[ANSWERED 2023] Choose one disorder of the central or peripheral nervous system and discuss its clinical manifestations, prognosis, and pathophysiology.

The central nervous system is one of the most important organs in the human body. The nervous system is essential in sustaining life and ensuring that all other forms of life operate efficiently. Understanding how different care processes affect the central nervous system is key to ensuring the best available care (Falkner & Green, 2018).

One of the disorders that affect the central nervous system is Alzheimer’s disease. Alzheimer’s disease is a neurological disorder, and with approximately 35 million affected people worldwide, the most common form of dementia (WHO, 2021). While Alzheimer’s disease often affects the elderly population, cases in younger people have also been reported. The disease is progressive and usually worsens gradually.

The initial stages are often mild and can be subtle, which can make it difficult to recognize the disorder (McCance & Huether, 2018). The manifestation of Alzheimer’s disease first affects the memory of a person, making it difficult to keep track of appointments, identify or find everyday objects, or remember recent events. Symptoms of moderate dementia include problems remembering personal history, and feeling disoriented about place or time (NIH, 2017). In the advanced stages of the disease, people lose their ability to communicate or care for themselves.

The prognosis of Alzheimer’s disease can be identified by the formation of amyloid plaques between and bundled neurofibrillary in the neurons. This process damages the neurons, and over time causes loss of neural connections and eventually cell death (Falkner & Green, 2018). This process usually affects the part of the brain responsible for memory first and slowly spreads to other parts of the brain, eventually causing loss of complete function and with that death (NIH, 2017). There is currently no cure for Alzheimer’s disease.

References

Falkner, A. & Green, S. Z. (2018). Neurological, perceptual, and cognitive complexities. In Grand Canyon University (Ed), Pathophysiology: Clinical applications for client health. https://lc.gcumedia.com/nrs410v/pathophysiology-clinical-applications-for-client-health/v1.1/

National Institute of Health [NIH]. (2017). What happens to the brain in Alzheimer’s disease? Health Information. https://www.nia.nih.gov/health/what-happens-brain-alzheimers-disease

WHO. (2021). Dementia. Fact Sheets. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/dementia

McCance, K. A. & Huether, S.E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby. ISBN: 978032341320.

Alternative Expert Answer

Guillain-Barré syndrome, sometimes known as GBS, is a rare, serious, and sometimes fatal autoimmune disorder in which the immune system attacks healthy nerve cells in the peripheral nervous system (PNS).   GBS is the most common cause of acute flaccid paralysis affects only about 1 in 100,000 people.  According to McCance et al, it is a demyelinating disorder caused by humoral and cell mediated immunologic reaction directed at peripheral nerves and nerve roots that is usually triggered by infections (McCance et al, 2018).

The diagnosis and treatment  of GBS can complicated as its clinical presentation and disease course are varied and to date, and international clinical guidelines did not exist prior to 2019 (Leonhard et al, 2019).

Patients with GBS typically present with weakness and sensory signs in the legs that progress to the arms and cranial muscles.  Distal sensory loss with or followed by weakness starting in the legs, progressing to arms and then cranial muscles is common.  Commonly, reflexes are decreased or absent at onset (Leonhard et al, 2019).

Muscular or neuropathic pain is commonly reported as is blood pressure, heart rate and pupillary dysfunction are also common. Diagnosis criteria includes a progressive weakness for no more than four weeks that consists of weakness of more than two limbs and areflexia (McCance et al, 2018). The progression of symptoms is rapid, and most patients reach maximum disability at two weeks.  The progression can lead to respiratory failure requiring intubation and ventilatory support for 20% of patients (Leonhard et al, 2019).

Diagnosis is made by ruling out other conditions and patient history, neurological, electrophysiological, and cerebrospinal fluid (CSF) examinations.  Abnormal results in electrophysiological studies, increased protein level and normal cell count in CSF are classic features of GBS, but patients in early progression of disease may not have these findings (Leonhard et al, 2019).

However, electrophysiological studies provide evidence of apparent PNS dysfunction and helps determine type of GBS:  acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN) (Leonhard et al, 2019).

As mentioned GBS is a post-infectious, immune-mediated neuropathies and research indicates that it’s mechanism is via molecular mimicry.  About 70% of patients diagnosed with GBS have recently had an infection illness 1-6 weeks prior to onset of symptoms (Nguyen and Taylor, 2022).   Common infections or causes associated are respiratory, GI, surgery immunization, viral infection and the Zika virus.

Antibodies, IgG attach on modes of Ranvier, T-cell mediated lymphocytic infiltration of nerves or antibodies cross reacting with gangliosides are thought to be the pathogenesis of GBS.  GBS All of this pathogenesis examples are directed at the peripheral motor nerves (McCance et al, 2018). As GBS advances, the muscles of the body become weak eventually developing flaccid paralysis. Due to the disruption of myelin coating, messages cannot be effectively transmitted.  The ANS is affected by producing cardiac arrhythmias and fluctuations in blood pressure

Despite a favorable prognosis for GBS patients, death occurs in 3–10% of cases, and most die due to cardiovascular and respiratory causes.  Risk factors for mortality include advanced age and severe disease at onset7. Most affected GBS patients complain of neuropathic pain, weakness and fatigue, that usually subsides in a 5 years (Nguyen & Taylor, 2022).

Typical residual issues include ongoing weakness, dysreflexia, paresthesia and loss of balances Neurological problems of foot drop in both feet, muscle wasting in the hands, loss of coordination due to decreased sensory input (sensory ataxia), and painful, burning, tingling or restrictive sensations (dysesthesia) may remain. Recurrent GBS affects approximately 5% of patients (McCance et al, 2018).

References:

Leonhard, S.E., Mandarakas, M.R., Gondim, F.A.A. et al. (2019) Diagnosis and management of Guillain–Barré syndrome in ten steps. Nat Rev Neurol 15, 671–683. https://doi.org/10.1038/s41582-019- 0250-9

McCance, K.L., Grey, T. C., & George, W. R. (2018). Altered cellular and tissue biology: environmental agents. In K. L. McCance & S. E. Huether, (Eds.),             Pathophysiology: The biologic basis for disease in adults and children. Mosby.

Nguyen TP, Taylor RS. Guillain Barre Syndrome. [Updated 2022 Jul 4]. In: StatPearls [Internet].   Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532254/

Module 2 Assignment

Assignment Description:

Write a 1500-2000-word APA formatted essay of the following topics:

• Classify and differentiate at least four types of stroke
• Elaborate on the difference between primary and secondary Parkinson’s disease
• Summarize the five categories of pain. Discuss their pathways. Explain the etiology of chronic and acute pain
• Explain the pathophysiology and common clinical manifestations of Diabetes Mellitus Type II