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Clinical Guide – Chapters 7, 8A, 8B, 9, 10 Pheochromocytoma: a tumor of the Adrenal Medulla (part of the adrenal gland above the kidneys that secretes hormones) that secretes excessive amounts of Catecholamines (Nor/Epinephrine, Nor/Adrenaline, dopamine) and excess 3-methoxy-4-hydroxy-mandelic acid (VMA), which is used in Urinary metabolism of these Catecholamines. >Symptoms: Hypertension, High blood pressure, severe headaches, nausea, vomiting, sweating, rapid/increased heart rate, palpitations, nosebleeds, anxiety, dizziness, sleep disorders, shortness of breath, fatigue, weight loos. >Treatment: Adrenalectomy (surgical removal of adrenal gland), Atenolol, Propranolol, Prazosin-Tongue Disorders-Ageusia: the loss of taste sense due to damage of the Facial nerve (CN VII) branch Chorda-tympani, or Glossopharyngeal nerve (CN IX) can also be caused by irritation and damage to taste receptors by chemicals or by damage to the taste center in the brain. >Hypogeusia: decreased taste sensitivity >Hypergeusia: increased taste sensitivitySore Tongue: Soreness or irritation of the muscle caused by trauma (induced by biting, or by eating/drinking too-hot or highly acidic things). Trauma is more commonly caused by biting if your teeth don't fit together properly (under-bite or over-bite), or if you grind your teeth. Other causes include diabetes, anemia, vitamin deficiencies, and some skin diseases.Glossodynia: “Burning mouth syndrome”, a disorder characterized by a burning sensation on the tongue. This may be a symptom of post-menopause, autoimmune disease, depression, anxiety, low grade tissue trauma, chemical substance irritation, vitamin/mineral deficiencies, or type 2 diabetes.Benign Migratory Glossitis: “Geographic Tongue”, A condition characterized by irregular, inflamed and irritated red patches on the tongue surrounded by a white ring. The tongue may be swollen or sore, and patches may change location/size/shape. The cause is unknown, and treatment usually includes an increase in hygienic rinsing frequency.Bell’s Palsy: A condition characterized by sudden weakness of the muscles on one half of the face. The patient may be experiencing inner ear pain, drooling and drooping on one side of the face, sound sensitivity, and taste abnormalities. This is caused by paralysis of the Facial nerve (CN VII) branch Chorda-tympani, due to damage or irritation, but this usually resolves itself within 6 months. Chorda-tympani innervates the anterior 2/3rd of the tongue so damage keeps the receptors from relaying taste sensory information to the taste center of the brain (Postcentral Gyrus). Treatment includes physical therapy or prednisone (a synthetic glucocorticoid-type of anti-inflammatory). -Olfactory Disorders-Anosmia: The loss of the sense of smell caused by inflammation of nasal mucosa, blockage of nasal passage ways, or neurological destruction (due to damage to the temporal lobe, chronic meningitis, damage to Olfactory nerve (CN I), or damage to the Olfactory bulb). Cause may be congenital, an early sign of Parkinson's, Alzheimer's, or a psychological or endocrine condition.Phantosmia: The phenomenon of smelling odors that are not present. This could be caused by olfactory hallucinations and may be a symptom indicating Schizophrenia, Parkinson's, or Neuroblastoma (cancerous growth originating from neuroblast cells). Treatment involves drug therapy, brain stimulation, or surgical removal of the olfactory bulbs or olfactory epithelium.Dysosmia: A disorder that distorts the perception of smell, so things smell differently than they should. Likely caused by a neurological disorder due to from head trauma or sinus disease. Condition may go away on its own over time, or it can be treated with nasal drops (to block airflow to the olfactory cleft), sedatives, or surgery to remove olfactory epithelium.