6 8.6 Disorders of the Nervous System and Sense Organs

Disorders of the Nervous System and Sense Organs^[1]

Age-Related Macular Degeneration^[2]

Age-related macular degeneration (AMD) is an eye disease that can blur central vision. It happens when aging causes damage to the macula — the part of the eye that controls sharp, straight-ahead vision. The macula is part of the retina (the light-sensitive tissue at the back of the eye). AMD is a common condition — it’s a leading cause of vision loss for older adults. AMD doesn’t cause complete blindness, but losing central vision can make it harder to see faces, read, drive, or do close-up work like cooking or fixing things around the house. AMD progresses very slowly in some people and faster in others. People with early AMD may not notice vision loss for a long time, so regular eye exams are important. See Figure 8.6 for a simulated image of central vision loss in a person with macular degeneration compared to Figure 8.6a of a simulated image of normal vision.

Figure 8.6. Macular Degeneration (“Eye disease simulation, age-related macular degeneration.jpg” by National Eye Institute, National Institutes of Health is in the Public Domain)

Figure 8.6a Simulated Image of Normal Vision (https://commons.wikimedia.org/wiki/File:Eye_disease_simulation,_normal_vision.jpg)

Alzheimer’s Disease^[3]

Alzheimer’s disease is a type of dementia, a progressive brain disorder that slowly destroys memory and thinking skills, and eventually, the ability to carry out the simplest tasks. Alzheimer’s is the seventh leading cause of death in the United States and more than 6 million Americans, most of them age 65 or older, have Alzheimer’s disease. The risk for developing Alzheimer’s disease increases as a person ages, with people over age 85 at highest risk. Alzheimer’s disease causes abnormal buildup of proteins that form amyloid plaques and tau tangles that damage neurons and impair communication between neurons, which results in brain shrinkage. See Figure 8.6b for an illustration of a healthy brain compared with the brain of a person with severe Alzheimer’s disease. Early symptoms of Alzheimer’s disease include short-term memory loss, wandering and getting lost, trouble handling money and paying bills, repeatedly asking the same questions, and changes in personality and behavior. There is no cure for Alzheimer’s disease, but medications can help slow the progression of the disease.

Figure 8.6b. Comparison of a Healthy Brain with a Brain With Severe Alzheimer’s Disease (Source: https://www.nia.nih.gov/health/alzheimers-and-dementia/alzheimers-disease-fact-sheet

A: “Healthy_Brain_and_Severe_AD_Brain_(24239522109)” by National Institute on Aging, National Institutes of Health is in the Public Domain

Anosmia

Anosmia is the loss of the sense of smell that can be caused by many viral respiratory illnesses or the result of the olfactory nerve being severed, usually due to blunt force trauma to the head. The sensory neurons of the olfactory epithelium have a limited life span of approximately one to four months, and new ones are made on a regular basis. The ability of these neurons to be replaced is lost with age. Age-related anosmia is not the result of impact trauma to the head, but rather a slow loss of the sensory neurons with no new neurons formed to replace them. As the replacement of olfactory neurons declines with age, anosmia can set in. Without the sense of smell, many sufferers complain of food tasting bland. Often, the only way to enjoy food is to add seasoning that can be sensed on the tongue, which usually means adding table salt. The problem with this, however, is that this increases sodium intake, which can lead to cardiovascular problems through water retention and the associated increase in blood pressure.

Anxiety^[4]

Everyone can feel anxious at times, but people with anxiety disorders often experience fear and worry that is both intense and excessive. These feelings are typically accompanied by physical tension and other behavioral and cognitive symptoms. These symptoms can cause significant distress and interfere with daily activities such as family life, social interactions, and school or work. An estimated 4% of the global population currently experiences an anxiety disorder, making anxiety disorders the most common of all mental disorders. Although effective treatments for anxiety disorders exist, only about one in four people with anxiety receive treatment because of barriers to care. Barriers to care include lack of awareness that anxiety is a treatable health condition, lack of investment in mental health services, lack of trained health care providers, and social stigma.

