NEUROLOGICA

L SYSTEM
DISORDERS
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TABLE OF CONTENTS
SR.NO. TOPICS
1 10
The Nervous System Stroke
2
Meningitis
3
Seizures
4
Alzheimer's Disease Multiple
5
Sclerosis Glasgow Coma Scale
6
Babinski Reflex
7
Cranial Nerves
8
Fibromyalgia
9

Traumatic Brain Injury

11

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THE NERVOUS
THE NERVOUS
SYSTEM
SYSTEM
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The Nervous System

The human nervous system is an extensive network of specialized cells that
allow us to perceive, understand and act on the world around us. Much of
the executive activity occurs in the brain, while the spinal cord mostly acts
as an information highway to connect the brain to many cells throughout
the body. Electrochemical signals connect the circuitry of the body and the
brain, allowing for bidirectional signaling.
The nervous system is separated in two classes: the central and peripheral
nervous systems.

Ce
ntral Nervous System (CNS)
The CNS consists of the brain and the spinal cord. Both are made of soft
delicate tissue protected by the skull and spinal vertebrae. The CNS acts as
the control centre, using neurons to send and receive information to and
from muscles, glands, organs and others systems in the body primarily
through the Peripheral Nervous System.
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The Blood Brain Barrier
Between the brain and its blood supply is the blood
brain barrier. As its name suggests, the blood brain
brain barrier prevents the transfer of non-lipid
soluble molecules, which may include toxic
molecules. It does however allow the transfer of
beneficial molecules such as amino acids and
glucose into the CNS. A related example would be
the manufacture of L-Dopa, a man-made version of
the neurotransmitter dopamine which is used as
treatment for Alzheimer’s disease. The reason why
patients are not simply given dopamine is that
dopamine itself is not able to cross the blood brain
barrier.

Peripheral Nervous System (PNS)

The PNS acts as a relay, transmitting information between the CNS and the
rest of the body. Unlike the CNS, the PNS is not protected by the vertebral
column and skull, or by the blood–brain barrier, which leaves it more
exposed to toxins and mechanical injuries. The PNS contains neurons that
junction with the CNS and have long axons that extend to all parts of the
body. These
axons are
referred to as
nerves. In
contrast with
CNS neurons,
PNS neurons
are able to
regenerate.
Consequently,
the properties
of the PNS
have been
studied in
regenerative
research
 What Does
Peripheral
Nervous System
(PNS) do?

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THE NERVOUS
STROKE
SYSTEM
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Stroke
A stroke is your brain’s equivalent of a heart attack, happening when there’s
an issue with blood flow to part of your brain. This can happen when blood
vessels are blocked or because of bleeding in your brain. Strokes are a life-
threatening emergency, and immediate
medical attention is critical to prevent
permanent damage or death.

A stroke is a life-threatening condition

that happens when part of your brain
doesn’t have enough blood flow. This
most commonly happens because of a
blocked artery or bleeding in your
brain. Without a steady supply of
blood, the brain cells in that area start
to die from a lack of oxygen.

IMPORTANT: A stroke is a life-threatening emergency condition where every

second counts. If you or someone with you has symptoms of a stroke,
IMMEDIATELY call 911 (or your local emergency services number). The
quicker stroke is treated, the more likely you’ll recover without disability. To
recognize the warning signs of a stroke, remember to think FAST:
F. Ask the person to smile. Look for a droop on one or both sides of their
face, which is a sign of muscle weakness or paralysis.
A. A person having a stroke often has muscle weakness on one side. Ask
them to raise their arms. If they have one-sided weakness (and didn’t
have it before), one arm will stay higher while the other will sag and drop
downward.
S. Strokes often cause a person to lose their ability to speak. They might
slur their speech or have trouble choosing the right words. T. Time is
critical, so don’t wait to get help! If possible, look at your watch or a clock
and remember when symptoms start. Telling a healthcare provider when
symptoms started can help the provider know what treatment options
 are best for you.

