Assignment On

Physiology-III
Assignment Topics: 5 disease of CNS

Submitted To: Md. Ruhul Kuddus shipon Lecturer, Department of pharmacy

Submitted by: Faisal Asif ID No: UG08-15-09-043 Batch: 15 Department of pharmacy

01927382632 01674833316

Date of Submission: 09-10-2010

1) Pituitary adenoma
Definition of Pituitary adenoma
The pituitary is a small complicated gland at the base of the brain. It makes several important hormones that regulate growth and the activity of several other major glands throughout the body. A pituitary adenoma is an abnormal growth, or tumor, in this gland. Pituitary adenomas are benign. This means they are not cancerous. They do not spread to other parts of the body. The growths can lead to vision problems because it is near the eyes. It can also lead to growth problems. It often can also disrupt the hormonal balance of the thyroid, adrenal, and gonads. Pituitary Gland

* Causes The cause is unknown. Some tumors are part of other endocrine disorders and are associated with genetic changes. These can be inherited. Tumors can also be a result of exposure to cancer causing substances like radiation. In some cases the DNA changes may occur for no known reason. * Risk Factors Factors that increase your chance of pituitary adenoma include:

A family or personal history of multiple endocrine neoplasia, type 1 (MEN1) a hereditary condition that increases the risk of developing pituitary, hypothalamus, and parathyroid and pancreatic tumors Other disorders that run in the family like Carney complex or acromegaly (giantism)

* Symptoms Symptoms can vary quite a bit and may not be present at all. It will depend on whether or not the tumor is secreting hormones and how large it is. The tumor's location at the base of the brain can also cause symptoms. Symptoms of hyperthyroidism

Tremors

Heart palpitations Anxiety Weight loss Insomnia

Symptoms from Corticotrophin-secreting Adenoma:

Menstrual disturbance High blood pressure High fasting glucose Skin changes (increased facial hair, acne, bruising, bluish stretch marks Buffalo hump (increased fatty tissue in back) Obesity especially around the wrist Round face

Growth Hormone-secreting Adenoma

Acromegaly (adult) Gigantism (child) High blood pressure High fasting blood sugar Facial features coarse Oily skin Excess sweating

Pituitary adenomas may also be associated with the following conditions:

Diabetes mellitus Kidney stones Cardiovascular disease High blood pressure Osteoporosis Thyroid disease

* * Treatment Treatment depends on the presence and type of hormones being secreted. It is not uncommon for these treatment options to be used in combination. Talk with your doctor about the best plan for you. --------------------------

2) Wilson Disease
What is Wilson disease? Wilson disease is a genetic disorder that prevents the body from getting rid of extra copper. A small amount of copper obtained from food is needed to stay healthy, but too much copper is poisonous. In Wilson disease, copper builds up in the liver, brain, eyes, and other organs. Over time, high copper levels can cause life-threatening organ damage.

What causes Wilson disease? Wilson disease is caused by a buildup of copper in the body. Normally, copper from the diet is filtered out by the liver and released into bile, which flows out of the body through the gastrointestinal tract. People who have Wilson disease cannot release copper from the liver at a normal rate, due to a mutation of the ATP7B gene. When the copper storage capacity of the liver is exceeded, copper is released into the bloodstream and travels to other organsincluding the brain, kidneys, and eyes. What are the symptoms of Wilson disease? A buildup of copper in the liver may cause ongoing liver disease. Rarely, acute liver failure occurs; most patients develop signs and symptoms that accompany chronic liver disease, including

swelling of the liver or spleen jaundice, or yellowing of the skin and whites of the eyes fluid buildup in the legs or abdomen a tendency to bruise easily fatigue

A buildup of copper in the central nervous system may result in neurologic symptoms, including

problems with speech, swallowing, or physical coordination tremors or uncontrolled movements muscle stiffness behavioral changes

Other signs and symptoms of Wilson disease include

anemia low platelet or white blood cell count slower blood clotting, measured by a blood test high levels of amino acids, protein, uric acid, and carbohydrates in urine premature osteoporosis and arthritis

How is Wilson disease treated? Wilson disease requires lifelong treatment to reduce and control the amount of copper in the body. Initial therapy includes the removal of excess copper, a reduction of copper intake, and the treatment of any liver or central nervous system damage. The drugs d-penicillamine (Cuprimine) and trientine hydrochloride (Syprine) release copper from organs into the bloodstream. Most of the copper is then filtered out by the kidneys and excreted in urine. A potential major side effect of both drugs is that neurologic symptoms can become worsea possible result of the newly released copper becoming reabsorbed by the central nervous system. About 20 to 30 percent of patients using d-penicillamine will also initially experience other reactions to the medication, including fever, rash, and other drug-related effects on the kidneys and bone marrow. The risk of drug reaction and neurologic worsening appears to be lower with trientine hydrochloride, which should be the first choice for the treatment of all symptomatic patients. Pregnant women should take a lower dose of d-penicillamine or trientine hydrochloride during pregnancy to reduce the risk of birth defects. A lower dose will also help reduce the risk of slower wound healing if surgical procedures are performed during childbirth.

