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.
