Additional CNS Dx Flashcards
Myasthenia Gravis is an NMJ diagnosis described as an autoimmune attack of ____
ACh receptors
what are the major risk factors for MG?
avg age ~60
females>males
prior immune disorder
MG is a ___ (UMN/LMN) diagnosis that tyically progesses for about 1.5 years. What are the primary deficits? (3)
LMN;
1. weakness (improves w/ rest)
2. diplopia and ptosis (about 1/2 pts exp this first)
3. laryngeal irritation (change in tone, projection, choking/aspiration hazard)
What can exacerbate signs and symptoms with MG?
** FATIGUE**
* Stress
* Meds (betablockers, Ca-channel blockers, and antibiotics)
*illness
* extreme heat
Of the 3 types of myesthenia gravis, which has the best prognosis?
ocular myasthenia
(as opposed to generalized mod or severe myesthenia)
What is a myasthenic crisis? Does it happen to everyone with MG?
myasthenia gravis exacerbation + respiratory failure happens to about 15-20% of people with MG, typically in first 8 months
In addition to the exacerbating fx of normal MG, what are 3 additional known precipitating factors for a myasthenic crisis?
PMS/pregnancy, surgery, and pain
How are myasthenic crises managed?
hint: just like GBS
IVIg and Plasmaphoresis
MG is diagnosed via the ice pack test, PFTs, and__ (3)
- edrophonium tests
- blood analysis
*Electro dx tests (NCV)
In addition to the medical treatments for myasthenic crises, other medical management strategies for MG include__ (2)
drugs (cholinesterase inhib, corticosteroids, and immunosuppresants)
surgery (tracheostomy, thymectomy)
**
What is involved in a repetitive nerve stimulation test and why does it help diagnosis of MG?
analysis of CMAP peak to peak amp. In MG we see a “tanking” contraction strength compared to the normal 5-8% decrease
What needs to be prioritized in an examination of MG? (4)
cranial nerves, respiratory fn, muscle strength and funcitonal mobility (esp power)
How is the prognosis for MG? A myesthenic crisis?
life expectancy and QOL
MG: normal life expectancy and likely to live/work IND between exacerbation with appropriate treatment
MC: up to 50% require inpt rehab after a crisis
What 4 items will be involved in your POC for a patient with MG?
- functional strengthening,
- energy conservation,
- breathing strategies,
- monitoring vitals/rep/swallowing for complications
Describe the pathophysiology and etiology behind hydrocephalus
CSF buildup in ventricles> enlargemnt and pressure on surrounding tissue
T/F: Hydrocephalus is a solely a congenital dx.
false. it can also be acquired and is also seen in older adults.
What is the difference beteen the 2 primary tyoes of hydrocephalus?
communicating hydrocephalus indicates a disrupted flow of CSF that can still get through a bit while non-communicating is completely blocked along 1 or more ventricle connections.
this subtype of communicating hydrocephalus presents with a clinical triad of s/s that includes: AMS, gait disturbance (magnetic) , and later urinary incontinence
normal pressure hydrocephalus
In addition to the MRI pictured below, what are 4 other methods of arriving at a hydrocephalic dx?
neurological (clinical) exam
CT
lumbar puncture
ICP monitoring (if app)
Sometimes hydrocephalus is managed by monitoring, but in the case that surgery is warranted, what 2 options are there? Which is NOT used for NPH?
- shunt palcement and endoscopic 3rd ventriculostomy
- endoscopic 3rd ventriculostomy
what is the goal of an endoscopic 3rd ventriculostomy?
killing off ependymal cells that are making the excessive CSF
T/F: Shunts are meant to be permanent–meaning the first one shouldn’t fail them and this could be a fatal medical emergency.
While failure is an emergency, shunts are meant to be be replaced periodically and should be checked roughly every 6 months.
In addition to reoccurence of hydrocephalus symptoms and redness/tenderness along the tract, what other 4 s/s would signify shunt dysfunction?
- visual changes
- N/V
- seizures (if acute)
- low grade fever or fatigue
How is the prognosis for hydrocephalus?
with early dx and treatment, prognosis is good with normal life expectancy. However lingering symptoms might persist with inc age and over progression.
T/F: for people with NPH, gait disturbance before AMS yields a better prognosis.
true.
what are the 2 primary origins of brain abscesses? how are they usually treated?
- TBI and infection
- drainage, antibiotics/antifungals
Aside from infection s/s like fever and AMS, what else might we expect in the clinical presentation of a brain abscess? (5)
HA, focal weaknesss, seizeures, visual disturbances and neck stiffness
encephalitis and meningitis s/s differ in that ____ is characterized by 2-3 weeks of flu symptoms, while NECK sitffness is one of the hallmark sign for ___
encephalitis
meningitis
how do the origins of encephalitis and meningitis differ?
encephalitis: viral
meningitis: bacterial,viral, fungal, injuries, cancer, drugs
How is encephalitis diagnosed? (5)
neuro exam, CT/MRI, blood test, spinal tap, brain biopsy
what is the prognosis like for encephalitis?
it can be life threatening if undx and the herpes subtype results in death within 18 mo for up to 75% of people who get it.
what long term effect do severe cases of encephalitis and meninhitis have in common?
permanent NS damage
What are the Kernig and Brudzinski Signs?
the “postical state” after a seizure usually lasts 5-10 min (potentially longer) and often presents with what kind of s/s? (4)
drowsiness and confusion
nausea
HA
HTN
what are the 6 types of generalized seizures?
absence, tonic, atonic (drop), clonic, myoclonic, tonic-clonic (grand mal w/ LOC)
On average, about how long should you wait to treat someone who has had a seizure? What might you educate them on? (2)
- 24 hours
- auras + postical states, triggers
what 4 demographic groups currently have the highest prevalence in brain tumors?
children<15
adults 60-70 y/o
Caucasian> Black and Hispanic
Males>Female
How are tumors graded?
these are the most common gliomas, often found in the frontal lobe. At stage 4, patient prognosis for 5 year survival is about 94%–unfortunatley beyond this stage it drops to 30%
astrocytomas
these are the most aggressive form of gliomas with a prognosis of less than 50% survival at 1 year and about 5.5% at 5.
glioblastoma
You are treating a female patient who is on Keppra and it has been suggested that you take into consideration HA and personality changes when forming your POC. You see a Hx of brain cancer in her chart. Which glioma is her presentation consistent with? What’s her prognosis?
- oligodendodroglioma
- 81% 5 year and 65% 10 year»_space; relatively slow growing!!
increased ICP and hydrocephalus (esp near 4th ventricle) are common complications for what types of gliioma?
ependymyoma and medulloblastoma
What is the difference between RF and prognosis of ependymomas and medullablastomas?
Med: M>F, children, 75% survival in 5 yrs vs
Ependymyoma (85%)
Like oligodendodrogliomas, ____ can also result in personality change, seizures and HA. However, these have a higher chance of 10 year survival (>80%)
meningiomas
Even though these are benign, as a result of their location along the optic tract, s/s of these tumors are usually first presented as visual deficits
pituitary adenomas
A majority (80%) of brain mets occur in the __. About 1/3 orginate from the ___. Prognosis with treatment is ~6months.
- cerebrum (the rest are in the posterior fossa)
- lung
other met origins: breast, skin, GI, kidneys
what 4 unusual characteristics would raise concern for a brain tumor?
- interupts sleep or worse w/ waking and improves
- elicited by posture, pressure or exertion
- abnormal or severe
- assoc w/ N/V, papilledema,or focal neurologic signs
PT should pay close attention to pulmonary hygeine, ICP and ___ while treating a pt with a brain tumor
cognitive status
