Conditions Flashcards
Stroke (cerebrovascular accident)
-Due to ischemia or infarction of brain tissue secondary to inadequate blood supply.
-Intercranial hemorrhage
Causes of inadequate blood supply:
-thrombus or embolus
-Atherosclerosis
-Traumatic shock
-Vasculitis
Transit ischemic, attack (TIA):
Symptoms of a stroke that results within 24 hours, secondary to ischemia without infarction .
Presentation of a stroke :
Sudden weakness of limbs
Sudden facial weakness
Sudden onset of dysphasia
Sudden onset of visual or sensory loss .
Risk factors :
Smoking
Hypertension
Vasculitis
Carotid artery disease
Previous stroke or TIA
Diabetes
Recognition pattern :
F -face
A- arm
S-speech
T-time
Arteries that can be occluded :
-Anterior, middle and posterior cerebral artery.
-Vertebral artery
-Basilar artery
-Internal carotid artery
-Circle of Willis
Subarachnoid hemorrhage
Bleeding in the sub arachnoid space where the cerebral spinal fluid is located. This is due to a ruptured cerebral aneurysm.
Most common in women, age 45 to 75
Presentations :
Neck stiffness
Photophobia
Sudden onset, occipital headache
Vision changes
Dysarthria, weakness, seizure, loss of consciousness
Risk factors :
Hypertension
Smoking
Excessive alcohol
Cocaine use
Family history
Multiple sclerosis
Chronic and progressive demyelination of myelinated neurons in the central nervous system.
More common in women, and under the age of 50. (20-40)
Charcot neurological triad:
Dysarthria
Nystagmus
Intention tremor
Causes : unknown
Smoking
Epstein bar virus
Low vitamin D
Obesity
Presentation:
-Optic neuritis -most common presentation
-Eye-movement abnormalities due to lesion of CN-6
-Focal weakness -Bell’s palsy, Horner syndrome, Limb paralysis and incontinence
-Focal sensory symptoms - trigeminal neuralgia, numbness, paresthesia
-Ataxia-sensory or cerebellar
-Lhermitte sign-electronic shock felt with neck flexes spine.
- Autonomic neuropathy- bowel and bladder symptoms and sexual dysfunction.
Upper motor neuron lesion
Signs and symptoms
Increase toner, spasticity
Brisk reflexes
On going plantar responses ( Hoffmann, chaddocks, Oppenheimer, Gordon’s)
Clonus
Lower motor neuron lesion
S/S:
Fasciculations (twitches)
Loss in reflexes
Muscle wasting
Reduced tone(flaccid)
Parkinson’s
Progressive reduction of dopamine and genic neurons in the substantial nigra within the basal ganglia.
Triad:
Resting tremor
Rigidity(cogwheel)
Bradykinesia
Presentation :
Male 70y/o
Parkinsonian gait
Shuffling
Reduced arm swing
Forward tilt
Stooped posture
Other feats;
Anosmia- first sign of P
Postural instability
Depression
Sleep disturbance
Cognitive impairment and memory problems
Benign, essential tremor
Condition associated with aging.
Presentation :
Find tremor affecting all voluntary muscles, most commonly seen in the hands .
Head tremor
Jaw tremor
Vocal tremor
worst one tired, stressed, or caffeinated
Improved with alcohol
DDX :
Parkinson’s
Multiple sclerosis
Huntington’s chorea
Huntington’s chorea
Genetic condition that causes progressive deterioration in the nervous system.
More common in 30 to 50 y/o
Anticipation- a genetically acquired disease.
The earlier the age of onset, the worse, the severity of the disease.
Presentation :
Chorea
Eye movement disorders
Dysarthria
Dysphasia
Facial nerve palsy
Typically presents with a unilateral facial weakness.
Facial nerve exits, the brainstem at the Cerebellopontine angle, passes through the temporal and parotid gland.
Divides into five branches :
Temporal
Zygomatic
buccal
Marginal mandibular
Cervical
Presentation:
Ptosis
Loss of nasolabial fold
Umnl: (stroke or tumor)
Forehead will be spared and patient can move their forehead.
Lmnl: ( Bell’s palsy or Ramsay hunt syndrome)
Forehead cannot be moved.
Brain tumors
Benign tumor-meningioma
Malignant tumor -glioblastoma
Presentation:
ICP:
Papilloedema
Altered mental state, visual field defect
Seizures
Unilateral ptosis
HEADACHES:
Worse on Valsalva maneuver
Vomiting
Constant
Nocturnal
Myasthenia gravis
Worsens with exercise!
Autoimmune condition that causes muscle weakness that gets progressively worse with activity, and improved with rest.
Strong link with thymoma, 20 to 40%
Presentation:
Diplopia- repeated upward gazing causes Diplopia
Ptosis- repetitive blinking
Weakness in facial movements
Dysphasia
Fatigue when chewing
Slurred speech
Weakness with repetitive movements
Thymectomy scar- removal of thymoma
Severe respiratory weakness which can be fatal(doesn’t occur in LEMS)
Patho:
In 85% of patients with MG, acetylcholine receptor antibodies are produced by the immune system->blocking the receptor->preventing muscular contraction.
-these antibodies also activate the complement system within the neuromuscular junction leading to damage of the postsynaptic membrane.
Lambert Eaton myasthenic syndrome
Betters with exercise!
Similar features to myasthenia gravis.
Typically occurs in patients with small cell lung cancer, although antibodies, target, and damage voltage gated calcium channels of the neuromuscular junction .(instead of ACH)
Presentation :
Proximal muscle weakness
Diplopia
ptosis
Dysphasia
Dry mouth
Blurred vision
Dizziness due to autonomic dysfunction
Charcot Marie Tooth
A dysfunction of myelin and axons which is an inherited disease that affects the peripheral motor and sensory nerves.
Symptoms usually start before 10 years of age, although delayed onset may be at 40.
Causes of peripheral neuropathy:
(ABCDE)
Alcohol
B12 deficiency
Cancer or chronic kidney disease
Diabetes and drugs
Every vasculitis
Presentations:
High foot arch-pes cavus
Distal muscle wasting
Weakness of lower limb-loss of ankle dorsiflexion.
Weakness in the hands
Reduce tendon reflexes
Reduce muscle tone
Peripheral sensory loss.
Guillian Barre
Acute paralytic polyneuropathy that affects the peripheral nervous system.
It causes acute symmetrical, ascending weakness and sensory deficits .
Usually triggered by infection, such as Epstein-Barr virus, and Campylobacter jejuni.
Patho:
B cells create antibodies against antigens that causes preceding infection in the myelin sheaths.
Presentation :
Symmetrical, ascending weakness
Reduced reflexes.
Peripheral loss of sensation or neuropathic pain.
May progress the cranial nerves causing facial nerve weakness.
Cauda Equina Syndrome
Mc in men 40-60y/o
Secondary to herniations
Presentation :
Back and buttocks pain
Perineum, genitalia, thighs, leg, saddle area, bladder/bowel/sexual dysfunction
Loss in reflexes at knee and ankle
