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Neuro > FND, CRPS, post-polio > Flashcards

FND, CRPS, post-polio Flashcards

1
Q

What is the second most common neurp dx in neuro clinics?

A

FND (functional neurologic disorder)

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2
Q

definition: Neurologic conditions in which there is a problem with the functioning of the nervous system and how the brain and body send and/or receive signals, rather than a structural disease process

A

FND

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3
Q

definition: Involuntary but learned habitual movement pattern driven by abnormal self-directed attention due to a complex combination of physical, psychological, and social influences on brain function

A

functional movement disorder

FMD

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4
Q

What commonly triggers FND?

A

emotional or physical event

40% of those do not have a psychiatric Hx

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5
Q

What are common functional neurologic disorders?

A
  • Tremor (50%)
  • Gait disorder (26%)
  • Dystonia (10%)
  • Weakness, paralysis
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6
Q

(true/false) Diagnosis of FND is no longer a diagnosis of exclusion

A

true

  • entrainment test
  • variation of change
  • “whack a mole” sign
  • varying frequency and/or direction of tremors
  • spinal injury center test
  • drift without pronation
  • Hoover’s sign
  • co-contraction around a joint w/o spasticity
  • varied sensory loss
  • difficulty with speech
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7
Q

What is the whack a mole sign?

FND Dx test

A

If person is experiencing abnormal movement in a limb, does it move to another limb if that limb is restrained

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8
Q

What is the Hoover’s sign?

FND

A

weakness of hip extension or flexion that decreases with contralateral activation

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9
Q

What is Reflex sympathetic dystrophy (RSD)?

form of CRPS

A

a regional, posttraumatic, neuropathic pain problem that most often affects 1 or more limbs

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10
Q

Are males or females most affected by CRPS?

A

females, 61-70 y/o

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11
Q

Are the UEs or LEs more frequently affected with CRPS?

A

UE

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12
Q

What is the most common precipitating event of CRPS?

A

fracture

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13
Q

CRPS Type __:

  • Pain that develops after an initial painful event that may or may not have been traumatic
  • There are no nerve injuries or lesions identified
    RSD*
  • Allodynia, hyperalgesia, or spontaneous pain is present and is not congruent with the distribution of a single peripheral nerve
  • History of edema, skin blood flow abnormalities, or sudomotor abnormalities in the painful region
  • No other concomitant conditions account for the pain
A

CRPS Type 1

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14
Q

CRPS Type _:
* Pain that develops after an identifiable, initial painful event or nerve injury
* Allodynia, hyperalgesia, or spontaneous pain is present and is not congruent with the distribution of a single peripheral nerve
* History of edema, skin blood flow abnormalities, or sudomotor abnormalities in the painful region
* No other concomitant conditions account for the pain**

A

CRPS Type 2

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15
Q

definition: a medical term used to describe something that stimulates the sweat glands.

A

sudomotor

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16
Q

definition: a pain due to a stimulus which does not normally provoke pain

A

allodynia

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17
Q

Stage ___ CRPS:

  • Changes in skin temperature, switching between warm or cold
  • Faster growth of nails and hair
  • Muscle spasms and joint pain
  • Severe burning, aching pain that worsens with the slightest touch or breeze
  • Skin that slowly becomes blotchy, purple, pale, or red; thin and shiny; swollen; more sweaty
A

stage 1 CRPS

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18
Q

How long does stage 1 CRPS typically last?

A

1-3 months

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19
Q

Stage ___ CRPS:

  • Continued changes in the skin
  • Nails that are cracked and break more easily
  • Pain that is becoming worse
  • Slower hair growth
  • Stiff joints and weak muscles
A

CRPS stage 2

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20
Q

How long does CRPS stage 2 last?

A

3-6 months

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21
Q

Stage ___ CRPS:

  • Limited movement in limb because of tightened muscles and tendons (contracture)
  • Pain in the entire limb
  • Muscle wasting
A

Stage 3 CRPS

commonly results in amputation

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22
Q

How long does Stage 3 CRPS last?

A

usually irreversible

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23
Q

What are medications used for CRPS management?

A
  • corticosteroids
  • gabapentin
  • lidoderm patches
  • topical capsaicin
  • hydrocodone
  • oxycodone
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24
Q

What regional anesthesia techniques are used for CRPS?

