NEUROLOGISCHE EN
LOCOMOTORISCHE
PATHOLOGIE
Semester 1
,Inhoudsopgave
1. Dwarslaesie............................................................................................................................................... 8
1.1 Definitie...........................................................................................................................................................8
1.2 Epidemiologie.................................................................................................................................................8
1.3 Etiologie..........................................................................................................................................................9
1.4 Prognose.......................................................................................................................................................10
1.5 De omschrijving van het letsel......................................................................................................................10
Neurologisch niveau.......................................................................................................................................10
Het sensibel niveau....................................................................................................................................10
Het motorisch niveau.................................................................................................................................11
Compleet/ incompleet....................................................................................................................................11
Compleet....................................................................................................................................................11
Incompleet.................................................................................................................................................11
1.6 Klinische syndromen incomplete laesies.......................................................................................................12
1.7 Classificatie volgens lichamelijke gevolgen..................................................................................................12
1.8 Gevolgen en stoornissen op lichamelijk vlak................................................................................................12
Blaasstoornissen.............................................................................................................................................12
Behandelingsmogelijkheden......................................................................................................................13
Decubitus........................................................................................................................................................14
Spinale shockfase...........................................................................................................................................14
Spasticiteit......................................................................................................................................................14
Symptomen................................................................................................................................................15
MAS- schaal................................................................................................................................................15
Circulatiestoornissen......................................................................................................................................15
Orthostatische hypotensie.........................................................................................................................15
Autonome dysreflexie................................................................................................................................16
Trombose...................................................................................................................................................16
1.9 De therapie...................................................................................................................................................16
2. Niet aangeboren hersenletsel................................................................................................................... 17
2.1 Definitie.........................................................................................................................................................17
2.2 Traumatisch hersenletsel (THL)....................................................................................................................17
Epidemiologie.................................................................................................................................................17
Oorzaken.........................................................................................................................................................17
Pathofysiologie...............................................................................................................................................17
Primair hersenletsel...................................................................................................................................18
Secundair hersenletsel...............................................................................................................................18
Ernst van het letsel.........................................................................................................................................18
Glasglow coma scale..................................................................................................................................19
Duur van de coma......................................................................................................................................19
Post traumatische amnesie (PTA)..............................................................................................................19
Ziektebeelden.................................................................................................................................................20
Trauma capitis............................................................................................................................................20
1
, Commito cerebri........................................................................................................................................20
Contisio cerebri..........................................................................................................................................20
Prognose.........................................................................................................................................................20
Niet responsieve waakzaamheid....................................................................................................................20
Gevolgen van een NAH...................................................................................................................................21
Sensomotorische problemen.....................................................................................................................21
Epilepsie.....................................................................................................................................................21
Zenuwschade.............................................................................................................................................21
Intellectuele schade...................................................................................................................................21
Gestoord geheugen....................................................................................................................................21
Gedragsproblemen....................................................................................................................................22
Praxiestoornissen.......................................................................................................................................22
Perseveratie...............................................................................................................................................22
Spraak- en Taalstoornissen........................................................................................................................23
Agnosie.......................................................................................................................................................23
Attentiestoornissen....................................................................................................................................24
2.3 Cerebrovasculair accident (CVA)..................................................................................................................24
Definitie..........................................................................................................................................................24
Epidemiologie.................................................................................................................................................24
Begrippen.......................................................................................................................................................25
Classificatie.....................................................................................................................................................25
Risicofactoren.................................................................................................................................................26
Prognose.........................................................................................................................................................26
Gevolgen en stoornissen op lichamelijk vlak.................................................................................................26
Splitsing van lichaam..................................................................................................................................26
Pushen........................................................................................................................................................27
Homonieme hemianopsie..........................................................................................................................27
Pijn..............................................................................................................................................................27
Incontinentie en obstipatie........................................................................................................................27
Stoornissen in denken, emoties en gedrag................................................................................................27
Epilepsie.....................................................................................................................................................28
Diagnose.........................................................................................................................................................28
Behandeling....................................................................................................................................................28
3. Amyotrofe laterale sclerose..................................................................................................................... 30
3.1 Definitie.........................................................................................................................................................30
3.2 Epidemiologie...............................................................................................................................................30
3.3 Etiologie........................................................................................................................................................30
3.4 De symptomen..............................................................................................................................................30
3.5 Klinisch beeld................................................................................................................................................31
3.6 Diagnose.......................................................................................................................................................31
3.7 De prognose..................................................................................................................................................31
3.8 De behandeling.............................................................................................................................................31
4. Multiple sclerose...................................................................................................................................... 32
