Exam 2: Neurology Flashcards
Degenerative disorders are progressive in nature, we must focus on…
symptom management, promoting independence, acceptance of loss of function
multi interdisciplinary approach
e.g. of degenerative disorders
dementias
Parkinson disease
MS
ALS
__________ progressive neurodegenerative disease characterized by a cognitive decline that causes impairment in daily functioning
Dementia
What are the subtypes of dementias
- Alzheimer’s (most popular)
- Vascular dementia
- Lewy body dementia
- Frontotemporal dementia (least popular)
What are risk factors of dementia
age > 65 years old
female gender – females live longer than men
Dementia is NOT a normal physiologic change of aging
Alzheimer’s will cause
memory loss, confusion, and cognitive declines
What is the patho of alzheimer’s
buildup of beta-amyloid plaques and TAU (neurofibrillary) tangles in the brain, which disrupts communication between neurons and leads to their eventual death
What are the early symptoms of alzheimer’s
difficulty remembering recent events, followed by language issues, disorientation, mood changes, and eventually the inability to perform daily tasks –> no cure
Vascular dementia patho
occurs when the brain’s blood supply is reduced due to stroke, small vessel disease, or other conditions affecting blood vessels
Vascular dementia leads to
cognitive decline because brain cells are deprived of oxygen and nutrients
What are symptoms of vascular dementia
difficulties with problem-solving, focus, organization, and slower thinking
What is the difference with vascular vs alzheimers dementia
Unlike alzheimer’s, memory loss may not be the initial symptom
With vascular dementia the progression can be
stepwise, worsening after each stroke or vascular event
What is LBD caused by
accumulation of abnormal protein deposits called Lewy bodies in the brain
What will LBD affect
memory, movement, and mental abilities
People with LBD often experience
visual hallucinations, fluctuations in cognitive abilities, Parkinsonism (stiffness, tremors, and slow movement), and sleep disturbances
T/F LBD has symptoms like Alzheimer’s and is often misdiagnosed
True
FTD is a group of disorders caused by damage to
frontal and temporal lobes of the brain
–personality, behavior, and language
FTD results in
personality changes, emotional problems, and difficulty with speech (aphasia)
FTD typically occurs in which age group
younger 50s or 60s
Unlike Alzheimer’s, FTD memory is usually
preserved in the early stages, but people may show socially inappropriate behaviors, poor decision making, or lack of empathy
What are diagnostic exams for dementia
CT/MRI, LP, biopsy post mortem most definitive
What MRI finding’s do we see with alzheimer’s
loss in volume of the brain but hypertrophy of the ventricles
Early stage of AD
independent in ADL’s
may deny presence of symptoms
forgets names; misplaces household items
has short term memory loss, difficulty recalling new info
shows changes in personality and behavior subtly
loses initiative and is less engaged in social relationships
has mild impaired cognition and problems with judgement
unable to travel alone to new destinations
often has decreased sense of smell
Mild stages of AD
has impairment of all cognitive functions
demonstrates problems with handling or is unable to handle money and finances
is possibly depressed or agitated
no longer AAOx3/4
has visuospatial deficits –> gets lost
has speech and language deficits: less talkative, decreased use of vocabulary, increasingly non fluent, and aphasic
incontinent of urine and stool
psychotic behaviors
wandering, trouble sleeping
Late stages of AD
completely incapacitated; BR
totally dependent ADLs
has loss of mobility and verbal skills
possibly has seizures and tremors
has agnosia
The priority collaborative problems for patients with AD include
memory and cognition
injury
elder abuse
symptom management at end of life
What is the priority for inter-professional care with AD
safety
prevent injury or accidents; prevent elder abuse
Pharmacological therapy for AD
AchE inhibitors: donepezil, galantamine, rivastigmine
NMDA antagonist: memantine
Antidepressants: SSRI
Psychotropic drugs: chemical restraints
Ginkgo, vitamin E
How do we help cope with restlessness and wandering
ensuring the patient is wearing identification bracelet
registering the patient for safe return program
providing frequent walk and structured activities
Interventions to mitigate risk for injury with AD
ensuring safety by removing all potentially dangerous objects, particularly in case seizures occur
T/F it’s important to make caregivers and family aware of their own health and stress resulting from new responsibility in AD care
True
Patho of Parkinson’s
loss of dopamine resulting in loss of tone, loss of inhibition of gross movement
atrophy and neuronal loss
Majority of parkinsons is _______
primary (idiopathic)
secondary is from something such as tumor or meds
Risk factors of Parkinson’s
genetic and environmental factors, affects more men over 40
PD is separated into stages…
Stage 1 is mild progressing to stage 5 which is completely dependent
TRAP for PD
tremor
rigidity
akinesia/bradykinesia
postural instability (late)
Rigidity assessment includes
cogwheel: rhythmic interruptions of movement
plastic: mildly restricted movement
lead pipe: total resistance to movement
Stages of parkinson’s with the characteristics include
1: unilateral limb involvement, minimal weakness, hand and arm trembling
2: bilateral limb involvement, mask-like face, slow shuffled gait
3: postural instability, increased gait disturbance
4: akinesia, rigidity
5: completely dependent
What are the priority problems with PD
decreased mobility and possible self care deficit
impaired cognition due to NT and neuronal changes
