NEUROLOGISCHE EN LOCOMOTORISCHE
PATHOLOGIE: MICHELE VERGOTE
1
,INHOUD
Inleiding neuropathologie ....................................................................................................................................... 7
Belangrijk kader neurologische pathologie ............................................................................................................................................ 7
Dwarslaesie ............................................................................................................................................................. 8
Inleiding.................................................................................................................................................................................................................. 8
Definitie .................................................................................................................................................................................................................. 8
Epidemiologie ................................................................................................................................................................................................... 10
Etiologie .............................................................................................................................................................................................................. 11
Prognose ............................................................................................................................................................................................................. 12
Omschrijving letsel ......................................................................................................................................................................................... 12
Neurologisch niveau ................................................................................................................................................................................. 13
Compleet/incompleet .............................................................................................................................................................................. 17
Klinische syndromen bij incomplete laesies ........................................................................................................................................ 18
Central cord syndrom............................................................................................................................................................................... 18
Anterior cord syndrom ............................................................................................................................................................................ 19
Posterior cord syndrom ........................................................................................................................................................................... 19
Hemicord syndrom = Brom-Sequard syndroom .......................................................................................................................... 20
Conus medullaris syndrom .................................................................................................................................................................... 20
Cauda equina syndroom ......................................................................................................................................................................... 21
Classificatie van lichamelijke gevolgen .................................................................................................................................................. 21
Gevolgen en stoornissen op lichamelijk vlak ...................................................................................................................................... 22
Blaasstoornissen ......................................................................................................................................................................................... 22
Decubitus....................................................................................................................................................................................................... 24
Spinale shockfase ....................................................................................................................................................................................... 25
Spasticiteit ..................................................................................................................................................................................................... 26
Circulatiestoornissen ................................................................................................................................................................................ 28
Seksuele stoornissen tem pijn (lezen in syllabus)......................................................................................................................... 30
Trombose ...................................................................................................................................................................................................... 30
Therapie............................................................................................................................................................................................................... 30
NAH (Niet-aangeboren hersenletsel) én CVA ................................................................................................. 31
Definitie NAH .................................................................................................................................................................................................... 31
THL = traumatisch hersenletsel ................................................................................................................................................................. 32
epidemiologie.............................................................................................................................................................................................. 32
Oorzaken ....................................................................................................................................................................................................... 33
Pathofysiologie ........................................................................................................................................................................................... 33
Ernst van het letsel .................................................................................................................................................................................... 35
Prognose hersenletsel .............................................................................................................................................................................. 37
2
, Niet responsieve waakzaamheid ......................................................................................................................................................... 38
Gevolgen NAH ............................................................................................................................................................................................ 39
CVA (HERSENINFARCT OF HERSENBLOEDING) ................................................................................................................................. 43
Vasularisatie van de hersenen .............................................................................................................................................................. 44
Epidemiologie.............................................................................................................................................................................................. 45
Enkele termen .............................................................................................................................................................................................. 46
Classificatie ................................................................................................................................................................................................... 47
Risicofactoren .............................................................................................................................................................................................. 48
Prognose........................................................................................................................................................................................................ 49
Gevolgen en stoornissen op lichamelijk vlak ................................................................................................................................. 49
Diagnose ........................................................................................................................................................................................................ 51
Behandeling CVA ....................................................................................................................................................................................... 52
Extra informatie........................................................................................................................................................................................... 52
ALS ......................................................................................................................................................................... 53
Definitie ............................................................................................................................................................................................................... 54
Epidemiologie ................................................................................................................................................................................................... 54
Etiologie .............................................................................................................................................................................................................. 54
Symptomen ....................................................................................................................................................................................................... 54
Klinisch beeld .................................................................................................................................................................................................... 55
Diagnose ............................................................................................................................................................................................................. 56
Prognose ............................................................................................................................................................................................................. 56
Behandeling ....................................................................................................................................................................................................... 57
Multiple Sclerose................................................................................................................................................... 57
Definitie MS ....................................................................................................................................................................................................... 57
Epidemiologie ................................................................................................................................................................................................... 58
Behandeling ....................................................................................................................................................................................................... 59
Subtypes van MS ............................................................................................................................................................................................. 59
Verloop en symptomen MS ........................................................................................................................................................................ 60
verloop............................................................................................................................................................................................................ 60
symptomen ................................................................................................................................................................................................... 61
Diagnose ............................................................................................................................................................................................................. 62
Extrapiramidale aandoeningen zoals Ziekte van Parkinson .................................................................................. 62
Parkinson ............................................................................................................................................................................................................ 62
Etiologie ......................................................................................................................................................................................................... 63
Epidemiologie.............................................................................................................................................................................................. 63
Fysiopathologie .......................................................................................................................................................................................... 64
Klinisch beeld ............................................................................................................................................................................................... 64
3