4.1 Epidemiologie...............................................................................................................................................32
2
, 4.2 De types........................................................................................................................................................32
4.3 Het verloop...................................................................................................................................................32
4.4 De symptomen..............................................................................................................................................33
De beginsymptomen......................................................................................................................................33
Latere symptomen.........................................................................................................................................33
4.5 De behandeling.............................................................................................................................................34
4.5 Diagnose.......................................................................................................................................................34
5. Extrapirmidale ziekte: de ziekte van Parkinson.........................................................................................35
5.1 Definitie.........................................................................................................................................................35
5.2 Etiologie........................................................................................................................................................35
5.3 Epidemiologie...............................................................................................................................................35
5.4 Fysiopathologie.............................................................................................................................................35
5.5 Klinisch beeld................................................................................................................................................36
Symptomen....................................................................................................................................................36
De 3 kernsymptomen.....................................................................................................................................36
Gevolgen.........................................................................................................................................................37
5.6 Diagnose.......................................................................................................................................................37
5.7 Behandeling..................................................................................................................................................37
Medicamenteus..............................................................................................................................................37
Chirurgie.........................................................................................................................................................38
5.8 Prognose.......................................................................................................................................................38
6. Aandoeningen van het perifeer zenuwstelsel: letsels van het bovenste lidmaat........................................39
6.1 Inleiding........................................................................................................................................................39
6.2 Innervatie van de arm...................................................................................................................................39
6.3 Plexus brachialis letsel..................................................................................................................................40
Het ontstaan...................................................................................................................................................40
6.4 Laesie van de n. musculocutaneus...............................................................................................................40
De anatomie...................................................................................................................................................40
Etiologie..........................................................................................................................................................41
Gevolgen.........................................................................................................................................................41
6.5 Laesie van de n. radialis................................................................................................................................41
Anatomie........................................................................................................................................................41
Etiologie..........................................................................................................................................................42
Gevolgen.........................................................................................................................................................42
Distaal radialisletsel...................................................................................................................................42
Hoog letsel.................................................................................................................................................43
6.6 Laesie van de n. medianus............................................................................................................................43
Anatomie........................................................................................................................................................43
Etiologie..........................................................................................................................................................43
Gevolgen.........................................................................................................................................................44
3
LOCOMOTORISCHE
PATHOLOGIE
Semester 1
,Inhoudsopgave
1. Dwarslaesie............................................................................................................................................... 8
1.1 Definitie...........................................................................................................................................................8
1.2 Epidemiologie.................................................................................................................................................8
1.3 Etiologie..........................................................................................................................................................9
1.4 Prognose.......................................................................................................................................................10
1.5 De omschrijving van het letsel......................................................................................................................10
Neurologisch niveau.......................................................................................................................................10
Het sensibel niveau....................................................................................................................................10
Het motorisch niveau.................................................................................................................................11
Compleet/ incompleet....................................................................................................................................11
Compleet....................................................................................................................................................11
Incompleet.................................................................................................................................................11
1.6 Klinische syndromen incomplete laesies.......................................................................................................12
1.7 Classificatie volgens lichamelijke gevolgen..................................................................................................12
1.8 Gevolgen en stoornissen op lichamelijk vlak................................................................................................12
Blaasstoornissen.............................................................................................................................................12
Behandelingsmogelijkheden......................................................................................................................13
Decubitus........................................................................................................................................................14
Spinale shockfase...........................................................................................................................................14
Spasticiteit......................................................................................................................................................14
Symptomen................................................................................................................................................15
MAS- schaal................................................................................................................................................15
Circulatiestoornissen......................................................................................................................................15
Orthostatische hypotensie.........................................................................................................................15
Autonome dysreflexie................................................................................................................................16
Trombose...................................................................................................................................................16
1.9 De therapie...................................................................................................................................................16
2. Niet aangeboren hersenletsel................................................................................................................... 17
2.1 Definitie.........................................................................................................................................................17
2.2 Traumatisch hersenletsel (THL)....................................................................................................................17
Epidemiologie.................................................................................................................................................17
Oorzaken.........................................................................................................................................................17
Pathofysiologie...............................................................................................................................................17
Primair hersenletsel...................................................................................................................................18
Secundair hersenletsel...............................................................................................................................18
Ernst van het letsel.........................................................................................................................................18
Glasglow coma scale..................................................................................................................................19
Duur van de coma......................................................................................................................................19
Post traumatische amnesie (PTA)..............................................................................................................19
Ziektebeelden.................................................................................................................................................20
Trauma capitis............................................................................................................................................20
1
, Commito cerebri........................................................................................................................................20
