Coma and Movement Disorders Flashcards
loss of consciousness
coma
consciousness relies heavily on intact
cerebral hemispheres and the reticular activating system
Describing someone who is far from alert or oriented to time and space, and exhibits other signs being confused, a state just short of frank delirium
obtunded
stupor
lack of critical consciousness and only responds to base stimuli
decerebrate posture indicates
midbrain injury
decorticate posturing indicates
thalamus and hemisphere injury
common cause for cheyne stokes
heart failure
is an abnormal pattern of breathing characterized by deep, gasping inspiration with a pause at full inspiration followed by a brief, insufficient release
apneustic
characteristics of thalamus or higher injury
cheyne stokes respiration
small reactive pupils
decorticate posturing
brainstem reflexes are intact
characteristics of mid-brain injury
central neurogenic hyperventilation
midposition fixed pupils
decererate posturing
EOM may be impaired
characteristics of pons injury
apneustic respiration miotic puils absent EOM absent corneal reflexes flaccidity
characteristics of medulla injury
gasping, apenic respiration
flaccidity
absent gag reflex
blood pressure, heart rate irregularities
treatment
ABC IV blood draw thamin naloxone/romazicone supportive treat specific condition
herniation of the temporal lobe over the tentorial notch
uncal herniation
what Cranial nerve is commonly compressed by an uncal herniation
CN III (blown pupil, ptosis, and eye deviaion down and out)
glawcow coma scale eye response
1= eyes never open
2=eye open to pain
3= eyes open to verbal stimuli
4=eyes open spontaneously
glascow coma scale verbal response
1= no response 2=incomprehensible sounds 3=inappropriate words 4=disoriented and converses 5= oriented
glaswcow coma scale motor response
1=one 2- decerebrae 3-decoritcate 4-flexion with withdrawal 5=localizes pain 6-obeys
sustained contractions that may be rapid or reptetitive, focal or generalized or idiopthic/symptomatic
dystonia
what three medications are associated with symptomatic dystonia
levodopa
haloperidol
phenothiazines
begins focally with food inversion, facial grimacing and spasms that cause marked distortion of the body and often disappears with sleep
idiopathic torsion dystonia
how is idiopathic torsion dystonia diagnosied
history and physical
how is idiopathic torsion dystonia treated
diazepam, anticholinergic meds, baclofen, and carbamazepine and possible thalamotoy
what are the causes of torticollis syndrome
hyperthyroidism antipsychotics ocular imbalance cervical spine disease fragment of idiopathic torsion dystonia
treatment of torticollis
underlying cause
botulinum toxin
surgery
contraction of the orbicularis oculi and other facial muscles; increased blinking, gramacing, extension of the jaw and tongue
blepharospasm
what patients are typically more affected by blepharospasm
females
when is the onset of blepharospasm
over age of 50
how is blepharospasm treated
botulinum toxin
what is the most common movement disorder
essential tremor
demographics of pts with essential tremor
females and whites
essential tremor is most apparent when ?
stress and outstretched arms
differential diagnosis for essential tremmor
hyperthryoidism lithium valproic acid alcoholism tricyclic antidepressants low b12 level parkinson disease
how is essential tremor treated
alcohol beta blocker primidone diazepam, clonazepam, lorazepam surgery-pacemakers
most commonly drug induced movement disorder
tardive dyskinesia
what part of the body does tardive dyskinesia involve usually
lower face and the orolingual buccal muscles
chewing, tongue darting, piano playing fingers, and marching in place are indicative of
tardive dyskinesia
treatment for tardive dyskinesia
avoid the drug complication!
eliminate cause
reserpine
what drugs can cause drug induced parkinsonism
alpha methyl dopa and metoclopramide, antipychotic medications
inner feeling of restlessness, unable to sit still and is found more often in women
acute akathisia
most common reactions and often responds to injection of diphenyhydramine, benztropine and diazepam
acute dystonic reaction
neurolepdrometic malignant syndrome is most common in
young adults
symptoms of neuroleptic malignant syndrome
autonomic dysfunction, fever, rigidity, akinesia, altered mental status, acidosis and myogloburnia
what is the treatment of neurolpetic malignant syndrome
drug withdrawal, bromocroptine and dantrolene
what is a potential long term complication of neuroleptic malignant syndrome
renal failure
when do you get syndeham chorea
ages 5-15 years of age (self limiting but may persist)
______is a manisfestation of rheumatic fever
sydenham chorea
antibodies to the subthalamic and caudate nuclei is indicative of
syndeham chorea
sydenham chorea affects males or females more
females
darting tongue
syndeham chorea
treatment for sydenham chorea
sedatives
phenothiazines, haloperidol
valproic acid
genetics of huntington chorea
autosomal dominant, CAG trinucleotide repead coding for huntingtin
chromosome affected in huntington chorea
4p
loss of GABA and cholinergic neurons
huntington chorea
associated with atrophy of the caudate nucleus
huntington chorea
loss of GABA and cholinergic neurons
huntington chorea
age grp affected by huntinton chorea
35-40 years old
features of huntington chorea
choreoathetosis, personality disorder, dementia, milkmaid grps, EOM difficulties, dancing gait, and dystonia and rigidity in advanced cases
how do you diagnose huntington chorea
H and P
genetic testing
neuroimaging
treatment of huntington chorea
haloperidol, phenothiazine, and tetrabenzine
when does senile chorea begin
after the age of 60
violent form of chorea
violent form of chorea
lesion of contralateral subthalamic nucleus
hemiballism
causes of hemiballism
vascular, hemorrhage, tumor or iatrogenic
when are tics seen
seen between age 5-10
simple, highly personalized, idiosyncratic mannerism
tics
sniffing, clearing throat, protruding chin, blinking
tics
treatment of tics
remove exacerbating causes, ignore it or in adults (sedatives and psychotherapy to help control tics)
multiple tics with vocalizations
gilles de la tourette’s syndrome
have anti-DNAase B antibodies
gilles de la tourette’s syndrome
sexual impulses
gilles de la tourette’s syndrome
is associated with OCD and ADD
tourettes syndrome
how do you diagnose tourette’s
H and P
treatment of tourette’s
remove preciptants clonidine haloperidol pimozide naltrexone marinol psychotherapy possibly a deep brain stimulator