-Ocular Disorders-Color blindness: A condition characterized by the deficiency of color perception in cone cells (some or all colors). Usually the cause is genetic, but it can be due to damage to the eye, optic nerve, or brain damage (via trauma, exposure to chemicals, or disease). There is no known treatment.Night blindness: “Nyctalopia” Poor vision at night or in dim lighting, where the patient cannot distinguish shades of gray, meaning there is an issue with light perception in the rod cells. The cause may be congenital or due to retinal damage, malnutrition (vitamin A deficiency), cataracts, or near sightedness. The most common cause is Retinitis Pigmentosa (where the rod cells in the retina lose the ability to respond to light due to Rhodopsin deficiency). Treatment includes vitamin A supplements for those with the deficiency (vit. A is a precursor for Rhodopsin). If left untreated, vision can degrade enough to affect daytime vision and begin total vision loss.Glaucoma: A group of eye conditions that can lead to blindness due to inter-cranial pressure. An obstruction of the eyes’ venous system connection to the internal environment of the eye (Canal of Schlemm, which drains intra-ocular fluid from the eye), causes an accumulation of intra-ocular fluid inside the eye. When this fluid is in excess it can compress the tissues of the retina and the internal ocular structures. If left untreated it can damage the retina, lens, and optic nerve, resulting in blindness. The cause may be genetically based, or due to a tumor, trauma, or infection. Symptoms include blurred or distorted vision, vision loss, and ocular pressure. Treatment may involve eye drops, laser surgery (Trabeculoplasty, opens drainage of trabecular meshwork).Visual Agnosia: The inability of the brain to perceive and recognize visual stimulus (such as familiar objects or faces). This can be due to brain damage of the visual association cortex, damage in the occipital lobe, or damage in the temporal lobe. -Ocular Disorders affecting how light hits the Retina-Emmetropia: Light hits the retina without issue, functions normallyHypertrophia: Causes far-sightedness, light hits behind the retina and must be corrected with a convex lensMyopia: Causes near-sightedness, light hits in front of the retina and must be corrected with a concave lensAstigmatism: Curvature of the lens is not uniform and can cause blurry vision and double-vision, must be corrected with a cylindrical lens-Auditory Disorders-Otitis Media: Infection and inflammation of the middle ear segment, associated with a build-up of fluid behind the ear drum, causing an ear ache. This can result from bacterial or viral infections in the fluid. Treatment with antibiotics is necessary, if left untreated it can progress into Bacterial Meningitis. Infection can cause inflammation of the tissue in the Eustachian tube, which results in negative pressure in a vacuum that accumulates fluid. Common pathogens involved in this condition include Streptococcus, Influenza, and the common cold. Symptoms include vertigo, nausea, ear pain, fever, and headaches. >Symptoms of Bacterial Meningitis: severe headaches, vomiting and nausea, vision problems, vertigo, disordered motor control, disordered sensory reception, coma.-Vestibular Disorders-Nystagmus: Abnormal eye movement caused by stimulus of semi-circular canals of the Vestibular System during rotation of the head. Seen as rapid “dancing” eye movement in the same direction as head rotation as opposed to the normal slow movement of eyes in the opposite direction of head movement (to maintain visual fixation). Causes may be congenital (due to a pre-existing neurological disorder), hormonal, nerve damage from head trauma, a tumor, bacterial/viral infection, or an auto-immune condition. If the cause is due to nerve damage, it would affect Cranial nerves III (Oculomotor), IV (Trochlear), and VI (Abducens), which innervate the extra ocular muscles for eye movement.Post-Rotatory Nystagmus: Characterized by eye movement in the opposite direction of head rotation BUT once rotation stops the eyes follow slowly towards the same direction. This is normal eye movement.Vertigo: A recurring feeling of dizziness and loss of balance associated with problems of the inner ear Vestibular Systems (balancing mechanism), issues in the cerebellum, or issues with neural connections between these two areas. Other causes include high/low blood pressure, Hypoglycemia (may or may not be associated with Type 1 Diabetes), Hypercholesterolemia or Hypocholesterolemia (as a result of excessive Lipitor dosage taken to treat Hyper), Dehydration, ADH (Antidiuretic Hormone) Deficiency, or Pregnancy.