Motor neuron diseases | Facial Pain | Head injury

Motor Neuron Diseases

Motor neuron diseases are caused due to the death of anterior horn cells. Spinal cord consists of an anterior and a posterior horn. Motor neuron diseases are incurable and progressively disabling. In posterior horn, sensory cells carries sensations. Anterior horn is responsible for motor control, and posterior horn is responsible for sensory control. In anterior horn, motor cells carry action potential from nerves to muscles, These are afferent fibers. Brain sends signal via corticospinal tract to motor neurons to generate action potential. Example: If a person wants to move his foot, the signal originates from Wernicke’s area (thinking area) into Broca‘s area, and from here via corticospinal tract enters the spinal cord. From spinal cord nerves carry action potential to that particular area where contraction is required, and due to firing of neurons muscle contraction occurs and limb moves. But, in case of motor neuron diseases:

motor neuron diseases
  • Anterior horn cells death starts.
  • If nerve root of brachial plexus is involved patient feels difficulty in moving his arms.
  • In case, lumbar region is involved then bowel bladder is affected.
  • Onset pattern of disease vary from person to person.
  • As cell death increases, disability also increases
  • consciousness remains normal. Swallowing becomes difficult.

Clinical examination:

  • Stiffness
  • Upper motor neuron lesion (hyper reflexes, stiffness)
  • Lower motor neuron lesion (hypo tone, flaccid, reflexes absent)

Treatment:

Motor neuron diseases are incurable. Supportive treatment is the only option. Physiotherapists plays an important role in motor neuron diseases. Diaphragm muscles progressively becomes weak and carbon dioxide narcosis might occur. Death mostly occurs due to chest infections or respiratory arrest.

  • NG tube is inserted
  • Foley’s catheter
  • Prevent bed sores
  • Suction, chest physiotherapy
  • Limb Physiotherapy
  • Riluzole (increase brain life up to 2 months)

Facial pain

Facial pain might occur due to many underlying causes like migraine, cluster headache, depression headache. If a person is suffering from flu. Nose have four sinuses maxillary, frontal, ethmoidal and sphenoidal. in case the infection spreads to the sinuses (cavities inside nose) It will cause sinusitis and pain. In oral region pain might be due to dental caries or throat infections. Ear infections like otitis media can cause pain in facial area. Inflammation of any organ in facial region may exhibit facial pain. A network of trigeminal nerves supply face. Inflammation of trigeminal nerves cause tingling sensation in facial region. It is called trigeminal neuralgia. Pain caused by trigeminal neuralgia have neurological nature.

Examination and treatment:

Patient complains pain in his cheeks area. To confirm the underlying pathology like in case of sinusitis X-RAY, CT scan or MRI can be performed. In case of dental caries dental X-RAY (radiographs) can be performed. After finding the root cause treatment plan is started accordingly. In case of trigeminal neuralgia amitriptyline (tricyclic antidepressant), anticonvulsants are prescribed. These medications will suppress the neurological symptoms, and pain subsides.

Head Injury

Head injury is of two types intracranial or extracranial. Injury might be due to some mild external injury called extracranial injury or due to a major underlying cause that even meninges or parenchyma might get damage called intracranial injury. Extracranial injury subsides easily with medications. But, in case of intracranial surgery neurosurgeon involvement is mandatory. CT scan or MRI can be performed to find the nature of injury.

Extracranial Intracranial
External causeInternal cause
Mild inflammationMeninges, parenchyma damage
Subsides easilyNeurosurgeon referral
Analgesics, antibioticsBurr hole craniotomy

Examination and treatment:

  • Classify pain as sharp or dull.
  • Intracranial or extracranial cause
  • Hematoma or hemorrhage

Sharp Extracranial Injury: In case of sharp extracranial injury stitching might be required and along with that analgesics and antibiotics are prescribed. It is superficial injury.

Sharp intracranial injury: If sharp pain goes deep and involves meninges or underlying tissues then the patient need to be referred to a neurosurgeon. Hematoma formation may occur. Brain consists of three meninges, dura mater, arachnoid and pia mater. Blood accumulates in between skull and dura mater it is called extradural hematoma. If blood accumulates below dura mater but above arachnoid mater it is called subdural hematoma. If injury is deeper and arachnoid mater is involved, blood enters into circulation, but no hematoma formation occurs in this region. It is called subarachnoid hemorrhage.

Contusion and concussion: If injury is deeper than subarachnoid space that brain parenchyma get involved it may cause contusion or concussion. Direct injury which affects neurons, myelin sheath or oligodendrocytes is called contusion. Function loss in a particular area of brain due to direct injury of myelin sheath, oligodendrocytes or neurons is called concussion. Example: In case of frontal region injury. This injury of forebrain is contusion, but the function loss due to this injury is concussion.

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