Aging Flashcards
Comprehensive Geriatric Assessment (CGA) consists of…
Physical health. Mental health Functional status Social functioning Environment
Benefits of CGA
Decreased nursing facility admission Decreased medication use Decreased mortality Decreased annual medical care costs Increase diagnostic accuracy Improved independence
marijuana withdrawal syndrome sx
Headaches Chills Irritability Anxiety Depression Shakiness Fever
Factors to look out for in the elderly
Social factors- Living arrangements
Nutrition- vulnerable to inadequate nutrition (loneliness, depression,medical disorders
Environmental- Identify SAFETY RISKS (home visit) – lighting, loose mats, kitchen storage
Sleep- spend less time in deep sleep
transition between sleep and waking up is often abrupt
Factors to look out for in the elderly cont
vision- Glare from lights at night- cataract
Eye pain– glaucoma, temporal arteritis
hearing- acoustic neuroma, wax,Paget’s disease,
GIT- hypothyroidism, dehydration,hypokalemia
Be Wary of Abuse and Neglect- Dominates interview, won’t leave, won’t let patient talk
Preparing for death- Instructions given by patients for their future treatment should they become incompetent to consent to, or refuse, such treatment
Laboratory tests done in Comprehensive Geriatric Assessment
Serum cholesterol
Blood glucose – glucose intolerance increases with aging
Heamoglobin
Vitamin b12-Rx IMI (beware of folate supplementation before correcting b12)
Thyroid function tests
In the 6 min walking test
One-time measure of functional status
Use it to guide recommendations for exercises,
Physical Therapy, adaptive devices for impairments,
driving.
Get up and go test
only valid for patients not using an assisted device
Get up and walk 3m, and return to chair
Preventive Interventions for healthy aging
Screening
Immunizations
counseling
Preventative measures towards healthy aging
Longer life
Reduced disability
Improved mental health
Lower health care costs
What would you screen for in elderly patients
Alcohol misuse Blood pressure Breast Cervical Colorectal Depression Osteoporosis
Malignancy screening
Pap smear
Mammography
For colorectal cancer, either colonoscopy every 10
years, an annual fecal occult blood test, or
sigmoidoscopy every 5 years
immunizations to be done in the elderly
influenza
pneumoccocal
zoster
theories of aging
programmed change theories- Developmental-genetic theories or telomore shortening
stochastic theories- Somatic Mutation and
Mitochondrial/Oxidation Theories
Stochastic theories
Damage to vital cell molecules from an accumulation of random events or from environmental agents or influences
skin changes in elderyly
Reduction in pappillary body in menopause, vascular loops decrease, collagen begins to interlace
Skin becomes drier, more wrinkled, stores more lipofuscin (yellow pigment)
Neural degeneration
Deposits of lipofuscin (oxidised lipids)
Retraction of dendrites – neurons die
Neurofibrillary tangles – twisted strands of insoluble TAU proteins
Fluid fills the spaces
Alzheimer’s disease
– increased stimulus-response time, – mild confusion – decrease in language skills – also learning ability and abstract thinking and reasonable judgement decrease
Genetics of inherited 3-5% of Alzheimers
Mutations in gene 21 (Downs’)- Codes for APP (amyloid precursor protein)
Mutations in genes 14 and 1- Code for presenilin 1&2
what does Estrogen increases in the brain
– choline acetyl transferase
– cholinergic neuron survival
– axonal sprouting
– dendrite spine formation
Endocrine disorders as a cause of mental illness in the aged
– Hyper/ Hypothyroidism - depression
– Addison’s - delirium
– Pheochromocytoma – panic attacks
– Diabetes mellitus – cognitive impairment and depression
– Hyperprolactinaemia – decreased libido and impotence
presbyopia
long-sightedness caused by loss of elasticity of the lens of the eye, occurring typically in middle and old age
presbyacusis
age related hearing loss
Progressive loss of hair cells on basilar membrane and loss of elasticity of tympanic and basilar membranes leads to (sometimes pronounced) hearing loss
Circulatory and Respiratory changes in old age
Circ- Systolic and diastolic blood pressure rise with age
Diminished response to beta-adrenergic stimulation
Diminished baroreceptor sensitivity
Diminished SA node automaticity
Resp- Diminished lung elasticity
Increased chest wall stiffness
GIT changes in old age
• Reduced saliva production, with swallowing difficulties
• Decreased hepatic function
• Decreased gastric acidity, with loss of intrinsic factor
secretion
• Reduced area of absorption in small intestines
• Decreased colonic motility
• Decreased rectal function – impaired defecation
Renal system changes in old age
• Sclerosis of glomerular vessels
• Thickening of glomerular basement membrane which leads to
1. Fall in renal plasma flow (50%)
2. Reduced GFR (50%)
3. Decreased capacity to compensate for disturbing
influences, i.e. to concentrate or dilute urine, to adapt to pH changes
Endocrine changes in old age
- Decreased thyroxine production and clearance
- ADH increases in the day but decreases at night – NB nocturia!!
