Conditions of the Nervous System Flashcards
What are common signs and symptoms of brain neoplasms?
1) Onset is usually gradual
2) Focal neurologic deficits: dependent on the location of the lesion
3) Seizures
4) *Headache, wakes patient at night
5) Signs of increase intracranial pressure: nausea, vomiting, headach, papilledema
What is in the ddx for someone presenting with symptoms of a brain neoplasm?
CVA, intracranial hemorrhage, meningitis, multiple sclerosis
What percentage of brain neoplasms are a result of metastasis from other primary sites?
About 50%
What primary cancer sites metastasize to the brain?
Lung
Breast
Melanoma
Colon
Which inherited diseases increase the risk for developing brain tumors?
Neurofibromatosis, tuberous, sclerosis, multiple endocrine neoplasia type 1 and retinoblastoma
What is the most common type of primary brain neoplasm?
Meningioma
Are most meningioma tumors typically malignant or benign
Benign
What is the most malignant type of astrocytoma?
Glioblastoma multiforme
What is the diagnostic study of choice for diagnosis of brain neoplasms?
MRI with contrast
What are the common signs and symptoms of acoustic neuromas?
Unilateral hearing loss
Tinnitus
Headache
Balance disturbance and/or vertigo
Facial weakness or parasthesia
What is the diagnostic imaging of choice to detect acoustic neuromas?
MRI with gadolinium enhancement
What disease is categorized as a rapidly progressive inflammatory demyelinating polyneuropathy?
Guillain-Barre
What are some of the common causes of Guillain-Barre Syndrome GBS?
1) 2-4 weeks post viral or bacterial illness (2/3 of cases): respiratory most common, followed by gastrointestinal
2) Recent vaccination
3) Medication use: penicillin and anti-motility drugs
What bacteria has been associated with development of GBS?
C.jejuni
What are the common signs and symptoms of GBS?
1) Progressive ASCENDING symmetric muscle weakness starting in the fingers and lower extremities
2) Mild sensory symptoms: paresthesias, numbness
3) Pain: shoulder girdle, back, buttock and thighs
4) Autonomic changes
5) Dyspnea, SOB, respiratory failure
6) Bowel or bladder dysfunction
What would find on CSF analysis in patient with GBS?
1) Increased protein
2) Normal WBC
What are the stages of progression in a patient with GBS?
1) Reach stage of greatest weakness by the 3rd week
2) Recovery usually within 2-4 weeks after progression ceases
3) 30% will have symptoms up to 3 years later
What is in the ddx for Guillain Barr’e?
1) Meningitis or encephalitis
2) Poliomyelitis
3) Rabies
4) Botulism
5) CVA
6) ALS
What causes botulism?
Ingestion of the neurotoxin of Clostridium botulinum
What are the 2 routes to be infected with botulism?
1) Food borne: Consumption of improperly canned food or raw honey in infants
2) Wound contamination: traumatic injury, intravenous drug use
What are the adult prodromal signs and symptoms of foodborne botulism?
1) Gastrointestinal Symptoms: Nausea/vomiting, abdominal pain and diarrhea, dysphagia, extremely dry mouth
2) Neurological symptoms: Sudden onset diplopia, dilated and fixed pupils
How does wound- borne botulism differ from foodborn botulism?
There are no gastrointestinal symptoms in wound botulism
How fast does botulism progress?
Symptoms typically start within 12-36 hours after consumption of contaminated food. After onset of symptoms, progresses quickly over 1-2 days.
How would you describe the paralysis in botulism?
Bilateral descending flaccid paralysis
What are the sensory deficits associated with botulism?
None typically found except for blurred vision
How high is the fever in botulism?
There is no fever
What is likely a sequelae of botulism?
Respiratory arrest and/or death if antitoxin is not received
If you have recovered from botulism, will you have future immunity?
NO
What is an inflammation of the brain called?
Encephalitis
What usually causes encephalitis?
1) Most commonly secondary to viral infections: HSV, West Nile Virsu
2) Bacterial: Mycoplasma pneumoniae
3) Fungal
4) Autoimmune: SLE or Hashimoto’s
5) Trauma
What are some of the signs and symptoms of encephalitis?
