Slide 1: The Spectrum of Brain Disorders
Neil Porter, MD Assistant Professor Department of Neurology University of Maryland
Slide 2: Case 1 – Phineas Gage
Slide 3: Phineas Gage
♦ Railroad foreman in 1848 ♦ Involved in an accident whereby a 3-foot
tamping iron was blown though his skull, landing 25 yards away.
Slide 4: Phineas Gage – Reconstruction
Slide 5: Phineas Gage
♦ Gage had no weakness but underwent a
personality change from solid and dependable to “fitful, irreverent and grossly profane”
Slide 6: Reconstruction of Gage Injury
The rod apparently injured both frontal lobes.
Slide 7: Conclusion
♦ The brain is an amazing and complex
instrument that is not well understood.
Slide 8: Goals and Objectives
♦ Goal: To gain an appreciation of the range
of disorders affecting the human brain ♦ Objectives
– To become familiar with categories of brain disorders – To become familiar with features of these various disorders – To learn about some specific examples of disorders in each category
Slide 9: Definitions
Slide 10: Neurology
♦ The study of the human nervous system
within medicine.
♦ Nervous System – Brain – Spinal Cord – Nerves
Slide 11: Neurologist
♦ A doctor trained in Neurology.
Slide 12: Tools of the Neurologist
♦ History
♦ Physical Exam
♦ “Laboratory Tests”
Slide 13: Categories of Brain Disorders
♦ Circulation problems (Strokes) ♦ Infections/Inflammatory conditions ♦ Tumors ♦ Seizures/epilepsy ♦ Trauma ♦ Chemical disorders ♦ Developmental disorders ♦ Degenerative disorders
Slide 14: Organization of the Talk
♦ For each category
– Features of each disorder – Types of disorders within each category – Case (example)
Slide 15: Circulation problems (Strokes)
♦ People with strokes suddenly lose function
such as walking, lifting or speaking due to poor circulation or bleeding into the brain.
Slide 16: Circulation problem: Types
♦ Stroke (poor circulation to part of the brain) – Blood clot – Bleed ♦ Poor circulation in general due to heart
attack or cardiac arrest
Slide 17: Circulation (Stroke): Case
One of my high school teachers suffered a stroke months ago, being left with rightsided weakness and loss of speech. He is slowly getting better with therapy.
Slide 18: Infections/Inflammation: Features
People with brain infections generally have fever, headache and confusion.
Slide 19: Infections/Inflammation: Types
♦ Infections – Meningitis (infected spinal fluid) – Encephalitis (infected brain) – Abscess (infected pocket within the brain) ♦ Inflammation (auto-immune) – Lupus
Slide 20: Infections/Inflammation: Case
A healthy 25 year-old engineer lost his ability to read over a period of months. He was found to have encephalitis, and over a treatment period of 2 years finally returned to normal.
Slide 21: Tumor Features
Tumor patients usually have worsening headaches, and possible weakness or numbness. Alternatively patients may come in with a seizure.
Slide 22: Tumor Types
♦ “Primary” – start in the brain – On the surface of the brain (meningiomas) – Inside the brain (gliomas) (like Kennedy) ♦ “Secondary” – travel to the brain – Metastatic cancer
Slide 23: Tumor: Case
♦ Teddy Kennedy recently had a seizure. He
was found to have a large brain tumor. He has received surgery and possible radiation and remains in the Senate.
Slide 24: Seizures/epilepsy: Features
♦ Epilepsy is the tendency to have seizures
(uncontrolled electrical brain activity). People with epilepsy may suddenly have staring spells or shaking spells or they may just “fall out.”
Slide 25: Seizures/epilepsy: Types
♦ Focal seizures (involve part of the brain) ♦ Generalized seizures (involve the whole
brain)
Slide 26: Seizures/epilepsy: Case
♦ A young girl started doing poorly in school.
Her teacher noted increased staring spells and less participation in class. She was found to have seizures and did fine after starting treatment.
Slide 27: Generalized seizure on EEG
Slide 28: Trauma: Features
♦ People in accidents may have sudden
problems (coma, confusion, amnesia) due to injury to their brains.
Slide 29: Trauma: Types
♦ Concussion (brain shock) ♦ Contusion (brain bruise) ♦ Bleed
Slide 30: Trauma: Case
♦ A 19 year-old girl was admitted to Shock-
Trauma after being involved in a car accident. She was in a coma for 3 weeks and then woke up after going to a rehab center. She is now home and back to work.
Slide 31: Chemical (metabolic): Features
♦ Chemical disturbances generally affect
people’s thinking, leading to confusion or sleepiness within a short period of time.
Slide 32: Chemical (metabolic): Types
♦ Salt imbalance (electrolyte imbalance) ♦ Hormone problems (glandular) ♦ Nutrition problems ♦ Medications ♦ Drug intoxications ♦ Poisoning
Slide 33: Chemical (metabolic): Case
A 60 year-old man with longstanding alcohol abuse is brought to the emergency room because he is agitated, confused and feeling that bugs are crawling on him.
Slide 34: Developmental Disorders: Features
♦ Children who are born with strokes, genetic
conditions, or infections can have problems with their development.
Slide 35: Developmental Disorder: Types
♦ Cerebral Palsy ♦ Mental retardation ♦ Autism
Slide 36: Developmental Disorder: Case
♦ A 4 year-old boy had problems getting
along with others at pre-school. He made poor eye contact and began getting upset when anyone disturbed the layout of his bedroom.
Slide 37: Degenerative Disorders: Features
♦ Degenerative conditions generally involve
the slow loss of skills such as thinking, walking over years
Slide 38: Degenerative Disorders: Types
♦ Alzheimer’s Disease ♦ Parkinson’s Disease ♦ Lou Gehrig’s Disease
Slide 39: Degenerative Disorder: Case
My father did masonry, tailoring, etc., until he began losing his memory at 66. He was eventually diagnosed with Alzheimer’s Disease. He slowly lost the ability to work, drive, and even talk, despite treatment.
Slide 40: Summary
♦ The brain is a wonderful organ! ♦ The brain is a complex organ! ♦ The brain is understandable. ♦ The brain is not well understood!
Slide 41: Questions and Comments?
