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Block 3: Neuro > Clin Med: Neuro II > Flashcards

Clin Med: Neuro II Flashcards

1
Q

Define essential tremor

A

movement disorder that is characterized by intention tremors

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2
Q

How does an essential tremor progress?

A

progresses slowly & benign

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3
Q

What are the two types of tremors?

A
  • resting
  • action
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4
Q

Define a resting tremor

A

tremor occurs at rest/with gravity

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5
Q

Define action tremor

A

voluntary muscle contraction

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6
Q

Define a postural action tremor

A

holding position against gravity

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7
Q

Define a postural action tremor

A

muscle contraction against object

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8
Q

Define an intention action tremor

A

w/ voluntary muscle movement when going to do something

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9
Q

Essential tremor age prevalence

A

bimodal
- age 20 then 65yos

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10
Q

Essential tremor RFs

A

FHx
- pattern of autosomal dominant

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11
Q

Essential tremor pathophys

A
  • neurodegeneration involving cerebellum
  • abnormal gamma amino-butyric acid (GABA) function resulting in reduced tone, localized in cerebellum & locus coeruleus
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12
Q

Essential Tremor Hx

A
  • starts in hands or forearms, bilateral
  • Can be postural (holding arms outstretched) or intention (writing, eating, pouring)
  • sometimes present w/ head tremor
  • 2/3 or pts–> relief w/n 15mins after drinking alcohol
    Ask about family history, medications, use of stimulants
    Amphetamine, caffeine, pseudoephedrine, meth, cocaine
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13
Q

Essential Tremor: things to ask about

A
  • FHx
  • meds,
  • use of stimulants
    –> Amphetamine, caffeine, pseudoephedrine, meth, cocaine
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14
Q

Essential Tremor PE

A

neuro exam- make sure there is no other cause

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15
Q

Essential Tremor Dx

A

clinically dx
- based on hx & neuro exam
- Tremor Task Force of the International Parkinson & Movement Disorder Society (IPMDS) dx criteria

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16
Q

Describe the criteria of the Tremor Task Force of the International Parkinson & Movement Disorder Society (IPMDS)

A
  • Bilateral upper limb action tremor w/ or w/o tremor in other: locations such as head, voice, or lower limbs
  • duration ≥ 3 years
    w/o other neuro signs such as dystonia, ataxia, or parkinsonism
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17
Q

Med Tx for Essential Tremor interfering w/ ADLs

A
  • 1st line: Propranolol
  • 2nd line: Benzos
  • Gabapentin
  • Botulinum Toxin (Botox)
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18
Q

Essential Tremor procedures that can be done if meds don’t work

A

Deep brain stimulation

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19
Q

Define Parkinson’s Dz

A

a progressive movement disorder characterized by bradykinesia, resting tremor, muscular rigidity & loss of postural reflexes

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20
Q

Parkinson’s Dz gender prevalence

A

Male > Female

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21
Q

Parkinson’s Dz RFs

A
  • FHx
  • environmental factors include
    –> consumption of well water
    –> agricultural occupations
    –> exposure to pesticides
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22
Q

Parkinson’s Dz pathophys

A

degeneration of dopamine neurons in substantia nigra leads to dopamine depletion in striatum & characteristic motor symptoms

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23
Q

What role does dopamine play in the substania nigra?

A

Dopamine produced in the substantia nigra communicates w/ the motor cortex to initiate movement

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24
Q

Motor signs & symptoms of Parkinson’s Dz

A
  • resting tremor
  • Bradykinesia
  • rigidity
  • worsened handwriting/dexterity
  • postural instability
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25
Q

Nonmotor symptoms of Parkinson’s Dz

A
  • pain
  • fatigue
  • sleep disturbances
  • mood disorders
  • cognitive changes
  • hallucination/delusion
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26
Q

Parkinson’s Dz PE

A
  • Bradykinesia
  • little facial expression
  • quiet, stuttering, or monotonous speech
  • “pill rolling tremor” resting tremor- improves w/ movement
  • Cogwheeling (spastic movement, even w/ passive motion)
  • Stooped gait/posture
  • Shuffling gait
  • DOES NOT PRODUCE WEAKNESS
  • Seborrheic Dermatitis
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27
Q

Parkinson’s Dz Dx

A
  • clinical
  • rule out other movement disorders
  • good response test dose to Levodopa & CAN be used for tx
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28
Q

Parkinson’s Dz Tx: Meds

A

Amantadine (loses efficacy over time)
Carbidopa/Levodopa
Dopamine agonists
Benztropine- anticholinergic effective for tremors

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29
Q

Parkinson’s Dz Tx: Non-Pharm

A

Physical/occupational therapy
Tai Chi
Encourage exercise
Counseling

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30
Q

In Parkinson’s Dz, if meds are ineffective, you can do…

A

deep brain stimulation

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31
Q

Define Huntington Dz

A
  • rare autosomal dominant
  • neurodegenerative disorder characterized by progressive motor, cognitive & psychiatric dysfunction
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32
Q

Huntington’s Dz RFs & onset age.

