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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
Q

What are the most important symptoms to look for in CRPS?

A

pain and hyperalgesia

in addition to: weakness and autonomic disturbances (distal limb edema)

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26
Q

definition: increased sensitivity to pain, which may be caused by damage to nociceptors or peripheral nerves.

A

hyperalgesia

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27
Q

Among adults ages 40+ years, ______ was most prevalent primary malignant brain and other CNS tumor .

A

glioblastoma

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28
Q

Diffuse and anaplastic ______ was the most prevalent of all malignant brain and other CNS tumors

A

astrocytoma

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29
Q

Among all brain tumors, ______ had the highest overall prevalence

A

meningiomas

30
Q

Where do primary tumors originate?

A

CNS

31
Q

What are gliomas?

A

Primary tumors that arise from supportive tissues of the brain (glial cells)

32
Q

Where are gliomas most often found in adults?

A

cerebral cortex

33
Q

What are the grades and corresponding names of astrocytomas?

A

Grade 1 and 2: low-grade
Grade 3: anaplastic, high grade
Grade 4: glioblastoma multiforme (GBM), high grade

34
Q

Type of tumor:

  • Grow rapidly
  • Invade nearby tissue
  • Contain highly malignant cells
  • 50% are bilateral or occupy more than one lobe
A

Glioblastoma Multiforme (GBM)

35
Q

What is the typical age of onset for astrocytomas?

A

mid-life

36
Q

Meningiomas are (slow/fast) growing

A

slow

37
Q

Where do meningiomas originate from?

A

dura mater or arachnoid mater

often found during autopsy

  • incidence increases with age (females > males)
38
Q

What % of meningioma cases are symptomatic when diagnosed?

A

25%

39
Q

type of tumor:
- benign epithelial tumor
- often impacts the optic chiasm
- hyper/hyposecretion of hormones
- rare before puberty

A

pituitary adenomas

  • Originates from the adenohypophysis of the pituitary gland
40
Q

A schwannoma is a _____ neuroma.

A

acoustic neuroma

41
Q

What are schwannomas?

Nerve sheath tumors

A

Encapsulated tumors composed of neoplastic Schwann cells

can arise on any cranial or spinal nerve

42
Q

What CN is commonly affected by acoustic neuromas?

A

CN VIII

typically in the internal auditory canal

43
Q

What is the 5-year survival rate of astrocytoma?

A

30%

44
Q

Grade 2 astrocytoms with radiation and surgical treatments have a ___% survival rate.

A

65%

50% for 10-year survival rate

45
Q

Grade 3 astrocytoma with radiation and surgical intervention has a ___% 5-year survival rate

A

22%

46
Q

What is the prognosis of GBM?

A

very poor - less than 20% survive 12 months

2% live for 5-years after dx

47
Q

What are the most important prognostic variables for GBM?

A
  • age
  • histology
  • postoperation Karnofsky performance score
48
Q

What is the 5-year survival rate of nonmalignant meningiomas?

A

70%

49
Q

What is the 5-year survival rate of malignant meningiomas?

A

55%

50
Q

What are important factors for prognosis of pituitary adenomas?

A

size and cell type of tumor

51
Q

What is the prognosis for acoustic neuromas?

A

good

rarely results in death

52
Q

What are complications from treatment of acoustic neuromas?

A
  • facial paralysis
  • deafness
  • equilibrium impairments
53
Q

What are s/s of tumors?

A
  • HA (70% of cases)
  • Sz (50-70% of cases)
  • altered mental status
  • ## papilledema
54
Q

What is acute poliomyelitis?

A

Highly contagious small enterovirus

55
Q

How is acute poliomyelitis transmitted?

A

orally

56
Q

What are sxs of acute poliomyelitis?

A
  • HA
  • vomiting
  • fatigue
  • sore throat
  • severe muscle pain
  • flaccid paralysis or paresis
57
Q

How is acute poliomyelitis often destroyed?

A

In the stomach or excreted

58
Q

(true/false) Poliomyelitis does not cross the BBB.

A

false

it does

  • affects CNS
  • kills motor neurons
59
Q

What type of polio enters the bloodstream and NOT the CNS?

A

nonparalytic polio

60
Q

The average time from acute poliomyelitis until the onset of PPS is about ____ years.

A

35 years

61
Q

What causes post-polio syndrome?

A

unknown

62
Q

What is the CPR for postpolio syndrome?

A
  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
Q

What are the sxs of postpolio syndrome?

A
  • fatigue
  • joint pain
  • muscle pain
  • weakness and atrophy
  • cold intolerance
  • respiratory insufficiency
  • dysphagia
  • ADL dysfunction
64
Q

What is the pathophysiology of critical illness NM abnormalities?

A

unknown

65
Q

What are risk factors for critical illness NM abnormalities?

A
  • hyperglycemia
  • SIRS
  • sepsis
  • multiple organ dysfunction
  • renal replacement therapy
  • catecholamines
  • ARDS
66
Q

What are sxs of critical illness NM abnormalities?

A
  • flaccid weakness
  • symmetrical
  • reduced/absent DTRs
  • distal LOSS of pain, temperature, and vibration
  • difficulty weaning from vent
  • anecdotal experience
67
Q

What helps with Dx of critical illness NM abnormalities?

A
  • EMG/nerve conduction studies
  • serum measurements of muscle necrosis
  • muscle biopsy
68
Q

(true/false) Often difficult to differentiate between CIP, CIM, or co-occurence

Critical illness polyneuropathy (CIP), critical illness myopathy (CIM)

A

true

69
Q

Critical illness NM abnormalities usually causes paralysis for how long?

A

> 4 weeks

often prolonged mechanical ventilation and ICU stay

70
Q

How long does CINMA take to improve?

A

weeks to months

50% recovery rate (some may not recover at all)

Neuro (45 decks)

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