...................................................................................................................................................... 133
3 ALGEMENE VEROUDERING VAN DE VERSCHILLENDE STELSELS ........................................................................................ 133
3.1 HET CARDIOVASCULAIRE STELSEL ........................................................................................................................................... 134
DE BLOEDVATEN ................................................................................................................................................................................. 134
3.2 HET PULMONAAL STELSEL ........................................................................................................................................................... 136
3.3 HET ZENUWSTELSEL ....................................................................................................................................................................... 136
OUDERDOMSZIEKTEN VAN HET ZENUWSTELSEL (ZIE TERUG) .............................................................................................................. 136
HET PERIFERE ZENUWSTELSEL ........................................................................................................................................................... 136
3.4 DE ZINTUIGEN .................................................................................................................................................................................... 137
OOG.................................................................................................................................................................................................... 137
OOR .................................................................................................................................................................................................... 138
7
,3.5 HET IMMUNOLOGISCH STELSEL .................................................................................................................................................. 140
3.6 HET UROGENITALE STELSEL ........................................................................................................................................................ 140
DE NIEREN .......................................................................................................................................................................................... 140
DE URINEWEGEN................................................................................................................................................................................. 140
URINAIRE INCONTINENTIE ................................................................................................................................................................... 141
3.7 HET LOCOMOTORISCHE STELSEL .............................................................................................................................................. 141
HET SKELET ........................................................................................................................................................................................ 141
ADDENDUM: ARTROPLASTIEK HEUP .................................................................................................................................................... 141
DE SPIEREN ........................................................................................................................................................................................ 142
KRAAKBEEN ........................................................................................................................................................................................ 142
4 PROFIEL VAN DE GERIATRISCHE PATIËNT ................................................................................................................................... 143
4.1 CASUSSEN .......................................................................................................................................................................................... 143
CASUS 1: MIA ..................................................................................................................................................................................... 143
CASUS 2: ROBERT .............................................................................................................................................................................. 143
4.2 KENMERKEN VAN DE GERIATRISCHE PATIËNT ...................................................................................................................... 144
LEEFTIJD ............................................................................................................................................................................................. 144
MULTIPLE PATHOLOGIE ....................................................................................................................................................................... 144
GEWIJZIGDE PRESENTATIE EN VERLOOP VAN PATHOLOGIE ................................................................................................................. 145
VERMINDERDE ADAPTATIEMOGELIJKHEDEN ........................................................................................................................................ 145
BEDREIGDE VALIDITEIT........................................................................................................................................................................ 145
POLYFARMACIE ................................................................................................................................................................................... 146
NEIGING TOT PSYCHISCHE STOORNISSEN ........................................................................................................................................... 146
SOCIALE PROBLEMATIEK ..................................................................................................................................................................... 146
BEHANDELING EN MULTIDISCIPLINAIRE AANPAK .................................................................................................................................. 147
4.3 BEOORDELING VAN DE FUNCTIONELE CAPACITEIT BIJ OUDEREN ................................................................................. 147
BARTHEL INDEX .................................................................................................................................................................................. 148
LAWTON EN BRODY IADL-TESTS ....................................................................................................................................................... 149
KATZ -SCHAAL..................................................................................................................................................................................... 150
5 VOORZIENINGEN VOOR OUDEREN IN BELGIË.............................................................................................................................. 152
5.1 VOORZIENINGEN VOOR OUDEREN THUIS ................................................................................................................................. 152
THUISVERPLEEGDIENSTEN .................................................................................................................................................................. 152
MANTELZORGERS ............................................................................................................................................................................... 153
8
, GEZINS- EN BEJAARDENHULP ............................................................................................................................................................. 154
5.1.3.1 Wie krijgt hulp? ....................................................................................................................................................................... 154
5.1.3.2 Hoe wordt die hulp georganiseerd? .................................................................................................................................... 154
5.1.3.3 Financiële bijdrage................................................................................................................................................................. 154
EXTRA DIENSTEN ................................................................................................................................................................................ 154
5.1.4.1 Boodschappendienst ............................................................................................................................................................. 154
5.1.4.2 Warme maaltijden aan huis .................................................................................................................................................. 154
5.1.4.3 Uitleendiensten....................................................................................................................................................................... 154
ZORGWONEN OF KANGOEROEWONEN ................................................................................................................................................. 155
ERGOBEGELEIDING EN WOONADVIES ................................................................................................................................................. 155
5.2 HET ZIEKENHUIS: DE G-DIENST.................................................................................................................................................... 155
5.3 GESPECIALISEERDE INSTELLINGEN .......................................................................................................................................... 157
WOONZORGCENTRA ........................................................................................................................................................................... 157
RUST- EN VERZORGINGSTEHUIZEN ..................................................................................................................................................... 158
DAGVERZORGINGSCENTRUM (DVC) .................................................................................................................................................. 158
CENTRUM VOOR KORTVERBLIJF .......................................................................................................................................................... 159
CENTRUM VOOR HERSTELVERBLIJF .................................................................................................................................................... 160
ASSISTENTIEWONING .......................................................................................................................................................................... 160
6 GROTE GERIATRISCHE PROBLEMEN .............................................................................................................................................. 161
6.1 IMMOBILISATIE .................................................................................................................................................................................. 161
EPIDEMIOLOGIE EN ETIOLOGIE ............................................................................................................................................................ 161
PREVALENTIE VAN FIXEREN IN GENT .................................................................................................................................................. 161
FYSIOLOGIE VAN BEDRUST .................................................................................................................................................................. 162
COMPLICATIES .................................................................................................................................................................................... 163
6.1.4.1 Tromboflebitis/ Diep veneuze trombose/ longembool....................................................................................................... 163
6.1.4.2 Pneumonie .............................................................................................................................................................................. 163
6.1.4.3 Osteoporose ........................................................................................................................................................................... 163
6.1.4.4 Spieratrofie.............................................................................................................................................................................. 163
6.1.4.5 Decubitus ................................................................................................................................................................................ 164
6.1.4.6 Depressie, mentale achteruitgang, verwarring en desoriëntatie ..................................................................................... 164
7 CAPITA SELECTA ................................................................................................................................................................................... 165
7.1 EUTHANASIE....................................................................................................................................................................................... 165
9
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