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3) Parkinson's disease
Parkinson's disease is characterized by abnormalities of motor function, several of which predominate, but all do not necessarily occur in all individuals. Slowness of movement and an inability to start a movement are hallmarks of the disease. The motor disturbance also results in diminished facial expression and a decreased rate of blinking. The second important manifestation is stiffness and rigidity so that the person encounters increased resistance when attempting to move a limb and a joint. The third manifestation, in some individuals, is a tremor that may be quite asymmetrical, occurring in just one hand, or may involve both hands and the trunk. What Causes Parkinson's Disease? Parkinson's disease is caused by the progressive impairment or deterioration of neurons (nerve cells) in an area of the brain known as the substantia nigra. When functioning normally, these neurons produce a vital brain chemical known as dopamine. Dopamine serves as a chemical messenger allowing communication between the substantia nigra and another area of the brain called the corpus striatum. This communication coordinates smooth and balanced muscle movement. A lack of dopamine results abnormal nerve functioning, causing a loss in the ability to control body movements

Symptoms of Parkinson's disease The symptoms of Parkinson's disease often start on one side of your body first and then affect both sides. The main symptoms are listed below.
as different muscles become affected you may develop:

problems with posture and balance - you may have falls and have difficulty turning in bed or getting out of a chair speech changes - your speech may become quiet or rapid, making it hard for others to understand you loss of facial expression - you may smile less, frown more and blink slowly small handwriting

Other symptoms that you can have aren't related to movement. These can include:

mental health problems - including depression, loss of memory, difficulty reasoning, increased anxiety and changes in behaviors bowel and bladder problems such as constipation and the need to urinate often problems with swallowing weight loss impotence low blood pressure when you stand up increased saliva and sweating sleep problems and tiredness

Treatment of Parkinson's disease

Treatment is aimed at restoring the levels of dopamine in your brain and controlling symptoms. The symptoms and progression of Parkinson's disease are different for each person. Your doctor will help you to decide which treatment is best for you depending on your symptoms and your individual needs. Medicines Several types of medicine are available. The main types are listed below.

Medicines that replace dopamine are the most effective treatment. These medicines are combinations of levodopa, which breaks down in the body to form dopamine, and another chemical that ensures that the levodopa reaches your brain. Dopamine replacement medicines can provide long-term improvement, although there are some side-effects such as feeling sick, vomiting and sudden sleepiness. They can also cause long-term problems such as unwanted movements of the face and limbs (dyskinesia) and may become less reliable over time, with symptoms fluctuating suddenly - often called the "on-off syndrome". Examples include cobenedopa (Madopar) and co-careldopa (eg Sinemet). Medicines that mimic the action of dopamine (dopamine agonists) are commonly taken together with levodopa or alone before using levodopa. Side-effects of dopamine agonists can include feeling sick, constipation, headache and sudden sleepiness. Examples include pramipexole (Mirapexin), ropinirole (e.g Adartrel, Requip) and rotigotine (Neupro). ------------------------------------------

4) Brain Tumors
Introduction:
Brain tumors in children are not uncommon. While in general tumors and cancers affect the elderly population more than children, there are a number of specific types of tumors which are known to affect children. Some of these, especially medulloblastoma (which is the most common type), affect the brain. Brain tumors can affect individuals of any age. However, there are a few specific types that can occur most commonly in young individuals, including infants. The most common types of brain tumors in children include: Medulloblastoma: By far the most common type of brain tumor affecting children, medulloblastoma generally presents in early life. It arises in the roof of the 4th ventricle, one of the fluid-filled spaces within the brain and can obstruct the flow of this fluid, often leading to hydrocephalus. Gliomas: Gliomas are a large class of primary brain tumors that can affect all ages. However, there are some specific types that occur in children. In particular, some forms of low-grade (benign) astrocytoma, particularly pilocytic astrocytoma occur in children. These tumors are often cystic and can involve various parts of the brain. Low-grade brainstem gliomas can also occur in children and are rare in older individuals. Ependymomas: A subclass of gliomas are ependymomas which are tumors arising from the cells lining the ventricles, the fluid-filled spaces within the brain. Because they grow

within the ventricles, they can also cause hydrocephalus in some cases, similar to medulloblastoma.

What Are The Symptoms of Brain Tumors in Children?