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Stroke Symptoms

The symptoms of stroke can involve one or more of the following:

One-sided weakness or paralysis.

Aphasia (difficulty with or loss of speaking ability).
Slurred or garbled speaking (dysarthria).
Loss of muscle control on one side of your face.
Sudden loss — either partial or total — of one or more senses (vision,
hearing, smell, taste and touch).
Blurred or double vision (diplopia).
Loss of coordination or clumsiness (ataxia).
Dizziness or vertigo.
Nausea and vomiting.
Neck stiffness.
Emotional instability and personality changes.
Confusion or agitation.
Seizures.
Memory loss (amnesia).
Headaches (usually sudden and severe).
Passing out or fainting.
Coma.

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What causes a stroke?
Ischemic strokes and hemorrhagic strokes can happen for many reasons. Ischemic
strokes usually happen because of blood clots.
These can happen for various reasons, such as:
Atherosclerosis.
Clotting disorders.
Atrial fibrillation (especially when it happens due to sleep apnea). Heart defects
(atrial septal defect or ventricular septal defect). Microvascular ischemic disease
(which can block smaller blood vessels in your brain).
Hemorrhagic strokes can happen for several reasons also, including: High blood
pressure, especially when you have it for a long time, when it’s very high, or both.
Brain aneurysms can sometimes lead to hemorrhagic strokes. Brain tumors
(including cancer).
Diseases that weaken or cause unusual changes in blood vessels in your brain,
such as moyamoya disease.

RELATED CONDITIONS

Several other conditions and factors can contribute to a person’s stroke risk.
These include:
Alcohol use disorder.
High blood pressure (this can play a role in all types of strokes, not just
hemorrhagic ones because it can contribute to blood vessel damage that makes a
stroke more likely).
High cholesterol (hyperlipidemia).
Migraine headaches (they can have symptoms similar to a stroke, and people with
migraines — especially migraines with auras — also have a higher risk of stroke at
some point in their life).
Type 2 diabetes.
Smoking and other forms of tobacco use (including vaping and smokeless
tobacco).
Drug misuse (including prescription and non-prescription drugs). JDMA

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Types of Brain Stroke

Brain stroke is mainly two types.
 Ischemic stroke: It is the most common type and contributes to 80% of
brain strokes.
Hemorrhagic stroke: It contributes to 20% of brain strokes.
Ischemic stroke can be either thrombotic or embolic.
Thrombotic stroke is the most common type of ischemic stroke. A
blood clot forms inside a diseased or damaged artery in the brain
resulting from atherosclerosis (cholesterol containing deposits called
plaque), blocking blood flow.
Embolic stroke is caused when a clot or small piece of plaque formed in
one of the arteries leading to the brain or in the heart, is pushed
through the blood stream and lodges in narrower brain arteries. The
blood supply is cut off from the brain due to the clogged vessel.
Haemorrhagic stroke can be due to Intracerebral haemorrhage or
Subarachnoid haemorrhage.
Intracerebral haemorrhage is the bleeding that occurs within the
brain tissue, most common cause is due to changes in the arteries
caused by long-term Hypertension.
Subarachnoid haemorrhage is bleeding that occurs between the
surface of the brain and skull. Common causes being cerebral
aneurysm or arteriovenous malformation (AVM).

