final exam intro to actue inflammatory demyelinating polyneuropathy (AIDP) Flashcards
UMN and/or CNS: (8)
Dementia
Stroke
TBI (including concussion)
Multiple Sclerosis
Cerebellar Disorders
SCI above T10
Parkinson’s Disease
Huntington Disease
Mixed (2)
ALS
SCI between T10-L2
LMN and/or PNS: (6)
SCI below L2
Vestibular hypofunctions
AIDP
CIDP
Post-Polio
Polyneuropathies
What is AIDP:
-the main subtype of
-acute _______ ______ that is initially ascending and progressive
-commonly related to recent _______ or _______ infections (vestibular neuritis/labyrinthitis)
occurs via demyelination of PNS at the ___________
GBS
acute flaccid paralysis
viral or bacterial
node of ranvier
Prevalence of AIDP:
men___women
race?
ages?
3-7% mortality rate due to?
20% have lasting deficits, which require?
> white
all ages: peak is in young adults or people in the 5th/8th decades
mechanical ventilation
bilateral AFOs
Etiology of AIDP:
common __________________ bacterial infection
—most common cause of the subtypes involving _______damage
common after ___________ and also common Sx and vaccinations
______% of patients who got GBS had a viral or bacterial infection in the 30 days preceding
post-campylobacter jejuni (c-jejuni)
axonal
influenza
90%
Pathophysiology of AIDP:
—typically attacks ________ nerves
—can attack sensory and motor but mainly _______
—in AIDP specifically, there is ________ sensory involvement
peripheral
motor
minimal
Pathophysiology of AIDP:
—in subtypes, there is more sensory or motor involvement?
—anti-inflammatory process involving T-cells and macrophages resulting in _______
—Node of Ranvier is partially affected leading to decreased ________ ________
sensory
demyelination
nerve conduction
Pathophysiology of AIDP:
Can have damage all the way to axons, especially in subtypes like AMAN, which can lead to lack of _______
sweating (involvement of autonomic nerves that control sweat gland function)
Symptoms of AIDP
bilateral ascending weakness
rapid and progressive initially
absence of DTRs
AMAN: Acute Motor Axonal Neuropathy:
–more or less severe
—more likely to have ________ involvement and _____ dependence
–significant residual symptoms
more severe
respiratory; vent
ASAN: Acute Sensory Ascending Neuropathy
–_________ changes more prominent than weakness
sensory
AMSAN: Acute Motor and Sensory Axonal Neuropathy:
–autonomic dysfunction is worse
–may have: (3)
postural hypotension, impaired sweating, bowel and bladder changes
CIDP: Chronic Inflammatory Demeneylanting Polyneuropathy
–onset?
–relapses/readmissions likely or unlikely?
slow onset
likely
Can facial nerve be affected by AIDP?
yes, CNs are peripheral nerves
—AIDP, patients may experience facial weakness or paralysis on one or both sides of the face.
What are the three phases of AIDP
Progressive
Plateau
Recovery
AIDP Progression:
rapid progression up to:
plateaus:
heal:
4 weeks
2-4 weeks similar to SCI
heal proximal –> distal but begins on distal –> proximal
The progressive phase of AIDP ends in _______________ of cases by 2 weeks and in 90% by ______ weeks.
50% ; 4 weeks
On average, peak impairment in AIDP occurs around _______________.
The progressive phase of AIDP involves ascending demyelination that can last from _______________.
4 weeks
2-6 weeks
Approximately _______________ of patients in the progressive phase of AIDP require mechanical ventilation.
AIDP can also attack the autonomic nervous system, leading to _______________.
30%
arrhythmia, tachycardia, BP changes, ileus
AIDP progressive phase pts. are usually kept in what setting due to possible need of ventilation?
acute care
Plateau or Stable Phase:
–around _____ weeks when progression stops but__________ has not fully occurred yet
–usually lasts 2-4 weeks
4; remyelination
Recovery Phase of AIDP:
- nerves start remyelinating and repairing
- process takes months to years depending on level of damage (heals 1 mm/day)
- recovery happens proximal to distal
Diagnosis for AIDP:
clinical features:
—bilateral and flaccid weakness of limbs
—decreased or absent DTRs
—absences of alternative diagnosis
Diagnosis for AIDP- additional features:
severe or mild sensory symptoms?
progress after 2-4 week of _______?
