HC2

• Multiple Sclerosis


  • Idiopathic
  • Demyelination of neurons, resulting in disruption of axon function
• Theories of Multiple Sclerosis

  • Autoimmune
  • Environmental factors with genetic predisposition
• Multiple Sclerosis


  • Vitamin D deficiency
  • More common in women
  • More common if Caucasians
  • Genetics
• Autoimmune processes in Multiple Sclerosis

  Leave scars known as sclerosis, plaques or lesions
• Multiple Sclerosis


  Impedes transmission of impulses to and from the brain/spinal cord
• Multiple Sclerosis can occur anywhere in CNS where there is white matter (myelinated nerve cells)
• Types of Multiple Sclerosis

  • Relapsing-remitting
  • Primary Progressive
  • Secondary Progressive
  • Progressive relapsing
• Relapsing-remitting Multiple Sclerosis


  Exacerbations and remissions in 85-90% of patients
• Primary Progressive Multiple Sclerosis

  10% of patients, no distinct periods of remission from onset
• Secondary Progressive Multiple Sclerosis

  40-50% of people with relapsing-remitting develop this form within 10 years of dx, starts out as r-r then gradually develops into a progressive pattern
• Progressive relapsing Multiple Sclerosis

  5% of patients, progressive from onset with acute exacerbations, superimposed on the progressive
• Diagnosing Multiple Sclerosis


  1. History

  2. Physical and neurological exam

  3. Evidence of demyelination in at least 2 areas of CNS, occurring at 2 different time

  4. Rule out other conditions
• Tests used to diagnose Multiple Sclerosis


  • MRI
  • Evoked potentials tests
  • Lumbar puncture
  • Optical coherence tomography
• Symptoms of Multiple Sclerosis

  • Fatigue
  • Visual disturbance
  • Sensory impairments
  • Motor impairments
  • Loss of postural control
  • Dizziness
  • Tremor
  • Dysphagia
  • Speech disturbances
  • Heat intolerance
  • Spasticity
  • Bowel and bladder dysfunction
• Management of Multiple Sclerosis


  • Medications (anti-depressants, antispasmodics, corticosteroids)
  • Catheterization
  • Tube feeding
  • Nerve blocks
• Uthoff's phenomenon


  Worsening of neurological function in MS patients in response to increases in core body temperature
• Parkinson's


  • Idiopathic
  • Degeneration of neurons that produce dopamine in an area of the Basal Ganglia called the Substantia Nigra
• Theories of Parkinson's


  • Accelerated aging
  • Environmental toxins
  • Free radical oxidative damage
• Parkinson's


  • More common in males
  • History of depression
• Symptoms of Parkinson's


  • Tremors
  • Rigidity
  • Bradykinesia
• Diagnosing Parkinson's


  1. History and physical examination

  2. Hoehn and Yahr Rating Scale (5 stages, 1 = unilateral involvement, mild symptoms, tremor to stage 5= wasting stage, bed ridden, unable to walk, severe swallowing problems)
• Primary symptoms of Parkinson's (TRAP)

  • Tremors (present when awake or at rest)
  • Rigidity (resistance to movement, festinating gait)
  • Akinesia or Bradykinesia (no movement or slow movement)
  • Postural instability (impaired balance)
• Festinating gait in Parkinson's


  Short, shuffled steps, forward tilt of trunk, reduced arm swing, rigid head, will increase in speed, losing control
• Other symptoms of Parkinson's

  • Loss of coordination
  • Micrographia
  • Lack of facial expression
  • Drooling
  • Dysphagia
  • Dementia
  • Sleep problems
  • Loss of bladder and bowel control
  • Depression
  • Muscle cramps
  • Pain
  • Fatigue
  • Skin problems
• Management of Parkinson's


  • Medications (dopamine agonists-converts into dopamine, anticholinergic drugs- reduce tremor)
  • Surgical (deep brain stimulation- will only reduce symptoms)
• Parkinson's


  • High fall risk
  • 'Freezing' behaviour
  • Possible dysphagia
  • Increased risk for pressure ulcers
• Coronary Artery Disease


  • Atherosclerosis
  • Angina and myocardial infarction are results of CAD
• Coronary Artery Disease can affect coronary arteries, myocardium, conduction system, pericardium and valves
• Coronary Artery Disease is the 2nd leading cause of death in Canada
• Atherosclerosis


  Caused by elevated levels of Low Density Lipid concentration in the bloodstream the "bad" cholesterol
• Myocardial Infarction


  Can be caused by a narrowing from plaque formation or a thrombus which forms when plaque ruptures and the artery attempts to heal itself but the clot blocks off the artery
• Tissue damage can spread for up to 6 weeks after an MI if heart works too hard
• Risk factors for Coronary Artery Disease

  • Heredity
  • More common for males
  • Age
  • Diabetes
  • High blood pressure
  • Smoking
  • Stress
  • Obesity
• Listen to the warning signs (chest pain)
• Tests for Coronary Artery Disease


  • Angiography
  • Blood and urine tests
  • Cardiac cath
  • Echocardiogram
  • Electrocardiogram
  • Stress test
• Angina


  Aching pain in central chest, may spread to left arm or jaw
• Other symptoms of Coronary Artery Disease


  • Fatigue
  • SOB
  • Cough
  • Psychological symptoms
• Psychosocial effects of Coronary Artery Disease


  • Fear and anxiety
  • Feeling helpless
  • Feeling of loss of control over health
  • Denial
  • Depression
• Management of Coronary Artery Disease


  • Anticoagulants and anti-platelet agents
  • ACE inhibitors
  • Vasodilators
  • Beta blockers
• Cardiac Rehabilitation


  • Improve cardiac condition
  • Physical conditioning
  • Reduce cardiac distress symptoms
  • Improve overall health
  • Prevent cardiac problems