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THE NERVOUS
MENINGITIS
MENINGITIS
SYSTEM
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Meningitis
Meningitis is an inflammation of the area surrounding your brain and
spinal cord (meninges). It’s sometimes called spinal meningitis. Your
meninges protect your brain and spinal cord from injury and provide
support and structure. They contain nerves, blood vessels and protective
fluid (cerebrospinal fluid).
Infectious diseases, like viruses and bacteria, and non-infectious
conditions, like cancer or
head injuries, can cause
meningitis. Meningitis is an
inflammation of
the protective layers
surrounding your brain and
spinal cord (meninges).
Bacteria,
viruses, fungi, parasites and
non
infectious conditions can
cause
meningitis. Symptoms include
fever, severe headache, neck
stiffness, nausea, vomiting and
light sensitivity. If you think you have meningitis, go to the ER immediately.
What is spinal meningitis?
Spinal meningitis is another name for meningitis, an inflammation of the
meninges surrounding your brain and spinal cord.
What is aseptic meningitis?
Aseptic meningitis is any case of meningitis where the fluid around your
brain and spine (CSF) tests negative for bacteria. This means either the
bacteria causing meningitis is difficult to grow or that your case of
meningitis isn’t caused by bacteria. The most common cause of aseptic
meningitis is a viral infection.
What’s the difference between meningitis and
 encephalitis?
The difference between meningitis and encephalitis is the location of the
inflammation. Meningitis is an inflammation of the protective lining of the
brain and spinal cord and encephalitis is an inflammation of the brain itself.

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Types of Meningitis
Types of meningitis are typically named for the cause or for how long
you’ve had symptoms.
They include:
Bacterial meningitis.
Viral meningitis.
Fungal meningitis.
Parasitic meningitis. Meningitis caused by certain parasites is called
eosinophilic meningitis or eosinophilic meningoencephalitis (EM).
Primary Amebic Meningitis (PAM). Meningitis can be caused by the
ameba Naegleria fowleri.
Drug-induced aseptic meningitis (DIAM). Rarely, certain medications
cause drug-induced aseptic meningitis (DIAM). Non-steroidal anti
inflammatory drugs (NSAIDS) and antibiotics are the most common
causes of DIAM.
Chronic meningitis. When meningitis has lasted a month or more, it’s
called chronic meningitis.
Acute meningitis. Bacterial meningitis is often acute, meaning that
symptoms are severe and come on suddenly.

Who is at an increased risk of meningitis?

Your age, where you live or travel and certain health conditions can
increase your risk of meningitis.

You’re at higher risk for meningitis if you:

Are under 5 years old. About 70% of all bacterial meningitis cases
affect children under age 5.
Have a weakened immune system. You might have a weakened
immune system if you’re living with HIV or cancer, if you’ve received
an organ or bone marrow transplant or if you’re on medications that
suppress your immune system.
 Live in a group setting, like in a college dorm.
Have a CSF leak.
Don’t have a spleen or have a damaged spleen.

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Live in or travel to places where infectious diseases that cause meningitis are
common.
Have chronic nose and ear infections, pneumococcal pneumonia or a widespread
blood infection.
Have a head injury, traumatic brain injury (TBI) or spinal cord injury. Are living
with sickle cell disease.
Are living with alcohol use disorder.

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THE NERVOUS
SEIZURES
SYSTEM
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Seizures
Seizures are changes in the brain’s electrical activity. These changes can
cause dramatic, noticeable symptoms or no symptoms at all. The
symptoms of a severe seizure include violent shaking and a loss of control.
Because some seizures can lead to injury or be a sign of an underlying
medical condition, it’s important to seek treatment if you experience
them.

Types of seizures
The three Trusted Source major types are focal onset seizures,
generalized onset seizures, and unknown onset seizures.

Focal onset seizures Focal aware seizure

Focal onset seizures occur in only one During a focal aware seizure, you’ll
areaTrusted Source of the brain. People remain fully conscious and be aware
may also refer to these as partial that something is happening, even if
seizures. you do not recognize it as a seizure. The
Focal onset seizures can start in symptoms of a focal aware seizure will
small areas of the brain, such as a depend on which part of the brain the
single lobe, but can affect large seizure starts.
areas. Focal aware seizures may be singular
Medical professionals typically split events but can also develop into other
focal onset seizures into two types: types of seizures. For this reason,
focal aware seizures and focal people often refer to them as warnings
awareness-impaired seizures. or auras.

