1. Anatomy and physiology of nervous system
Katrin Gross-Paju

2. Basis for understanding nervous system diseases
Neurological symptoms=location of brain damage
How do you determine the cause/disease?
Course
Acute onset
Progressive
Investigations
Visualisation
Anatomy
Modern possibilties
Neurophysiology
Genetic studies
Treatments

3. Diagnostic process – what brain region?
Symptoms
Signs

4. Brain and skull

5. Motor functions Voluntary movements Damage Weakness
Total weakness - paralysis
Very mild weakness - paresis

6. Movement coordination
Too little movements
Parkinson´ disease
Too many movements
involuntary
Taalamus
Nucl caudatus
Globus pallidus
Putamen
Subst nigra
Nucl ruber

7. Cerebellum: balance and coordination
Balance and coordination problems

8. Dominant hemisphere – speech problems

10. Autonomous nervous system

11. Autonomous nervous system:
III
VII, IX X S2 S4

12. Tilt test
Vähemalt 5 min enne testi algust lamada. Vaikne ruum. Sümptomite tekkimisel pt lastakse algasendisse. Vererõhku mõõdetakse lamades ja 1 minut peale püstitõusmist või vertikaliseerimist kraadise nurga alla. 1minutiga enamasti patsientidel kel ortostaasi talumatsu, tekib OH, aga edasine jälgimine aitab selgitada seisundi tõsidust – vererõhu edasist langust
Kui koos OH-ga esineb reflektoorne tahhükardia, siis ei saa välistada et OH on tekkinud sekundaarselt hüpovoleemia tõttu. Kui tahhükardiat ei ole, siis autonoomne häire

13. Postural ortostatic tachycardia syndrome

14. complaints

15. Paradoxical drop of blood pressure

16. Clinical symptoms
Older age
Falls
Dizzeness when standing

17. Methods of investigation

18. Complaints, signs, disease history

19. Disease by history
Headache

21. Computed tomography - CT
X-ray
Emergency situation

22. CT brain

23. Traumatic brain injury

24. Stroke – intracerebral hemorrhage
BROTT ET AL 1997 Yu Yl et al. Stroke 1992
Poungvarin N et al. NEJM 1987
Mendelow AD et al. Lancet 2005, MAYER ET AL 2005

25. Stroke – ischaemic strokeND

26. Magnet-resonance tomography
Magnetic field
1,5 T
3 T

28. Normal brain

29. Acute stroke
Flairis nähtamatu

30. Diagnosis: demyelinating disease
KT-s nähtamatu

31. Prognosis: Demyelinating diseases

32. EEG

33. Epilepsy

34. SPE(C)T – dopamine transporter
Diseases affecting dopamine transport

35. Impact of a neurological disease

36. Extensive brain damage – PML
JC virus induced brain damage in HIV

37. treatments Disease course modifying treatments (cure) Symptom control
Limited to autoimmune diseases
Symptom control
Parkinson`s disease
Genetic diseases
Exact cause – no treatment