- DHEA decreases a lot: replacement betters mood and muscle mass and strength (in men)
- Vitamin D absorption and activation decreases
- Cholecystokinin increases – satiating effect with aging
- Dynorphin (opioid peptide) and neuropeptide Y decline with aging - satiation
factors in incontinence
Bladder factors: underactive detrusor
detrusor/sphincter
Factors affecting our ability to cope with the bladder:
impaired mental function
mobility and dexterity problems
Urethral Factors: incompetent urethral closure
weakness of pelvic floor muscles
Risk factors for Stress Urinary incontinence
Increasing parity, probably related to obstetrical trauma
Increased intra-abdominal pressure- medical factor/environmental factors
Pelvic floor trauma and denervation injury- non-/obstetric trauma
Hormonal status and estrogen deficiency
Connective tissue disorders
drugs that cause Urinary incontinence
Sedative hypnotics Diuretics Anticholingeric agents (Antihistamines, Antispasmodics Andrenergic agents Calcium channel blockers
surgeries and dz that cause Urinary incontinence
Abdominoperineal resection
Radical hysterectomy
Polio (almost always recovers)
Lumbar disc disease
Meningomyelocele
Sexual changes in older women
↓ Vaginal lubrication
↓ elasticity of the vaginal walls
↑ Plateau phase
Sexual changes in older men
More time to get an erection Testicles may not elevate that high Longer time to orgasm and ejaculation Increase in the length of the refractory period Incr Plateau stage with age
Differences between female and male menopause
Female
Abrupt & Complete lost of ovarian function
Marked reduction in Estrogen and Progesterone
Peri- and postmenopausal women
Male
No abrupt or incomplete lost of testicular function
Gradual reduction in Testosterone
No peri- and postmenopausal men
Vaginismus
when the muscles of a woman’s vagina squeeze or spasm when something is entering it
Most frequent adverse drug reactions in
elderly persons
– Bleeding due to oral anticoagulants,
– Hypoglycaemia from diabetes treatment
– Gastric complications from NSAIDs
Elderly patients and drug sensitivity
less sensitve to- beta blockers
more sensitvive - warfarin , opioids and benzodiazepines
Water soluble drugs eg
atenolol propranolol hydrochlorothiazide lithium cimetidine
highly protein drugs eg
salicylates phenytoin warfarin, sulphonamides theophylline)
Drugs requiring phase I metabolism
TCA
antipsychotic drugs
diazepam
calcium channel blockers
Appropriate prescribing in the elderly requires
Formulating a therapeutic goal
Drugs should be initiated at low doses (50%)
Long acting agents should be avoided.
Drug regimens should be kept simple and reviewed frequently
5 eg of Drugs that should often be avoided for elderly patients
carisoprodoli chlorzoxazone cyclobenzaprine metaxalone methocarbamol (all are muscle relaxant)
Drugs that should ALWAYS be avoided for elderly
patients include barbiturates, flurazepam, meprobamate,
chlorpropamide, meperidine, pentazocine, trimethobenzamide, belladonna alkaloids, dicyclomine, hyoscyamine,
and propantheline
Cardiac glycosides
class of organic compounds that increase the output force of the heart and increase its rate of contractions by acting on the cellular sodium-potassium ATPase pump
potentially inappropriate drugs based on condition
heart failure- drugs containing Na
HT- pseudoephedrine, diet pills
gastric/duodenal ulcer- NSAIDS, aspirin
blood clotting disorder or anticoagulant Rx- NSAIDS, aspirin
bladder flowe obstruction- anticholinergics, H1 blockers
insomenia- decongestants
cognitive impairment- anticholinergics
chrionic constipation- anticholinergics
urinary incontinence Rx
Conservative treatment (lifestyle interventions and bladder retraining)
Physiotherapy
Drug therapy–Antimuscarimes, estrogens
Surgery- Anterior colporrhaphy, Colposuspension
Procidentia
the falling down of an organ from its normal anatomical position
Vaginal vault prolapse
a condition in which the upper portion of the vagina loses its normal shape and sags or drops down into the vaginal canal or outside of the vagina
spinal stenosis
Back/buttock pain
Worse on walking downhill, improves on sitting/leaning forward.
