12.CNS Diseases patology of nervous system.pptx

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1. Arsi university Health science college 1 Central Nervous System Disorders Birhanu F. (Medical Doctor,MPH,Lecturer )

2. 2 Seizure and epilepsy

3. Definitions 3

4. … 4 Epilepsy - Recurrent seizures due to chronic underlying process -ILAE: Two or more unprovoked seizure due to chronic underlying process.

5. Active epilepsy: At least one seizure in the previous 5 years Epilepsy in remission: No seizure in the previous 5 years. 5

6. Epidemiology Overall prevalence =5-10 person /1000 Incidence=0.3-0.5% In USA 120, 000 new cases per year 5-10% of pop. once in life Sex: Male: Female=1.5:1 Age: -Bimodal distribution-Childhood and late adulthood -Childhood absence and epilepsy remits as patient gets older 6

7. Classification of Seizures Importance Focused diagnostic approach for etiology Appropriate treatment Prognosis International League Against Epilepsy (1981): - based on Clinical Feature & EEG. Partial (focal) Seizure :- Seizure activity restricted to discrete areas of the cerebral cortex. - cause is usually structural. Generalized Seizures:- - simultaneously involve diffuse regions of the brain. - cellular, biochemical, or structural. 7

8. Table 360-1. Classification of Seizures 1. Partial seizures a. Simple partial seizures (with motor, sensory, autonomic, or psychic signs) b. Complex partial seizures c. Partial seizures with secondary generalization 2. Primarily generalized seizures a. Absence (petit mal) b. Tonic- clonic (grand mal) c. Tonic d. Atonic e. Myoclonic 3. Unclassified seizures a. Neonatal seizures b. Infantile spasms C ) Febrile seizure 8

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10. 1.Partial seizure Accounts 70% of seizure in adults(40% in children) A partial seizure is epileptic activity confined to one area of cortex with a recognizable clinical pattern. Either remains focal or spreads to generate epileptic activity (secondary generalization) The focal onset of a seizure may not be clinically evident 10

11. Partial seizure… A. Simple partial seizure Preserves consciousness B. Complex partial seizure Loss of consciousness is characteristic C. Partial seizure with secondary generalization Mistaken for primary generalized seizure Focus is usually frontal lobe EEG to establish the diagnosis Treatment is different for both primary and secondary generalized 11

12. 2. Generalized seizure ► Bilateral clinical & EEG events, no focal onset. a. GTC (Grand mal) seizure Main seizure type-10% of all epilepsy Common seizure type in metabolic derangements No aura : Vague premonitory symptoms-hours before Tonic- clonic activity usually symmetric Strained cry Cyanosis- common 12

13. … GTC seizure 13

14. … b. Absence (petit mal) Brief loss of consciousness-seconds No loss of postural muscle control No post ictal confusion Motor manifestation: Bilateral blinking of eye lids Chewing movements Clonic movement of the hands Coexist with GTC or myoclonic May occur hundreds of times a day Main seizure type in children (4-8 year) Accounts for 15-20% First clue-day dreaming or decreased school performance 14

15. Petit mal Vs Grand mal seizure 15

16. 16 Meningitis

17. Meningitis 17 Inflammation of leptomeninges. Etiologies Microorganisms Chemical Carcinomatous …

18. Pyogenic Meningitis 18 Bacterial meningitis : is an acute purulent infection within the subarachnoid space. Meningoencephalitis : meninges, the subarachnoid space, and the brain parenchyma are all frequently involved in the inflammatory reaction

19. Pyogenic… 19 Currently, the organisms most commonly responsible for community-acquired bacterial meningitis are: Streptococcus pneumonia (~50%), N. meningitides (~25%), group B streptococci (~15%), and Listeria monocytogenes (~10%). H. influenza now accounts for <10% of cases of bacterial meningitis in most series

20. .. Pneumococcal meningitis S.pneumoniea is the most common cause of meningitis in adults >20 years of age, accounting for nearly half the reported cases. Predisposing conditions:- pneumococcal pneumonia acute or chronic sinusitis otitis media, alcoholism diabetes splenectomy head trauma with basilar skull fracture and CSF rhinorrhea. Mortality remains ~20% despite antibiotic therapy. 20

21. Clinical Presentation Classic clinical triad of meningitis is fever, headache, and nuchal rigidity. Decreased level of consciousness occurs in >75% of patients and can vary from lethargy to coma. Nausea, vomiting, and photophobia are also common complaints. 21

22. Diagnosis Examination of the CSF . Blood culture . 22

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24. Differential Diagnosis of ABM 24 Viral meningoencephalitis Subdural and epidural empyema Brain abscess Subarachnoid hemorrhage Chemical meningitis

25. Prognosis… Common sequelae include:- - Decreased intellectual function, - Memory impairment, - Seizures, - Hearing loss and Dizziness, and - Gait disturbances. - blindness 25

26. Treatment of ABM 26 Supportive management - maintenance fluid, antipyretic, analgesic. Empirical Antimicrobial therapy Adjunctive therapy

27. The END!!! 27 THANK YOU!