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Neuro 2 > additional neuro system disorders > Flashcards

additional neuro system disorders Flashcards

1
Q

MG what is it

A

A neuromuscular junction disorder characterized by progressive muscular weakness and fatigability on exertion
Autoimmune disease
Antibody-mediated attack on acetylcholine receptors at neuromuscular junction

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2
Q

mg etiology

A

unkown maybe thymus dysfx

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3
Q

mg risk factors
Age
Sex
Other

A

Average age of onset: 59 years
Female: Male = 2:1
Prior autoimmune disorder

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4
Q

mg s/s

A

Lower motor neuron disorder
Progression typically seen within 18 months of symptom onset

Weakness
Worsens with continuing contraction, improves with rest
Particularly muscles of face and throat – eye lid mm weak
Generalized weakness throughout body
Extremities
Intercostal muscles

Diplopia and ptosis

Laryngeal irritation

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5
Q

mg exacerbating facotrs

A

Stress
Extreme heat
fatigue
meds BB, CC blockers, some antibiotics

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6
Q

mg subtypes

A

Ocular myasthenia – most start w/ ocular
Only affects the muscles that move the eyes and eyelids
Double vision, blurry vision, ptosis

Mild generalized myasthenia

Severe generalized myasthenia

Myasthenic Crisis
Myasthenia gravis + respiratory failure

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7
Q

myasthenic crisis what is it

A

complications of mg characterized by sig mm weakness resulting in respiratory failure -> require incubation

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8
Q

how common in myasthenic crisis

A

15-20 percent
Median time to first myasthenic crisis from onset of MG ranges from 8-12 months

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9
Q

what can myasthenic crisis involve

A

Can involve the upper airway muscles, respiratory muscles, or a combination of both muscle groups
Both inspiratory and expiratory respiratory muscles can be affected, manifesting as dyspnea

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10
Q

potential complications of myastheenic crisis
Like other dx

A

Potential complications: fever, infection, DVT, cardiac complications

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11
Q

tx of myasthenic crisis

A

ivig
plasmaphoresis

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12
Q

dx testing mg

A

Edrophonium test – reversable AcH inhib
Blood analysis – abnormal antibodies
Ice Pack Test – cooling may improve NMJ transmitting
Electrodiagnostic Testing
NCV: Repetitive Nerve Stimulation
Pulmonary Function Tests

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13
Q

medical management mg

A

IVIg – 5days, Plasmapheresis every other day for 10 days

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14
Q

NCV repetitive nerve stim mg

A

Repetitive supramaximal stimuli
Analyze CMAP amplitude (peak-to-peak)

Normal 5-8% drop

mg = big decline

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15
Q

mg examination Cranial nerves

A

Examine for diplopia, ptosis, progressive dysarthria or nasal speech, difficulty in chewing and swallowing, difficulties in facial expression, drooping facial muscles

CN II, CN3 4 and 6, CN5 9 and 10, CN7, CN 12

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16
Q

mg examination mm strength

A

Proximal more involved than distal,
fatigability,
repeated muscle use results in rapid weakness
Endurance typically poor

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17
Q

mg exam functional mobility

A

Common difficulty with climbing stairs, rising from a chair or lifting

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18
Q

mg exam components

A

cranial nerves
respiratory function
mm strength
functional mobility

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19
Q

mg prognosis

A

Even with moderately severe cases, with appropriate treatment people can continue to work and live independently between exacerbations

Life expectancy = normal

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20
Q

hydrocephalus what is it

A

Abnormal buildup of CSF in the ventricles
Leads to ventricular enlargement  places excessive pressure on surrounding brain tissue

Most commonly seen in infants and older adults

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21
Q

hydrocephalus communicating vs non communicating

A

Communicating Hydrocephalus
CSF flow disrupted after leaving ventricles
However, can still get through

Non-Communicating Hydrocephalus
CSF flow blocked along one or more of the narrow passages connecting the ventricles

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22
Q

clinical triad of s/s for normal pressure hydrocephalus

A

CLINICAL TRIAD OF SYMPTOMS
Altered mental status

Gait disturbance

Urinary incontinence

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23
Q

clinical triad NPH altered mental status

A

Mild dementia
Disorientation, confusion, apathy, personality changes, decreased attention span, reduced processing speeds, motor slowing most affected

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24
Q

clinical triad NPH gait distrubance

A

Shuffling, “magnetic” gait – like festinating/shuffling – really hard to pick their feet off of the ground

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25
Q

clinical triad NPH urinary incontinence

A

Appears later in disease than gait and cognitive impairments

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26
Q

normal pressure hydrocephalus what is it

A

Idiopathic or result of bleeding in the brain’s CSF

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27
Q

hydrocephalus dx

A

neuro exam
MRI
lumbar puncture
ICP monitoring when applicable

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28
Q

medical management surgery for hydrocephalus

A

Shunt placement – most common – in chest cavity or abdomen
Endoscopic third ventriculostomy
*not used for NPH (normal pressure)