Contisio cerebri..........................................................................................................................................20
Prognose.........................................................................................................................................................20
Niet responsieve waakzaamheid....................................................................................................................20
Gevolgen van een NAH...................................................................................................................................21
Sensomotorische problemen.....................................................................................................................21
Epilepsie.....................................................................................................................................................21
Zenuwschade.............................................................................................................................................21
Intellectuele schade...................................................................................................................................21
Gestoord geheugen....................................................................................................................................21
Gedragsproblemen....................................................................................................................................22
Praxiestoornissen.......................................................................................................................................22
Perseveratie...............................................................................................................................................22
Spraak- en Taalstoornissen........................................................................................................................23
Agnosie.......................................................................................................................................................23
Attentiestoornissen....................................................................................................................................24
2.3 Cerebrovasculair accident (CVA)..................................................................................................................24
Definitie..........................................................................................................................................................24
Epidemiologie.................................................................................................................................................24
Begrippen.......................................................................................................................................................25
Classificatie.....................................................................................................................................................25
Risicofactoren.................................................................................................................................................26
Prognose.........................................................................................................................................................26
Gevolgen en stoornissen op lichamelijk vlak.................................................................................................26
Splitsing van lichaam..................................................................................................................................26
Pushen........................................................................................................................................................27
Homonieme hemianopsie..........................................................................................................................27
Pijn..............................................................................................................................................................27
Incontinentie en obstipatie........................................................................................................................27
Stoornissen in denken, emoties en gedrag................................................................................................27
Epilepsie.....................................................................................................................................................28
Diagnose.........................................................................................................................................................28
Behandeling....................................................................................................................................................28
3. Amyotrofe laterale sclerose..................................................................................................................... 30
3.1 Definitie.........................................................................................................................................................30
3.2 Epidemiologie...............................................................................................................................................30
3.3 Etiologie........................................................................................................................................................30
3.4 De symptomen..............................................................................................................................................30
3.5 Klinisch beeld................................................................................................................................................31
3.6 Diagnose.......................................................................................................................................................31
3.7 De prognose..................................................................................................................................................31
3.8 De behandeling.............................................................................................................................................31
4. Multiple sclerose...................................................................................................................................... 32
4.1 Epidemiologie...............................................................................................................................................32
2
, 4.2 De types........................................................................................................................................................32
4.3 Het verloop...................................................................................................................................................32
4.4 De symptomen..............................................................................................................................................33
De beginsymptomen......................................................................................................................................33
Latere symptomen.........................................................................................................................................33
4.5 De behandeling.............................................................................................................................................34
4.5 Diagnose.......................................................................................................................................................34
5. Extrapirmidale ziekte: de ziekte van Parkinson.........................................................................................35
5.1 Definitie.........................................................................................................................................................35
5.2 Etiologie........................................................................................................................................................35
5.3 Epidemiologie...............................................................................................................................................35
5.4 Fysiopathologie.............................................................................................................................................35
5.5 Klinisch beeld................................................................................................................................................36
Symptomen....................................................................................................................................................36
De 3 kernsymptomen.....................................................................................................................................36
Gevolgen.........................................................................................................................................................37
5.6 Diagnose.......................................................................................................................................................37
5.7 Behandeling..................................................................................................................................................37
Medicamenteus..............................................................................................................................................37
Chirurgie.........................................................................................................................................................38
5.8 Prognose.......................................................................................................................................................38
6. Aandoeningen van het perifeer zenuwstelsel: letsels van het bovenste lidmaat........................................39
6.1 Inleiding........................................................................................................................................................39
6.2 Innervatie van de arm...................................................................................................................................39
6.3 Plexus brachialis letsel..................................................................................................................................40
Het ontstaan...................................................................................................................................................40
6.4 Laesie van de n. musculocutaneus...............................................................................................................40
De anatomie...................................................................................................................................................40
Etiologie..........................................................................................................................................................41
Gevolgen.........................................................................................................................................................41
6.5 Laesie van de n. radialis................................................................................................................................41
Anatomie........................................................................................................................................................41
Etiologie..........................................................................................................................................................42
Gevolgen.........................................................................................................................................................42
Distaal radialisletsel...................................................................................................................................42
Hoog letsel.................................................................................................................................................43
6.6 Laesie van de n. medianus............................................................................................................................43
Anatomie........................................................................................................................................................43
Etiologie..........................................................................................................................................................43
Gevolgen.........................................................................................................................................................44
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