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Neuro 2 > Additional CNS Disorders > Flashcards

Additional CNS Disorders Flashcards

1
Q

What is myasthenia gravis?

A

neuromuscular junction disorder characterized by progressive muscular weakness and fatigability on exertion
- autoimmune disease
- worsens after periods of activity and improves with periods of rest

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2
Q

risk factors for myasthenia gravis

A
  • average age of onset - 59 years
  • female: male - 2:1
  • prior autoimmune disorder
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3
Q

S&S of myasthenia gravis

A
  • LMN disorder - motor dominant disorder
  • weakness
  • diplopia and ptosis
  • laryngeal irritation - increased risk for choking
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4
Q

characteristics of myasthenia gravis weakness

A
  • worsens with continuing contraction and improves with rest
  • particularly muscles of face and throat
  • generalized weakness throughout body
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5
Q

What is the first symptom of myasthenia gravis in 50% of patients?

A

extraocular impairments - diplopia and ptosis

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6
Q

exacerbating factors of myasthenia gravis. What is the biggest exacerbation?

A
  • fatigue
  • illness
  • stress
  • extreme heat
  • some medications - beta-blockers, calcium channel blockers, some antibiotics

The biggest exacerbation to the weakness is repetitive contraction

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7
Q

What is affected with ocular myasthenia?

A

muscles that move the eyes and eyelids
- double vision, blurry vision, ptosis

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8
Q

What is myasthenic crisis?

A

myasthenia gravis + respiratory failure
- significant worsening of muscle weakness resulting in respiratory failure that requires intubation and mechanical ventilation

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9
Q

What muscles are affected during a myasthenic crisis?

A
  • upper airway muscles
  • respiratory muscles (both inspiratory and expiratory)
  • or both muscle groups
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10
Q

potential complications of myasthenic crisis

A
  • fever
  • infection
  • DVT
  • cardiac complications
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11
Q

treatment for myasthenic crisis

A
  • IVIg
  • Plasmaphoresis
  • cholinesterase inhibitors
  • corticosteroids
  • immunosuppressants
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12
Q

diagnostic testing for myasthenia gravis

A
  • edrophonium test (reversible acetylcholinesterase inhibitor)
  • blood analysis
  • Ice pack test
  • electrodiagnostic testing (nerve conduction)
  • pulmonary function tests
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13
Q

What are the surgical management options for myasthenia gravis?

A
  • videothoracoscopic thymectomy - removal of thymus gland
  • tracheostomy
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14
Q

What will be seen with nerve conduction velocity testing with myasthenia gravis?

A

receive maximal stimuli and as muscle tires out there will be a reduction in amplitude

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15
Q

What needs to be examined during a myasthenia gravis eval?

A
  • CN tests
  • respiratory function
  • muscle strength
  • functional mobility
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16
Q

What should be examined with cranial nerves during a myasthenia gravis exam?

A
  • diplopia
  • ptosis
  • progressive dysarthria or nasal speech
  • difficulty in chewing and swallowing
  • difficulties in facial expression
  • drooping facial muscles
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17
Q

What should be seen with muscle strength myasthenia gravis exam?

A
  • proximal > distal
  • fatigability
  • repeated muscle use results in rapid weakness
  • poor endurance
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18
Q

What type of movement/activities do myasthenia gravis patients have the most difficulty with?

A

Patients have the most issue with power exercises (MaxA with sit-to-stand) but then less assist with walking once they are up
- climbing stairs
- rising from a chair or lifting

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19
Q

prognosis of myasthenia gravis

A
  • 25-50% require inpatient rehab
  • most people can continue to work and live independently between exacerbations with appropriate treatment
  • normal life expectancy
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20
Q

PT goals for myasthenia gravis

A
  • functional strengthening
  • energy conservation techniques
  • breathing exercises and strategies
  • monitor changes in patient’s condition for complications, vital signs, respiration and swallowing
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21
Q

What causes hydrocephalus? Who is it typically seen in?