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29
Q

s/s of shunt dysfunction

A

MEDICAL EMERGECY

S&S of shunt dysfunction:
HA
Diplopia
Photosensitivity
N/V
Neck/shoulder soreness
Seizures
Redness or tenderness along shunt tract
Low-grade fever
Excessive sleepiness or exhaustion
Reoccurrence of hydrocephalus symptoms

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30
Q

prognosis hydrocephalus

A

If left untreated, can be fatal.
Early diagnosis and successful treatment greatly ↑ chance of good recovery
Life expectancy = normal
Many patients make close to or full recovery from shunt placements
↑ chance of lingering symptoms with ↑ age, and as time progresses with disease

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31
Q

NPH prognosis

A

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

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32
Q

_____ may be needed for hydrocephalus through a person’s life

A

Multiple surgeries may be needed to repair or replace a shunt

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33
Q

brain absesss what is it

A

Pus-filled swelling in brain
Cause: bacteria or fungi
Typically preceded by infection or severe TBI

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34
Q

s/s of brain absess

A

Symptoms: location-dependent
HA, Altered mental status, focal weakness, seizures, visual disturbances

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35
Q

tx for brain absess

A

Treatment: antibiotics/antifungals, drainage

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36
Q

complications of brain absess

A

Complications: recurrence, brain damage, seizures, meningitis

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37
Q

encephalitis what is it

A

Inflammation of brain tissue cause by viral infection – herpes

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38
Q

s/s ecephalitis

A

Symptoms: Flu-like signs and symptoms that last for 2-3 weeks + neuro signs – usually tx viral and encephalitis will go away

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39
Q

more severe s/s mor difficult to tx encephalitis

A

muscle weakness, paralysis, memory loss, sudden impaired judgment, poor responsivenessVary from mild to life threatening

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40
Q

despite mild s/s for encephalitis

A

can be life threatening if undx

41
Q

meningitis s/s

A

Inflammation of meninges in brain or spinal cord

42
Q

cause meningitis

A

Cause: bacterial, viral,

fungal, parasitic, amebic

43
Q

s/s fo meningitis

A

Hallmark signs: headache, fever and neck stiffness

44
Q

prevention meningitis
and treatemnt

A

Prevention: Childhood vaccinations, hygeine
Treatment: Antibiotics, antifungals, steroids

45
Q

kkernigs sign

neck regidity/brudinksis neck sign

A

pt supine w/ hip fl 90 knee can be fully ext

fl neck causes knee fl

46
Q

CNS infection gen tx guidelines

A

patients may fully recover without need for PT or

tx symptom management

47
Q

seizure what is it

A

Sudden, uncontrolled electrical disturbance in the brain
May or may not have preceding aura (more common with epilepsy)

48
Q

causes of seizures
primary and secondary

A

Primary: Epilepsy
Secondary: 2/2 trauma, infection, inflammation, certain medications

49
Q

seizure can result in

A

Result in motor, cognitive, and autonomic manifestations
Can lead to alterations in consciousness

50
Q

seizure is followed by
What is it
How long
Characterized by

A

a “postictal state”
Lasts 5-30 minutes, but can last longer with more severe seizure episodes
Characterized by drowsiness, confusion, nausea, HA, HTN
Monitor vitals closely

51
Q

types of seizure
focal
absence - petit mal
tonic
atonic - drop
clonic
myoclonic
tonic clonic - grand mal

A

Focal
Can occur with or without LOC

Absence (“Petit mal” seizures)
Common in children
Characterized by staring off into space, or by subtle body movements

Tonic
Characterized by muscle stiffening

Atonic (“Drop seizures)
Sudden loss of muscle tone/control, often causing patient to drop to the ground

Clonic
Characterized by repeated or rhythmic, jerking muscle movements

Myoclonic
Sudden, brief jerks or twitches of arms and legs

Tonic-clonic (“Grand mal seizures”)
Body stiffening, shaking, abrupt LOC
Often with bladder incontinence and/or biting of tongue

52
Q

seizure last longer than __ medical emergency

A

5 min

53
Q

medications seizures

AE

A

Medications - Anticonvulsants
AE - drowsiness, ataxia, vertigo, cognitive dysfunction

54
Q

what to do if seizure

A

stay calm
call for help
ensure pt safe position away from anything they might hurt themselves with
adequate vent
DONT put hands in mouth
eval for postictal s/s

55
Q

tx guidelines for seizure

A

General rule of thumb for generalized seizures: 🚫 PT for 24 hours
pt often asymptomatic between seizure

56
Q

pt edu seizure

A

Auras, postictal state
Triggering factors

57
Q

brain tumor incidence age and gender

A

Children 0-15 years old
Adults in 5th-7th decades of life
Caucasian > Black and Hispanic Americans
Males > Females

58
Q

eitology brain tumor

A

phones, occupational/industrial hazards, radiation exposure

59
Q

Grade I brain tumor

A

The tissue is benign. The cells look nearly like normal brain cells, and they grow slowly.

60
Q

Grade II brian tumor

A

The tissue is malignant. The cells look less like normal cells than do the cells in a Grade I tumor.