When giving a patient with PD monoamine oxidase B inhibitors such as selegiline (eldepryl) what must we watch for
tyramine food interactions
can cause severe HTN and very bad headaches
MS patho
autoimmune disorder: chronic disease characterized by demyelination and axonal nerve damage
MS affects ______ more than _____
women more than men (3:1)
What are the types of MS
relapsing-remitting
primary
secondary
progressive-relapsing
What are the priority problems with MS patients
decreased immunity
decreased mobility
decreased cognition
What must be watch for with natalizumab for MS
hepatotoxicity and progressive leukocephalopathy (PML) –> opportunistic viral infection
What must we watch for with novantrone-mitoxantrone-chemo for MS
cardiac toxicity, leukemia
What must we watch for with fingolimod (gilenya) for MS
monitor pulse for bradycardia first 6 hours after taking
What is ALS
progressive degeneration of both upper and lower motor neurons
lou gehrig’s disease
Is there a diagnostic test for ALS
no
What are s/s of ALS
muscle weakness, atrophy, decreased DTR’s, fatique
What is the focus of ALS care
supporting self care and coping strategies
What is Myasthenia gravis
acquired progressive autoimmune disease characterized by muscle weakness
What are the two main types of MG
ocular
generalized
Patho of MG
destruction of Ach receptors–antibodies attached to AChR’s
MG is sometimes associated with
thymoma
What are diagnostic tests for MG
+AChR antibody, MuSK titers, RNS, Tensilon test
Diagnostics tests for MG will also differentiate
cholinergic to myasthenic crisis
What is the main medication we give patients with MG
mestinon (pyridostigmine)
With Cholinesterase inhibitor drugs what must we remember when admin
admin 45 min to 1 hour before meals
observe drug interactions
enhance neuromuscular impulse transmission by preventing decrease of Ach by the enzyme ChE
Crisis situations in MG include
myasthenic crisis: acute exacerbation of disease process often due to infections
Cholinergic crisis: toxic response to medication
How do we differentiate crisis in MG
A tensilon test is definitive in identifying the type of crisis the patient is experiencing
What is the priority when a MG emergency crisis occurs
maintain adequate respiratory function and promote gas exchange
ICU monitoring may be needed due to mechanical ventilation
Cholinesterase inhibiting drugs are withheld because they increase respiratory secretions and are usually ineffective for the first few days after crisis occurs
What can we give when there is a cholinergic emergency crisis
atropine
What is GBS
acute inflammatory polyneuropathy
immune mediated response triggers destruction of myelin sheath
What is GBS associated with (microbiology-wise)
Camplylobacter jejuni, Epstein barr virus, Cytomegalovirus
What is the most common GBS
4 types: ascending GBS is the most common
GBS can cause respiratory
depression
Diagnosis of GBS
clinical presentation with history or viral or bacterial infection, EMG, CSF, MRI-no single test
Main management for patient with GBS
airway compromise
plasmapheresis: removing circulating antibodies assumed to cause disease
IVIG
Primary vs secondary headaches
Primary: migraine, tension, cluster
secondary: caused by unknown
Migraine pattern
pulsatile and unilateral; progress slow-severe
Migraine phase
prodromal
aura
headache
postdromal
Migraine frequency
episodic, increase with stress, hormones
Cluster headaches onset
young men, ETOH or nitrate use
Cluster headache frequency
episodic–lasts days or weeks
Cluster headache pattern
Intense (most painful of primary H/A), unilateral, severe, begin infraorbital, sweating, flushing, tearing
Is there a prodromal phase of cluster
no
tension headache onset
most common–associated with anxiety
tension headache frequency
episodic or chronic
tension headach pattern
dull, constant, bilateral, neck to shoulders
Seizure vs epilepsy vs status epilepticus
Seizure: abnormal paroxysmal electrical discharge from the cerebral cortex (partial or generalized)
Epilepsy: recurrent or chronic seizure
Status epilepticus: seizure lasting over 30 minutes or two or more sequential seizures without recovery between them
THIS IS A MEDICAL EMERGENCY
Partial Seizure: simple-focal
consciousness is preserved
motor: focal twitching that spreads to other body parts in a sequential fashion
sensory: pins and needles sensation or visual hallucinations
Partial Seizure: complex
consciousness is impaired
cognitive disruptions (deja vu)
affective symptoms (fear, anxiety)
automatisms: repetitive involuntary activity such as lip smacking
usually no recall of the event
can progress to generalized tonic-clonic
Generalized seizures are characterized by
Sudden LOC and immediate symmetric abnormal motor acitivity
Generalized seizures: tonic clonic
formerly called grand mal or convulsion
LOC usually under 2 minutes
stiffness of the body then jerking of the limbs
Generalized seizures: absence
formerly called petit mal
sudden onset with interruption of activity
momentary LOC lasts a few seconds
seen in children (stare into space)
misdiagnosed often as ADD or daydreaming
Generalized seizures: myoclonic
sudden brief contractions
large jerking movements of a major muscle group, such as an arm
falling from a sitting position or dropping what is heal
frequently occur when awaking or when falling asleep
Generalized seizures: Tonic or Atonic
Abrupt fall either with stiffening (tonic) or with loss of muscle tone (atonic)
What is the patho of trigeminal neuralgia
impaired inhibition mechanism in the brainstem caused by excessive firing of irritated fibers in the trigeminal nerve CN V
Trigeminal neuralgia clinical manifestation
very severe pain, triggers
Bells palsy patho
paralysis of cranial nerve 7
Clinical manifestation of bell’s palsy
facial paralysis, with forehead involvement, alterest taste and pre auricular pain 48 hours prior to event