Ataxia

Ataxia is a neurological condition characterized by the loss of muscle control, resulting in difficulties with balance, coordination, and movement. Ataxia is often the result of exposure to external substances, focal lesions, or a genetic disorder. Focal lesions include strokes affecting the cerebellar arteries, tumors that may impinge on the cerebellum, trauma to the back of the head and neck, or multiple sclerosis. Alcohol intoxication or drugs such as ketamine can cause ataxia that is typically reversible. Mercury in fish can cause ataxia as well. Hereditary conditions can lead to degeneration of the cerebellum or spinal cord, as well as malformation of the brain, or the abnormal accumulation of copper seen in Wilson’s disease.

Bell’s Palsy^[5]

Bell's palsy is a neurological disorder that causes paralysis or weakness on one side of the face. Bell’s palsy results from a problem in the seventh cranial nerve, also called the facial nerve, which connects the brain to the muscles that control facial expression. The seventh cranial nerve also affects taste and ear sensation.^[6] Bell’s palsy is the most common cause of facial paralysis. Symptoms of Bell’s palsy include sudden weakness or paralysis on one side of the face, a drooping eyebrow and mouth, and drooling from one side of the mouth and difficulty closing one eyelid, which causes eye dryness. Most often these symptoms lead to significant facial distortions. See Figure 8.6c for an image of a person with Bell’s palsy.

Figure 8.6c. Bell’s Palsy (Source: https://commons.wikimedia.org/wiki/File:Bellspalsy.JPG )

A: “Bellspalsy” by James Heilman, MD is licensed under CC BY-SA 3.0

People living with Bell’s palsy also may develop facial pain or abnormal sensations, excessive tears in one eye, problems with taste, sensitivity to loud noises, pain around the jaw and behind the ear, and/or problems eating or drinking. In rare cases, Bell’s palsy can affect both sides of the face. Symptoms appear suddenly over a 48- to 72-hour period and generally begin to improve after a few weeks. The symptoms vary from person to person and can be mild to severe. People with Bell’s palsy usually recover some or all facial function within a few weeks to six months. Sometimes, facial weakness may last longer or be permanent.

Cataract^[7]

A cataract results when the lens of the eye or its attached membrane becomes cloudy or opaque due to the breakdown of proteins in the lens. When this occurs, light has difficulty passing through the lens and cannot focus on the retina. See Figure 8.6d for an image of cloudy lens that occurs in people with cataracts.

Figure 8.6d. Cloudy Lens in Bilateral Cataracts (Source: https://live.staticflickr.com/8233/8407832849_861cc82e5e_b.jpg)

Although cataracts primarily affect older adults, it can affect those of all ages. In younger clients, cataract development is often associated with trauma to the eye. Other than age, other risk factors for the development of a cataract are dietary deficiencies, the use of alcohol or tobacco, the presence of diabetes mellitus, or other ocular disorders such as glaucoma.

One eye or both can be affected, and severity of vision loss can vary. However, a cataract is a progressive disease that will eventually lead to blindness once the cataract matures (the lens of the eye becomes completely obscured). See Figure 8.6e for a simulated image of blurred vision of a person with cataracts.

Figure 8.6e. Cataracts

https://commons.wikimedia.org/wiki/File:Eye_disease_simulation,_cataract.jpg

Other signs and symptoms that may be present depending on cataract severity are as follows:

• Decreased visual acuity
• Blurred and/or double vision
• Rainbow colored halos seen around objects
• Increased effects of glare (from headlights or sunlight) on vision
• Changes in color vision in which objects appear faded or yellowish
• Visible clouding of the lens

Treatment of a cataract depends on the severity of the disorder. In early stages, treatment may consist of corrective lenses and/or medications, but once the opacity of the cataract starts to interfere with activities of daily living, surgery is usually recommended.

Color Blindness^[8]

The content in this section is adapted from the American Academy of Ophthalmology.

Color blindness, also known as color deficiency, is when colors are seen abnormally. Color blindness is usually a genetic condition that is present at birth in which cones in the retina are completely or partially absent. Color blindness can also be acquired from trauma to the eye and is also associated with specific disorders such as alcoholism and diabetes.

