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52 y/o F presents to ER with gradual onset of muscle weakness and lethargy…
52 y/o F presents to ER with gradual onset of muscle weakness and lethargy secondary to ALS
Upstream Causes
Direct causes
ALS is a neurodegenerative disease that damages nerve cells in the brain and spinal cord
upper motor neurons in brains motor cortex
axons extend to either the brain stem or spinal cord
nerve impulses then travel to lower motor neurons
lower motor neurons
axons relay the signals to body's muscles
Indirect causes: Established risk factors for ALS
Heredity
familial ALS increase risk by 50%
Age
increases with age (most common between 40-mid 60's)
Sex
men are slightly higher risk than women
Genetics
familial ALS and noninherited ALS have similarities in human genome
Indirect causes: Environmental factors
Smoking
most likely environmental risk factor (greatest for women after menopause)
Environmental toxin exposure
exposure to lead or other substances
Military service
could include exposure to certain metals, chemicals, traumatic injuries, viral infections, intense exertion
Downstream Effects
complications most likely to be seen in this patient going forward
Respiratory System/ skeletal muscular system
breathing problems
paralysis of breathing muscles
treatment: CPAP, BiPAP, tracheostomy with respirator
could be fatal due to compete respiratory failure
Nervous system/ skeletal muscular system
Speaking problems
gradual aphasia leading to complete aphasia
treatment: other communication technologies
Eating Probelms
malnutrition and dehydration due to damage of digestive system muscles leading to dysphasia.
treatment: feeding tubes
could lead to pneumonia due to food in lungs
Dementia
frontotemporal dementia
Background Information
Anatomy
The anatomy of the cerebrum
Corpus Callosum
Connects cerebral hemispheres (a commissure)
Gyri
Bumps or concolutions
Sulci
Grooves in gray matter
Central Sulcus
Fissures
Longitudinal: separates the cerebral hemishperes
Transverse: separates cerebrum from cerebellum
Lateral fissure of Sylvius
Lobes of the Cerebrum
Frontal lobe
Parietal lobe
Occipital lobe
Temporal lobe
The anatomy of the spinal cord
Nervous Tissue types
White Matter
Part of the spinal cord filled with myelinated axons
Gray matter
Parts of the spinal cord filled with neuron cell bodies, dendrites, & unmyelinated axons
the meninges
pia matter
most inner layer
dura mater
outer layer
arachnoid mater
middle layer
dorsal gray horns
this region of gray matter is posterior in the spinal cord & contains the cell bodies of interneurons
central canal
this middle open space contains CSF
ventral root
this is the bundle of motor neurons that leaves the anterior side of the spinal cord to travel to muscles & glands
white matter funiculi
these are columns of myelinated axons on the outer surface of the spinal cord, surrounding the gray matter horns
ventral gray horns
this region of gray matter is anterior in the spinal & contains the cell bodies of motor neurons traveling to skeletal muscles & glands
dorsal root ganglia
this is an enlargement along the dorsal root of a spinal nerve where sensory neuron cell bodies are found
lateral gray horns
this region of gray matter is lateral in the spinal cord; it has autonomic motor neurons
dorsal median sulcus
this is a narrow groove on the posterior side of the spinal cord
ventral median fissure
this is a slightly wider groove on the anterior side of the spinal cord
dorsal root
this is a bundle of sensory neurons that enters the posterior side of the spinal cord
The specific types of neurons / neuron structures found in each part of the spinal cord
Receptor Cells
Receives information from a stimulus
Example: your finger gets hit by a hammer
Sensory Neurons (monitor change)
carry the impulse to the spinal cord
Example: travels the length of the arm to the spinal cord
Interneuron (process & interpret)
Impulse is transmitted to the brain and the motor neurons via synapses
Example: travels to the brain to register pain and out to the finger
Motor neurons (Generate response)
sends the processed information back to finger
Example: carries impulse to the effector cells in the fingers, hand, and arm
The specific types of neurons found in ascending & descending tracts
Descending tracts (motor tracts)
upper motor neuron
in the brain or the brainstem
lower motor neuron
the neuron the synapses with the muscle
Ascending tracts (Sensory Tracts)
3 neurons
1st order
the neuron that has receptors & brings the information to the spinal cord
2nd order
the interneuron in the dorsal horn of the spinal cord
3rd order
the neuron in the thalamus that connects with the cerebral cortex
Specific examples of ascending & descending tracts
Ascending tracts example
The Spinothalamic Tracts
starts in the spinal cord
ends in the thalamus
1st order: dorsal root to the dorsal horn
2nd order: dorsal horn to the thalamus
3rd order: thalamus to the cerenrum
the Spinocerebellar Tract
starts in the spinal cord
ends in the cerebellum
1st order: dorsal root to the dorsal horn
2nd order: dorsal horn to the cerebellum
Physiology
The physiology of the cerebrum
Functional Areas of the Cerebrum
Frontal lobe: Prefrontal association areas
idea and plan for voluntary movement, thoughts and personality
Frontal Lobe: Premotor cortex
coordinates voluntary movements
Frontal lobe: Primary motor cortex
voluntary movement
Parietal lobe: Primary somatosensory cortex
somesthetic sensations and proprioception
Parietal lobe: Sensory association areas
integration of sensory information
Occipital lobe: Visual association areas
higher vision processing
Occipital lobe: Primary visual cortex
vision
Temporal lobe: Wernicke's area
language comprehension
Temporal lobe: Auditory association areas, primary auditory cortex
hearing
Temporal lobe: Limbic association cortex
emotions, learning, and memory
Temporal lobe: Olfactory cortex
smell
Frontal Lobe: Broca's area
speech formation
The process of movement
precentral gyrus
"primary motor cortex" involved in executing voluntary motor movements
basal nuclei
processes movement-related information
cerebellum
controls movement coordination, balance, equilibrium, muscle tone
descending spinal cord tracts
voluntary motor function, muscle tone, reflexes, equilibrium, visceral innervation, modulation of ascending sensory signals
Normal Cellular Process
Healthy nervous system
basic unit: Neurons
transports messages from one part of the body to another in the form of nerve impulses
Motor neuron
Cell body
biosynthetic center of the cell
axon
responsible for sending messages
dendrites
responsible for receiving messages
nerve impulse
A nerve impulse is transmitted when the terminal fibers of one neuron's axon release neurotransmitters that attach to dendrites of receptor neurons