A
  • FHx
  • 30-50yo
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33
Q

Huntington’s Dz genetic pattern

A

autosomal dominant

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34
Q

Huntington’s Dz pathophys

A
  • The gene that codes for glutamine repeats too many times, causing too much production of glutamine
    –> Higher # of repeats the more serious & earlier the onset
  • The glutamine settles in the basal ganglia
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35
Q

Huntington’s Disease Hx

A
  • about 2/3 of pts present w/ initial neuro manifestations such as:
    changes in eye movements
  • decr coordination
  • minor involuntary movements
  • alt in executive functioning
  • depressed or irritable mood
  • chorea
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36
Q

Huntington’s Dz HEENT PE

A

ocular motor apraxia

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37
Q

Huntington’s Dz Neuro PE

A
  • impaired fine motor skills present early in dz
  • mild hyperreflexia
  • choreatic movements spread to all muscles & can’t be voluntarily suppressed
  • inability to maintain steady grip
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38
Q

Huntington’s Dz Psych PE

A
  • depression, apathy, anxiety, aggression, paranoid, hypersexual
  • decr conc., memory loss, loss of awareness
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39
Q

Is Huntington’s a clinical Dx?

A

YES
- based on FHx, progressive motor abnl (chorea), mental changes

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40
Q

How to confirm Huntington’s Dz Dx?

A

DNA analysis

41
Q

Why get a MRI w/ Huntington’s Dz?

A

evaluates level of cerebral/caudate nucleus atrophy

42
Q

Is there a cure of Huntington’s Dz?

A

NO

43
Q

Are their meds that delay the progression of Huntington’s Dz?

A

NO

44
Q

Huntington’s Dz Tx

A
  • Haloperidol for behavioral disturbances
  • Amantadine
  • Genetic counseling- screen all 1st-degree relatives
45
Q

Most cerebral palsy pts survive ___ years after onset

A

10-25

46
Q

Define Cerebral Palsy

A

non-progressive disorder involving movement & posture due to a perinatal or neonatal

47
Q

Cerebral palsy RFs

A
  • prenatal exposure to toxins or inflammation
  • fetal growth restriction
  • birth defects & congenital malformations
  • genetics
  • premature or postdates delivery
  • neonatal complications
  • perinatal complications
48
Q

Cerebral Palsy Hx

A
  • difficulty swallowing (may be first noticeable symptom)
  • motor delay (not meeting developmental milestones)
  • stiff muscle (spasticity)
  • abnl in gait & ambulation
  • cognitive or learning impairment
  • speech & language problems
  • seizure
49
Q

Most common motor delays in Cerebral Palsy include:

A
  • not sitting by 8mos
  • not walking by 18mos
  • early hand preference before age 1yr
50
Q

When should you refer a child for suspected cerebral palsy?

A

delayed motor milestones or persistent toe walking

51
Q

What question should be asked to a parent of child with suspected CP, to assess developmental monitoring?

A

“Do you have any concerns about your child’s development?”

52
Q

What ages should you do a developmental screening in children with CP?

A

9, 18, 24-30 months

53
Q

In children w/ the following early motor features of CP, especially if known RFs for CP are present

A
  • movement abnormalities
  • tone abnormalities including hypotonia, spasticity, or dystonia
  • abnormal motor development including delayed head control, rolling, and crawling
  • feeding difficulties
54
Q

Cerebral Palsy tx

A

multiple disciplinary team to tx various symptoms

55
Q

Cerebral Palsy main goal of tx

A

Incr level of function & have the most normal life as possible

56
Q

What meds may a child require

A
  • Baclofen, seizures, GERD/vomiting
57
Q

Define restless leg syndrome

A

a neurologic disorder characterized by the irresistible urge to move the legs
- worse at rest, relieved w/ movement & occurring in the evening or at night

58
Q

Restless Leg Syndrome: gender most & age

A
  • women > men
  • all ages but >65yo
59
Q

Meds that exacerbate restless leg syndrome

A
  • antidepressants
  • anticonvulsants
  • antihistamines
  • beta blockers
  • lithium
  • serotonin reuptake inhibitors
60
Q

Restless Legs Syndrome Patho

A

Binding dysfunction of dopamine to presynaptic & postsynaptic receptors in the basal ganglia
- Dopamine issue w/ the basal ganglia

61
Q

Restless Legs Syndrome Hx

A
  • overwhelming urge to move legs
  • partial or complete relief of urge sensation by movement, for as long as movement continues
  • Circadian pattern w/ high freq in evening & at night often interfering w/ sleep
62
Q

Restless leg syndrome Dx

A
  • Rule out things that can make this worse
  • iron studies (related to IDA)
  • kidney dz, DM, Vit B12 def, folic acid def, thyroid dysfunction
  • “levodopa” test- a single decr symptoms for about 2 hrs
63
Q

Can Levadopa be used as tx for restless leg syndrome?