Focal impaired-awareness seizure

This type of seizure affects your consciousness. During a focal impaired
awareness seizure, you may not be able to move, talk, or hear as you did
before. You may also not be able to remember the event.
Focal impaired-awareness seizures can last for up to 2 minutesTrusted
Source. This type of seizure typically affects a larger portion of the brain
than focal aware seizures.
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Generalized onset seizures
These seizures start in both sides of the brain simultaneously. Among the
more common types of generalized onset seizures are:
Tonic.
Tonic seizures will result in your muscles stiffening up.
Clonic.
The convulsions in clonic seizures may cause abnormal, jerky movements of
your limbs. You will likely lose consciousness during these seizures that can
last for a few minutes.
Tonic-clonic.
Tonic-clonic seizures include a combination of both tonic and clonic
symptoms.
Myoclonic.
During a myoclonic seizure you may experience sudden muscle spasms.
These are typically too short lived to affect consciousness and pass quickly.
Myoclonic seizures may be of generalized onset as well as focal onset.
Absence.
People may also refer to these as petit mal seizures. Absence seizures last for
only a few seconds. They can cause you to blink repeatedly or stare into
space. Other people may mistakenly think you’re daydreaming. Atonic.
During atonic seizures your muscles suddenly go limp. Your head may nod, or
your entire body could fall to the ground. Atonic seizures are brief, lasting
about 15 seconds. People may refer to these seizures as drop attacks.

Generalized onset seizures

Sometimes no one witnesses the beginning of a seizure.
For example, someone may wake up in the middle of the night and observe
their partner having a seizure.
This often means there’s insufficient evidenceTrusted Source for medical
professionals to diagnose the root cause of a seizure. In these instances,
they will define the seizure as an unknown onset seizure.

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Symptoms of a Seizure
You can experience both focal and generalized seizures simultaneously, or
one can happen before the other. The symptoms can last anywhere from a
few seconds to several minutesTrusted Source per episode. Sometimes
symptoms occur before the seizure takes place. These can include:
a sudden feeling of fear or anxiousness
a feeling of being sick to your stomach
dizziness
a change in vision
a jerky movement of the arms and legs that may cause you to drop
things
an out-of-body sensation
a headache
deja vu
Signs that indicate a seizure is in progress include:
losing consciousness, followed by confusion
having uncontrollable muscle spasms
drooling or frothing at the mouth
falling
having a strange taste in your mouth

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THE NERVOUS
ALZHEIMER'S
DISEASE
SYSTEM
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Alzheimer's Disease
Overview
Alzheimer's disease is a progressive neurologic disorder that causes the
brain to shrink (atrophy) and brain cells to die. Alzheimer's disease is the
most common cause of dementia — a continuous decline in thinking,
behavioral and social skills that affects a person's ability to function
independently.
Approximately 5.8 million people in the United States age 65 and older live
with Alzheimer's disease. Of those, 80% are 75 years old and older. Out of
the approximately 50 million people worldwide with dementia, between 60%
and 70% are estimated to have Alzheimer's disease.
The early signs of the disease include forgetting recent events or
conversations. As the disease progresses, a person with Alzheimer's disease
will develop severe memory impairment and lose the ability to carry out
everyday tasks.
Medications may temporarily improve or slow progression of symptoms.
These treatments can sometimes help people with Alzheimer's disease
maximize function and maintain independence for a time. Different
programs and
services can help
support people
with Alzheimer's
disease and their
caregivers.
There is no
treatment that
cures
Alzheimer's
disease
or alters the
disease
process in the
brain.
In advanced
stages
of the disease,
complications from
severe loss of brain
function — such as
dehydration,
malnutrition or
infection — result in
death.

