Degenerative And Demyelinating Diseases Of The Nervous System

El Paso, TX. Chiropractor, Dr. Alexander Jimenez anotarisa degenerative uye kuderedza zvirwere zvehutachiona hwezvirwere, zvirwere, zvirwere uye kurapa.

Degenerative & Demyelinating Zvirwere

Motokari yeNeuron Diseases

• Motokari isina simba kunze kwekuchinja kwekunzwa
• Amyotrophic lateral sclerosis (ALS)
• ALS Variants
• Primary primary lateral sclerosis
• Progressive bulbar palsy
• Nhaka dzakagarwa dzinokonzera anterior runyanga cell degeneration
• Werdnig-Hoffmann chirwere mucheche
• Kugelberg-Welander chirwere muvana uye vaduku vakuru

Amyotrophic Lateral Sclerosis (ALS)

• Inobata varwere 40-60 yemakore emakore
• Kuparadza kune:
• Anterior horn cells
• Cranial nerve motor nuclei
• Corticobulbar uye maturakiti e corticospinal
• Nhamba yepamusoro yemotokari yegeuroni (atrophy, fasciculations) NEpamusoro motokari yeuroni inowanikwa (spasticity, hyperreflexia)
• Survival ~ makore matatu
• Rufu runokonzerwa nekushaya simba kwebhururi uye kufema kwemapfupa uye hutachiona hunotapukira

ALS Variants

• Kazhinji kacho zvinozopedzisira zvava kuchinja kuAlS pattern
• Primary Lateral Sclerosis
• Musoro wepamusoro motokari yeururoni inotanga kutanga, asi varwere vanozopedzisira vava nechepasi motokari neuron zviratidzo zvakare
• Kupona kunogona kuva makore gumi kana kupfuura
• Progressive Bulbar Palsy
• Kusarudzwa kunosanganisira musoro nemutsipa

Inherited Motor Neuron Conditions

• Anterior horn cell degeneration
• Werdnig-Hoffmann chirwere
• Inobata vacheche
• Kugelberg-Welander chirwere
• Inobata vana nevakuru vechidiki

Chechi, Archibald. Kutya uye Kuora Mwoyo. WB Saunders Co., 1923.

Alzheimer's Disease

• Inoratidzirwa nehutachiona hwehutachiona (zvikamu zve hyperphosphorylated tau protein) & beta-amyloid plaques
• Kazhinji zvinoitika mushure mezera re 65
• Hereditary risk factors
• Kuchinja-chinja mu beta amyloid gene
• Epsilon 4 version ye apolipoprotein

kuongorora chirwere

• Pathologic diagnosis ndiyo nzira chete yekunyatsoongorora chirwere chacho
• Kufananidza kunogona kukwanisa kukonzera zvimwe zvinokonzera dhementia
• Zvidzidzo zvekufungidzira zvinoshandiswa zvinogona kuwedzerwa kugadziriswa kuti zviongororwe zvinobatsira mune ramangwana
• Chirongwa cheCSF kuongorora maitiro emapurotini uye beta amyloid inogona kuva yakakosha sekuongororwa mutsva munguva yemberi

Amyloid Zvibodzwa & Neurofibrillary Tangles

sage.buckinstitute.org/wp-content/uploads/2015/01/plaque-tanglesRNO.jpg

Nzvimbo dzeBongo Dzinobatwa neAlzheimer's Disease

• Hippocampus

• Kurasikirwa kwekuyeuka kwezvino

• Posterior temporo-parietal association nzvimbo

• Nyoro anomia & kuvaka apraxia

• Nucleus basalis yaMeynert (cholinergic neurons)

• Kuchinja mukuona maonero

Kufambira mberi

• Sezvo nzvimbo dzakawanda dzekortical dzichibatanidzwa, murwere acharamba achinyanyisa kushaya njere, asi paresis, kurashikirwa kwezvinhu, kana kuonekwa kwemafupa aripo.

Treatment Options

• Mishonga inhibit central central nervous system acetylcholinesterase

• Donepezil
• Galantamine
• Rivastigmine

• Aerobic Exercise, 30 maminitsi zuva nezuva

• PT / OT kuchengetedza mabasa ehupenyu hwezuva nezuva

• Antioxidant uye anti-inflammatory therapies
• Muchikwata chepamusoro, zvingada nguva yakazara, mumusha wekutarisira

Vascular Dementia

• Cerebral arteriosclerosis inotungamirira kune chirwere
• Mwoyo murefu uchave wakanyora zvinyorwa zvepfungwa kana zviratidzo zvekurwadziwa (spasticity, paresis, pseudobulbar palsies, aphasia)
• Inogona kubatanidzwa neAlzheimer's disease kana zvichienderana ne-amyloid angiopathy

Frontotemporal Dementia (Hosha ye Pick)

• Familial

• Inosangana nechemberi uye nguva dzemulobes

• Inogona kuonekwa pamafungidziro kana kufambira mberi kunowanikwa munzvimbo idzi