Symptoms can range in severity and include the following:

• Issues with seeing colors or color brightness
• Inability to distinguish between similar shades of colors such as red and green or blue and yellow
• Difficulty learning colors in children

Color blindness can be diagnosed by a test where clients are shown patterns consisting of dots in a variety of colors. Clients with color blindness are unable to decipher the number or shape that is present in the dots. See Figure 8.6f for an example of this type of test.

Figure 8.6f. Test Used to Diagnose Color Blindness (Source: https://upload.wikimedia.org/wikipedia/commons/thumb/b/b1/Ishihara_9.svg/640px-Ishihara_9.svg.png)

A: “Ishihara_9” a derivative work by Pbrks is in the Public Domain.

Congenital color blindness cannot be cured. However, special lenses are available to help the client distinguish colors. If color blindness is an acquired condition, treating the underlying condition may improve color vision.

Concussion^[9]

A concussion is a mild traumatic brain injury that affects brain function. Effects are often short term and can include headaches and trouble with concentration, memory, balance, mood and sleep. Concussions usually are caused by an impact to the head or body that is associated with a change in brain function. Not everyone who experiences a blow to the body or head has a concussion. Some concussions cause the person to lose consciousness, but most do not. Falls are the most common cause of concussions. Concussions also are common among athletes who play a contact sport, such as football or soccer. Most people recover fully after a concussion.

Deafness^[10]

Hearing loss affects people of all ages and can be caused by many different factors. The three basic categories of hearing loss are sensorineural hearing loss; conductive hearing loss; and mixed hearing loss, which is a combination of both types:

Sensorineural Hearing Loss: Sensorineural hearing loss occurs when the inner ear or the vestibulocochlear nerve becomes damaged. This loss generally occurs when some of the hair cells within the cochlea are damaged. Sensorineural loss is the most common type of hearing loss. It can be a result of aging, exposure to loud noise, injury, disease, certain drugs, or an inherited condition. Hearing aid devices can be beneficial for people with sensorineural hearing loss. Individuals with moderate to severe sensorineural hearing loss who do not have adequate benefit from hearing aids may have cochlear implant surgery. A cochlear implant electrically stimulates the cochlea, which stimulates the nerve that carries sound to the brain.^[11]

Conductive Hearing Loss: Conductive hearing loss occurs in the outer or middle ear where sound waves are not able to carry all the way through to the inner ear. Sound may be blocked by earwax or a foreign object located in the ear canal; the middle ear space may be impacted with fluid, infection or a bone abnormality; or the eardrum may have been injured. In some people, conductive hearing loss may be reversed through medical or surgical intervention. Conductive hearing loss is most common in children who may have recurrent ear infections or who insert foreign objects into their ear canal.

Depression^[12]

Depression is a serious mental illness that causes persistent feelings of sadness and affects how the person acts and perceives the world. Nearly three out of ten people have been diagnosed with major depressive disorder. Symptoms of depression can appear differently in each person and can vary from mild to severe. These symptoms can include the following:

• Feeling sad, irritable, empty and/or hopeless
• Losing interest or pleasure in activities formerly enjoyed
• A significant change in appetite (eating much less or more than usual) and/or weight (notable loss or gain unrelated to dieting)
• Sleeping too little or too much
• Decreased energy or increased tiredness or fatigue
• Increase in purposeless physical activity (e.g., inability to sit still, pacing, hand-wringing) or slowed movements or speech that are severe enough to be observable by others
• Feeling worthless or excessively guilty.
• Difficulty thinking or concentrating, forgetfulness, and/or difficulty making minor decisions.
• Thoughts of death, suicidal ideation, or suicide attempts.

Most people diagnosed with depression can benefit from medication, psychotherapy, or both.^[13]

Guillain-Barré Syndrome^[14]

Guillain-Barré (pronounced gee-YAN bah-RAY) syndrome is an autoimmune disorder where the immune system mistakenly attacks some peripheral nerves. This damage interferes with the transmission of signals, leading to muscle weakness and other symptoms. Symptoms typically last a few weeks, with most individuals recovering without long-term, severe neurological complications. The first symptoms of Guillain-Barré syndrome include weakness or tingling sensations that start in the legs and can spread to the arms and face. For some people, these symptoms can lead to paralysis of the legs, arms, or muscles in the face. In approximately one third of people, the chest muscles are affected, making it hard to breathe. Most people recover fully from even the most severe cases of Guillain-Barré syndrome, although some continue to experience weakness.