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Symptoms
Memory loss is the key symptom of Alzheimer's disease. Early signs include
difficulty remembering recent events or conversations. As the disease
progresses, memory impairments worsen and other symptoms develop. At
first, a person with Alzheimer's disease may be aware of having difficulty
remembering things and organizing thoughts. A family member or friend may
be more likely to notice how the symptoms worsen.
Brain changes associated with Alzheimer's disease lead to growing trouble
with:
Memory
Everyone has occasional memory lapses, but the memory loss associated
with Alzheimer's disease persists and worsens, affecting the ability to
function at work or at home.
People with Alzheimer's may:
Repeat statements and questions over and over
Forget conversations, appointments or events, and not remember them
later
Routinely misplace possessions, often putting them in illogical
locations
Get lost in familiar places
Eventually forget the names of family members and everyday objects
Have trouble finding the right words to identify objects, express
thoughts or take part in conversations
Thinking and reasoning
Alzheimer's disease causes difficulty concentrating and thinking, especially
about abstract concepts such as numbers.
Multitasking is especially difficult, and it may be challenging to manage
finances, balance checkbooks and pay bills on time. Eventually, a person
 with Alzheimer's may be unable to recognize and deal with numbers.
Planning and performing familiar tasks
Once-routine activities that require sequential steps, such as planning and
cooking a meal or playing a favorite game, become a struggle as the disease
progresses. Eventually, people with advanced Alzheimer's often forget how to
perform basic tasks such as dressing and bathing.

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Making judgments and decisions
Alzheimer's causes a decline in the ability to make reasonable decisions and
judgments in everyday situations. For example, a person may make poor or
uncharacteristic choices in social interactions or wear clothes that are
inappropriate for the weather. It may be more difficult to respond effectively
to everyday problems, such as food burning on the stove or unexpected
driving situations.
Changes in personality and behavior
Brain changes that occur in Alzheimer's disease can affect moods and
behaviors. Problems may include the following:
Depression
Apathy
Social withdrawal
Mood swings
Distrust in others
Irritability and aggressiveness
Changes in sleeping habits
Wandering
Loss of inhibitions
Delusions, such as believing something has been stolen
Preserved skills
Many important skills are preserved for longer periods even while
symptoms worsen. Preserved skills may include reading or listening to
books, telling stories and reminiscing, singing, listening to music, dancing,
drawing, or doing crafts.
These skills may be preserved longer because they are controlled by parts of
the brain affected later in the course of the disease.
When to see a doctor
A number of conditions, including treatable conditions, can result in memory
loss or other dementia symptoms. If you are concerned about your memory
or other thinking skills, talk to your doctor for a thorough assessment and
diagnosis.
If you are concerned about thinking skills you observe in a family member
or friend, talk about your concerns and ask about going together to a
doctor's appointment.

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THE NERVOUS
MULTIPLE
SCLEROSIS
SYSTEM
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Multiple Sclerosis
Multiple sclerosis (MS) is a potentially disabling disease of the brain and
spinal cord (central nervous system).
In MS, the immune system attacks the protective sheath (myelin) that
covers nerve fibers and causes communication problems between your
brain and the rest of your body. Eventually, the disease can cause
permanent damage or
deterioration of the nerve
fibers.
Signs and symptoms of MS vary
widely between patients and
depend on the location and
severity of nerve fiber damage
in
the central nevous system.
Some
people with severe MS may lose
the ability to walk
independently
or ambulate at all. Other
individuals may experience
long
periods of remission without any
new symptoms depending on the
type of MS they have.
There's no cure for multiple
sclerosis. However, there are
treatments to help speed the recovery from attacks, modify the course of
the disease and manage symptoms.

Symptoms

Multiple sclerosis signs and symptoms may differ greatly from person to
person and over the course of the disease depending on the location of
affected nerve fibers.
Common symptoms include:
Numbness or weakness in one or more limbs that typically occurs on
one side of your body at a time
Tingling

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Electric-shock sensations that
occur with certain neck movements, especially bending the neck forward
(Lhermitte sign)
Lack of coordination
Unsteady gait or inability to walk
Partial or complete loss of vision, usually in one eye at a time, often
with pain during eye movement
Prolonged double vision
Blurry vision
Vertigo
Problems with sexual, bowel
and bladder function
Fatigue
Slurred speech
Cognitive problems
Mood disturbances
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THE NERVOUS
GLASGOW

