Class notes
nervous system anatomy notes
- Course
- Anatomy (ANATOMY100)
- Institution
- Humber College ( )
nervous system anatomy
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bloodstream (i.e.,Diseases of the Central bacteremia, viremia,
Nervous System fungemia, parasitemia) and
subsequent hematogenous
seeding of the CNS, which
is the most common mode of spread for most agents
(e.g., meningococcal, cryptococcal, syphilitic, and
Brain & Meninges pneumococcal meningitis); (2) a retrograde neuronal
» Meningitis (i.e., olfactory and peripheral nerves) pathway (e.g.,
» Rabies Naegleria fowleri, Gnathostoma spinigerum); or (3)
» Encephalitis direct contiguous spread (i.e., sinusitis, otitis media,
congenital malformations, trauma, direct inoculation
Nerve Diseases during intracranial manipulation).
» Hansen’s disease Epidemiology
» Tetanus » Most frequent in children less
» Poliomyelitis than 5years old with peak rate in
» Transmissible Spongiform Encephalopathy the 6-12months age group.
Incubation Period
» 2-10 days (Meningococcal)
Mode of Transmission
» Person to person thru infected
droplets of respiratory secretion.
» Close contact such as household, day care centers,
nursery schools, military camps.
Signs and Symptoms
» Sudden onset of high fever for 24hours, petechiae,
red macular rashes,
nuchal rigidity (stiff neck-
pain w/neck flexion),
photophobia.
» Meningeal irritation.
» Kernig sign: In a supine
patient, flex the hip to
90°. While the knee is
flexed at 90°, an attempt
to further extend the leg
produces pain in the
hamstrings and resistance
to further extension.
» Brudzinski sign:
Passively flex the neck
while the patient is in a
MENINGITIS supine position with
» Inflammation of the meninges extremities extended. This
» May be bacterial or viral (aseptic) maneuver produces
» May result from complications of neurosurgery, flexion of the hips in
trauma, infection or the sinus or ears, or systemic patients with meningeal
infections irritation.
Etiologic Agents
» Streptococcus pneumoniae Diagnosis
» Heamophilus influenza type » Lumbar puncture (high
B WBC, high protein, low
» Neisseria meningitidis glucose, cloudy CSF).
» Enterovirus » LP: insertion of a spinal
» HSV needle through the L3-L4
» Mumps virus interspace into the lumber
subarachnoid space to
Pathophysiology obtain CSF; the test is
» Initially, the infectious agent colonizes or establishes contraindicated in clients
a localized infection in the host. This may be in the with increased ICP because this procedure will cause
form of colonization or infection of the skin, a rapid decrease in pressure in the CSF around the
nasopharynx, respiratory tract, gastrointestinal tract, spinal cord, leading to brain herniation
or genitourinary tract. Most meningeal pathogens are Preprocedure: obtain informed consent;
transmitted through the respiratory route, as have the client empty the bladder
, Postprocedure: monitor V/S and
neurological signs that may indicate leakage Mode of Transmission
of CSF; position the client flat as » Bites of rabid animals
prescribed; encourage fluids to replace CSF » Human-to-human transmission has only occurred
obtained from the specimen collection or with corneal transplants.
from leakage » Transmission of virus in saliva through mucous
» G/S of petechial scraping, CSF, blood (Gram membranes, open wounds, or scratches is possible
negative diplococci). but rarely documented.
Complications Signs and Symptoms
» Deafness, ataxia, seizure, obstructive hydrocephalus, » Rabid dog: withdrawn, dumb, paralytic; furious
arthritis, pneumonia, DIC, myocaarditis. stage: bites without provocation.
» In man:
Treatment ♪ Prodromal: headache; malaise; anorexia; sore
» PenG IV throat; salivation; diaphoresis; tingling sensation;
» Chloramphenicol if with allergy to Pen numbness at site of bite; low grade fever
» Mannitol (for cerebral edema) ♪ Excitement/maniacal:
» Dexamethasone (anti-inflammatory) hydrophobia; aerophobia; increased
anxiety; cranial affectation
Nursing Interventions ♪ Paralytic stage: die of paralysis
» Medications as ordered or respiratory arrest
» Assess for signs of increasing ICP: widening pulse
pressure, HPN, bradycardia (Cushing’s Triad) Diagnosis
» Priority: airway, safety » History of exposure to saliva of infected animal
» Strict respiratory precaution until 1st 24hours of » Negri bodies in samples of brain tissue of infected
antibiotic treatment animal; Fluorescent Rabies Antibody Staining
» Institute seizure precautions
» Keep room dark Treatment
» Elevate the HOB 30deg; avoid neck flexion and » Symptomatic and supportive
extreme hip flexion » Wash area of bite with soap
» Prevent stimulation and restrict visitors and running water.
» Suctioning of secretions; hand washing
Nursing Interventions/Considerations
» Strict isolation of aeg throughout the course of
RABIES illness; caution against contamination of open wound
» Severe viral infection of CNS that is communicated or mucous membrane with aeg’s saliva.
to humans by the saliva of infected mammals. » Immunization:
» Also Hydrophobia, caused by Rhabdovirus ♪ Active
(neurotropic virus from Genus Lyssavirus). « Purified Verocell Rabies Vaccine (PVRV)
0.5ml/vial
« Purified Duck Embryo Vaccine (PDEV) 1ml/vial
« Purified Chick Embryo Cell Vaccine (PCECV)
1ml/vial
« May be administered IM/ID
♪ Passive
« Rabies Human Immune Globulin
Pathophysiology ENCEPHALITIS
» When the rabies virus enters muscles, it replicates » Acute viral encephalitis (enkephalos + -itis, meaning
locally and then is transported through peripheral brain inflammation) is often an unusual
sensory nerves to the spinal ganglia, where it manifestation of common viral infections and most
replicates and travels up the spinal cord to the brain. commonly affects children and young adults.
The virus migrates to the gray matter of the brain and » In general, viral encephalitides can be divided into 4
predominates in the neurons of the limbic system, separate categories based on the cause and
midbrain, and hypothalamus. Efferent nerves pathogenesis of the following complications:
transport virus to the acinar glands of the ♪ Acute viral encephalitis;
submaxillary salivary glands, where it achieves high ♪ Postinfectious encephalomyelitis;
concentrations. ♪ Slow viral infections of the CNS;
♪ And chronic degenerative diseases of the CNS,
Epidemiology which are presumed to be of viral origin.
» 4.4/100,000 population
» Highest incidence in R Etiology
IV,V,VII » Person-person spread
» Source: saliva of rabid dogs, ♪ Mumps: frequent in unimmunized population
bats, cats, cattle ♪ Measles
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