, Diagnose ........................................................................................................................................................................................................ 65
Behandeling ................................................................................................................................................................................................. 66
Prognose........................................................................................................................................................................................................ 67
Aandoeningen van het perifeer zenuwstelsel: letsels van het bovenste lidmaat (zelfstudie) .............................. 67
Inleiding............................................................................................................................................................................................................... 68
Innervatie van de arm .................................................................................................................................................................................... 68
Plexus brachialis letsel ................................................................................................................................................................................... 70
Laesie van de n.musculocuraneus ............................................................................................................................................................ 71
Laesie van de n.radialis ................................................................................................................................................................................. 72
Laesie van de n.medianus ............................................................................................................................................................................ 74
Laesie van de n.ulnaris .................................................................................................................................................................................. 77
Aard van het letsel .......................................................................................................................................................................................... 78
Prognose aandoeningen perifere zenuwstelsel ................................................................................................................................. 79
Reumatologie (start locomotorische pathologie) ................................................................................................. 79
De term ‘reuma’ ............................................................................................................................................................................................... 80
Artrose ................................................................................................................................................................................................................. 80
Epidemiologie.............................................................................................................................................................................................. 81
Pathofysiologie ........................................................................................................................................................................................... 82
Etiologie v. arthrosis deformans .......................................................................................................................................................... 82
Diagnose en behandeling ...................................................................................................................................................................... 83
Reumatoïde artritis ......................................................................................................................................................................................... 84
Epidemiologie en etiologie .................................................................................................................................................................... 84
Fysiopathologie .......................................................................................................................................................................................... 84
Symptomen .................................................................................................................................................................................................. 84
Diagnose en verloop ................................................................................................................................................................................ 85
Behandeling ................................................................................................................................................................................................. 85
Ziekte van Bechterew..................................................................................................................................................................................... 86
Epidemiologie en etiologie .................................................................................................................................................................... 86
Symptomen .................................................................................................................................................................................................. 87
Behandeling ................................................................................................................................................................................................. 87
Jicht ....................................................................................................................................................................................................................... 88
Fysiopathologie .......................................................................................................................................................................................... 88
Epidemiologie.............................................................................................................................................................................................. 88
Symptomen .................................................................................................................................................................................................. 89
Behandeling ................................................................................................................................................................................................. 89
Systemische lupus erythematosus (geen examenleerstof) ............................................................................................................ 89
Osteoporose ...................................................................................................................................................................................................... 89
4
PATHOLOGIE: MICHELE VERGOTE
1
,INHOUD
Inleiding neuropathologie ....................................................................................................................................... 7
Belangrijk kader neurologische pathologie ............................................................................................................................................ 7
Dwarslaesie ............................................................................................................................................................. 8
Inleiding.................................................................................................................................................................................................................. 8
Definitie .................................................................................................................................................................................................................. 8
Epidemiologie ................................................................................................................................................................................................... 10
Etiologie .............................................................................................................................................................................................................. 11
Prognose ............................................................................................................................................................................................................. 12
Omschrijving letsel ......................................................................................................................................................................................... 12
Neurologisch niveau ................................................................................................................................................................................. 13
Compleet/incompleet .............................................................................................................................................................................. 17
Klinische syndromen bij incomplete laesies ........................................................................................................................................ 18
Central cord syndrom............................................................................................................................................................................... 18
Anterior cord syndrom ............................................................................................................................................................................ 19
Posterior cord syndrom ........................................................................................................................................................................... 19
Hemicord syndrom = Brom-Sequard syndroom .......................................................................................................................... 20
Conus medullaris syndrom .................................................................................................................................................................... 20
Cauda equina syndroom ......................................................................................................................................................................... 21
Classificatie van lichamelijke gevolgen .................................................................................................................................................. 21
Gevolgen en stoornissen op lichamelijk vlak ...................................................................................................................................... 22
Blaasstoornissen ......................................................................................................................................................................................... 22
Decubitus....................................................................................................................................................................................................... 24
Spinale shockfase ....................................................................................................................................................................................... 25
Spasticiteit ..................................................................................................................................................................................................... 26
Circulatiestoornissen ................................................................................................................................................................................ 28
Seksuele stoornissen tem pijn (lezen in syllabus)......................................................................................................................... 30
Trombose ...................................................................................................................................................................................................... 30
Therapie............................................................................................................................................................................................................... 30
NAH (Niet-aangeboren hersenletsel) én CVA ................................................................................................. 31
Definitie NAH .................................................................................................................................................................................................... 31
THL = traumatisch hersenletsel ................................................................................................................................................................. 32
epidemiologie.............................................................................................................................................................................................. 32
Oorzaken ....................................................................................................................................................................................................... 33
Pathofysiologie ........................................................................................................................................................................................... 33
Ernst van het letsel .................................................................................................................................................................................... 35
Prognose hersenletsel .............................................................................................................................................................................. 37
2
, Niet responsieve waakzaamheid ......................................................................................................................................................... 38