Encephalitis^[15]

Encephalitis is inflammation of the brain that can be caused by viral or bacterial infections, or by a person’s immune system mistakenly attacking brain cells. Viruses that can lead to encephalitis can be spread by insects such as mosquitos and ticks. When inflammation is caused by an infection in the brain, it’s known as infectious encephalitis, and when it’s caused by the immune system attacking the brain, it’s known as autoimmune encephalitis. Most people with infectious encephalitis initially have flu-like symptoms, such as headache, fever, achy muscles or joints, fatigue, or weakness. These symptoms are followed by more serious symptoms over a period of hours to days, such as stiff neck, confusion, agitation or hallucinations, seizures, loss of feeling or the ability to move certain areas of the face or body, trouble with speech or hearing, and loss of consciousness, including coma. Encephalitis can be deadly, so early diagnosis and treatment is important.

Epilepsy^[16]

Epilepsy is a neurological disorder characterized by recurrent seizures that are caused by abnormal electrical activity in the brain. There are a wide variety of symptoms associated with seizures, ranging from the person staring blankly, rapid jerking of their arms or legs, or losing consciousness. Epilepsy is diagnosed in people who have had at least two unprovoked seizures at least 24 hours apart. Seizures are treated with medications, medical procedures, and sometimes surgery. In some cases, epilepsy resolves on its own.

Glaucoma^[17]

Glaucoma is a chronic, progressive eye disease that leads to vision loss due to damage to the optic nerve. A major risk factor for glaucoma is excessive eye pressure caused by an abnormality in the eye’s drainage system that causes fluid to build up inside the eye, resulting in excessive pressure that damages the optic nerve. Damage to the optic nerve causes loss of peripheral vision that, if left untreated, slowly impacts central vision. Once vision is lost, it cannot be recovered. See Figure 8.6g for a simulated image of peripheral vision loss in a person with glaucoma.

Figure 8.6g. Glaucoma (Source: “Eye disease simulation, glaucoma.jpg” by National Eye Institute, National Institutes of Health is in the Public Domain)

Huntington’s Disease^[18]

Huntington's disease is a rare, progressive, genetic disease that causes deterioration of neurons in the brain and affects a person’s movements, thinking ability, and mental health. Huntington’s disease symptoms can develop at any time, but they often begin when people are in their 30s or 40s. If the disease develops before age 20, it’s called juvenile Huntington’s disease. When Huntington’s develops early, symptoms can be different, and the disease may have a faster progression. Medications are available to help manage the symptoms of Huntington’s disease but cannot prevent the physical, mental, and behavioral decline caused by the disease.

Meningitis

Meningitis is an inflammation of the meninges, the three layers of fibrous membranes that surround the CNS. Meningitis can be caused by infection by bacteria or viruses. Bacterial meningitis is often more severe than viral meningitis and can be fatal. Fatality occurs in 5 to 40 percent of children and 20 to 50 percent of adults with bacterial meningitis. Symptoms of meningitis include fever, chills, nausea, vomiting, light sensitivity, neck stiffness, severe headache, and confusion. Some types of meningitis can be prevented with the administration of vaccines.

A lumbar puncture is used to test for meningitis. During a lumbar puncture, a needle is inserted into the lumbar region of the spinal column, through the dura mater and arachnoid membrane, and into the subarachnoid space so that cerebrospinal fluid can be withdrawn for laboratory testing. Bacterial meningitis is treated with antibiotics. A serious risk of meningitis is damage to peripheral structures because of the nerves that pass through the meninges. For example, hearing loss is a common result of meningitis.