COMA SCALE

SYSTEM
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Glasgow Coma Scale

The Glasgow Coma Scale (GCS) is used to describe the level of
consciousness in an individual.
It is often used to gauge the severity of an acute brain injury due to
trauma or medical cause. The test is simple, reliable, and correlates
well with outcomes following brain injury. It is composed of 3
domains which are assessed separately and given numerical scores.
The sum of these scores is the Glasgow Coma Score. The three areas
are

1. 2. 3. Activity.
VERBAL MOTOR
Eye Opening,
Verbal Response,
and Motor
EYE

OPENING RESPONSE RESPONSE

6
Spontaneo 5 4 3 2 1
us To Obeys
sound commands
Localising
To
Withdrawl
pressure
Abnormal
None flexion
4321 Extension
None
Oriented
Confused 54321
Words
Sounds
None
 Glasgow Coma Scale Scoring

Mild Moderate Severe 13-15 9-12 3-8

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EYE-OPENING (1-4 Points)

1.
Does not open eyes in response to
anything.
2.
Opens eyes in response to painful stimuli.
3.
Opens eyes in response to voice.
4.
Opens eyes spontaneously.

VERBAL RESPONSE (1-5 Points)

1.
Makes no sounds.
2.
Incomprehensible sounds.
3.
Utters incoherent words.
4.
Confused, disoriented.
5.
Oriented, converses normally.

MOTOR ACTIVITY (1-6 Points)

1.
 Makes no movements.
2.
Decerebrate (extensor) posture (an abnormal posture that can include
rigidity, arms and legs held straight out, toes pointed downward, head
and neck arched backward).
3.
Decorticate (flexor) posture (an abnormal posture that can include
rigidity, clenched fists, legs held straight out, and arms bent inward
toward the body with the wrists and fingers bend and held on the
chest).
4.
Withdrawal from painful stimuli.
5.
Localizes to painful stimuli.
6.
Obeys commands.

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EXAMPLE

So a patient who has scores of Eye = 3, Verbal = 4 and Motor = 5 is said to

have a GCS of 12.
You would express this as a GCS 12 = E3, V4, M5.
There are some GCS scores that are significant and must be memorized:
3: The lowest possible GCS; this indicates a patient is wholly
unresponsive.
8: The point of intubation; any patient with an 8 or lower is strongly
considered for intubation, as they are unlikely to maintain a patent
airway.
15: The highest GCS score; a patient who opens their eyes spontaneously,
is oriented and alert, and obeys commands has a GCS of 15.

MODIFIERS

Modifiers are used to eliminate misleading scores--it's all about accuracy,

especially as it pertains to outcomes. For example:
You can communicate that the patient is intubated with modifiers like
V1t where it indicates that the patient makes no verbal sounds but it's
secondary to an (endotracheal) tube.
Other common modifiers are E1c where "c" stands for closed due to
swelling or damage. Sometimes, the "1" is omitted, and instead of using
V1t, you could just see Vt since, in that case, the 1 is seen as a
redundancy.

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THE NERVOUS
BABINSKI
 BABINSKI
REFLEX SYSTEM
REFLEX
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Babinski Reflex
The Babinski reflex is a reflex response in the bottom part of the foot. It
occurs as a reaction to stroking the sole of the foot with a blunt object. The
Babinski reflex is one part of the neurological testing that doctors use to
check for healthy development or underlying neurological conditions.
Irregular reflex reactions may be a sign of an underlying neurological
condition, which will require further testing for a diagnosis.
The Babinski reflex, also called the Babinski sign or plantar reflex, is an
automatic reflex in the foot in response to stimulation. Joseph Babinski, a
French neurologist, first documented the reflex in 1896.
Testing for the Babinski reflex involves stroking the sole of the foot and
assessing the response in the toes. If the Babinski reflex is present, the big
toe will move upward as the other toes fan outward.
Although it took some time for the reflex to gain recognition, it is now one of
the most importantTrusted Source signs in clinical neurology. Doctors still
use the Babinski reflex as a standard part of neurological testing.