1) Fever
2) Altered consciousness
3) Personality changes, confusion
4) Seizures
5) Stiff neck
6) Nausea and vomiting
7) Focal neurologic deficits
8) Rash
What is the most important diagnostic test done in patient suspected of encephalitis?
CSF sampling
What is in the DDx for encephalitis?
1) Meningitis- can often coexist with encephalitis (meningiocephalitis)
2) Lyme Disease
3) Syphilis
4) CVA
5) Drug or alcohol intoxication
6) Intracranial tumor
How does herpes zoster most commonly present?
Painful unilateral eruption of vesicles along a single dermatome
What physical therapy modality is helpful for herpes zoster?
UV light treatment
What drugs are use to treat acute herpes zoster?
Acyclovir, valacylovir
What is a sequelae of herpes zoster?
Post- herpetic neuralgia
What homeopathic remedies could you consider herpes zoster?
Rhus tox
Sulphur
What vaccination is used to prevent herpes zoster?
Zoster vaccine recombinant, adjuvanted
What are the causative agents of bacterial meningitis?
Neisseria meningitides
Haemophilius influenzae type b
Streptococcus pneumoniae 80%
What are some of the signs and symptoms of bacterial meningitis?
Rapid onset of fever, chills
Headache
Stiff neck
Photophobia
Confusion
Drowsiness, stupor
Seizures
How rapid is the onset of bacterial meningitis?
Very rapid onset (3-7 days after exposure) and progression
What are some of the sequelae of bacterial meningitis?
Seizures
Deafness
Death
When do you see petechial rash?
Meningococcal meningitis: due to broken blood vessels resulting from meningococcal septicemia
What are some of the viral agents that cause viral meningitis?
1) Enteroviruses: Coxsackie virus or echovirus 85%
2) Mumps
3) HSV 1 or 2
4) HIV
What are some of the signs and symptoms of viral meningitis?
1) Fever
2) Headache
3) Stiff neck
4) Altered mental status
5) Mild photophopia
Which type of meningitis can have a spontaneous recovery?
Viral
What are the 2 physical exam signs that are positive in meningitis?
Brudzinski’s sign : Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.
Kernig’s sign: Extension of the knee on a flexed hip at 90° causes restriction and pain Beyond 135°
What diagnostic technique is used to help diagnose meningitis?
CSF examination and culture
What type of meningitis has low glucose in 60% of cases?
Bacterial meningitis
What type of meningitis has lymphocytes in the CSF?
Viral Meningitis
What are common etiologies for peripheral neuropathy?
1) Diabetes mellitus
2) HIV infection
3) Vitamin deficiencies: B12 , B1, B6 (although too much can cause neuropathy also)
4) Chemotherapy
5) Alcohol induced
What physical therapy modality is indicated for neuropathy?
Infrared Treatment
Which accessory nutrients are useful in treating peripheral neuropathy especially in diabetic patients?
Alpha lipoic acid
Benfotiamine (highly absorbable thiamine)
What herbs are useful for treating diabetic neuropathy?
Borago officinalis oil and Capsicum annuus topically
What are the common signs symptoms of acute poliomyelitis?
1) Only 5- 10% of people develop symptoms
2) 3 main presentations
-Abortive (flu-like): 2-3 days of fever, malaise, HA, sore throat, N/V, abdominal pain and diarrhea
-Non-paralytic (aseptic meningitis): 3-7 days of abortive poliomyelitis plus stiff neck and back
-Paralytic: all features listed above with asymmetric, flaccid lower motor neuron weakness, intense myalgia
What are the common signs and symptoms of tetanus?
1) Sore throat with dysphagia
2) Local muscle rigidity at site of entry
3) Headache
4 ) Lockjae and risus sardonicus
5) No fever
6) Muscle spasms and seizures
7) Respiratory compromise
What is the treatment for a patient suspected of having tetanus?
Tetanus immune globulin immunization, diazepam IV, magnesium sulfate IV and metronidazole in hospital
What are some of the risk factors associated with cerebrovascular accidents CVA?
