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PCE - Neurology > Inflammatory/Infectious conditions of the NS and cerebellar lesions > Flashcards

Inflammatory/Infectious conditions of the NS and cerebellar lesions Flashcards

1
Q

What is Lyme Disease, what does it develop from?

A

An infectious condition of the nervous system that mimics other diseases like MS, fibromyalgia, chronic fatigue syndrome, Guillain barre

Comes from a bacterium, Borrelia burgdorferi, through ticks

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2
Q

What are the 3 stages of Lyme disease

A
  • localized presentation: erythema, flu-like
  • Systemic: neuro (headache and neck stiffness) MSK and cardiac (tachy, brady, arrhythmia, myocarditis)
  • final stage: long term neuro + arthritis (1/3) + cognitive deficits
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3
Q

Lyme disease Rx

A

Antibiotics

PT:

  • Relieve pain
  • increase strength in deconditioned patients for home exercises
  • FITT without exacerbating symptoms
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4
Q

What is guillain-barre syndrome

A

Antibody mediated demyelination of schwann cells in PNS from spinal nerves to terminating fibers

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5
Q

Guillain-Barre causes

A
  • immune disorder

- 2/3 had recent illness in last 30 days (flu vaccine)

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6
Q

Guillain Barre S&S

A
  • onset to peak 4 weeks
  • rapid ascending motor weakness and distal sensory loss
    - spreads to arms, trunk, and face
  • stocking and glove pattern of loss*
  • absent DTR
  • may require mechanical ventilation
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7
Q

Guillain Barre Rx

A

Sometimes in hospital for 6-8mths

MEDICAL: Plasmaphoresis, immunoglobin

PT:

  • joint protection
  • chest treatment, mobilization
  • strength
  • ROM (usually opposite to ALS progression)
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8
Q

What is meningitis?

A

Infectious disease (bacterial or viral) that causes inflammation in the meninges of the brain and spinal cord

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9
Q

What is the result of the BBB breaking down in someone with meningitis

A

release infection into blood stream- Immune response leads to edema in the brain and subsequent increase in intracranial pressure

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10
Q

Meningitis can lead to..

A

Thrombosis, infarction, scars, edema

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11
Q

Who is meningitis commonly seen in

A
  • under developed countries, dorms (living in close proximity with poor hygiene)
  • vulnerable populations including infants, elderly, and immunocompromised
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12
Q

Meningitis Types

A
  • aseptic: (fungus, virus, parasite, can also get with: herpes simplex 2, Epstein Barr, lupus)
  • tuberculosis: abscess or edema
  • bacterial: in child or infant is considered a medical emergency
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13
Q

Meningitis S&S

A
  • Brudzinski’s sign: involuntary flexion of hips and knees when neck is passively flexed
  • Kernig’s sign: painful knee extension from position of hip and knee flexion
  • fever, headache, neck stiffness
  • vomiting, joint/muscle pain, drowsiness, confusion, seizure, cold hands and feet, rash
  • focal CNS signs (nerve palsies, deafness), * pain with neck, hip, or knee flexion*
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14
Q

What is Brudzinski’s sign

A

involuntary flexion of hips and knees when neck is passively flexed

Sign in meningitis

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15
Q

What is Kernig’s sign

A

Painful knee extension from position of hip and knee flexion

Sign in meningitis

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16
Q

What are the different possible severities in Meningitis

A
  • acute (hrs-days)
  • sub-acute (2wks plus)
  • chronic (1mo+)
17
Q

What is Encephalitis?

What areas tend to be effected?

A

infection (1° or 2°) of the brain + spinal cord or brain parenchyma (nervous tissue in brain)

Frontal and temporal lobes

18
Q

Encephalitis S&S

A 
o Headache, seizure, LOC, coma (may last for weeks)
o nausea, vomiting
o agitation
o meningeal irritation
o stiffness
19
Q

What may be a long term effect of encephalitis

A

Diffuse softening, edema, can lead to necrosis, hemorrhagic necrosis, scarring

20
Q

Meningitis + encephalitis mangament

A

Investigate ASAP: EEG, CSF tap, MRI

Rx:

  • Bacterial: IV antibiotics and corticosteroids
  • Viral: Control symptoms with rest and fluids
21
Q

What is Creutzfeldt Jakob disease

A
  • Movement disorder/dementia - rapidly progressive + fatal
22
Q

Creutzfeldt Jakob disease population?

A

Young adults

23
Q

Creutzfeldt Jakob disease pathology

A
  • caused by prions (misfolding proteins)  bovine spongiform encephalopathy (mad cow disease)
  • contracted by ingestion or via the nose
  • incubates 5-8yrs
24
Q

What is challenging about diagnosing Creutzfeldt Jakob disease

A

Cannot diagnose until death

25
Q

What occurs in Post-Polio syndrome

Initial effect

Longer duration effect

A

Disease attacks neurons in brainstem + anterior horn cells (spinal cord)

INITIAL EFFECT: death of those motor neurons controlling skeletal muscles
o Those that survive: sprout new nerve terminals to make up for loss
o RESULT: some movement recovery + enlarged motor units

Prolonged: high metabolic stress on larger motor units: more than neuron can handle
o RESULT: gradual deterioration of sprouted fibers & eventually neuron
- MUSCLE WEAKNESS + PARALYSIS

26
Q

3 types of cerebellum lesion

A
  • archicerebellum lesion
  • Paleocerebellum lesion
  • Neocerebellum lesion
27
Q

What system is effected in archicerebellum lesions?

What is the presentation of this lesion

A

Central vestibular system (vestibular control of head and body position)

Gait and trunk ataxis (incoordination of movement) - will fall towards side of lesion

28
Q

What is the presentation of someone with a paleocerebellum lesion

A

Hypotonia, trunk ataxia, ataxic gait - will lose core activity, jerky movements

29
Q

What is the presentation of someone with a Neocerebellum lesion

A
  • intention tremor, dysdiadochokinesia, dysmetria, dyssynergia
  • errors in timing - loss of fine coordination
  • additional impairments : asthenia (generalized weakness), hypotonia, motor learning impairments, cog deficits, emotional dysregulation
30
Q

Tests for cerebellar lesions

A
  • Coordination tests
  • Romber sign
  • Falling to side of lesion
31
Q

What is a romberg sign indicate

A

o to rule out sensory loss as cause of imbalance

o if similar imbalance eyes open and closed likely cerebellar in origin

32
Q

Why do people with cerebellar lesions fall to side of lesion

A

Cerebellum is ipsilateral

33
Q

Cerebella lesions S&S

A
  • lurching gait, falling to side of lesion, stiff legged
  • intention tremor, dysdiadochokinesia, nystagmus, dysmetria (overshooting target)
  • cerebellar ataxia, decomposition of movement, pendular knee jerk
  • others: hypotonia, falling, dysphonia or dysarthria

PCE - Neurology (8 decks)

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