A
  1. sympathetic block (ganglion)
  2. somatic block (epidural)
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25
What are the most important symptoms to look for in CRPS?
pain and hyperalgesia ## Footnote in addition to: weakness and autonomic disturbances (distal limb edema)
26
definition: increased sensitivity to pain, which may be caused by damage to nociceptors or peripheral nerves.
hyperalgesia
27
Among adults ages 40+ years, ______ was most prevalent primary malignant brain and other CNS tumor .
glioblastoma
28
Diffuse and anaplastic ______ was the most prevalent of all malignant brain and other CNS tumors
astrocytoma
29
Among all brain tumors, ______ had the highest overall prevalence
meningiomas
30
Where do primary tumors originate?
CNS
31
What are gliomas?
Primary tumors that arise from supportive tissues of the brain (glial cells)
32
Where are gliomas most often found in adults?
cerebral cortex
33
What are the grades and corresponding names of astrocytomas?
Grade 1 and 2: low-grade Grade 3: anaplastic, high grade Grade 4: glioblastoma multiforme (GBM), high grade
34
Type of tumor: * Grow rapidly * Invade nearby tissue * Contain highly malignant cells * 50% are bilateral or occupy more than one lobe
Glioblastoma Multiforme (GBM)
35
What is the typical age of onset for astrocytomas?
mid-life
36
Meningiomas are (slow/fast) growing
slow
37
Where do meningiomas originate from?
dura mater or arachnoid mater | often found during autopsy ## Footnote - incidence increases with age (females > males)
38
What % of meningioma cases are symptomatic when diagnosed?
25%
39
type of tumor: - benign epithelial tumor - often impacts the optic chiasm - hyper/hyposecretion of hormones - rare before puberty
pituitary adenomas ## Footnote - Originates from the adenohypophysis of the pituitary gland
40
A schwannoma is a _____ neuroma.
acoustic neuroma
41
What are schwannomas? | Nerve sheath tumors
Encapsulated tumors composed of neoplastic Schwann cells | can arise on any cranial or spinal nerve
42
What CN is commonly affected by acoustic neuromas?
CN VIII | typically in the internal auditory canal
43
What is the 5-year survival rate of astrocytoma?
30%
44
Grade 2 astrocytoms with radiation and surgical treatments have a ___% survival rate.
65% | 50% for 10-year survival rate
45
Grade 3 astrocytoma with radiation and surgical intervention has a ___% 5-year survival rate
22%
46
What is the prognosis of GBM?
very poor - less than 20% survive 12 months | 2% live for 5-years after dx
47
What are the most important prognostic variables for GBM?
- age - histology - postoperation Karnofsky performance score
48
What is the 5-year survival rate of nonmalignant meningiomas?
70%
49
What is the 5-year survival rate of malignant meningiomas?
55%
50
What are important factors for prognosis of pituitary adenomas?
size and cell type of tumor
51
What is the prognosis for acoustic neuromas?
good | rarely results in death
52
What are complications from treatment of acoustic neuromas?
- facial paralysis - deafness - equilibrium impairments
53
What are s/s of tumors?
- HA (70% of cases) - Sz (50-70% of cases) - altered mental status - papilledema -
54
What is acute poliomyelitis?
Highly contagious small enterovirus
55
How is acute poliomyelitis transmitted?
orally
56
What are sxs of acute poliomyelitis?
- HA - vomiting - fatigue - sore throat - severe muscle pain - flaccid paralysis or paresis
57
How is acute poliomyelitis often destroyed?
In the stomach or excreted
58
(true/false) Poliomyelitis does not cross the BBB.
false | it does ## Footnote - affects CNS - kills motor neurons
59
What type of polio enters the bloodstream and NOT the CNS?
nonparalytic polio
60
The average time from acute poliomyelitis until the onset of PPS is about ____ years.
35 years
61
What causes post-polio syndrome?
unknown
62
What is the CPR for postpolio syndrome?
1. a prior episode of poliomyelitis with residual motor neuron loss 2. a period (usually ≥ 15 years) of neurologic and functional stability after recovery from the acute illness 3. gradual or rarely abrupt onset of new weakness or abnormal muscle fatigue, muscle atrophy, or generalized fatigue 4.exclusion of other conditions that could cause similar manifestations
63
What are the sxs of postpolio syndrome?
- fatigue - joint pain - muscle pain - weakness and atrophy - cold intolerance - respiratory insufficiency - dysphagia - ADL dysfunction
64
What is the pathophysiology of critical illness NM abnormalities?
unknown
65
What are risk factors for critical illness NM abnormalities?
- hyperglycemia - SIRS - sepsis - multiple organ dysfunction - renal replacement therapy - catecholamines - ARDS
66
What are sxs of critical illness NM abnormalities?
- flaccid weakness - symmetrical - reduced/absent DTRs - distal LOSS of pain, temperature, and vibration - difficulty weaning from vent - anecdotal experience
67
What helps with Dx of critical illness NM abnormalities?
- EMG/nerve conduction studies - serum measurements of muscle necrosis - muscle biopsy
68
(true/false) Often difficult to differentiate between CIP, CIM, or co-occurence | Critical illness polyneuropathy (CIP), critical illness myopathy (CIM)
true
69
Critical illness NM abnormalities usually causes paralysis for how long?
> 4 weeks | often prolonged mechanical ventilation and ICU stay
70
How long does CINMA take to improve?
weeks to months | 50% recovery rate (some may not recover at all)

Neuro (45 decks)

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