A

abnormal buildup of CSF in ventricles that places excessive pressure on surrounding brain tissue
- most commonly seen in infants and older adults

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22
Q

communicating vs non-communicating hydrocephalus

A

Communicating – CSF can still flow between the ventricles
- See more of a backup

Non-communicating – see CSF blockage

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23
Q

What is normal pressure hydrocephalus (NPH)?

A

Idiopathic or result of bleeding in the brain’s CSF (subarachnoid or intraventricular hemorrhage), head trauma, infection, tumor, or a complication of surgery

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24
Q

clinical triad of symptoms of normal pressure hydrocephalus

A
  • altered mental status - vary from day to day and varies between patients
  • gait disturbance - magnetic gait
  • urinary incontinence - appears later in the disease
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25
Q

How to diagnosis hydrocephalus?

A
  • neuro exam
  • MRI/CT
  • Lumbar puncture
  • ICP monitoring
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26
Q

surgical interventions for hydrocephalus

A
  • shunt placement
  • endoscopic third ventriculostomy (not used for NPH)
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27
Q

S&S of shunt dysfunction

A
  • headache
  • diplopia
  • photosensitivity
  • N/V
  • neck/shoulder soreness
  • seizures
  • redness or tenderness along shunt tract
  • low-grade fever
  • excessive sleepiness/exhaustion
  • reoccurrence of hydrocephalus symptoms
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28
Q

prognosis of hydrocephalus

A
  • if left untreated, can be fatal
  • early diagnosis and successful treatment = normal life expectancy
  • lingering symptoms can occur with increased age
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29
Q

With normal pressure hydrocephalus, when _____________ precedes _______________ = more favorable outcome is expected

A

When gait disturbance precedes mental deterioration = more favorable outcome is expected

30
Q

symptoms of brain abscess

A

size and location dependent
- Headache
- altered mental status
- focal weakness
- seizures
- visual disturbances
- fever and chills w/ coinciding neck stiffness

31
Q

What is encephalitis?

A

inflammation of brain tissue cause by viral infection

32
Q

symptoms of encephalitis

A

flu-like S&S that last 2-3 weeks + neuro signs
- fatigue, sore throat, vomiting, headache
- confusion, irritability, unsteady gait, drowsiness, visual sensitivity

33
Q

What will an encephalitis exam look for?

A

Exam will look for sores around lips or genitals, mosquito bites, ticks. Complete neurologic exam, blood test, CT scan or MRI, spinal tap, brain biopsy

34
Q

What is meningitis?

A

inflammation of meninges in brain or spinal cord from bacterial, viral, final, parasitic, amebic

35
Q

3 hallmark signs with meningitis

A
  • headache
  • fever
  • neck stiffness
36
Q

other S&S of meningitis

A
  • vomiting/nausea
  • confusion/difficulty concentrating
  • seizures
  • sleepiness/difficulty waking up
  • sensitivity to light
  • lack of interest in drinking/eating
  • skin rash in some cases
37
Q

prevention and treatment for meningitis

A

prevention - childhood vaccinations, hygiene
- This is a preventable diagnosis

treatment - antibiotics, antifungals, steroids

38
Q

What are tests that can be done to look for meningitis?

A

Kernig’s sign - supine w/ hip flexed 90 deg and knee cannot be fully extended

Brudzinski’s sign - passive flexion of neck causes flexion of both legs and thighs

39
Q

T/F: Seizures have a preceding aura

A

false - they may or may not have a preceding aura
aura are more common with epilepsy

40
Q

What often follows a seizure? How long does this last and what are the characteristics?

A

postictal state - period of time where patient is “out of it”
- lasts 5-30 minutes but can last longer with more severe seizure episodes
- characterized by drowsiness, confusion, nausea, headache, HTN

41
Q

What type of seizure can occur with or w/o LOC?