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The Babinski reflex is a marker for the health of the cortical spinal tract,
which is a nerve channel sending information between the brain and the
body and limbs. It is primarily responsible for motor control in the body
and limbs.

Adults vs. children

The Babinski reflex is one type of standard check for neurological health.
In very young children, a Babinski reflex is normal.
A study in the International Journal of Physiology found that the Babinski
reflex occurs in about 62–75% of newborns. As newborns generally do not
yet have a fully developed nervous system, the reflex is not necessarily a
sign of a neurological condition.
While the reflex response is normal in infants, it should be absent after 24
months Trusted Source of age. In some cases, the reflex response disappears
earlier — potentially as early as 1 year of age.
Doctors consider a Babinski reflex response that appears in adults or
children over the age of 2 years to be an abnormal reflex response. It may
be a sign of an underlying neurological condition or nervous system
disorder.

Associated conditions

In adults and children over the age of 2 years, the Babinski reflex may be a
sign of an underlying central nervous system disorder or another issue in
the cortical spinal tract.
Possible associated disorders include:
spinal cord injury
tumors in the spinal cord
defects in the spinal cord or spinal column
brain tumors
multiple sclerosis (MS)
Lou Gehrig disease
stroke
meningitis
cerebral palsy

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THE NERVOUS
CRANIAL
CRANIAL
NERVES
SYSTEM
NERVES
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Cranial Nerves
The cranial nerves are composed of twelve pairs of nerves that emanate from
the nervous tissue of the brain. In order to reach their targets they must
ultimately exit/enter the cranium through openings in the skull. Hence, their
name is derived from their association with the cranium. The following are
the list of cranial nerves, their functions, and tumor examples:

Name Function Tumor Example

#

olfactory The olfactory nerve

Esthesioneuronblastoma
I carries impulses for
the sense of smell.

II optic The optic nerve carries impulses IV trochlearThe trochlear nerve controls
for the sense an extraocular
of sight. muscle.
III occulomotor The occulomotor nerve Optic nerve glioma Schwannoma
is responsible
for motor enervation
of upper eyelid
muscle, extraocular
muscle and pupillary
muscle.

Schwannoma

V trigeminal Malignant peripheral The trigeminal nerve

is responsible for sensory enervation (chewing).

of the face and motor enervation to nerve sheath tumor
muscles of mastication (MPNST)
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Schwannoma
VI abducent The abducent nerve
enervates a muscle,
which moves the
eyeball.
VII facial The facial nerve enervates the Schwannoma (rare)
muscles of the face
(facial expression).
VIII vestibulocochlear The
vestibulocochlear nerve is responsible Vestibular
for the sense of Schwannoma
hearing and balance
(body position sense).

IX glossopharyngeal The
glossopharyngeal nerve enervates Glomus tumor
muscles involved in
swallowing and taste.
Lesions of the ninth
nerve result in
difficulty swallowing
and disturbance of
taste.
X vagus The vagus nerve enervates the
gut
MPNST,
(gastrointestinal tract),
paraganglioma
heart and larynx.

XI hypoglossal sternocleidomastoidSchwannoma
muscles and the
trapezius muscles.

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XII The accessory nerve muscles of the
accessory enervates the tongue.
Schwannoma
THE NERVOUS
FIBROMYALGIA
FIBROMYALGIA
SYSTEM
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Fibromyalgia
Fibromyalgia is a long-term, or chronic, condition. It causes symptoms such
as:
musculoskeletal pain, or pain in the muscles and bones
tenderness
general fatigue
sleep and cognitive disturbances
This condition can be hard to understand, even for healthcare professionals.
Its symptoms mimic those of other conditions, and there are no tests to
definitively confirm a diagnosis. As a result, fibromyalgia is often
misdiagnosed.
In the past, some healthcare professionals even questioned whether
fibromyalgia was real. Today, it’s much better understood. Around 4 million
adults in the United StatesTrusted Source, or around 2 percent, have been
diagnosed with fibromyalgia. Most fibromyalgia cases are diagnosed in
females. Most people get diagnosed in middle age, but fibromyalgia can also
affect children.
Some of the stigmas that previously surrounded fibromyalgia have eased,
but it can still be challenging to treat. Medications, therapy, and lifestyle
changes can help you manage your symptoms and improve your quality of
life.
You may also experience remission-type periods in which your pain and
fatigue improve.

