Causes of Acute Nervous System Disorders - Essay Example

? Pathophysiology of the Nervous System Insert (s) Pathophysiology of the Nervous SystemIntroduction The patient described in case scenario 1 is a 24year old male who is likely to be suffering from nervous system disorder. The patient is lying on the floor with arms curled tightly towards his chest and his head back ached while his eyes are rolling back with a fixed gaze. On the other hand, the patient’s mouth is open and his facial muscles are visibly pulled back tight. Generally the presenting symptoms of nervous system disorders depend on the area of nervous system affected as well as the cause of such disorders. Some nervous system disorders are considered to be degenerative because they progress slowly and result in the gradual loss of nervous functions while others are regarded as acute as they occur suddenly occur. There are a number of possible causes of acute nervous system disorders some of which include mental health problems, exposure to toxins, infections, injuries particularly to the spinal cord and head and congenital problems. As witnessed in the patient, nervous system problems can be manifested through a number of signs and symptoms such as numbness of the body, reduced level of consciousness, inability to walk or stand and seizures. Most of these symptoms are consistent with Dystonic reactions which are a disorder of the nervous system that results to twisting and abnormal posture as a result of abnormal contractions of the muscles (Okun, M.S. 2002, p.247). Consequently the likely diagnosis of the condition is dystonic reaction due to medications. This is particularly because most of the symptoms observed in the patient such as abnormal postures, twisting rolling back his eyes with a fixed gaze are consistent with dystonic reaction to some of the common pharmaceutical drugs such as neuroleptics. This paper uses the above case analysis to discuss the signs, differential diagnosis and pathophysiology of the case. Additionally the paper also critically analyzes the current management practices of the condition as well as presents a critique of some of the evidence supporting these management practices. Differential diagnosis The potential diagnosis of the case is dystonic reaction due to medications. Studies have found that the condition is mostly brought about as a result of adverse reactions to neuropleptics drugs. There is however a number of other disorders should be considered in the differential diagnosis of the condition witnessed in the case. Misdiagnosis of the condition may occur because there are a number of other organic related disorders which often result in the development of similar symptoms. Generally there are a number of other neurological disorders that may potentially cause similar symptoms as that of dystonic reaction. For example, seizures and intracranial pressure may also result in similar presenting symptoms such as, the patient’s mouth being open and tight facial muscles (McCormick and Manoguerra, 1999, p.304). Although both conditions can cause nervous system related complications, most of the symptoms such as eyes rolling back with a fixed gaze among other symptoms are only consistent with the potential dystonic reaction. For example the fact that the patient was lying on the floor with arms curled tightly towards his chest was a likely suggestion that he was suffering from a cardiac arrest. Similarly the other symptoms like rolling eyes with a fixed gaze as well as open mouth and tight facial muscles may all be a likely suggestion of seizure and reduced consciousness as commonly seen in patients suffering from the other related nervous system disorders. The primary causes nervous system disorders such as dystonic reactions and seizures include genetic causes, reaction to certain pharmaceutical drugs, poisoning and infections. Generally dystonic reactions due to medications refer to the adverse effects that occur immediately after initiating neuroleptic drug therapy. These reactions may however occur with a diverse number of other medications. The condition is primarily characterized by the occurrence of intermittent or sustained involuntary face muscle contractions as well as other extremities. Generally dystonic reactions refer to the adverse effects that occur immediately after initiating neuroleptic drug therapy. These reactions may however occur with a diverse number of other medications. Dystonic reactions may sometimes also be characterized by the occurrence of intermittent or sustained involuntary face muscle contractions as well as other extremities. Although Dystonic reactions are not often life threatening, the reactions may be very uncomfortable and are at times accompanied by distress and anxiety on the affected patients. An effective medical intervention can however reverse the motor disturbances within minutes. Despite having a number of clinical symptoms and signs, the disease is often difficult diagnose because most of the presenting symptoms are often similar to the symptoms of other nervous system complications such as Parkinson’s disease and seizures (Derinoz and Caglar, 2012, p.18). During the diagnosis, one of the best predictors that can be used to confirm whether the presenting symptoms are as a result of drug induced dystonic reaction is if the patient is having a previous history of the nervous disorder or if the patent had a recent exposure to some of the precipatating drugs which are normally associated with acute dystonic reactions. Pathophysiology of the dystonic reaction The pathophysiology of dystonic reaction due to medications is based