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Neuro > Guillain Barre Syndrome and MS > Flashcards

Guillain Barre Syndrome and MS Flashcards

1
Q

what part of the CNS does GB syndrome affect?

A

nerve roots and peripheral nerves

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2
Q

what is the prognosis for GB syndrome?

A

it is good, most pts return return to PLOF within 1-2 yrs

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3
Q

what is the age risk factors for GB syndrome?

A

none, it can affect any age

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4
Q

what gender risk factors are there for GB syndrome?

A

men are 2x more likely

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5
Q

what is the significance of GB syndrome and infectious diseases?

A

2/3 of people who are diagnosed with GB had sxs of infectious disease 2 weeks prior to GB

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6
Q

explain the pathology of GBS

A

an infection activates an immune cascade that breaks up the myelin.

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7
Q

what are 2 medical tests that help with the dx of GBS?

A

Examination of CSF for increased protein.
Nerve conduction test

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8
Q

what are some clinical signs that help the dx for GBS?

A

Progressive weakness of multiple nerve roots.
Symmetrical onset
Develops over a few days to weeks
Hyporeflexia or areflexia

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9
Q

what is a very common clinical presentation of pts with GBS?

A

severe fatigue

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10
Q

explain the 3 steps/progression of GBS using the correct terms

A

Nadir (peak) of motor impairments happens 2-8 weeks after onset.
Plateau occurs for 2-4 weeks
Improving occurs for 2 months to several years

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11
Q

talk about ventilation and GBS? How often is it required, what causes it and what are the implications of it?

A

it is required in ~40%. It is needed because of weakness of the intercostals, abdominals, diaphragm.
It increases risk of pneumonia

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12
Q

how often is cranial nerve involvement in pts with GBS and what CNs are involved?

A

around 50%. CN 7, the facial nerve

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13
Q

how often do ANS sxs occur in pt with GBS and what are some ANS sxs that occur?

A

around 50%.
Orthostatic hypotension
cardiac dysrhythmias
BP fluctuations
ileus (lack of muscle contractions of intenstines)

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14
Q

how would you educate a GBS pt if they asked whether they will be able to ambulate again or not?

A

I’d say it is highly likely, depending on their prognostic factors. 80% of GBS pts ambulate 6 months after onset.

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15
Q

what is the most common residual affect from GBS?

A

weak anterior tibialis

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16
Q

what percentage of GBS pts die?

A

5-10%

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17
Q

what are some factors associated with increased risk of mortality? (GBS)

A

severe weakness
bulbar dysfunction
ANS sxs
rapid onset
Age >60 y/o
Need for ventilation
Pulmonary infections

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18
Q

what is the sensation changes associated with GBS?

A

pain, hyperesthias

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19
Q

what can be done during a GBS pts recovery that will increase their chances of having recurring episodes of temporary loss of fx?

A

strenuous exercise and fatigue

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20
Q

what exercises are recommended during the nadir and plateau stages?

A

AAROM and AROM

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21
Q

describe MS in one sentence

A

It is an autoimmune disease that causes demyelination in the brain and SC

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22
Q

what age range is associated with MS?

A

20-50

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23
Q

in one sentence, what is a major difference between MS and GBS?

A

MS is UMN disorder and GBS is LMN

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24
Q

what gender, ethnicity, and regions are associated with increased risk of MS?

A

women
caucasian
colder countries/areas

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25
Q

Does GBS, MS, or ALS have an increased risk if a family member has a hx?

A

MS and ALS

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26
Q

explain the signifigance of oligodendrocytes and astrocytes in MS

A

oligodendrocytes get attacked and can remyelinate but eventually die off. These dead areas are filled with astrocytes and become hardened/plaques

27
Q

explain what the area of predilection is for MS

A

it is when MS prefers specific areas. It prefers optic nerve, white matter, and the cerebellar peducles

28
Q

what areas in the spinal cord does MS prefer?

A

corticospinal tract and posterior column

29
Q

Proteins found in CSF…explain how this is different between MS and GBS

A

They both protein in their CSF but there will be IgG present in MS but not in GBS

30
Q

in order for a MS dx what criteria is required?

A

other dx to be r/o and one of the following…
an MRI showing lesions in 2 different areas OR any new lesion seen on an MRI after the original scan

31
Q

what are the 4 major subtypes of MS?