Numbness/parasthesia
osteophyte
a bony projection associated with the degeneration of cartilage at joints
joints most commonly affected by osteoarthritis
neck, spine, fingers, thumbs, hips, knees, or toes
Heberden’s and Bouchard’s nodes
H- bony growths that develop on distal interphalangeal joints
B- hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints
Crystal Arthropathy
Gout-increased uric acid- Diuretic use (important risk factor in females)
Psuedogout- Calcium crystals deposition, Commonly affects Wrist/knee
patients with which types of cancers can develop and RA like picture
breast GI Lung ovarian lymphoproliferative
hypertrophic osteoarthropathy
Paraneoplastic manifestation that causes RA like sx
Acute/severe/burning bone pain
clubbing of the fingers and toes
periostitis of long bones
Rheumatoid arthritis-like syndrome
Paraneoplastic manifestation that causes RA like sx
explosive onset RF
asymmetric polyarthritis(lower limbs)
Poorly responsive to Rx (steroids, biologics, NSAIDs, DMARDs)
Lupus-like syndrome
Paraneoplastic manifestation that causes RA like sx
Poly- serositis
Raynaud’s phenomenon
antinuclear antibodies
Inflammatory myopathies
Paraneoplastic manifestation that causes RA like sx
Onset > 50
Dermatomyositis look for underlying malignancy
Paraneoplastic vasculitis
Paraneoplastic manifestation that causes RA like sx
chronic unexplained vasculitis
rapidly progressive digital gangrene
Cutaneous leukocytoclastic vasculitis-most frequent
Seen more so in lymphoproliferative disorders
Polymyalgia Rheumatica
Paraneoplastic manifestation that causes RA like sx
Discomfort/stiffness- shoulders and pelvic girdle Fatigue Weight loss anemia of chronic disease elevated erythrocyte sedimentation rate
atypical heart sx of elderly
dyspnoea diarrhoea fatigue N&V syncope confusion dizziness
cardiovascular effects on aging
decr B adrenergic and baroreceptor responsiveness
impaired sinus node fx
impaired endothelia
incr vascular and myocardial stiffness
morphological changes in heart
lipid, lipofucin and amyloid deposits
thicken and stiffening of aortic and mitral leaflets and pericardium
incr cardiac fat and fibrous connective tissue
tortuosity of coronary aa and incr in nr and size of collaterals brances
morphological changes in heart CONT
decr density of B1 receptors
reduction in sensitivity of catecholamines
Drivers of Infectious Diseases
Microbial adaption and change Human susceptibility to infection Climate and weather/Changing ecosystems Human demographics and behavior War and famine Lack of political will Intent to harm
More frequent infections of elderly
- Herpes zoster
- Listeriosis
- Urinary tract infection
- Bacteremia
- Meningitis
nosocomia UTI causes in elderly
e coli staph aures and epidermidis candida pseudomonas enterococcus faecalis
pneumonia causes in elderly
RSV influenza chlamydophila pneumonia strep pneumo H influenza
Pressure sores
areas of damaged skin caused by staying in one position for too long.
They commonly form where your bones are close to your skin, such as your ankles, back, elbows, heels and hips
pressure ulcers Rx
Pressure relief
Appropriate nutrition
Debridement
Amoxicillin-potassium clavulanate
Colonization
the presence of proliferating bacteria without a host response
baactria in pressure sores
anaerobes- Peptostreptococcus, Bacteroides fragilis
aerobes- Staphylococci, Enterococci, Proteus mirabilis
Atypical presentation CCF in elderly
more sedentary lifestyle Confusion Somnolence Irritability, Fatigue Anorexia
medications predisposing to delirium
Anticholinergics
Benzodiazepines
Opiates
Tricyclic antidepressants
Preventing delirium
Low dose Haloperodol pre and post op Avoid restraints Minimize medications Prevent hypoxia Nutrition Encourage ambulation
5 characteristics of frailty
o subjective report of fatigue o low physical activity o Grip strength o gait speed o Unintentional weight loss.