-Neurological Disorders-Gliosis (and glial scarring): Hyperplasia (enlargement due to increased cell proliferation) or Hypertrophy (enlargement of cell size) of glial cells that occurs in reaction to damage to the CNS. Oligodendrocytes respond to the CNS damage by filling the area with cytoplasm, then Astrocytes proliferate to fill the damaged area (keeping the damaged axons/brain tissue from regenerating) and form glial scar tissue. Neuroglial Tumors (Glioma): Make up 50% of intercranial tumors. >Astrocytomas & Glioblastomas: are tumors of Astrocytes, which cause the following symptoms: headaches, seizures, memory loss, & behavioral changes. The tumors are very invasive and grow large but have minimal effect on neighboring neurons (meaning they are unlikely to metastasize to nearby neurons). Treatment typically involves surgical removal of tissue, chemo therapy, and radiation. >Ependymoma: a tumor of the Ependyma cells that line the ventricles of the brain and the central canal of the spinal cord. Symptoms include irritability, sleeplessness, vomiting, nausea, and headaches. These tumors are not as invasive and grow slowly. The area is typically treated with radiation after surgical removal of the tumor.Multiple Sclerosis (M.S., demyelinating disease in CNS): A disease in which the immune system degrades the protective myelin sheath of nerves. It usually begins around the ages of 20-40 and starts degenerating the optic nerves, spinal cord, and cerebellum first. Axons degenerate due the loss of their myelin sheath, resulting in a loss of action potential signals. This causes vision loss, pain, fatigue, impaired coordination, tremors, motor issues with movement, walking, muscle cramps and involuntary movement, Vertigo, anxiety, mood swings, impaired speech, sexual dysfunction, and diaphragm paralysis. There is no cure and the symptoms can only be partially managed with physical therapy and steroids.-Muscular Disorders-Duchenne Muscular Dystrophy: A heritable degenerative muscle disease that is typically diagnosed in male adolescents around 2-10 years of age. This sex-linked genetic defect causes a deficiency of dystrophin submembrane protein, which is important for the structure and contractile ability of muscles. This deficiency causes muscle fibers to degenerate and the affected muscles will enlarge with fat and connective tissue instead. The loss of muscle fiber will cause dystrophy and muscle weakness, resulting in symptoms such as frequent falling, trouble getting up, waddling gait, big calves, learning disabilities, shortening of muscles and muscle weakness, fatigue, scoliosis, walking on tip toes, and difficulties standing or swallowing. Since there is no cure, treatments including Prednisone (anti-inflammatory steroid), and occupational/physical therapy only target symptom management.Myotonic Dystrophy: A heritable genetic defect of chromosome 19 that causes muscular dystrophy via Myotonia (prolonged muscle contractions that have decreasing ability to relax). This affects the tonicity (tone) of the muscles as they weaken and atrophy. Symptoms include slurred speech, locked jaw, mental deficiencies, abnormal heart rhythm, hair loss, cataracts, infertility in men, and issues breathing during sleep (sleep apnea). This is commonly observed in young adulthood but can develop at any age and in any variation of symptom severity. Chromosome 19 codes for a protein kinase found in the skeletal muscle that has some regulatory effect on the structure of skeletal muscle.-Neurotransmitter Disorders-Parkinson’s: A dopamine deficiency due to the lack of secretion by the Substantia Negra (black substance) in the brainstem, which is involved in the control of movement. Nervous damage causes a drop in the synthesis of dopamine. Symptoms include tremors, stiffness, slow movement, motor issues, loss of balance, involuntary movement, muscle rigidity and contractions, disordered sleep, speech impairments, anxiety, and fatigue. Treatments include L-dopa, a precursor to dopamine which can cross the Blood Brain Barrier to help synthesize new dopamine (dopamine cannot cross the Blood Brain Barrier and must be synthesized within it, after L-dopa crosses over). Anesthetics block synaptic transmission and nerve conduction to alleviate some involuntary movements and wild neural firings.Schizophrenia: A condition caused by an excess of dopamine secreted by the Substantia Negra of the brain stem resulting in symptoms such as delusion, amnesia, confusion and disorientation, isolation, disorganization, mood swings, speech disorders (characterized with rapid frenzied speech), fatigue, and a lack of motor coordination. There is no cure, but symptoms can be managed with lifelong medication and therapy. ................
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