A

clinically isolated syndrome
relapsing remitting MS
primary-progressive MS
secondary-progressive MS

32
Q

what if the subtype of MS, clinically isolated syndrome is active?

A

it will become relapsing-remitting MS

33
Q

what is the most common subtype of MS?

A

relapsing remitting

34
Q

explain the difference between remission and relapse

A

relapse: brief episodes where sxs worsen then get better
remission: when the disease doesn’t progress and the pt has a complete or almost complete return to normal fx

35
Q

explain the disease course of pts with primary-progressive MS

A

they progressively worsen without relapsing or remitting.

36
Q

explain the disease course associated with secondary progressive MS

A

it begins as relapsing remitting MS but then the pt gets to a point where they stop really having relapses or remissions and they just progressively get worse.

37
Q

explain what an exacerbation is and what qualifies as an exacerbation

A

an exacerbation has to last >24 hours. It is when new or recurrent sxs last >24 hrs and they aren’t related to any other disease or injury

38
Q

what can cause exacerbations?

A

infections, diseases of organs, stress

39
Q

what is pseudo exacerbation?

A

an exacerbation but less than 24 hours

40
Q

explain what Uthoff’s symptom is

A

an adverse reaction to heat that is immediate and dramatic impact on fx.

41
Q

what are some things you would educate a pt about if the suffer from Uthoff’s symptom?

A

avoid enviroments or activities that increase body temp. If you feel these sxs come on then try to cool of and the sxs should resolve.

42
Q

what is Lhemitte’s sign?

A

when you cervical flex it causes a sharp pain

43
Q

What occurs with Relative afferent pupillary defect (RAPD)?

A

shine a light into one eye and they both dilate

44
Q

what 5 vision changes can be present in MS pts?

A

diplopia, RAPD/Marcus Gunn, scotoma, nystagmus, optic neuritis

45
Q

what type of nystagmus would a pt with MS have?

A

vertical nystagmus

46
Q

what are some sensory changes in pts with MS?

A

parasthesia and numbness
pain: headaches, Lhemitte’s sign, hyperpathia
Tic douloureux

47
Q

what tests can be used to test for cerebellar lesions?

A

heel to shin test
dysdiadokinesia
finger to nose
gait

48
Q

explain the relationship between MS and spasticity

A

75% of MS pts have it. Greater in LE. Fluctuates daily

49
Q

what time of day should we schedule pts with MS, why?

A

In the morning, their fatigue worsens throughout the day

50
Q

What factors can increase an MS pts fatigue? (6)

A

depression
spasticity
some medication
exertion
heat
decreased sleep

51
Q

what are 4 possible sxs of MS if the cerebellum is involved?

A

ataxia
postural tremor
intention tremor
vestibular dysfunction

52
Q

what impairments might a pt with MS have that lead to gait ataxia?

A

dysmetria
dyssynergia
dysdiadochokinesia

53
Q

spasticity in what muscle may cause scissoring when walking?

A

abductors

54
Q

how often does sxs of speech and swallowing affect MS pts? What are some sxs that they may experience?

A

40%
Dysarthria
Dysphonia
Dysphagia

55
Q

how often do patients with MS experience cognitive impairments?

A

50% of MS pts

56
Q

what are 4 predictors of better prognosis in MS pts?

A

onset w/ only 1 sx
Benign and RRMS
<40 y/o
Few overall lesions on brain scan

57
Q

what affect can medications have on the relapses associated with MS?

A

can decrease relapse rate by 30% and reduce severity

58
Q

what are 2 preventative and restorative interventions for MS during the early stages?

A

exercise and community classes

59
Q

what are 2 preventative and restorative interventions for MS during the middle stages?

A

exercise and community classes

60
Q

what are the parameters for aerobic conditioning in patients with MS? frequency, intensity, length

A

3-5 days a week, alternate days
60-85% HRmax
30 minutes a day or 3 10-minute sessions

61
Q

what are some compensation ideas for gait ataxia?

A

light weights, weighted boots/jacket, weighted canes/walker/utensils

62
Q

what is the scoring for the fatigue scale for motor and cognitive functions?

A

<43 mild
<53 moderate
<63 severe

63
Q

explain the scoring for the 12-item MS walking scale?

A

it is 0-100 and the higher score indicates more disability

64
Q

explain the scoring for the MSQOL-54

A

it is 0-100 and the higher the score the higher the QOL

Neuro (3 decks)

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