deck_3350254 Flashcards
four cardinal features of nacrolepsy
- excessive day time sleepiness with sleep attacks”
what does polysomnogram of narcolepsy show?
short sleep latency with REM onset(REM sleep occuring during wakefulness)
obstructive sleep apneasymptoms? risk factors? tx?
obstruction of upper airway during sleep with preservation of respiratory effort risk factors: age, obesity, ethanol usesymptoms: excessive daytime sleepiness, snoring, cessation of breathing during night, mornng headaches, cognitive complaints tx: CPAP, weight loss
insomnia
difficulty getting to sleep or staying asleep, or non refreshing sleep at least 1 month
restless leg syndrome
urge to move legs, usually during periods of rest or inactivity, typically in the evening (crawling sensation that gets worse when legs remain still and are relieved by moving them)
what is RLS associated with?
iron deficiency anemia
what is restless leg syndrome treated with?
dopamine agonists
REM sleep behavior disorder
loss of normal skeletal muscle atonia during REM sleep, associated with acting out dreams
night terrors
sudden unexplained bouts of terror/fear occurring in stage 3 or 4 sleep. common amongst chidlren who often can neither be awakened or consoledlast for 10 minutesonset usually in first cycle of sleep
sleepwalking
common, more frequent in childrenno memory of doing it, difficult to arouse
bruxism
common sleep disorder where you grind your teeth, can lead to dental erosion
syncope
transient loss of conscoiusness and postural tone that results from brain hypoperfusion, lasts seconds
pre?syncope
light headedness, visual changes, buckling of knees, cognitive slowing, neck pain, headache
cardiogenic syncope
MI, arrhythmias, valvular outflow obstruction
orthostatic syncope
autononomic failture (SC injury or diabetic neuropathy)volume depletion (blood loss, dehydration)medications (anti?hypertensives and antidepressants)
vasovagal syncope
normal variant, most commoncna be caused by pee/poop/coughcarotid sinus hypertesensitivitycan be triggered by noxious stimuli (hearing bad news, seeing blood, strong emotionits a PARASYMPATHETIC response
which kind of syncope is most common?
vasovagal?? exaggeration of normal reflex
tx of vasovagal syncope
avoidance of triggers
tx of orthostatic syncope
if due to orthostatic hypotension, discontinue BP meds, tight stockings, blocks under head of bed, hydrate, more salt, avoid prolonged standing or fast transitions
seizure
symptom?? pathological discharge of of neurons that results in stereotypical behavior or sensation (the symptoms depend on where seizure is)
epilepsy
chronic condition of recurent UNPROVOKED epileptic seizures? if your seizure happens everytime after a certain stimulus, it is not epilepsy
status epilepticus
rare emergency where someone has seizures for more than 30 minutes?? great morbidity and mortality
simple partial motor seizure
recurrent stereotypic motor event (lift your hand over your head)focal onsetconsciousness intact
simple partial sensory seizure
weird vision, smells, numbness in one armfocal onsetconsciousness intact
complex partial seizure
focal onsetinvolves limbic or cognitive structuresaffects cognition, speech, memory impairment (others notice it, bu you dont remember bc of impaired hippocampus)
can a partial onset seizure become a generalized seizure?
yes, partial onset seizure can secondarily spread and become a generalized tonic clonic seizure
generalized onset seizures:absencetonic?clonicinfantile spasmsatonic
absence: subtle? kids stare into space, fine afterwards (no postictal confusion)tonic?clonic: typical seizures you think ofinfantile spasms: baby does weird thing with arms, you see if on EEGatonic: drop attacks (usually have to wear headaches bc when you fall out you can harm head)
how can you tell if its generalized onset seizure?
on EEG, all cortical neurons begin to fire simultaneously, and if its focal the abnormal discharges start in one place (and may or may not spread)
febrile seizures
most common?? 4% of populationseizures only occur with fever (generalized onset seizure)only in small children
absence epilepsy
looking like a few second staring spellreturns immediately to normalknow its going on bc of EEG
infantile spasms
child has generalized onsetassociated with developmental regressionalso associated with tuberis sclerosis
lennox?gasteaux syndrome
presents in first decade, associated with developental regression
juvenile myoclonic epilepsy
adolescentsgeneralized onset seizure, suddenly drop tooth brush, knock over drinkin young, healthy people (normal development)threshold lowered by drinking, no sleep, etc
temporal lobe epilepsy
seizures are either simple partial (deja vu, transient sense of fear, unpleasant olfactory experience)orcomplex partial?? above sensations followed by confusion and speech problems that last second to minutes, followed by amnesia of event and post ictal cognitive changes (dont feel great)
where do temporal lobe seizures arise from?
hippocampus or amygdala (medial temporal lobe)can see changes on MRI
who is prone to get temporal lobe epilepsy?
most likely if you had seizures as a kid, hit your head as a kid, had a high fever (usually some factor precedes it)
how is epilpesy evaluated?
on EEG to identify type of epilepsy and then MRI to see if there is an underlying cause
what are normal brain waves?
beta: consciously alert agitatedalpha: physical and mental relaxation (normal)theta: somnolence with reduced consciousnessdelta: unconciousness or deep sleep
what does an abnormal EEG with epileptiform discharges show?
characterizes epilepsy syndrome, guides management with medication
abnormal EEG with diffuse slowing
can confirm presence of encepalopathy
normal EEG?? what does that help with?
does NOT exclude any diagnosis
evoked postentials
derivative of EEG, measure the brain waves teh are evoked by an electrical stimulus in teh limbs?? used for intra?operative monitoring during spine surgery
polysomnograms
derivative of EEG in combo with other meausurements, useful in IDing sleep disorders