1) Advanced age
2) Diabetes
3) HTN
4) Smoking
5) OCP/HRT usage
6) Atrial Fibrillation
7) Atherosclerosis
What types of defects are caused by a brain-stem stroke?
Respiratory
Heart Rate
Blood pressure
Voice
Eye movement
Gross motor defects
Minimal sensory defects
What are the 2 causes of inadequate perfusion of the brain in a stroke?
1) Infarction or ischemia
2) Hemorrhage
What position do you put a stroke victim in?
Head and back elevated 30 degrees to relieve intracranial pressire
What effect does smoking have in women on oral contraceptives?
It increases the risk of MI and stroke
What determines the types of defects seen with TIAs?
The location of the ischemia in the brain
What are some of the symptoms of a carotid artery deficit?
Ipsilateral blindness
Contralateral hemiparesis with paresthesias
What are some of the symptoms of a vertebrobasilar deficit?
Vertigo
Confusion
Sudden sensorineural deafness
Ataxia (without coordination): falling to the side of the lesion
What usually causes an epidural hematoma?
Head trauma resulting in a tear in the middle meningeal artery
What are the common signs and symptoms of cluster headaches?
1) Unilateral , stabbing pain over periorbital or temporal region
2) Occur in clusters: 15-80 minutes, up to 8 times per day
3) Lacrimation, conjunctival injection
4) Rhinorrhea or nasal congestion
5) No aura
6) Patient is usually agitated and extremely restless
What is an important condition to rule out in someone you suspect has cluster headaches?
Temporal Arteritis
What can you consider for acute treatment of cluster headaches?
Sumatriptan
100% oxygen for 15 minutes
What drug is used prophylactically to prevent recurrence of cluster headaches?
Calcium Channel blockers: Verapamil
What are the common signs and symptoms of migraine headaches?
Unilateral throbbing pain
Nausea and vomiting
Photophobia and phonophobia
Can present with and without aura
What types of headaches have an aural prodrome?
Classic migraines, common migraines do not have an aura
What herb is used prophylactically to prevent recurrence of migraines?
Tanecetum parthenium
What mineral has been used to treat acute migraines?
Magnesium sulfate
What drug is used to treat acute migraines?
Sumatriptan
What is the typical presentation of tension headaches?
Midl to moderate intensity, bilateral, non-throbbing, band-like pain
What are the symptoms of TMJ syndrome?
Bruxism (unconsciously grind or clench teeth)
Masseter or temporalis pain and spasm
Unilateral radiating facial pain
Crepitus on opening jaw
Frequent headaches
What kind of headache onset do you usually see with a brain tumor?
A gradual onset, new type of headache in a patient who has not previously had headaches is a cause for concern
What cranial nerve is affected in Bell’s Palsy? Give name and cranial nerve number
CN 7: Facial Nerve
What infections are associated with Bell’s palsy?
HSV, Herpes zoster, Lyme Disease, CMV, EBV
What other condition is associated with Bell’s palsy?
Pregnancy or the immediate post-partum state
What nutrients are used to treat Bell’s palsy?
B6
B12
EFAs
Zinc
What is a homeopathic remedy to consider for Bell’s palsy when the patient reports it started after being exposed to cold, dry air?
Causticum
What are some central causes of vertigo?
Vestibular migraine, brainstem ischemia, multiple sclerosis, Chiari malformation
What may trigger the onset of trigeminal neuralgia?
Brushing the hair or chewing, post-dental procedure
What are the symptoms of trigeminal neuralgia?
Acute, brief attacks of severe shooting pains along mandibular and maxillary branches of the trigeminal nerve
What pharmaceutical medications could be prescribed for trigeminal neuralgia?
Carbamazepine, phenytoin
What vitamins/minerals may be indicated in trigeminal neuralgia?
Vitamins B1, B6, B12
What is an herb that can be used topically to reduce the pain of trigeminal neuralgia?
Capsicum annuum
Describe the sequence of events in a tonic-clonic type (grand mal) seizure
The seizure begins with tonic contractions of muscles with loss of control and rigidity followed by clonic phase of bilateral limb jerking
Does the patient with a tonic-clonic seizure regain consciousness immediately afterwards?
