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Toxoplasmosis
Parasite in rat intestines, cat eats rat, cat poop, parasite now in cat poop
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Neoplasms of the Central Nervous System (definition of a neoplasm)
- Tumors that originate within the CNS, malignant or benign, can lead to serious complications, even death, as a result of compression of vital structures
- *Any kind of tumor in brain can be deadly
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Astrocytomas
- Most common tumor occuring in adults
- Most aggressive & malignant with death usually occuring 1 year after diagnosis
- Found most often between 40-60 years of age
- Come from astrocytes
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Glioblastoma
is the most common type of astrocytoma
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Astrocytes
are responsible for the blood/brain barrier
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Oligodendrogliomas
- Rare with a good prognosis
- Occur within cerebral hemisphere
- In adults ages 30 to 50
- Grows slow & often presents with seizures
- Are responsible for myelin production
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Ependymomas
- uncommon
- occuring at all ages
- low grade, slow, malignant tumor that can spread through the CSF
- triggers hydrocephalus secondary to obstruction of the 4th ventricle
- ependymal cells are responsible for circulation of CSF
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Meningiomas
- occur in any age, most often in middle aged women (2:1)
- an encapsulated tumor that arises outside the brain substance & attaches to dura
- typically benign, found along the external surfaces of the brain & within the ventricles
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Multiple Sclerosis (MS)
- most common demyelingating disease of the CNS
- most likely an autoimmune disease
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MS Incidence
- geographical residence 1/1000 in the U.S.
- 2:1 females to males
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MS pathology
relapsing & remitting disease; the incomplete recovery from each episode leads to a progressive deterioration
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MS Structural Alterations
Inflammatory reaction with poor resolution, incomplete remyelination, forming the chronic plaque
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MS Clincal Manifestations
manifestitions include: paresthesias, spasticity, gait abnormalities, and speech problems
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MS Prognosis
average life expectancy 20-30 years after diagnosis
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Massage for MS (FYI)
- massage can be really helpful
- their symptoms can change, take note of what type of massage (relax, stiff joints etc.)
- avoid contrast treatments
- shorter sessions
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Dementia
- is not part of normal aging
- loss of cognitive function
- causes can be not enough stimulation
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Alzheimer's Disease
- Unknown etiology
- most common cause of dementia
- lose chunks of brain tissue
- 3% of ages 66-74, 19% of ages 75-84, 47% of ages >85
- 2:1 female to male
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Alzheimer's Disease Pathology
- characterized by plaques (heuritic) & tangles (neurofibrillary)
- there is a cortical atrophy & a widening of the venticles
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Alzheimer's Disease Functional Significance
- Progressive impairment of memory and other cognitive features over 5-15 years
- forgetfulness
- memory loss
- speech difficulties
- leading ultimately to dementia
- incontinence
- loss of speech
- the ability to walk
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FYI Massaging Client with Alzheimer's
- Informed Consent by someone they know
- Having that person there with them, in case they can't remember why you are working on them
- relaxation massage
- be cautious of bed sores
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Parkinsonism
- Depigmentation of the substantia nigra with loss of neurons
- 2% of population in N. America, affecting more men than women
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Parkinsonims functional significance
- Disturbance of motor functions:
- rigidity
- expressionless faces
- stooped posture
- gait disturbances
- slowing of voluntary movements
- characteristic pill rolling tremor
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Massage for Parkinsonism FYI
- Helps to lengthen flexors
- good position is prone to counteract flexion
- rhythmic & repeatative strokes help brake up px cycle
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Huntington's Disease
- disorder involving the extrapyramidal motor system (controls motor activities associated with maintaing balance & posture)
- characterized by involuntary writhing movements (choreal) and demetia
- not apparent until adulthood between the ages 40-50
- relentless progression
- death occurring within 15 years at onset
- cognitive & emotional disturbances precede onset of abnormal movements
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Huntington's Disease Functional Significance
- eventually incapsulated by movements with a severe loss of cognitive function & deteroration of intellect.