Migraine^[19]

A migraine is a neurological condition consisting of recurrent headaches that are moderate to severe in intensity. A migraine can last for hours to days and can have a great impact on quality of life and the ability to complete activities of daily living. The exact pathology of migraines is complex and not completely understood, but it is thought to involve inflammatory mediators acting on pain receptors. Migraines can be triggered by a variety of factors with some common triggers being stress, changes in hormone levels, changes in sleep, strong odors, changes in weather or temperature, missing meals, or eating foods with high levels of aspartame or tyramine. Additionally, migraines have a genetic link and are seen more commonly in women.

Migraines are classified into two main categories: migraine with and without aura. An aura is a change in function or onset of symptoms that precedes a migraine. Although there are a variety of auras that may be experienced by those with migraines, some potential auras are changes in vision, the presence of paresthesia (tingling sensations), or the loss of bodily functions such as hearing, movement or language. The pain of a migraine is usually located to one side of the head and is usually described as pulsating or throbbing. Other common symptoms during a migraine are nausea, vomiting, and sensitivity to light and sound. After the migraine passes, most clients are fatigued and may be unable to concentrate.

Diagnosis of migraine can be done by taking a client history and completing a physical exam and comparing signs and symptoms to established diagnostic criteria. In some instances, imaging of the brain may be completed.

The treatment of migraines consists of medications and lifestyle changes. Medications may be used to relieve pain during a migraine, relieve nausea and vomiting, or prevent migraines from occurring in the first place. Some alternative treatments are consistent exercise, yoga, avoiding triggers and cognitive-behavioral therapy.

Multiple Sclerosis^[20]

Multiple sclerosis (MS) is an autoimmune disease that causes inflammation and destruction of the myelin in the central nervous system. As the insulation around axons is destroyed, scarring in the white matter of the brain and spinal cord occurs, referred to as sclerosis. The loss of myelin disrupts the transmission of nerve impulses, leading to a variety of symptoms ranging from mild to severe. Symptoms of MS depend on the person, the location of the damage in their nervous system, and the severity of damage to the nerve fibers. Symptoms include numbness and tingling, weakness, vision loss, loss of bladder and bowel control, and loss of the ability to walk. Many individuals with MS experience flare-ups of symptoms, followed by remissions. There is no cure for MS, but medications are used to slow the progression, prevent flare-ups, and manage the symptoms.

Orthostatic Hypotension

Orthostatic hypotension, also known as postural hypotension, is a condition where blood pressure drops significantly when a person stands up, often causing dizziness, lightheadedness, or fainting. This condition can occur due to a malfunction of the autonomic nervous system that regulates involuntary body functions like heart rate and blood vessel constriction. When standing, the body normally responds to changes in blood pressure by constricting blood vessels and increasing heart rate to maintain adequate blood flow to the brain. However, in orthostatic hypotension, this compensatory mechanism is impaired, causing blood to pool in the lower extremities and reducing blood flow to the brain. Individuals with orthostatic hypotension must take extra time when standing to allow the blood flow to their brain to adjust and prevent falls.

Otitis Media^[21]

Otitis media is inflammation or infection of the middle ear that is often caused by an upper respiratory infection (e.g., a “cold”), resulting in fluid build-up in the eustachian tubes, fever, and ear pain. Children are more likely than adults to get otitis media because their eustachian tubes are shorter, narrower, and more horizontal. Otitis media often resolves on its own, but if it does not resolve in a few days, antibiotics may be prescribed. Some children are prone to multiple ear infections that can cause hearing problems. Surgery may be performed to place a small tube through their eardrum to help drain the excess fluid and prevent recurrent infections

Parkinson’s Disease^[22]

Parkinson's disease is a progressive neurological disorder that affects an individual’s ability to move. It is caused by the deterioration of neurons in the brain that produce dopamine, a neurotransmitter that coordinates movement. Symptoms of Parkinson’s disease include hand tremors; muscle stiffness; balance problems; slurred speech; and a slow, shuffling walk. While there’s no cure for Parkinson’s disease, medications can help manage symptoms. In some cases, brain surgery may be performed that helps lessen symptoms.

