CNS Disorders Flashcards by Ali Haselhorst

Multiple Sclerosis

Autoimmune progressive demyelinating dz of the CNS

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MS Clinical features

Optic neuritis
Fatigue
Bladder dysfunction
Uhohoff's phenomenon: heat causes worsening sx
Muscle weakness
Sensory deficits
Ataxia

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MS Testing

Oligoclonal bands and inc IgG in CSF

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What Criteria do you use to Dx MS?

McDonald’s Criteria

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Myelomeningocele

Dev birth defect of the neural tube resulting in spinal deformity involving SC, nerve roots, vertebrae and skin often in lumbar or sacral spine

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Anencephaly

Cephalic end of neural tube fails to close resulting in absence of large portion of brain, skull and scalp

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Spina bifida oculta

Defect in posterior bony elements of spine only, often asx

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Meingocele

Protrusion of meninges through bony defect w/o accompanying nervous tissue

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RF of neural tube defects

Maternal:

Folic acid deficiency
Obesity
Diabetes
Hyperthermia
Meds: Valporic acid, Carbamazepine

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Penatal Dx of Neural tube defects

Maternal serum AFP
Prenatal US
Amniocentesis can confirm ABN results

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Red flags in Neural tube defects

Pain
HA
Inc difficulty in school
Rapidly advancing scoliosis
Chang in strength, ton or sensation
Change in bladder fx or sx

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What can apnea, stridor or severe dysphagia represent in pts with neural tube defects?

Syrinx
Tethered cord
AC II manifestation
Shunt malfunction

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Plagiocephaly

ABN shape of the had resulting from external forces

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Brachycephaly

Back of the head has flattened uniformly

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Scaphocephaly (dolichochephaly)

Head w/ long, narrow shape

Common in premature babies

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Plagiocephaly RF

Multiple gestation pregnancy
Assisted delivery
1st born child
Male sex
Prolonged supine positioning
Infrequent tummy time
SCM imbalance
Torticollis
Slow achievement of  motor milestones

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Simple Partial Seizure

no LOC and generally short duration

Can have sensory, motor, autonomic or psychic sx

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Complex partial seizure

Classically has an aura, associated w/ an impaired level of consciousness and automatism

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Generalized Tonic/clonic (gand mal) seizure

Associated aura
LOC
Tonic/clonic bilateral movement patterns
Postictal phase

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Tonic seizure

Tonic muscle contraction

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Clonic seizure

Jerking motion

Can be asymmetric

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Atonic seziure

Drop attacks
Loss of muscle tone
Impaired consciousness only last a few seconds
Head may drop forward

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Absence or petite mal seizure

Sudden lack of awareness and lack of motor activity
Tone preserved
Seem “spaced out”

Myoclonic seizures

Brief sudden contraction of muscle or group of muscles

Vagal nerve stimulator

Implantable device which attaches to the left vagus nerve w/ a goal to prevent or interrupt a seizure

Paraplegia

Paralysis of both lower limbs due to an injury or ABN of the thoracic, lumbar or sacral SC

Expected bladder capacity

age in years + 2= ounces (x30 equals cc)

Age to initiate bowel/bladder management in SCI

3 yo

Age to begin self-cath and bowel program

Developmental age 5 yo

Level of SCI o become a community ambulator

L3 o lower injury and preserved lower limb ROM

Tetraplegia

Paralysis of both lower limbs due to an injury or ABN cervical SC

How many levels of motor function will patients with complete C4 tetraplegia gain in the first year?

On motor level

What age can SCI children use a sliding board for transfers?

5-7 yo

Transverse Myelitis

Monofocal monophasic inflammatory d/o of the SC

Diseases Associated with Transverse Myelitis

``` CT d/o Sarcoidosis Bechet's dz Sjogren's synd SLE Lyme dz HIV Mycoplasma Herpes Leukemia/lymphoma virus-1 Syphilis ```

Transverse Myelitis Testing

Gadolinium enhanced MRI LP for CSF analysis for WBC Determine infectious cause R/O compressive SC lesion

Treatment of Transverse Myelitis

IV high dose steroids for 5 days then taper PLEX if no improvement after 5-7 days of steroids IV cyclophosphamide may be considered for aggressive or non responsive TM

Prognosis of Transverse Myelitis

Most pts experience spontaneous recovery w/in 6 mo w/ additional improvement up to 2 years Age at onset

Anoxic Brain Injury/Hypoxic Ischemic Encephalopathy

Result of interrupted blood flow or oxygen supply to the brain

Neuronal ATP depleted w/in ___ of anoxia

3-5 min

Areas of greatest susceptibility to ischemia in the brain

``` Vascular end zones (watershed) Highest metabolism Hippocampus Cerebellum (purkinje cells) Insular cortex Basal ganglia ```

Findings associated w/ poor outcomes w/ anoxic brain injury

``` Ongoing CPR on arrival to ED Absent brainstem reflexes at 24 hours Anoxia >25 min Water temp >10 deg celcius Initial GCS 24 hours Absent N20 waves on SEPs Diffusion restriction in basal ganglia and cortex on MRI ```

Infectious causes of Encephalopathy

Enteroviruses >80% of cases Arboviruses Herpesviruses

Parainfectious causes of Encephalopathy

Acute demyelinating encephalomyelitis (ADEM)

EEG findings in Viral Encephalitis

Diffuse, high voltage delta slowing

EEG findings in Herpes Encephalitis

Periodic lateralized epileptiform discharges

EEG findings in ADEM

High voltage slowing or normal EEG

Tx of Herpes Encephalitis

Acyclovir

Tx of ADEM

High dose steroids IVIG PLEX

Shaken Baby Syndrome CF

``` Retinal hemorrhages Marks or bruises in unusual locations Irritability AMS Apnea/resp compromise Seizures Poor feeding Lethargy Skull or other fx ```

Mild TBI

Trauma-induced AMS hat may or may not involve LOC | GSC > or =13 w/o neuroimaging ABN

Mild TBI CF

HA and dizziness MC

TBI Red flags

``` Focal neuro deficits Mental status disorientation Seizures Significant vomiting Dramatic worsening of HA Skull fx or hematoma History of high velocity trauma Age ```

Moderate to Severe TBI

Severe: GSC = 8 and duration of LOC >24 hours Moderate: GSC 9-11 and duration of LOC 1-23 hours

Second impact syndrome

Severe brain swelling after potentially mild TBI while individual is still sx from prior concussion

Amyblyopia

Functional reduction in visual acuity from disuse during visual development

Most CN injuries from trauma resolve w/in

6 mo