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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
How to diagnosis hydrocephalus?
- neuro exam - MRI/CT - Lumbar puncture - ICP monitoring
26
surgical interventions for hydrocephalus
- shunt placement - endoscopic third ventriculostomy (not used for NPH)
27
S&S of shunt dysfunction
- 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
28
prognosis of hydrocephalus
- if left untreated, can be fatal - early diagnosis and successful treatment = normal life expectancy - lingering symptoms can occur with increased age
29
With normal pressure hydrocephalus, when _____________ precedes _______________ = more favorable outcome is expected
When gait disturbance precedes mental deterioration = more favorable outcome is expected
30
symptoms of brain abscess
size and location dependent - Headache - altered mental status - focal weakness - seizures - visual disturbances - fever and chills w/ coinciding neck stiffness
31
What is encephalitis?
inflammation of brain tissue cause by viral infection
32
symptoms of encephalitis
flu-like S&S that last 2-3 weeks + neuro signs - fatigue, sore throat, vomiting, headache - confusion, irritability, unsteady gait, drowsiness, visual sensitivity
33
What will an encephalitis exam look for?
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
What is meningitis?
inflammation of meninges in brain or spinal cord from bacterial, viral, final, parasitic, amebic
35
3 hallmark signs with meningitis
- headache - fever - neck stiffness
36
other S&S of meningitis
- 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
prevention and treatment for meningitis
prevention - childhood vaccinations, hygiene - This is a preventable diagnosis treatment - antibiotics, antifungals, steroids
38
What are tests that can be done to look for meningitis?
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
T/F: Seizures have a preceding aura
false - they may or may not have a preceding aura aura are more common with epilepsy
40
What often follows a seizure? How long does this last and what are the characteristics?
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
What type of seizure can occur with or w/o LOC?
focal
42
characteristics of absence seizures
- common in children - they will space out - characterized by staring off into space or by subtle body movements (eye movement and lip smacking)
43
characteristics of tonic seizures
muscle stiffening in trunk, arms, and legs
44
characteristics of atonic seizures
sudden loss of muscle tone/control, often causing patient to drop to the ground
45
characteristics of clonic seizures
repeated or rhythmic, jerking muscle movements in neck, face, and arms
46
characteristics of myoclonic seizures
- less dramatic than clonic - sudden, brief jerks or twitches of arms and legs
47
characteristics of tonic-clonic seizures
- entire body - body stiffening, shaking, abrupt LOC - often with bladder incontinence and/or biting of the tongue
48
common side effects of anticonvulsants
- drowsiness/fatigue - ataxia - vertigo - cognitive dysfunction
49
general treatment guidelines for seizures
- 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
What category of people are at higher risk for primary brain tumors?
- children 0-15 y/o - adults 5-7 decades of life - caucasian > black and Hispanic Americans - males > females
51
Grade 1 brain tumor
- benign - cells look nearly like normal brain cells and they grow slowly
52
Grade 2 brain tumor
- malignant - cells look less like normal cells compared to grade 1
53
Grade 3 brain tumor
- malignant tissues - cells look very different from normal cells - the abnormal cells are actively growing
54
Grade 4 brain tumor
- malignant tissues - cells look most abnormal and tend to grow quickly
55
What is the most common form of gliomas? What is the most aggressive form of primary brain cancer?
most common - astrocytomas most aggressive - glioblastoma
56
characteristics of astrocytomas
- 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
What type of tumor has seizures? What are other common clinical manifestations?
oligodendroglioma - seizures - headache - personality changes
58
common sites and typical population for oligodendroglioma
common site - frontal and temporal lobe typical onset - 4-6th decade, female:male - 2:1
59
treatment for oligodendroglioma
symptom-dependent - observation - seizure control - surgery, radiation, chemo
60
Where are ependymomas found? What does this cause? What is the most common site?
grow into ventricles or adjacent brain tissue - affects CSF - 4th ventricle is the most common site
61
common complication to ependymomas
increased ICP leading to hydrocephalus
62
What is the most common type of brain cancer in kids?
medulloblastoma
63
Which brain tumors affect CSF flow
medulloblastoma and ependymomas
64
population with medulloblastoma
- children and > 45 y/o - males > female
65
What are common sequelae of medulloblastoma?
- hydrocephalus - increased ICP
66
characteristics of meningiomas
- slow growing - originate in dura matter or arachnoid membrane - can be benign or malignant
67
symptoms of meningiomas
clinical symptoms often do not manifest until tumor compresses adjacent structures - most common symptoms: headache and weakness - seizures - personality changes - visual deficits
68
characteristics of pituitary adenomas
- benign epithelial tumors - frequently encroach optic chiasm - cause either hyper or hyposecretion of hormones
69
common sites of origin for metastatic brain tumors
- 1/3 originate from the lung - breast - skin - GI tract - kidneys
70
common clinical symptoms of metastatic brain tumors
- seizures - headaches - focal weakness - mental and behavioral changes - ataxia - aphasia - increased ICP
71
Acommon S&S of brain tumors
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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