Peripheral Neuropathy^[23]

Peripheral neuropathy is weakness, numbness, and pain caused by peripheral nerve damage. Common causes of peripheral neuropathy are diabetes and peripheral vascular disease. Symptoms include pain, pins-and-needles sensations, numbness, and weakness. Peripheral neuropathy decreases sensation, especially in the feet and legs, which affects a person’s ability to walk and increases their risk for falls. It also makes them prone to injuries in the toes and feet that can lead to advanced infections requiring amputation. There is no cure for peripheral neuropathy, but controlling underlying conditions (like diabetes) may prevent the condition from worsening. Symptoms are managed with medications.

Refractive Errors^[24]

Refractive errors are a common type of vision problem that occur when the shape of a person’s eye prevents light from focusing correctly on their retina. Refractive errors are the most common type of vision problem, with more than 150 million Americans having a refractive error. There are four common types of refractive errors: myopia, hyperopia, astigmatism, and presbyopia.

Myopia (Nearsightedness)^[25]: Nearsightedness makes far-away objects look blurry. It happens when the eyeball grows too long from front to back, or when there are problems with the shape of the cornea or the lens. These problems make light focus in front of the retina, instead of on it. Nearsightedness usually starts between ages 6 and 14. See Figure 8.6h2 for an illustration of myopia.

Figure 8.6h. Myopia (https://commons.wikimedia.org/wiki/File:Myopia_Diagram.jpg)

Hyperopia (Farsightedness)^[26]: Farsightedness makes nearby objects look blurry. It happens when the eyeball grows too short from front to back, or when there are problems with the shape of the cornea or lens. These problems make light focus behind the retina, instead of on it. People with farsightedness are usually born with it. See Figure 8.6i for an illustration of hyperopia.

Figure 8.6i. Hyperopia (https://commons.wikimedia.org/wiki/File:Hyperopia.gif)

Astigmatism^[27] can make objects look blurry or distorted. It happens when the cornea or lens has a different shape than normal, which makes light bend differently as it enters the eye. Some people with astigmatism are born with it, but many people develop it as children or young adults. People with astigmatism often have another refractive error, like nearsightedness or farsightedness.

Presbyopia^[28] makes it hard for middle-aged and older adults to see things up close. As you age, the lens in your eye gets harder and less flexible and stops focusing light correctly on the retina. Everyone gets presbyopia as they get older, usually after age 45. See Figure 8.6j for a simulated image of what a person with presbyopia sees without corrective lenses.

Figure 8.6j. Simulated Vision of a Person With Presbyopia (“Pesto ingredients – blurred.jpg” by Colin is licensed under CC BY-SA 4.0)

Schizophrenia^[29]

Schizophrenia is a serious mental illness caused by genetics, imbalanced neurotransmitters in the brain, and environmental factors. People with schizophrenia may hallucinate, meaning they see things or hear voices that aren’t present. They may feel paranoid and think other people are trying to hurt them or they may not make sense when they talk. Some people with schizophrenia lack insight or awareness of their disorder and do not think they need treatment. If untreated, this disorder can make it hard for a person to take care of themselves or keep a job and may result in homelessness. Symptoms of schizophrenia usually start between ages 16 and 30. There is no cure for schizophrenia but medications can help control many of the symptoms. Additional treatments include psychotherapy and skills teaching.

Sciatica^[30]

Sciatica refers to pain that travels along the sciatic nerve from the buttocks and down the back of the leg. Sciatica most often happens when a herniated disk or an overgrowth of bone puts pressure on the lumbar spine nerve roots, causing inflammation, pain, and possible numbness in the affected leg. Pain often resolves with self-care measures, medications, and physical therapy. However, severe sciatica associated with leg weakness or bowel or bladder changes may require surgery.