CN involvement or involvement?
Autonomic Dysfunction
Absence of __________?*
mild
plateau
involvement
fever
Diagnosis for AIDP: CSF Analysis
_______ CSF protein levels after 1 week
continued increase with _______ testing
less than _____ leukocytes/mm
increased
repeat
10
Diagnosis for AIDP: nerve conduction velocity studies
_________ at 2 weeks
________ across the entire nerve
_________ potential present in case of axonal damage
slowest
decreased
fibrillation
How do you check CSF, what diagnostic test is used?
Lumbar puncture/spinal tap
AIDP: medical management
In an acute situation, you should _____ the patient. Monitor changes, and be prepared to _______ if necessary.
The two main treatments are:
admit; intubate
high dose IVIG
plasmapheresis
*don’t have to do both, each is individually effective
IVIG: immunoglobin treatment
a _________ that attacks foreign mechanisms
need ______ dose
_____ day course via IV
best for __________ adults in the first two weeks of onset
protein
high
5
non-ambulatory
Plasmapheresis: plasma exchange
–filter blood plasma and remove ____
–most effective within ____ weeks of onset
antibodies
2
AIDP medical management: plateau phase
_______ off vent
get into _______
wean/get off
therapy
AIDP medical management: recovery phase
EMG to _______ nerve conduction recovery over time
refer to ______
track
PT
AIDP worse prognosis w/
age >40
delay in diagnosis
delay in treatment
C-jejuni infection causing it
if mechanically ventilated at any point
AIDP better prognosis w/
younger age
no diarrhea preceding the diagnosis
lower level of disability symptoms and admission
longer interval between symptom onset and admission (non-rapid progression)
no need for mechanical ventilation
MOST AIDP pts. recover in ______ years?
AIDP pts. still see changes up to ______ years?
About _____% do not reach full recover
first year
3 years
20%
AIDP settings: usually begins in _______ specifically, may not have tolerance for _________
acute care (ICU), acute rehab
PT exam/eval: early/progressive stage
-acute care (ICU)
-integ
-msk
-neuro
-cardiopulm: ABG –> PO2 cannot be less than 70mmg or that would be indicative of ________ ________
range of motion
positioning and pressure injuries (roll, prone)
MMT
DTRs, sensation (likely intact)
respiratory failure (tachypnea/confusion)
PT interventions: early/progressive stage
- positioning (prevent wounds)
- PROM (maintain jt. mobility)
- respiratory treatments - prone better ability to breathe, clearing secretions, assisted coughing, spirometry,
PT interventions: early/progressive stage - high intensity exercise at this phase results in ________ functional status
worsened
PT exam/eval: plateau stage
-neuro
-msk
-integ
-cardiopulm: begin to _____ off vent, vitals, respiratory ability, upright positioning
DTRs, Sensory
ROM, muscle function
pressure injuries
wean
PT interventions: plateau stage
PROM:
INTEG:
Cardiopulm:
Functinal mobility such as:
PROM: progress to AAROM, and AROM as able
INTEG: edu, self management
Cardiopulm: incentive spirometry, cough physiotherapy, breathing techniques
upright in chair, STS, transfers
PT exam/eval: recovery phase
-neuro
-msk
-integ
-cardiopulm:
DTRs, sensory
ROM, muscle function
pressure injuries
vitals, respiratory ability
PT intervention: recovery phase
-PROM
-Strengthing
-Integ:
-Cardiopulm:
-Functional mobility
PROM: progress to AAROM/AROM as able
Strength: eccentrics not contraindicated but use your judgement
-Integ: edu, self management (mirrors) , wound care from earlier phases
-Cardiopulm: incentive spirometry, cough physiotherapy, breathing techniques, aerobic training (cycle ergometer is good) 30-60 min 3x/weerk at 70-90% HR Max
-Functional mobility: make salient and applicable
AIDP POC: discharge planning at each phase depends on:
if vent need –> great for ______ setting
severity and disability in ea.
how long ea phase last
insurance coverage
functional mobility
psychosocial/environmental factors
LTACH