No, there may be a prolonged period of unconsciousness
A caregiver describes the following pattern if seizures in the patient: sudden brief loss of awareness, but not loss of consciousness. There is no aura. They stare and have mild clonic movements. This may happen 100 times/ day. What type of seizure do they have?
Absence seizure (petit mal)
What type of seizure has a single or multiple shock-like concentration of face, trunk, or extremities that comes on suddenly with no loss of consciousness?
Myoclonic or minor motor seizure
What type of seizure causes sudden muscle stiffening, impaired consciousness and often falling?
Tonic
What type of seizure causes sudden loss of control of muscles, especially in the legs resulting in collapsing to ground?
Atonic
What nutrients are used to treat epilepsy?
Manganese
Taurine
Vitamin E
Choline
Vitamin B12
Vitamin B6
Omega 3 Fatty Acids
What type of diet is indicated for epilepsy?
Ketogenic Diet
What botanical medicine is indicated for epilepsy?
Cannabis sativa
What are some of the homeopathic remedies to consider for epilepsy?
Cuprum
Stramonium
What drugs are commonly used to treat seizure disorders?
Carbamazepine
Clonazepam
Gabapentin
Phenytoin
Which epileptic drugs require therapeutic monitoring?
Carbamazepine and Phenytoin
What class of drugs are first line treatment for status epilepticus?
Benzodiazepines, especially Diazepam
What is the proper name for Lou Gehrig’s disease?
Amyotrophic lateral sclerosis (ALS)
What cells are affected with ALS?
Lower motor neurons: anterior horn cells, upper motor neurons: precentral gyrus
What are the hallmark changes that occur with ALS?
Progressive muscle weakness and atrophy without sensory loss
What are common signs and symptoms seen in ALS?
1) Upper motor neuron: incoordination, hyperflexia, spasticity
2) Lower motor neuron: Muscle weakness and atrophy, fasiculations, muscle cramps
Which muscles are most commonly affected in ALS?
Limb, bulbar, axial and respiratory
Which muscles are usually spared with ALS?
Facial muscles
What are the 3 main signs and symptoms of Huntington’s Disease?
Chorea
Psychiatric illness
Dementia
Does Huntington’s Disease chorea have motor, sensory or both motor and sensory findings?
Motor only
What is the autoimmune demyelinating disease of CNS?
Multiple sclerosis
You suspect a patient has multiple sclerosis. What diagnostic imaging technique is indicated?
MRI
What therapeutic diets are used for treatment of MS?
Swank Diet: extremely low fat diet
What conditions may exacerbate MS symptoms?
Stress
Worse in heat
What are the common signs and symptoms of MS?
Numbness, tingling in 1 or more limb
Muscle weakness
Vision changes: Optic neuritis
Fatigue
Urinary Retention or Incontinence
A deficiency in what neurotransmitter is associated with Parkinson Disease?
Dopamine
What are some of the signs and symptoms of Parkinson disease?
Pill rolling resting tremors of hands
Lack of facial expression
Cannot stop or start movement very well
Shuffling gait
Cogwheel rigidity
What mnemonic can you use to remember the s/sx of Parkinson Disease?
SMART
Shuffling gait
Mask-like facies
Akinesia
Rigidity
Tremor
What is the prototype anti-Parkinsonism drug?
Levodopa
How does levodopa work as an anti-Parkinsonism drug?
It is decarboxylated to dopamine in the brain and improves motor, neurological, & altered mood symptoms of Parkinson’s disease
What drug, a selective dopamine agonist in the pituitary, is used to treat Parkinson’s disease?
Bromocriptine
What are some of the adverse effect of Bromocriptine?
N/V
Dizziness
Hallucinations
Nasal Stuffiness
What accessory nutrients are used to treat Parkinson’s Disease?
Antioxidants:
IV glutathione
Alpha lipoic acid
SAMe
NAC
Vitamines E and C
What is post-polio syndrome?
Delayed onset of weakness years after recovery
What are the common signs and symptoms of acute traumatic brain injury?
Altered consciousness
Severe, persistent headache
Repeated vomiting
What are the common signs and symptoms of chronic traumatic brain injury?
Headaches
Dizziness
Fatigue
Irritability
Memory problems
Difficult focusing