Stroke (Cerebrovascular Accident)^[31]

The supply of blood to the brain is crucial to its ability to perform many functions. Without a steady supply of oxygen and blood glucose, the nervous tissue in the brain cannot maintain its extensive electrical activity and neurological function is compromised. The medical term for disruption of blood supply to the brain is a cerebrovascular accident (CVA), commonly called a stroke. There are two main types of strokes: ischemic and hemorrhagic. Ischemic strokes are caused by a blockage in an artery in the brain from a blood clot or embolism. When blood cannot travel through the artery, the affected brain tissue that is deprived of oxygen and glucose. Hemorrhagic strokes result from bleeding in the brain due to a ruptured blood vessel. A third type, a transient ischemic attack (TIA), also known as a “mini-stroke,” involves a temporary interruption of blood flow to the brain without causing permanent damage. Although temporary, TIAs are warning signs of an impending stroke.

A stroke results in loss of very specific functions based on the location of the blocked artery or ruptured blood vessel. For example, loss of blood flow to specific regions of the cerebral cortex can cause a person to lose the ability to voluntarily move a specific region of the body, speak, swallow, or recognize faces. The mnemonic “BE FAST” helps people remember what to look for in someone who is having symptoms of a stroke:

• Balance: Is the person having sudden issues with balance or coordination?
• Eyes: Does the person have sudden changes in vision, such as blurred vision, double vision, or loss of vision?
• Face: Look at the person’s face. Is one side of their face drooping? Can they make regular facial expressions or is one side not moving effectively?
• Arms: Ask the person to raise their arms above the head. Can the person lift one arm but not the other?
• Speech: Has the person’s speech changed? Are they slurring words or having trouble saying things?
• Time: If any of these things are happening, then it is time to call for help.

A stroke can be fatal or cause a variety of long-term deficits affecting motor function, speech and language, cognitive abilities, and emotional and behavioral changes. These deficits can impact a person’s ability to perform daily tasks and can significantly affect quality of life. Recovery from a stroke depends on the speed of treatment and severity of the blockage or bleed. Treatment is based on the cause of the stroke. An ischemic stroke may be treated with medications to break up the clot or surgery to remove the clot. Treatment for a hemorrhagic stroke may include surgical procedures to stop the bleeding. With fast treatment, a person having a stroke has increased chances for survival. Physical, occupational, and speech therapy can help victims of strokes recover and relearn many functions that were lost due to brain injury.

Traumatic Brain Injuries

Head injuries, known as traumatic brain injuries (TBIs), can range from mild concussions to severe brain injuries causing death. TBIs can result from various causes, including falls, motor vehicle accidents, sports injuries, and violence. Falls are most common among young children (ages 0–4 years), adolescents (15–19 years), and older adults (over 65 years). Symptoms of TBI include headache, dizziness, confusion, nausea, and loss of consciousness.

Strong blows to the skull can cause a skull fracture that may result in bleeding inside the skull with subsequent injury to the brain. The most common is a linear skull fracture, in which fracture lines radiate from the point of impact. Other fracture types include a comminuted fracture, in which the bone is broken into several pieces at the point of impact, or a depressed fracture, in which the fractured bone is pushed inward. In a contrecoup (counterblow) fracture, the bone at the point of impact is not broken, but instead a fracture occurs on the opposite side of the skull. Fractures of the occipital bone at the base of the skull can occur in this manner, producing a basilar fracture that can damage the artery that passes through the carotid canal.

A blow to the lateral side of the head may fracture the bones of the pterion. The pterion is an important clinical landmark because a major branch of an artery that supplies blood to the layers of the brain is located underneath it. If the underlying artery is damaged, bleeding can cause the formation of a hematoma (collection of blood) between the brain and interior of the skull. As blood accumulates, it puts pressure on the brain. Symptoms associated with a hematoma may not be apparent immediately following the injury, but if untreated, blood accumulation continues to exert increasing pressure on the brain that can result in death within a few hours.

Subdural Hemorrhage/Hematoma

A subdural hematoma occurs when a blood vessel near the surface of the brain bursts, causing blood to build up between the brain and the brain’s tough outer lining called the dura mater. A subdural hematoma is a life-threatening problem because it causes increased pressure that compresses the brain and can result in loss of consciousness, paralysis, or death. Most subdural hemorrhages result from trauma to the head, such as a motor vehicle accident or severe sports injury, that damages tiny veins within the meninges. However, older adults may bleed after minor trauma like a fall, especially if they are taking medications that prevent blood from clotting.^[32]