on the fact that some drugs such as neuroleptic drugs often induce the blockade of nigrostriatal D2 receptors. According to many researchers, dystonic reactions are mostly related to the drug dose but the reactions are often idiosyncratic and not easy to predict. Generally most of the drugs responsible for dystonic reactions usually produce their effects by receptor blockade as well as receptor antagonism in the nervous system (Fines and Brady, 1997, p.514). Additionally dystonic reactions may also occur due to increased nigrostriatal dopaminergic activities that usually result from compensatory responses to the blockade of dopamine receptor by the drug actions. This is particularly because neuroleptic drugs usually function by altering the balance of dopaminergic and cholinergicoutputs in the basal ganglia and this may result in dystonic reactions. Many researchers agree that dystonic reactions usually result from imbalances of the cholinergic and dopaminergic neurotransmission. Despite the unpredictability of the relationship between dystonic reactions and D2 receptor antagonists, the presence of high potent D2 receptor antagonists that are found in some drugs are largely responsible for the occurrence of acute dystonic reactions. Generally many of the patients with the symptoms of dystonic reactions often develop the condition after a single exposure to the drug. Apart from neuroleptic drug therapy, there are a number of other drugs that often play a critical role in the occurrence of dystonic reactions. Most of those drugs can potentially result in nervous system disorders such as characterized by a number of signs and symptoms such as irregular heartbeats, muscle weakness, confusion and seizures. The other important symptoms that were also identified in the patient described in the above case include the occurrence of irregular psychological behaviours like delirium as well as fainting due lack of nervous coordination. Another serious form of dystonic reaction due to medications is known as tardive dystonia. According to Marsden and Jenner(2000, p.52), this condition usually results in the development of symptoms such as multiple involuntary movements and other related neurological syndromes depending on the dosage as well as the length of exposure of the patients to the drugs. Sometimes however, the presenting symptoms may be similar to those of Parkinson’s disease and this usually poses a serious challenge in the differential diagnosis of the disease. Despite the fact that some patients using neurleptic drugs may not have all the presenting symptoms of the disorder, the drug can affect their nerves as well as other muscles thereby leading to fatigue, paralysis and respiratory difficulties. Apart from using the presenting symptoms, diagnosis of the disorder can also be done by using electrical censors that are usually placed in the affected muscles that have the ability to show the pulsating nerve signals and detect the abnormalities as the signals can be sent even if muscles are at rest. The probability of developing dystonic reactions in a patient is largely dependant on both the dosage, length of exposure as well as the presence of pre existing nervous system disorders in a patient. The symptoms may occur within a few hours after using the causative medication but sometimes the onset of the presenting symptoms may be delayed for days. As witnessed in the patient described in the case scenarios, the most common symptoms of drug induced dystonic reactions include sustained pain felt in various parts of the body, lip smacking, cramping and relentless muscle spasms due to uncoordinated muscle movements this symptoms results to abnormal posture and poor coordination of movement. Additionally the patient may also suffer from difficulty in swallowing and pain in muscles around the neck. Secondary to these symptoms others related to same may include lack of sleep, permanent disability, stress, anxiety that pose great mental and physical health to the affected person. The condition is however not usually life threatening and dystonic reactions generally resolve within a few days even without any treatment. Lastly, there are a diverse number of ways through which dystonic reactions can present in the affected patients. Although the diagnosis is not always very obvious, patients who have a history of exposure to the medications associated with dystonic reactions should be considered to be suffering from the condition. Some of the common forms of dystonic reactions include Oculogyric crisis,layryngeal dystonia and Opisthotonic crisis among others. Paramedic intervention and rationale There are a number of paramedic intervention measures that can be taken as part of the emergency management of the patient before the patient suffering from acute dystonic reaction. Generally the type of paramedic intervention measure to be taken when dealing with patients suffering from potential dystonic reactions due to medications. According to Fisch(2003, p.407), it is important to assess the condition of the patient and determine his conscious level before undertaking any intervention measure. It is worth noting that most of the paramedic interventions are primarily geared towards reducing the symptoms associated nervous disorder as well as relieving pain on the affected patient (Campbell, 2001, p.20). Generally a number of management techniques of the disease such as isolating the causative agent and reducing its effect have been found to assist in the elimination of symptoms and recovery of the affected patient. For example, in reference to the symptoms of dystonic reactions described