• zviratidzo

• Kusateerera

• Unhu hwakashata

• Kushungurudzika
• Kushamwaridzana nemafambiro asina kunaka
• Kushushikana

• Matambudziko emutauro

• Kazhinji hapana chiyeuchidzo kana nzvimbo dzakaoma

• Pathology inoratidza miviri ye Pick mukati me-neurons

• Migumisiro mukufa mu 2-10 makore

Sarudza Bodies / Cytoplasmic Inclusions

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mabatiro

• Antidepressants

• Sertraline
• Citalopram

• Rambai mishonga inogona kukonzera kuora mwoyo kwepfungwa kana kuvhiringidzika

• Sedatives
• Benzodiazepines

• kusimbisa muviri

• Lifestyle modification
• Kuchinja maitiro therapy

Parkinson Disease

• Inogona kuitika chero ipi zvayo, asi ishoma vasati yava nemakore 30, uye inowedzera kuwanda kunowedzera kune vanhu vakura

• Unyanzvi hwekuzvarwa asi hunogonawo kunze kwemhuri

• Inogona kukanganiswa nezvimwe zviitiko zvezvakatipoteredza

• Kubudisa 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)
• Mishonga inobereka zvinodhaka zvakanyanya radicals

• Inobata zvinyorwa zvinyorwa zvinyorwa

• Dopaminergic neurons

• Pazvirwere, kuvapo kweLeby Bodies

• Kuunganidza alpha-synuclein

Lewy Bodies

scienceofpd.files.wordpress.com/2017/05/9-lb2.jpg

Zviratidzo zvePasinsinism

• Rigidity (dzose ndege)

• Passive ROM
• Kushingaira kushingaira
• Ive iine cogwheel zvakasikwa nekuda kwekudengenyeka kwezviratidzo

• Bradykinesia

• Kuderera kwekufamba
• Kusakwanisa kutanga kufamba
• Kusununguka

• Kuzorora kudedera (illpill-rolling )

• Yakasikwa nekuscillation kwemasimba emasimba anorwisana

• Postural defects

• Anteriorly flexed (yakakotama) kugadziriswa
• Kusakwanisa kubhadhara zvinokanganisa, zvichikonzera kugadziriswa

• Mask-kufanana nemaitiro

• Dambudziko rekushaya utano hwemwoyo

• Gare gare mukufambira mberi, nekuda kwechimiro chakaipa kuunganidza

Pathology

• Kushayikwa kweDopamine mu striatum (caudate uye putamen) yebasal ganglia

• Dopamine inowanzova nemigumisiro yekukurudzira denderedzwa yakananga kuburikidza nebhasal ganglia, nekudzivisa nzira isina kukodzera

Carbidopa / Levodopa

• Kunyanya kurapwa kwakajairika ndeyomushonga unobatana

• Levodopa

• A dopamine anopandukira anoyambuka ropa-uropi hunopesana

• Carbidopa

• Dopamine decarboxylase inhibitor iyo isingayambuki BBB
• Amino acids ichaderedza kubudirira (kukwikwidza) saka mishonga inofanira kubviswa kubva pamaprotini

Kurapwa kwenguva refu neCarbidopa / Levodopa

• Simba remurwere rekuchengetedza dopamine rinodzikira nekushandisa mishonga uye nekudaro kuvandudzwa kubva kumishonga kunogara kwenguva pfupi uye ipfupi nguva iyo mushonga unoshandiswa

• Nokufamba kwenguva zvinogona kukonzera kupararira kweiyo dopamine receptors

• Peak-dose dyskinesia

• Kushandiswa kwenguva refu kwenguva inoshungurudza pachiropa

• Mimwe migumisiro inogona kusanganisira kunyorera, hypotension uye kukonzera

Other Treatment Options

• Mishonga

• Anticholinergics
• Dopamine agonists
• Dopanime breakdown inhibitors (Monoamine oxidase kana catechol-O-methyl transfase inhibitors)
• High dose glutathione

• Kuchengetedza ubongo zvinoshanda neuro-rehab maitiro

• Vibration
• Retropulsive stimulation
• Kudzokorora reflex kukurudzira
• Targeted CMT / OMT

Multiple System Atrophy

• Zviratidzo zvePalinson Disease zvakabatanidzwa nechimwe kana zvinotevera zvinotevera:

• Pyramidal zviratidzo (Striatonigral degeneration)
• Autonomic dysfunction (ShyDrager syndrome)
• Cerebellar kuwana (Olivopontocerebellar atrophy)

• Kazhinji hazviiti zvinoenderana nehutachiona hwePalinson Disease

Progressive Supranuclear Palsy

• Kufambira mberi kunofambira mberi kunosanganisira tau mapuroteni munzvimbo dzakawanda kusanganisira rostral midbrain

• Zviratidzo zvinowanzotanga kusvika kumakore 50-60

• Gait difficulty

• Inokosha dysarthria

• Voluntary vertical gaze rakaoma

• Retrocollis (kukurumidza kuwedzera kwemutsipa)