- paranoia & delusions are often present
- increased risk of suicide
- infections the most common cause of natural death
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FYI Massage for Huntington's Disease
Work closely with a physician
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Amyotrophic Lateral Sclerosis (ALS) aka Lou Gehrigs Disease
- Unknown etiology
- a progressive, degenerative disorder of the pyramidal system (control skeletal muscle movements)
- 5-10% of cases familial
- relentless progression
- begins as weakness of the hands & clumsiness
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Amytrophic Lateral Sclerosis Functional Significance
- median survival 5 yrs
- death comes secondary to respiratory insufficiency
- cognitive function often preserved throughout the course of the disease
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Acquired Metabolic Deficiences
- Thiamine Deficiency (vitamin B1)
- B12 Deficiency
- Carbon Monoxide
- Ethanol
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Thiamine Deficiency (Vitamin B1)
- Development of abrupt psychotic symptoms
- usually associated with alcoholism (alcohol interferes with metabolism)
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FYI Subcategory of thiamine deficiency : Wernicke encephalopathy
fairly rapid onset of confusion, ataxia
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FYI Subcategory of thiamine deficiency : Korsakoff syndrome
permanent memory deficit
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B12 Deficiency
- severe & irreversible injury within the nervous system
- sensory & motor problems with lower extremities, may ultimately lead to paraplegia
- *vegetarians, vegans etc need to be super careful
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Carbon Monoxide
Hypoxia
- CO gets "stuck" on red blood cell, replacing O2
- exhaust fumes
- severe cases - blood transfusion
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Ethanol (alcohol)
- directly toxic to CNS tissue
- chronic alcohol abuse leads to irreversible injury
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The Purpose of Pain
Possible Essay Question
- Pain is primarly a protective mechanism meant to bring to conscious awareness the fact that tissue damage is occurring
- accompanied by motivated behavioral responses (such as withdrawal or defense)
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Pain Receptors (3)
- 1. Mechanical nociceptors: respond to mechanical damage such as cutting, crushing, or pinching
- 2. Thermal nociceptors: respond to temperature extremes, esp heat
- 3. Polymodal nociceptors: respond equally to all kinds of damaging stimuli, including irritating chemicals released from injured tissues
- They are all naked nerve endings
- Do not adapt to sustained or repetitive stimulation
- all other nociceptors can be sensitized by the presence of prostaglandins
- FYI: pain medication makes sensor to brain become smaller
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The Brain's Opiate System
- endorphins & enkephalins - neurotransmitters involved with pre and post synaptic px inhibition for up to hrs after release
- multiple receptor sites within the brain and can partially or totally suppress many px signals entering through the peripheral nervous system.
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Types of Pain
- Fast Pain: felt within 0.1 seconds after stimulus. Described as sharp, acute, electric, and stays within the skin.
- Slow Pain: felt 1+ seconds after stimulus and grows slowly for up to several minutes. Described as burning, aching, throbbing, nauseating and involves tissue destruction.
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Mechanism of Referral Pain
- Px felt @ site separate from the tissue causing px
- Px initiated @ visceral organ is referred to an area of the body surface. Important in clinical diagnosis.
- Branches of px fibers from the viscera (organs) synapse in the spinal cord with the same neurons that receive px from the skin.
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Causes of true visceral px
- Ischemia
- Chemical Stimuli
- Spasm of a hollow viscus
- Over distention of a hollow viscus
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Ischemia
- lack of blood flow
- leads to px of the viscera in the same way it works in other areas of the body, the acidic metabolic end products
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Spasm of hollow viscus
mechanical stimulation of px fibers leads to ischemia & cramps
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Over distension of a hollow viscus
extreme overfilling leads to collapse of blood vessels and ischemia
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Headache of the Intracranial Origin
- the brain itelf is almost insensitive to px
- stretching dura at the base of the brain can lead to a headache
- any trauma, stretching, crushing of blood vessels of the meninges and brain lead to px
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Headache of Meningitis
- most severe of all headaches
- inflammation of the meninges and the venous sinuses
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Headache Caused by Low CSF Pressure
brain no longer floats causing the weight of the brain to stretch and distort the dural surfaces
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Migraine headache
- vascular problems
- begins with various prodromal sensations including: nausea, partial loss of vision, visual aura, and other types of sensory hallucinations (sensitive to light, sound, smell etc.)
- prodomal symptoms usually begin 1/2 to 1 hr before the headache
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Alcoholic headache
- result of alcohol
- directly toxic to tissues
- directly irritating the meninges
- dehydration factor
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Tension headache
- most common
- contraction of neck and scalp muscles often as a result of stress, depression and anxiety
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Cluster headaches
- affect one side of the head
- occur in clusters, often at the same time of day, every day for weeks
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Stress
a change in the environment that is preceived as a threat, challenge, or harm to the person's sense of balance
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Relaxation Therapy
(Possible Essay)
Breathing
Muscle Relaxation
Autogenic training
Guided imagery
Distraction
- Breathing: simple technique, breath slow & deep while avoiding hyperventilation
- Muscle Relaxation: progressively tense & relax muscle groups until body feels relaxed
- Autogenic training: replace painful or unpleasant sensations with pleasant ones through autosuggestion
- Guided Imagery: Take a mental vacation
- Distraction: use your own interests & activies to divert attention
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