ALS, Aphasia, Bell's palsy, Trigeminal neuralgia, and pseudotumor cerebri Flashcards
What is the only system ALS affects
Motor system
Which nerves are specifically affected in ALS
1.) Anterior horn cells - LMN’s, corticobulbar muscles2.) Corticospinal tract - UMN’s
What is the usual onset for ALS
50 to 70
Does ALS have familial inheritance
Yes, only 10%, rest are sporadic
What is the mortality rate of ALS at 5 and 10 years
5 years = 80%10 years = 100%
What is the hallmark feature of ALS
Progressive muscle weakness - starts in arms/legs, then spreads
What is end-stage ALS
Respiratory failure
What is not affected in ALS
1.) Bladdar/bowel control2.) Sensation3.) Cognitive function4.) Extraocular muscles5.) Sexual function
What should you do to help aid in the diagnosis of ALS
1.) EMG - fibrillations and fasciculations at rest as result of LMN injury (if myopathy, should have no electrical activity at rest but then amplitude decreases with continued use)2.) Nerve conduction studies - If decreased nerve conduction, probably demyelination (MS, guillian), if repetitive stimulation causes fatigue, then myasthenia gravis
What is treatment for ALS
Supportive, maybe riluzole (glutamate blocking agent - delays death by 3 to 5 months)
Where is aphasia affecting brain most of the times
In the dominant hemisphere (right handed = 95% on left hemisphere, left handed = 50% on left hemisphere)
Four causes of aphasia
1.) Stroke - most common2.) Trauma to brain3.) Brain tumor4.) Alzheimers disease
Four types of aphasia
1.) Wernicke’s aphasia2.) Broca’s aphasia3.) Conduction aphasia4.) Global aphasia
Difference between wernicke’s and broca’s aphasia
Wernicke’s: Receptive, fluent but impaired comprehension of written/spoken languageBroca’s: Expressive, nonfluent with slow speech with good comprehension, usually has right hemiparesis and hemisensory loss
When do patients improve with aphasia, and when is the best time to give speech therapy
Spontaneously recover within first month, and speech therapy only helpful in first few months
What is the pathophysiology of bells palsy
Hemifacial weakness/paralysis of bottom and upper face via CN 7 due to swelling
What is the prognosis of bells palsy
Good - 80% recover
What are the causes of bells palsy
Possibly viral (herpes simplex), upper respiratory infection often preceedes it
What is the differential when bells palsy is there
Trauma of temporal bone, lyme disease, tumor, guillain barre (palsy bilateral), and herpes zoster
What should you not administer when lyme disease is suspected, especially in endemic areas
Steroids - do not give
What should you do if bells palsy remains for more than 10 days
EMG
What should be used for treatment of bells palsy
Prednisone and acyclovir, with eye patch at night to avoid corneal abrasion
What should you do if bells palsy’s paralysis keeps progressing
Surgical decompression of CN 7
What is trigeminal neuralgia
Idiopathic condition with intense pain without motor or sensory paralysis, relapsing/remitting course that becomes more refractory to treatment