• Yakanyanya dysphagia

• Emotional lability

• Unhu hunochinja

• Kuziva njodzi

• Hazvipindure zvakanaka kumushonga wep PD

Kuparadzanisa Lewy Muviri Wezvirwere

• Kufambira mberi kwemagariro evanhu
• Kukurukurirana kwakanyanyisa uye kukanganisa kunokanganisa
• Kusanganiswa
• Parkinsonian zviratidzo

nemultiple sclerosis

• Multiple machena mutsara mutsara (makanda ekutsvaira mvura) muCNS

• Inoshandiswa muhukuru
• Zvakanaka-cirscribed
• Visible paMRI

• Maziso emagetsi anowanzoonekwa

• Nzira dzeropa dzinenge dzisingabatanidzwi

• Kazhinji kune vana vari pasi peCNUMX, asi kazhinji inopa vasati vava nemakore 10

• Utachiona hunokonzerwa nehutachiona hunoita kuti mutezo wemuviri unofanirwa nehutachiona husingazivikanwi nehutachiona-myelin antigen

• Zvirwere zvinotapukira uye zvekudzivirira zvirwere zvinobatsira

Mhando dze MS

• Primary PR progressive MS (PPMS)

• Secondary progressive MS (SPMS)

• Kudzokorora kunokwana multiple sclerasis (RRMS)

• Nyaya inowanzozivikanwa
• Inogona kukura zvakasimba, zvisingabvumirwi sezviri kugadzirisa uye kudzoka
• Pakupedzisira inova seSPMS

Optic Nerve Kubatanidzwa

• Mu 40% yematambudziko emu MS

• Pain uye maziso omeso

• Kutarisa kusvibiswa mumunda (central kana paracentral scotoma)

• Funduscopic kuongorora

• Ngaratidze papilledema kana ibwe rinosanganisira optic disk
• Ngaparege kuonekwa isingaiti kana mapepa ari shure kwe optic disk (retrobulbar neuritis)

Medial Longitudinal Fasciculus Kubatanidzwa

• Kuodzwa mwoyo kweMLF kunobata mukati mekuchengetedzeka kwechirimbuzi ophthalmoplegia

• Munguva yekutarisa kwepamusoro pane peresis yemirairo yepakati uye nystagmus yemaziso akasiyana

• Convergence inoramba ichitsvaga

Zvimwe Zvingaita MS Symptoms

• Myelopathy

• Spastic hemiparesis
• Matambudziko ane manzwiro ematurakiti (DC-ML)
• Paresthesias

• Cerebellar kubatanidzwa

• Ataxia
• Dysarthria

• Vestibular system inobatanidza

• Kusanzwisisa
• Mild vertigo
• Nystagmus

• Tic douloureux (trigeminal neuralgia)

• Lhermitte chiratidzo

• Kupfura kana kutinhira kunotaridzwa kunonzi trunk uye nhengo pamutsipa wehove
• Kuneta
• Kushamba kutsva kunowedzera zviratidzo

Kusiyana Kwokufunga

• Multiple emboli uye vasculitis

• Inogona kuonekwa sechinhu chakachena chena pamutemo weMRI

• Central nervous system sarcoidosis

• Inogona kubvisa reversible optic neuritis nedzimwe zviratidzo zveCNS

• Whipple chirwere

• Zvirwere zvinopisa
• Kuita maziso omeso

• Vitamini B12 kukwana

• Dementia
• Spasticity
• Dorsal column

• Maningovascular syphilis

• Multifocal CNS kukuvadza

• CNS chirwere cheLyme

• Multifocal chirwere

Kusiyanisa Kuongororwa: Kuongorora Kuongorora

• Kuyera ropa kunogona kubatsira kusiyanisa

• Kuzara ropa kuverenga
• Antinuclear antibodies (ANA)
• Serum muedzo we syphilis (RPR, VDRL, nezvimwewo)
• Fluorescent treponemal antibody test
• Lyme titer
• ESR
• Angiotensin inoshandura enzyme level (kusvika r / o sarcoidosis)

Diagnostic Studies Of MS

• MRI uye uye pasina kusiyana

• 90% yematambudziko eSMS akaoneka MRI yakawanikwa

• CSF zvakawanikwa

• Kurema kwemononuclear white blood cells
• Oligoclonal IgG bands

• Kuwedzera globulin kuhuwandu hwe albumin

• Izvi zvinoonekwawo mu 90% yematambudziko emu MS

• Kuwedzera myelin maitiro emuprotein mazinga

Prognosis

• Avhareji kupona mushure mekuongororwa i ~ 15 kune 20 gore
• Rufu runowanzobva kune hutachiona hwepamusoro uye kwete nekuda kwemigumisiro yechirwere pachayo

Sources

Alexander G. Reeves, A. & Swenson, R. Kukanganiswa kweNervous System. Dartmouth, 2004.
Swenson, R. Degenerative Diseases of the Nervous System. 2010.