A

NO

64
Q

1st line tx for restless leg syndrome

A

Gabapentin/Pregabalin

65
Q

Restless Leg Syndrome Tx

A
  • Tx of any underlying issues (iron def, thyroid, etc)
  • Avoidance of alcohol, caffeine, nicotine
  • Sleep hygiene
  • Gabapentin/Pregabalin 1st line tx
66
Q

Define Bell Palsy

A

inflammation & weakness of the 7th cranial nerve
- facial nerve

67
Q

Two causes of Bell Palsy

A

idiopathic or 2nd toherpes simplex 1 infx

68
Q

The highest incidence of Bell Palsy is b/t what ages?

A

15 - 45yo

69
Q
A
70
Q

Is testing needed for diagnosis Bell Palsy?

A

NO

71
Q

Bell Palsy (suspicion of underlying dz ) Dx Labs

A
  • CBC
  • test for syphilis
  • HIV test
  • fasting glucose
  • Lyme titer
  • ANA titer (Lupus)
72
Q

Bell Palsy Tx

A
  • Eye protection & artificial tears (risk of corneal abrasions)
  • Steroids (usually prednisone)
  • (+/-) antivirals
73
Q

Define Diabetic Peripheral Neuropathy

A

Periph neuropathy resulting from damage to the PNS, described as pain &/or impaired sensations in extremities

74
Q

What % of DM pts will develop diabetic periph neuropathy?

A

50%

75
Q

RFs for Diabetic Periph Neuropathy

A
  • Poor glycemic control
  • Smoking
  • HTN
  • Dyslipidemia
76
Q

Diabetic Peripheral Neuropathy is assoc w/ what other conditions?

A

diabetic retinopathy & nephropathy

77
Q

Diabetic Periph Neuropathy patho

A

Intracellular hyperglycemia leads to:
- Mitochondrial dysfunction
- Incr oxidative stress
- Incr inflammatory injury

78
Q
A
79
Q
A
80
Q
A
81
Q

Diabetic Periph Neuropathy Tx

A
  • PREVENTION IS KEY (optimize glucose control)
  • Meds
  • Weight bearing exercise
  • May require referral to neurologist or pain management
  • Foot inspection at every visit
82
Q

1st line Med Tx for Diabetic Periph Neuropathy

A

OTC pain relievers
- doesn’t control pain well

83
Q

2nd line Med Tx for Diabetic Periph Neuropathy

A
  • Pregabalin (Lyrica)
  • Duloxetine (Cymbalta)
  • Gabapentin (Neurontin)
84
Q

Guillain Barre Syndrome aka

A

Acute idiopathic polyneuropathy

85
Q

Describe Guillian Barre Syndrome

A

Demyelinating dz of the PNS

86
Q
A
87
Q

Guillain Barre Syndrome gender prevalence

A

men>women

88
Q

When does Guillain Barre Syndrome usually occur?

A

1-4 after a resp or GIT infx

89
Q

What infxs are commonly assoc. w/ Guillain Barre Syndrome?

A

Campylobacter jejuni > CMV, EBV, Influenza A, mycoplasma pneumoniae, hepatitis

90
Q

Guillain Barre Syndrome pathophys

A

PNS myelin sheath is attacked by the pts own immune system
- In campylobacter, there is an lipooligosaccharide on the membrane the bacteria that is identical to a ganglioside on the neuron

91
Q

Guillain Barre Syndrome Hx:S/S

A
  • progressive symmetrical weakness & sensory of distal legs & arms (starts in arms)
  • recent infx
92
Q

What symptoms of autonomic dysfunction are common in Guillain Barre Syndrome?

A
  • Cardiac arrhythmia
  • Excessive sweating
  • nausea,abdo pain, constipation
  • urinary retention
93
Q

Guillain Barre Syndrome PE

A
  • cardiac arrhythmias or resp distress
  • muscle weakness & sensory abnormalities
  • reduced/absent tendon reflexes (may be normal in early states)
94
Q

How is Guillain Barre Syndrome usually diagnosed?

A

clinical

95
Q

Guillain Barre Syndrome Dx

A
  • CSF–> elevated PROs + normal WBCs
  • nerve conduction studies & EMG
  • PFT @ initial exam & intermittently
96
Q

Guillain Barre Syndrome Tx

A
  • hospital req (2-4 wks) ensure timely transfer to ICU as indicated
  • Immunoglobulin OR plasmapheresis STAT
  • monitor for life-threatening manifestations: resp failure, arrhythmias, dysphagia, ileus
  • Early PT & psychosocial support
97
Q

When can a pt w/ Guillain Barre Syndrome be discharged?

A

pt can walk & symptoms have stopped progressing

98
Q

In Guillain Barre Syndrome what is reported as the cause of death?

A

resp failure, infx, or autonomic dysfunction w/n those first 2-4 wks

Block 3: Neuro (10 decks)

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