Billet 23

1.Autonomic nervous system: anatomical

Physiological peculiarities,clinical examination
and additional investigations, signs of
impairment.
Ans.The autonomic nervous system is a control
system that acts largely unconsciously and
regulates bodily functions, such as the heart
rate, digestion, respiratory rate, pupillary
response, urination, and sexual arousal. This
system is the primary mechanism in control of
the fight-or-flight response
Clinical examination
 Autonomic function tests. These tests
measure how your heart rate and blood
pressure respond during exercises such as
deep breathing and forcefully exhaling
(Valsalva maneuver).
  Tilt-table test. This test monitors the
response of blood pressure and heart rate
to changes in posture and position,
simulating what occurs when you stand up
after lying down.
 Gastrointestinal tests. Gastric-emptying
tests are the most common tests to check
for digestive abnormalities such as slow
digestion and delayed emptying of the
stomach (gastroparesis).
 Quantitative sudomotor axon reflex test.
This test evaluates how the nerves that
regulate your sweat glands respond to
stimulation
 Thermoregulatory sweat test.
 Urinalysis and bladder function
(urodynamic) tests.
 Ultrasound. If you have bladder signs and
symptoms,
Symptoms
 Dizziness and fainting when standing,
caused by a sudden drop in blood pressure.
 Urinary problems, such as difficulty starting
urination, incontinence, difficulty sensing a
full bladder and inability to completely
empty the bladder, which can lead to
urinary tract infections.
 Sexual difficulties, including problems
achieving or maintaining an erection
(erectile dysfunction) or ejaculation
problems in men. In women, problems
include vaginal dryness, low libido and
difficulty reaching orgasm.
 Difficulty digesting food, such as feeling full
after a few bites of food, loss of appetite,
diarrhea, constipation, abdominal bloating,
nausea, vomiting, difficulty swallowing and
heartburn, all due to changes in digestive
function.
  Inability to recognize low blood sugar
(hypoglycemia), because the warning
signals, such as getting shaky, aren’t there.
 Sweating abnormalities, such as sweating
too much or too little, which affect the
ability to regulate body temperature.
 Sluggish pupil reaction, making it difficult to
adjust from light to dark and seeing well
when driving at night.
 Exercise intolerance, which can occur if
your heart rate stays the same instead of
adjusting to your activity level.
2.Herpes Simplex encephalitis.
Aetiology,Pathogenesis,clinicalmanifestations,
treatment.
Ans.
Etiology

HSV-1 and HSV-2

Pathogenesis- Biological basis.
 Primary HSV infections are usually oral
(gingivostomatitis), corneal (keratitis), or
genital (penile, vaginal, cervical). Once
transmitted, the virus then enters
peripheral sensory nerves, travels ty
retrograde axonal transport to the neuronal
cell body,and establishes a latent infection
that can persist for the life of the host
 The lesions take the form of an intense
hemorrhagic necrosis of the inferior and
medial Parts of the temporal lobes and the
orbital parts of the frontal Lobes. The
temporal lobe lesions are usually bilateral
but need not symmetrical.
Clinical manifestations
Treatment
*Treatment: - Acyclovir Is given
intravenously in a dosage of 30 mg/kg per
day (1-12,5mg/kg/8lhr/iv with physiologic
solution) and continued for 10 to 14 days in
order to prevent relapse. Acyclovir carries
little risk and Can be discontinued if further
clinical or laboratory features point To
another diagnosis: - management of brain
 edema due to mass Lesions should be
applied. Mannitol 1-1,5g/kg/day
CorticosteriodsDexamethasone 10mg/iv.
Then 4-6 mg/im/6hr Seizures are Usually
brought under control by high doses of
conventional Anticonvulsants.(fenitoin,
carbamazepin, fenobarbital, valporic Acid)
3.Disturbances of the nervous system
causedby toxic substances
(pesticides,herbicides)
Ans.
Nervous system disturbances due to pesticides
toxicity may Not be visible at the moment of
intoxication. Some pesticides Toxicities may
take 3-4 weeks to manifest from the moment
of intoXication. Mild intoxication may develop
asthenic, vegetative and neuroasthenic
disturbances. Grave intoxications may cause
toxic encephalopathy, polyneuropathy,
extrapyramidal disorders, cerebellar
disturbances, convulsion.