lecture 4: guillain barre syndrome and CNS tumors Flashcards
what is another name for guillain barre syndrome
Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP)
guillain barre syndrome is an immune mediated ____ that affects ____ ___ and ____ nerves , leading to ____ neuropathy and flaccid paralysis with possible sensory and ANS effects
polyneuropathy
nerve roots
peripheral
motor
guillain barre syndrome usually follows an ____
infection
what kind of onset is guillain barre syndrome
rapid
is Guillain-Barré Syndrome/ a UMN or LMN disorder
lower
schwann cells make up the myelin
what age and sex does Guillain-Barré Syndrome/ usually affect
males
any ages but usually > 50
what is usually the first symptoms of someone with Guillain-Barré Syndrome/
weakness and tingling/loss of sensation in the hands and feet , ascending the limbs
how are the motor symptoms in Guillain-Barré Syndrome/
goes distal to proximal (ascending paralysis)
rapid and progressive
relative symmetrical motor involvement
how is the sensory loss in Guillain-Barré Syndrome/
glove adn stocking
how are the relaxes in Guillain-Barré Syndrome/
decreased
what cranial nerve involvement is in Guillain-Barré Syndrome/
CN 7,9, 10 , 11 , 12
what is present in up to 50% if pts with Guillain-Barré Syndrome/
dysautonomia
1/3 patients required assisted ___ due to paralysis and weakness in diaphragm, intercostals , accessory inspiratory musculature
ventilation
is the single breath count test is < ___ then they might require mechanical ventilation for Guillain-Barré Syndrome/
19
what Guillain-Barré Syndrome disability scale is used as a outcome measure what score is it if that patient is
confined to bed or chair
requiring assisted ventilation
dead
4,5,6
when is the acute stage of GBS
1-10 days
when is the peak of motor sysmtoms for GBS
2-8 weeks post onset
when is the plateau periods for GBS
2-8 weeks
when can improvement begin for GBS
2-3 months post onset
what does it mean when most patients have a fulminating course of GBS
disease develops rapidly and severely
when is max paralysis for GBS
1-2 days of onset
most GBS patients will reach their peak at how many weeks
3 weeks
what factor of GBS are associated with poor prognosis
Severity of muscle weakness (especially tetraplegia)
• If respiratory support required
• Cranial nerve involvement associated with loss of eye movement, swallowing
• Rapid rate of progression from onset
• Length of time to nadir
• Older age at onset
• History of GI illness
• Recent cytomegalovirus
what kind of deficit do GBS patients have and what is the primary movement dysfucntion
force production and weakness
during the ascending phase of GBS is PT invovled
maybe or maybe not
education is important durign this stage and gentle PROM , AAROM and AROM
what kind of ROM is being done during the plateau stage of GBS
AAROM and AROM
when do u Encourage multi-joint and cross-plane work without forgetting need for
single joint and/or gravity minimized positions for GBS patients
during the plateau stage
what considerations should u have during the descending phase of GBS
• Eccentric contractions
• Fast-twitch fibers
• Pain
• Fatigue
• Vitals
when should u avoid exercise for GBS patients
in acute and progressive stages , limited to ROM (AROM or AAROM)
when can u do Limited repetition low resistance activities can be commenced once strength
begins to return
after plateau
when should u avoid eccentric contr4actions from GBS
if less then or equal to 3/5 strength
what are the two distinct groups that CNS tumors are presents in
childeren 0-14 and adults 40-70
white , male
what is teh difference between primary and secondary tumor presentation
primary: originate in the CNS
secondary: metastatic tumors that spring to the CNS from systemic cancer sits out of the brain
what is the Most common cause of cancer death in children and adolescent 0-19 years
primary CNS tumors
how does secondary tumors usually spread
through arterial circulation
what determines the impairment the patient with a tumor will have
location
what is the most common type of non malignant brain tumor
meningioma
what is the most common type of malignant brain tumor
glioblastoma
what sign and symptoms is present in 50% of patients with CNS tumor
headache
what are the signs and symptoms of a CNS tumor
headache
seizures
altered mental status
papilledema
what are focal neurological signs of CNS tumor
weakness,
numbness, loss of coordination, vision
problems, speech difficulties, seizures,
altered mental state (memory loss, confusion,
change in personality)
what is the frontal and parietal lobe responsible for
frontal: personality , movement , sense of smell
parietal lobe: identification of objects , sense of pain and touch , spatial position
what is the temporal and occipital lobe responsible for
temp: mem, speech, musical rhythm
occ: vision
what does the pons and medulla control
pons: eye and face movement
medulla: heart and lungs
when is a headache a red flag
- interrupts sleep or is worse on waking and improves thru the day
- elicited by postural changes, coughing , or exercise
- recent onset is more severe
-new onset of headaches in older poeple
- associated with nausea, commit , papilledema or focal neurological sings
has exercise been found to provide positive benefits to cancer survivors
yes