Symptoms vary depending on the specific type of tumor and its location. Headache is one of the most common symptoms and may be accompanied by visual changes. Other symptoms can include seizures, changes in personality, fatigue and increased sleep, problems with balance, and others. Symptoms of hydrocephalus, which can occur with some tumors, include headache, deteriorating level of consciousness, and others.

Diagnosis and Treatment

As with brain tumors in adults, brain tumors in children are generally diagnosed by imaging studies which demonstrate the tumor. These can include CT scan and/or MRI scan. Once they are identified, final diagnosis of the type of tumor requires biopsy or removal of the tumor. ---------------------------------------

5) Medulloblastoma
Introduction:
Medulloblastoma is a cancerous tumor of brain that mainly affects children. Medulloblastoma originates in the cerebellum or posterior fossa of brain. It is also called as a primitive neuroendocrine tumor, accounting for 10-20% of primary CNS neoplasms and around 40% of all posterior fossa tumors. It can take place soon after birth and into puberty. However, most tumors take place either before age ten or sometime in the late teens or early twenties. Medulloblastoma is a highly invasive embryonic neuroepithelial tumor which has tendency to disseminate throughout the CNS early in its course. Untreated tumors can easily spread to other areas of the brain and to the spine. Read out the following article to get full details about medulloblastoma including causes, symptoms, diagnosis, and treatment.

Causes:
The exact cause of medulloblastoma is unknown same as with most brain tumors and researchers are continuing to work for finding possible causes. Some symptoms that listed may also be potential underlying causes of Medulloblastoma. The tumor can take place in relation with two rare types of genetically linked family cancer syndromes, Gorlins syndrome and Turcots syndrome. Gorlins syndrome is occurred due to defect in a gene known as PTC located on chromosome. Medulloblastoma and also cancers of the skin and ovary can be caused due to this defect. Turcots syndrome is caused by a defective gene known as APC and it can present with cancer of the intestinal tract as well as medulloblastoma. Both of these syndromes are quite uncommon and only account for a fraction of medulloblastoma cases. Medulloblastoma as a symptom of that condition:

Nevoid basal cell carcinoma syndrome Nijmegen breakage syndrome Microcephaly immunodeficiency lymphoreticuloma

Symptoms:
Symptoms may be delicate and only slowly become worse, or they may take place very rapidly. The most common symptom is headache. Brain tumors are mostly associated with headache symptoms including:

Headache that gets worse while waking up in the morning, and then clears up within a few hours Double vision, weakness, or numbness Headaches that may get worse with coughing or exercise, or with a change in body position

Headaches that take place while sleeping and with at least one other symptom (such as vomiting or confusion)

A patient of medulloblastoma may suffer from seizure. Sometimes brain tumors symptoms are associated with mental changes that may include:

Increased sleep Memory loss Impaired concentration Changes in personality and behavior Problems with reasoning

Other possible symptoms include:

Speech difficulty Hearing loss, with or without dizziness Gradual loss of movement or feeling in an arm or leg Unsteadiness and problems with balance Unexpected vision problem (especially if it takes place with a headache), including vision loss (usually of peripheral vision) in one or both eyes, or double vision

Symptoms of medulloblastoma are same in infants, older children and teenagers. Some non-specific symptoms for example nausea and vomiting, headache, and vague visual disturbances indicate the first sign of a tumor in the cerebellum. Other more striking signs include double vision, sudden difficulty writing, and problems walking and moving that worsen over time.

Treatment:
A childs health, size and position of the tumor are the factors to be considered for the treatment of medulloblastoma. The doctor can take decision for the best type of treatment after the test results. Childhood brain tumors can occur in various stages and it is important to know these stages for the selection of treatment plans and more accurate prognosis. There are four stages defined for medulloblastoma:

T1: The tumor having the size of less than 3 cm diameter. T2: The tumor has the size of greater than 3 cm in diameter and has invaded one other brain structure besides the cerebellum. T3: The tumor has invaded two other brain structures in addition to the cerebellum. T4: The tumor has spread down into the midbrain or upper spinal cord.

The treatment plan will generally be designed by a team of specialists known as a multidisciplinary team (MDT) which includes a pediatric oncologist (a doctor specializing in the treatment of childhood cancers), a pediatric neurosurgeon (a doctor specializing in childhood brain surgery), as well as a pediatric neurologist and radiation oncologist (a doctor specializing in the use of radiation to treat cancer).

Prevention:
Currently, no known ways are available to prevent medulloblastoma. Gorlins and Turcots syndrome are the genetic disorders which predisposes to medulloblastoma so people having the rare genetic disorders should be especially aware of any signs or symptoms of medulloblastomas. Children of parents having these genetic disorders should have routine screening performed by a pediatrician for any signs of a brain tumor.