physiologic reserve
The capability of an organ to carry out its activity under stress
MACROscopic renal changes with age
Volume is stable until age 50, Renal cortex decreases with age Renal medulla increases with age until 50, then declines Renal cysts increase with age Atherosclerosis of renal arteries
MICROscopic renal changes with age
Nephrosclerosis
Decreased nephron number
Glomerular hypertrophy
Functional changes of kidney
Sclerosis of glomeruli leads to decreased solute delivery to the juxtaglomerular apparatus causing HT
Sclerosis of tubules leads to decreased excretion/resorption of electrolytes and water
Interstitial sclerosis leads to decreased Vitamin D & erythropoietin production and loss of medullary concentrating effect
sodium balance in kidneys
Increased resorption in the proximal tubule
Decreased resorption in the distal tubule/collecting duct
Increased susceptibility to side effects of Thiazide diuretics & SSRI’s
Increased propensity for confusion, cramping and muscle dysfunction
other electrolytes in the old kidney
hyperkalaemia
hypercalcaemia
Hypocalcaemia is rarer- CKD with vitamin D deficiency
delirium facts
Acute onset of disturbance in consciousness and attention (acute confusion)
The clinical picture fluctuates over 24 hours
Symptoms often worse at night (sundowning)
Results in changed behavior (apathy / agitation
Perceptual disturbances (illusions / hallucinations)
Hypersensitive to light / sounds
causes of delirium
Medications (anti-cholinergic / narcotic / steroid / especially when multiple medications are used)
Major surgery (postoperative states / cardiac / hip fracture)
Infection (chest, UTI, CNS)
independent risk factors of delirium
Use of physical restraints Malnutrition Use of bladder catheter Any iatrogenic event Use of 3 or more medications
Management of delirium
Investigate and Rx cause Promote mobilization Avoid physical restraints Encourage intake of fluid and food Aid orientation (clock, signs) Optimize sensory input (glasses & hearing aids) Normalize sleep patterns
Antipsychotic medication in delirium
Haloperido
Risperidone
Olanzapine
Quetiapine
Avoid BZ, except in withdrawal delirium
creutzfeldt-jakob disease
rare, degenerative, fatal brain disorder in which abn prion build up in the brain causing it to shrink and become ladden with holes
patients usually die within one yr of onset
Huntington’s disease
fatal genetic disorder that causes the progressive breakdown of nerve cells in the brain
usually presents with depression, chorea, dementia
dementia sx
Memory problems, particularly for recent events (short term memory impairment) Reduced concentration Personality or behavior changes Apathy and withdrawal or depression Loss of ability to do everyday tasks Poor judgement
components on mini mental state exam (MMSE)
orientatoin registration attention and calculation recall language
dementia mx
Non-pharmacological:
Mild to moderate dementia: cognitive stimulation
Pharmacological:
Acetylcholinesterase inhibitors: donepezil, galantamine, rivistigmine
Memantine (NMDA antagonist
mx of Behavioral and Psychological
Symptoms of Dementia (BPSD)
Non-pharmacological:
Identify the behavioral problem and Rx
Assist with reality orientation
Keep the patient busy with exercise and activities
Consider a cholinesterase inhibitor
Avoid anticholinergic medications
Antipsychotics
Antidepressants
indicators of sexual abuse
difficulty walkiing/standing
recurrent cystitis or genital infx
indicators of emotional abuse
Anxious, withdrawn, depression
Change is appetite / weight
Fear or hesitancy to talk
indicators of financial abuse
Unusual bank balances, illegible signature, unpaid accounts
Disparity between income and assets and lifestyle
indicators of neglect
Untreated illnesses
Malnutrition, dehydration
Dirty appearance
Risk Factors: Abuser
Female Poor previous relationship Low self-esteem Resentment towards elder Inadequate training
Prevention of elder abuse
- Education about illness
- Support system for relieve carer of duties
- Adequate diet
- Access to medical facilities
- Encourage caregivers to ask for help
relative contraindications to exercise in the elderly
cardiomyopathy
valvual dz
complex ventricular ectopy
absolute contraindications to exercise in the elderly
Recent ECG chage or myocardial infarction unstble angina 3rd degree heart bloock acute congestive heat failure uncontrlooed metabolic dz
guidlines for cardiac stress testing
oldre than 65 and sedentary coronary artery dz or cardiac sx diabetes major sx of pulm or metabolic dz men over 45 and women over 55 who plan to exercise at more than 60 %VO2 max
senior fitness test rikli and jones
chair stand arm curl 6 min walk 2 min step back scratch 8ft up and go
exercise prescription should include
aerobic exercises
strengthening
flexibility/ ROM
balance
exercise barriers in the elderly
injury and poor health
social isolation
discomfort
environmental difficulties
General Indicators of the need of palliative care
Decreasing activity
Choice of no further active treatment
Sentinel Event e.g. serious fall, bereavement, transfer to nursing home
Serum albumen <25g/l
Specific Clinical Indicators
cancer organ failure Symptomatic Renal Failure –nausea and vomiting, anorexia, pruritus general neurological dz parkinsons Frailty / Dementia
Adjuvants to drugs
Bone and soft tissue pain –NSAIDs/corticosteroids
Neuropathic-burning tingling pain tricyclics
-shooting pain anticonvulsants e.gcarbamazepine
Cramping visceral pain-anticholinergics
Hyperosmolar hyperglycemic state
a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis.
Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness
Hyperosmolar hyperglycemic state
a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis.
Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness
The Giants of Geriatric Medicine: (ISAAC)
Immobility Instability (falls) Incontinence Intellectual impairment Iatrogenic Disorders
claudication
pain caused by too little blood flow to your legs or arms
decrease in the lungs’ defence mechanisms
↓cough‐reflex
↓ciliary action of the mucus membranes
↓immunoglobulin production
↓production of phagocytic macrophages
Pseudo‐dementia
Temporary impaired intellectual function may result from depression.
diagnostic pitfalls The S.O.A.P. method
S – Subjective: The patient, the family member/ nurse.
O – Objective: Help the patient with mobility if necessary.
A – Assessment: Write down the diagnosis and hand to the patient.
P – Plan: Explain about the treatment. Write in large letters the names of the medicines
Presentation of cancer in the aged
- Widespread metastases
- Hormonal syndromes
- Hypercalcaemia
- Hypoglycaemia or hyperglycaemia
- Hypertrophic pulmonary osteoarthropathy- Caused by bronchus carcinoma
- Skin lesions
- Abnormal vascular syndromes
Hypertrophic pulmonary osteoarthropathy (HPOA)
a syndrome characterized by the triad of periostitis, digital clubbing and painful arthropathy of the large joints, especially involving the lower limbs
tenesmus
a continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness
Piles (haemorrhoids)
Swollen and inflamed veins in the rectum and anus that cause discomfort and bleeding
colorectal tumours of elderly
Ascending ‐ May present as iron deficiency, weight loss or a palpable mass
Transverse- May mimic gall colic or gastritis
Descending colon- Constipation, false diarrhoea or total intestinal obstruction
Lung cancer in the elderly
dyspnoea
chest pain
haemoptysis
symptoms of nerve infiltration
Achalasia
a motor disturbance which presents as dysphagia for fluid and solid foods.
T2DM complications
neuropathy
myocardial infarction
diabetic foot
T1DM presentation
Marked loss of weight Polyuria Polydipsia Blurred vision Diabetic ketoacidosis
diabetes presentation in elderly
nonspecific sx: weakness, fatigue, weight loss, frequent minor infections
Neurologic findings: cognitive impairment, acute confusion, depression
Nonketotic hyperosmolar coma
Blood glucose values often > 55.5 mmol/L
Marked elevation of plasma osmolality without significant ketosis or acidosis
1/3 have no previous history of diabetes
Precipitants: infection, medications, acute medical illnesses, limited access to water
Treatment: IVI saline; insulin
Causes for falling
ortostatic hypotension, poor vision, poor muscle strength, drugs like benzo’s or anti-convulsants, impaired mobility
osteopenia Rx
Adequate calcium and vitamin D intake Weight-bearing exercise Bisphosphonates eg Alendronate/ Zoledronic acid Teriparatide Denosumab
hyperthyroidism sx and s/s
Loss of weight, wasting Palpitations, atrial fibrillation Sweatiness Tremor Anxiety/irritability Heat intolerance Diarrhoea
hyperthyroidism Rx
Drugs - Carbimazole (Neomercazole): can use it in Grave’s disease for 12-18 months
- Beta-blockers
Radioactive iodine
Surgery
hyperthyroidism in elderly sx
CVS: atrial fibrillation, congestive cardiac failure, angina, acute myocardial infarction
CNS: apathy, depression, confusion, lassitude
hyperthyroidism sx in elderly and young
Weight loss i.s.o increased appetite Fine tremor Eyelid retraction Increased perspiration Increased frequency of bowel movements
Apathetic hyperthyroidism
form of presentation of hyperthyroidism without its characteristic signs and symptoms. The cardinal symptoms of apathetic hyperthyroidism are depression and apathy
hypothyroidism sx
● Myalgia ● Bradycardia ● Proximal myopathy ● Slowly relaxing reflexes ● Carpal tunnel syndrome ● Dry thickened skin ● Cold intolerance
Hypothyroidism in the elderly sx
Puffy face, delayed deep tendon reflexes, and myxoedema supports diagnosi
testosterone neg effects
low sperm count enlarged prostate shrikiage of testicles development of breasts headaches baldness polycythaemia
three main causes of CHF
coronary heart disease, diabetes mellitus, and hypertension.