61
Q

grade III brain tumor

A

The malignant tissue has cells that look very different from normal cells. The abnormal cells are actively growing

62
Q

grade IV brain tumor

A

The malignant tissue has cells that look most abnormal and tend to grow quickly.

63
Q

brain tumor medical managemnet
radiation vs radiosurgery

A

Radiation
Can be focused on one specific location or the entire brain

Radiosurgery
Utilizes multiple beams of radiation to give a highly focused form of protons to kill tumor cells

64
Q

Gliomas what is it
onset
most common site

A

form from glial cells
Onset > 45 years
Most common site: frontal lobes

65
Q

most common glioma

A

astrocytomas

66
Q

treatment gliomas

A

Treatment: surgery, radiation, chemo

67
Q

prognosis gliomas

A

mild grade I = high survival rate
severe Grade 3-4 = min-mod survival rate

68
Q

glioblastoma what is it

A

Glioblastoma: most aggressive form of primary brain CA, mean survival rate 5 years post-diagnosis – AUTO STAGE 4

69
Q

glioblastoma survival rate

A

40% survival at 1 year
5.5% survival at 5 years

70
Q

oligodendodroglioma what is it
Common site

A

start in oligodendricites
Slow-growing, progressive tumor, typically develop over several years
Common site: frontal and temporal lobes

71
Q

oligodendodroglioma onset

A

4-6th decade

72
Q

oligodendodroglioma gender

A

male

73
Q

oligodendodroglioma tx

A

s/s dependent
Observation, seizure control –> surgery, radiation, chemo

74
Q

oligodendodroglioma prog
5
10

A

81% 5-year survival
65% 10-year survival

75
Q

epnedymomas what is it
Most common site

A

Grow into ventricles or adjacent brain tissue
Most common site: 4th ventricle

76
Q

tx ependymomas

A

Treatment: primarily surgical followed by radiation

77
Q

common complications ependymomas

A

Common complication: ↑ ICP, hydrocephalus
Shunt placement

78
Q

common complications ependymomas

A

Common complication: ↑ ICP, hydrocephalus
Shunt placement

frequent recurrence

79
Q

prognosis ependymomas
5

A

Prognosis:
Frequent recurrence
85% 5-year survival

80
Q

medullobastoma what is it
complications

A

Typically grow into 4th ventricle, blocking CSF flow
Hydrocephalus, ↑ ICP common sequelae

81
Q

medulloblastoma onset and gender

A

> 45
male

82
Q

tx medulloblastoma

A

Treatment: surgery followed by radiation. chemo

83
Q

prog medulloblastoma

A

75% 5-year survival

84
Q

meningiomas wht is it

A

Slow growing, originate in dura matter or arachnoid membrane. Can be benign or malignant

85
Q

meningiomas clinical s/s

A

Clinical symptoms often do not manifest until tumor compresses adjacent structures
Most common symptoms: HA, weakness.
Seizures, personality changes, visual deficits

86
Q

meningiomas tx

A

Treatment: surgical resection vs observation – usually wait until neuro s/s

87
Q

prognosis meningiomas

A

Prognosis: 82% 10-year survival

88
Q

pituitary adenomas
what is it

A

Benign epithelial tumors
Frequently encroach optic chiasm

89
Q

s/s pituitary adenomas

A

Cause either hyper- or hyposecretion of hormones

90
Q

tx and prognosis pituitary adenomas

A

Treatment: surgical resection, drug therapy
Prognosis: 96% 5-year survival

91
Q

metastatic brain tumor
general
common clinical manifestations

A

Originate from malignancies outside of the the CNS and spread to the brain
Common clinical manifestations:
Seizures, HA, focal weakness, mental and behavioral changes, ataxia, aphasia, ↑ ICP

92
Q

metastatic brain tumors prognosis

A

w/ tx 6 mo

93
Q

brain tumor s/s

A

Could present as anything…depends on where the tumor is.
HA
seizure
altered mental status

94
Q

brain tumor HA - characteristics

A

Interrupts sleep or is worse on waking and improves throughout the day
Is elicited by postural changes, coughing, or exercises - any inc ICP
More severe or much different than usual
Associated with nausea and vomiting, papilledema, or focal neurological signs

95
Q

A ____ during adulthood is suggestive of a ______

A

A first seizure during adulthood is suggestive of a brain tumor

96
Q

altered mental status brain tumor range from….

A

Range from decreased concentration, memory, affect all the way to severe cognitive deficits and confusion

97
Q

pt management brain tumor

A

Early mobilization helps to prevent or lessen the incidence of pulmonary embolism and/or ventilator acquired pneumonia
Address any pulmonary hygiene issues
Be aware of intracranial pressure (ICP)
Monitor cognitive status closely

tx impairments that arose from the tumor

98
Q

Grade 1-2 = pt management
grad 3-4 = pt management

A

Grade I-II: If surgery was successful these patients can do REALLY well
Grade III-IV: Patients still can make excellent gains initially, but decline is inevitable

Neuro 2 (9 decks)

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