Inflammatory/Infectious conditions of the NS and cerebellar lesions Flashcards
What is Lyme Disease, what does it develop from?
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
What are the 3 stages of Lyme disease
- 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
Lyme disease Rx
Antibiotics
PT:
- Relieve pain
- increase strength in deconditioned patients for home exercises
- FITT without exacerbating symptoms
What is guillain-barre syndrome
Antibody mediated demyelination of schwann cells in PNS from spinal nerves to terminating fibers
Guillain-Barre causes
- immune disorder
- 2/3 had recent illness in last 30 days (flu vaccine)
Guillain Barre S&S
- 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
Guillain Barre Rx
Sometimes in hospital for 6-8mths
MEDICAL: Plasmaphoresis, immunoglobin
PT:
- joint protection
- chest treatment, mobilization
- strength
- ROM (usually opposite to ALS progression)
What is meningitis?
Infectious disease (bacterial or viral) that causes inflammation in the meninges of the brain and spinal cord
What is the result of the BBB breaking down in someone with meningitis
release infection into blood stream- Immune response leads to edema in the brain and subsequent increase in intracranial pressure
Meningitis can lead to..
Thrombosis, infarction, scars, edema
Who is meningitis commonly seen in
- under developed countries, dorms (living in close proximity with poor hygiene)
- vulnerable populations including infants, elderly, and immunocompromised
Meningitis Types
- 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
Meningitis S&S
- 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*
What is Brudzinski’s sign
involuntary flexion of hips and knees when neck is passively flexed
Sign in meningitis
What is Kernig’s sign
Painful knee extension from position of hip and knee flexion
Sign in meningitis
What are the different possible severities in Meningitis
- acute (hrs-days)
- sub-acute (2wks plus)
- chronic (1mo+)
What is Encephalitis?
What areas tend to be effected?
infection (1° or 2°) of the brain + spinal cord or brain parenchyma (nervous tissue in brain)
Frontal and temporal lobes
Encephalitis S&S
o Headache, seizure, LOC, coma (may last for weeks) o nausea, vomiting o agitation o meningeal irritation o stiffness
What may be a long term effect of encephalitis
Diffuse softening, edema, can lead to necrosis, hemorrhagic necrosis, scarring
Meningitis + encephalitis mangament
Investigate ASAP: EEG, CSF tap, MRI
Rx:
- Bacterial: IV antibiotics and corticosteroids
- Viral: Control symptoms with rest and fluids
What is Creutzfeldt Jakob disease
- Movement disorder/dementia - rapidly progressive + fatal
Creutzfeldt Jakob disease population?
Young adults
Creutzfeldt Jakob disease pathology
- caused by prions (misfolding proteins) bovine spongiform encephalopathy (mad cow disease)
- contracted by ingestion or via the nose
- incubates 5-8yrs
What is challenging about diagnosing Creutzfeldt Jakob disease
Cannot diagnose until death
What occurs in Post-Polio syndrome
Initial effect
Longer duration effect
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
3 types of cerebellum lesion
- archicerebellum lesion
- Paleocerebellum lesion
- Neocerebellum lesion
What system is effected in archicerebellum lesions?
What is the presentation of this lesion
Central vestibular system (vestibular control of head and body position)
Gait and trunk ataxis (incoordination of movement) - will fall towards side of lesion
What is the presentation of someone with a paleocerebellum lesion
Hypotonia, trunk ataxia, ataxic gait - will lose core activity, jerky movements
What is the presentation of someone with a Neocerebellum lesion
- 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
Tests for cerebellar lesions
- Coordination tests
- Romber sign
- Falling to side of lesion
What is a romberg sign indicate
o to rule out sensory loss as cause of imbalance
o if similar imbalance eyes open and closed likely cerebellar in origin
Why do people with cerebellar lesions fall to side of lesion
Cerebellum is ipsilateral
Cerebella lesions S&S
- 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