RHF
induces systemic venous congestion that causes symptoms such as pitting edema, jugular venous distension, and hepatomegaly.
Biventricular CHF
manifests with clinical features of both RHF and LHF, as well as general symptoms such as tachycardia, fatigue, and nocturia
Systolic dysfunction (reduced EF) specific causes
Cardiac arrhythmias
Dilated cardiomyopathy (e.g., Chagas disease, chronic alcohol use, idiopathic)
Myocarditis
Diastolic dysfunction (preserved EF) specific causes
Constrictive pericarditis
Restrictive or hypertrophic cardiomyopathy
Pericardial tamponade
Brain natriuretic peptide (BNP)
helps to promote diuresis, natriuresis, vasodilation of the systemic and pulmonary vasculature, and reduction of circulating levels of endothelin and aldosterone
General features of heart failure
Nocturia Fatigue Tachycardia, various arrhythmias Heart sounds: S3/S4 gallop Pulsus alternans
ccf Rx
1st line- diuretics (loop and thiazide), ACE-I, BB, aldosterone
2nd line- hydralizine plus nitrate, ivabradine, digoxin, ARNI (angiotensin receptor-neprilysin inhibitor), Nesiritide (BNP derivative
Cardiorenal syndrome
complex syndrome in which renal function progressively declines as a result of severe cardiac dysfunction
Progressive supranuclear palsy (PSP
a degenerative disease involving the gradual deterioration and death of specific volumes of the brain. The condition leads to symptoms including loss of balance, slowing of movement, difficulty moving the eyes, and dementia
Wernicke‑Korsakoff syndrome
Wernicke’s encephalopathy and Korsakoff’s psychosis are the acute and chronic phases, respectively, of the same disease. WKS is caused by a deficiency in the B vitamin thiamine
WE (classic clinical triad)- Confusion, Ataxia, Ophthalmoplegia
Progressive multifocal leukoencephalopathy
a rare infection of the brain that is caused by the JC (John Cunningham) virus. People with a weakened immune system are most likely to get the disorder. People may become clumsy, have trouble speaking, and become partially blind, and mental function declines rapidly.
Pseudodementia
Complaints of memory loss
Mostly depressed mood
Patient gives short answers, e.g., “I don’t know”
Late neurosyphilis
Frontotemporal dementia, psychosis, cognitive dysfunction, personality changes
Paresis
Argyll Robertson pupil
Tabes dorsalis
Normal pressure hydrocephalus (NPH)
Gait disorder
Dementia
Urinary incontinence
Common paraneoplastic manifestations
cachexia, hyperthermia, increased risk of thrombosis
Opsoclonus-myoclonus syndrome (OMS)
Symptoms include rapid, multi-directional eye movements (opsoclonus), quick, involuntary muscle jerks (myoclonus), uncoordinated movement ( ataxia ), irritability, and sleep disturbance
often associated with neuroblastoma in children and mammary or small cell lung cancer in adults
specific paraneoplastic
neuromuscular- Lambert-Eaton myasthenic syndrome
myasthenic gravis
Paraneoplastic encephalomyelitis
Cognitive defects (e.g., memory deficits, speech impairment, psychiatric manifestations)
Seizures
Dyskinesias
Lymphocytic pleocytosis
an abnormal increase in the amount of lymphocytes in the cerebrospinal fluid
Leser-Trélat sign
Activation of epidermal growth factor receptors → manifests as multiple, sudden-onset seborrheic keratoses
Trousseau syndrome (thrombophlebitis migrans)
Malignancy-related hypercoagulability → recurring clots that resolve and appear again elsewhere in the body (migrans
Neuroleptic malignant syndrome
life-threatening idiosyncratic reaction to antipsychotic drugs characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction
Nephrogenic diabetes insipidus (NDI)
an inability to concentrate urine due to impaired renal tubule response to vasopressin (ADH), which leads to excretion of large amounts of dilute urine