A

focal

42
Q

characteristics of absence seizures

A
  • common in children - they will space out
  • characterized by staring off into space or by subtle body movements (eye movement and lip smacking)
43
Q

characteristics of tonic seizures

A

muscle stiffening in trunk, arms, and legs

44
Q

characteristics of atonic seizures

A

sudden loss of muscle tone/control, often causing patient to drop to the ground

45
Q

characteristics of clonic seizures

A

repeated or rhythmic, jerking muscle movements in neck, face, and arms

46
Q

characteristics of myoclonic seizures

A
  • less dramatic than clonic
  • sudden, brief jerks or twitches of arms and legs
47
Q

characteristics of tonic-clonic seizures

A
  • entire body
  • body stiffening, shaking, abrupt LOC
  • often with bladder incontinence and/or biting of the tongue
48
Q

common side effects of anticonvulsants

A
  • drowsiness/fatigue
  • ataxia
  • vertigo
  • cognitive dysfunction
49
Q

general treatment guidelines for seizures

A
  • hold PT for 24 hours after seizure or until MD clearance
  • for more severe seizures - treat symptoms as they appear
  • patient education: auras, postictal state, triggering factors
50
Q

What category of people are at higher risk for primary brain tumors?

A
  • children 0-15 y/o
  • adults 5-7 decades of life
  • caucasian > black and Hispanic Americans
  • males > females
51
Q

Grade 1 brain tumor

A
  • benign
  • cells look nearly like normal brain cells and they grow slowly
52
Q

Grade 2 brain tumor

A
  • malignant
  • cells look less like normal cells compared to grade 1
53
Q

Grade 3 brain tumor

A
  • malignant tissues
  • cells look very different from normal cells
  • the abnormal cells are actively growing
54
Q

Grade 4 brain tumor

A
  • malignant tissues
  • cells look most abnormal and tend to grow quickly
55
Q

What is the most common form of gliomas? What is the most aggressive form of primary brain cancer?

A

most common - astrocytomas

most aggressive - glioblastoma

56
Q

characteristics of astrocytomas

A
  • all ranges from diffuse to focal and benign to malignant
  • onset > 45 y/o
  • most common site is frontal lobe
  • treatment - surgery, radiation, chemo
57
Q

What type of tumor has seizures? What are other common clinical manifestations?

A

oligodendroglioma
- seizures
- headache
- personality changes

58
Q

common sites and typical population for oligodendroglioma

A

common site - frontal and temporal lobe

typical onset - 4-6th decade, female:male - 2:1

59
Q

treatment for oligodendroglioma

A

symptom-dependent
- observation
- seizure control - surgery, radiation, chemo

60
Q

Where are ependymomas found? What does this cause? What is the most common site?

A

grow into ventricles or adjacent brain tissue
- affects CSF
- 4th ventricle is the most common site

61
Q

common complication to ependymomas

A

increased ICP leading to hydrocephalus

62
Q

What is the most common type of brain cancer in kids?

A

medulloblastoma

63
Q

Which brain tumors affect CSF flow

A

medulloblastoma and ependymomas

64
Q

population with medulloblastoma

A
  • children and > 45 y/o
  • males > female
65
Q

What are common sequelae of medulloblastoma?

A
  • hydrocephalus
  • increased ICP
66
Q

characteristics of meningiomas

A
  • slow growing
  • originate in dura matter or arachnoid membrane
  • can be benign or malignant
67
Q

symptoms of meningiomas

A

clinical symptoms often do not manifest until tumor compresses adjacent structures
- most common symptoms: headache and weakness
- seizures
- personality changes
- visual deficits

68
Q

characteristics of pituitary adenomas

A
  • benign epithelial tumors
  • frequently encroach optic chiasm
  • cause either hyper or hyposecretion of hormones
69
Q

common sites of origin for metastatic brain tumors

A
  • 1/3 originate from the lung
  • breast
  • skin
  • GI tract
  • kidneys
70
Q

common clinical symptoms of metastatic brain tumors

A
  • seizures
  • headaches
  • focal weakness
  • mental and behavioral changes
  • ataxia
  • aphasia
  • increased ICP
71
Q

Acommon S&S of brain tumors

A

Headaches
- interrupts sleep or worse in AM and improves through day
- elicited by postural changes, coughing, or exercise
- severe and associated with N&V, papilledema, or focal neuro signs

Seizures are common - 1st seizure during adulthood is suggestive of brain tumor

Altered mental status

Neuro 2 (19 decks)

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