in case scenario 1, the first major paramedic interventions include withdrawing and discontinuing the patient from the offending medication. In this regard, if the medication responsible for the dystonic reactions is still crucial for the health of the affected individual, then it should immediately be substituted with atypical neuroleptics such as Olanzapine and clozapine which do not usually cause the nervous disorder. This is particularly because lowering the dose or discontinuing the use of the causative drug can significantly help ease the presenting symptoms on the patient. Depending on the severity of the dystonic reaction, it is also important to perform the necessary paramedic intervention measures such as resuscitation to help the patient to regain consciousness. Once the causative agent has been removed, a number of resuscitation procedures which basically include basic life support and continuous monitoring of the patient’s breathing and heat beat should be carried out immediately. For instance before the patient is transported to the nearest medical facility, the paramedics should administer at least two gentle breaths to helping maintain the flow of oxygen rich blood to the various vital organs of the body before more advanced care of the nervous disorder is available (Priori and Barbieri S. 2001,p.547). Additionally a pulse check may also be performed to confirm any signs of life in the patient before compressions done to improve oxygenation and ensure that the patient has access to adequate fresh air. This can also be achieved by lying the patient down on a flat surface while at the same time raising his legs up to improve preload. On the other hand, Anticholinergic as well as common muscle relaxers may also be used to treat some of the symptoms such as tight facial muscles. Sedatives and neurosuppression drugs such as Clonazepam, Dopamine ,agonistsA ,Baclofen and Cannabidiol can also be effectively used in treatment of the symptoms of the disorder. Additionally these drugs have an important relief effect on both the brain and the muscles (Roberge, 2006, p.301). For example, administering nenztropine through intravenous injection for the next 24-48 hours after the occurrence of dystonic reactions not only help to relieve the symptoms but can also be effective in the prevention of further occurrence of disorder. It is however important that all the drugs such as Anticholinergic and antidepressants used in the treatment of this disorder should be strictly taken as prescribed and any likely symptom of side effect should be reported to the qualified specialists. Pain management is another important intervention practice that should be undertaken alongside the treatment of the presenting symptoms. As soon as the patient is diagnosed to be suffering from drug induced dystonic reactions, the level of his muscle pains should be assessed at treated as soon as possible. According to Lubarr and Bressman (2011, p.281), this particularly involve undertaking measures that help in the alleviation of pain as well as reducing it to a level that is comfortable and can be managed by the patient. In this regard, the reduced pain will be demonstrated by the signs of improved physical, behavioural, psychosocial and cognitive functioning in the patient. There are a number of pharmacological and non pharmacological interventions that can be employed to help the patient overcome pain. Recording and monitoring the vital signs of improvement is also one o the important interventions necessary for patients diagnosed with acute dystonic reactions due to medications. Generally some of the vital signs that should be monitored include the patient’s blood pressure (BP), pulse rate (PR), body temperature (T) and neuro status. As part of the management practices for the nervous disorder, the blood pressure (BP) as well as the pulse rate (PR) of the patient should be measured regularly. If there is no improvement, then the diagnosis may be wrong and the medications should be changed immediately. Lastly, after the patient has regained consciousness, it has been found that physical exercise can be very beneficial in treatment of this disorder. Certain physical exercises geared towards mobility and strengthening of muscles helps relieve the pain associated with the condition such exercises include splinting, therapeutic exercise, manual stretching, soft tissue and joint mobilization, postural training and bracing, electrical stimulation of the muscles and change of environmental conditions in addition to gait training (Priori and Barbieri S. 2001,p. 256). In some cases, the symptoms of dystonic reactions may persist even after terminating the causative drug and administration of Anticholinergic, adrenergic antagonists as well as muscle relaxers. However with careful management and intervention measures, the symptoms may eventually disappear with time. Conclusion In conclusion, drug induced dystonic reactions are distressing complications commonly observed in patients taking antipsychotic and neuroleptic drugs. Generally the probability of developing dystonic reactions in a patient is largely dependant on both the dosage, length of exposure as well as the presence of pre existing nervous system disorders in a patient. Paramedic interventions for the nervous disorder include gradually withdrawing the patient from the offending drug and administering nenztropine through intravenous injection. The condition is however not life threatening and dystonic reactions usually resolve within a few days even without any treatment or intervention. 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