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Fibromyalgia symptoms
Fibromyalgia causes what’s now referred to as regions of pain. Some of
these regions overlap with the areas of tenderness traditionally known as
tender points or trigger points. However, some of these previously noted
areas of tenderness are not included in the regions of pain.
The pain feels like a consistent, dull ache. A healthcare professional will
consider a diagnosis of fibromyalgia if you’ve experienced musculoskeletal
pain in four out of the five regions of pain outlined in the 2016 revision to the
fibromyalgia diagnostic criteria.
Current diagnostic criteria refer to fibromyalgia pain as multisite pain. In
contrast, the 1990 fibromyalgia diagnostic criteria defined fibromyalgia
pain as chronic widespread pain.
In addition, the diagnostic process now focuses on the severity of pain and
the areas of musculoskeletal pain. In the past, the duration of pain was the
focal point of a fibromyalgia diagnosis.

Other symptoms of fibromyalgia include:

fatigue
trouble sleeping
nonrestorative sleep, or sleeping for long periods of time without
feeling rested
headaches
trouble focusing or paying attention
dry eyes
rash
itching
pain or a dull ache in the lower abdomen
bladder problems, such as interstitial cystitis
depression
anxiety

The condition can affect your emotions as well as your physical health.
Discover more signs and symptoms of fibromyalgia.

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THE NERVOUS
TRAUMATIC
TRAUMATIC
BRAIN INJURY
SYSTEM
BRAIN INJURY
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Traumatic Brain Injury

Traumatic brain injury (TBI) happens when a sudden, external, physical
assault damages the brain. It is one of the most common causes of
disability and death in adults. TBI is a broad term that describes a vast
array of injuries that happen to the brain. The damage can be focal
(confined to one area of the brain) or diffuse (happens in more than one
area of the brain). The severity of a brain injury can range from a mild
concussion to a severe injury that results in coma or even death.

What are the different types of TBI?

Brain injury may happen in one of two ways:

Closed brain injury.

Closed brain injuries happen when there is a nonpenetrating injury to
the brain with no break in the skull. A closed brain injury is caused by a
rapid forward or backward movement and shaking of the brain inside
the bony skull that results in bruising and tearing of brain tissue and
blood vessels. Closed brain injuries are usually caused by car accidents,
falls, and increasingly, in sports. Shaking a baby can also result in this
type of injury (called shaken baby syndrome). Penetrating brain injury.
Penetrating, or open head injuries happen when there is a break in the
skull, such as when a bullet pierces the brain.

What is diffuse axonal injury (DAI)?

Diffuse axonal injury is the shearing (tearing) of the brain's long connecting
nerve fibers (axons) that happens when the brain is injured as it shifts and
rotates inside the bony skull. DAI usually causes coma and injury to many
different parts of the brain. The changes in the brain are often microscopic
and may not be evident on computed tomography (CT scan) or magnetic
resonance imaging (MRI) scans.
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Primary Brain Injury
Secondary Brain Injury
Primary brain injury refers to the sudden and profound injury to the brain that
is considered to be more or less complete at the time of impact. This happens at
the time of the car accident, gunshot wound, or fall.
Secondary brain injury refers to the changes that evolve over a period of hours
to days after the primary brain injury. It includes an entire series of steps or
stages of cellular, chemical, tissue, or blood vessel changes in the brain that
contribute to further destruction of brain tissue.

What causes a head injury?

There are many causes of head injury in children and adults. The most common
injuries are from motor vehicle accidents (where the person is either riding in
the car or is struck as a pedestrian), violence, falls, or as a result of shaking a
child (as seen in cases of child abuse).

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