Gevolgen NAH ............................................................................................................................................................................................ 39
CVA (HERSENINFARCT OF HERSENBLOEDING) ................................................................................................................................. 43
Vasularisatie van de hersenen .............................................................................................................................................................. 44
Epidemiologie.............................................................................................................................................................................................. 45
Enkele termen .............................................................................................................................................................................................. 46
Classificatie ................................................................................................................................................................................................... 47
Risicofactoren .............................................................................................................................................................................................. 48
Prognose........................................................................................................................................................................................................ 49
Gevolgen en stoornissen op lichamelijk vlak ................................................................................................................................. 49
Diagnose ........................................................................................................................................................................................................ 51
Behandeling CVA ....................................................................................................................................................................................... 52
Extra informatie........................................................................................................................................................................................... 52
ALS ......................................................................................................................................................................... 53
Definitie ............................................................................................................................................................................................................... 54
Epidemiologie ................................................................................................................................................................................................... 54
Etiologie .............................................................................................................................................................................................................. 54
Symptomen ....................................................................................................................................................................................................... 54
Klinisch beeld .................................................................................................................................................................................................... 55
Diagnose ............................................................................................................................................................................................................. 56
Prognose ............................................................................................................................................................................................................. 56
Behandeling ....................................................................................................................................................................................................... 57
Multiple Sclerose................................................................................................................................................... 57
Definitie MS ....................................................................................................................................................................................................... 57
Epidemiologie ................................................................................................................................................................................................... 58
Behandeling ....................................................................................................................................................................................................... 59
Subtypes van MS ............................................................................................................................................................................................. 59
Verloop en symptomen MS ........................................................................................................................................................................ 60
verloop............................................................................................................................................................................................................ 60
symptomen ................................................................................................................................................................................................... 61
Diagnose ............................................................................................................................................................................................................. 62
Extrapiramidale aandoeningen zoals Ziekte van Parkinson .................................................................................. 62
Parkinson ............................................................................................................................................................................................................ 62
Etiologie ......................................................................................................................................................................................................... 63
Epidemiologie.............................................................................................................................................................................................. 63
Fysiopathologie .......................................................................................................................................................................................... 64
Klinisch beeld ............................................................................................................................................................................................... 64
3
, Diagnose ........................................................................................................................................................................................................ 65
Behandeling ................................................................................................................................................................................................. 66
Prognose........................................................................................................................................................................................................ 67
Aandoeningen van het perifeer zenuwstelsel: letsels van het bovenste lidmaat (zelfstudie) .............................. 67
Inleiding............................................................................................................................................................................................................... 68
Innervatie van de arm .................................................................................................................................................................................... 68
Plexus brachialis letsel ................................................................................................................................................................................... 70
Laesie van de n.musculocuraneus ............................................................................................................................................................ 71
Laesie van de n.radialis ................................................................................................................................................................................. 72
Laesie van de n.medianus ............................................................................................................................................................................ 74
Laesie van de n.ulnaris .................................................................................................................................................................................. 77
Aard van het letsel .......................................................................................................................................................................................... 78
Prognose aandoeningen perifere zenuwstelsel ................................................................................................................................. 79
Reumatologie (start locomotorische pathologie) ................................................................................................. 79
De term ‘reuma’ ............................................................................................................................................................................................... 80
Artrose ................................................................................................................................................................................................................. 80
Epidemiologie.............................................................................................................................................................................................. 81
Pathofysiologie ........................................................................................................................................................................................... 82
Etiologie v. arthrosis deformans .......................................................................................................................................................... 82
Diagnose en behandeling ...................................................................................................................................................................... 83
Reumatoïde artritis ......................................................................................................................................................................................... 84
Epidemiologie en etiologie .................................................................................................................................................................... 84
Fysiopathologie .......................................................................................................................................................................................... 84
Symptomen .................................................................................................................................................................................................. 84
Diagnose en verloop ................................................................................................................................................................................ 85
Behandeling ................................................................................................................................................................................................. 85
Ziekte van Bechterew..................................................................................................................................................................................... 86
Epidemiologie en etiologie .................................................................................................................................................................... 86
Symptomen .................................................................................................................................................................................................. 87
Behandeling ................................................................................................................................................................................................. 87
Jicht ....................................................................................................................................................................................................................... 88
Fysiopathologie .......................................................................................................................................................................................... 88
Epidemiologie.............................................................................................................................................................................................. 88
Symptomen .................................................................................................................................................................................................. 89
Behandeling ................................................................................................................................................................................................. 89
Systemische lupus erythematosus (geen examenleerstof) ............................................................................................................ 89
Osteoporose ...................................................................................................................................................................................................... 89
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