Misc Neurologic behaviors Flashcards by Melissa Ring

What is Tourettes

Repetitive stereotyped, involuntary movements and vocalizations

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What is a simple tic in Tourettes

Sudden, brief, repetitive movement involving limited muscle groups

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What is a complex tic in Tourettes

Distinct, coordinated patterns of movement involving several muscle groups and may appear purposeful

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Which type of tic are you concerned for self harm

complex

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What is echolalia

Repeating others words

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What is coprolalia

Inappropriate swearing

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What is a premonitory urge in Tourettes

Urge/sensation in muscle prior to onset of tic…could make tic more complex than it is

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Which gender and age group are most commonly diagnosed with Tourettes

Boys
pediatrics.. around age 6

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What type of inherited disease is Tourettes

autosomal dominant

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At what age do tics increase in frequency and severity

8-12y/o

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When will improvement in tics be seen

adolescents.. could be tic free

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Can tics change over time

yes

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What are the three main tic disorders

tourettes
persistent
provisional

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What type of tics do Tourettes patients have and roughly how long will they last

both motor and vocal tics
present for at least a year

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What type of tics do persistent tic disorder patients present with and how long do they last

motor OR vocal
Present for at least 1 year

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What type of tics do provisional tic patients have and for how long

motor or vocal or both
Present for LESS than a year

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What are the dx requirements for Tourettes

2+ motor tics
1+ vocal tic
Tics present for at least a year
Onset prior to 18y/o
Sx are not a result of medications

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What else are Tourettes patients often diagnosed with

at least 1 mental health, behavioral, or developmental disorder
-OCD
-ADHD

Asthma

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What is the focus for treatment of Tourettes

tic suppression

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What are common drugs used to treat Tourettes (only approved drugs)

Neuroleptics
-haloperidole
-pimozide
-aripiprazole

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Which type of treatment will be utilized before medications

Therapy
-biofeedback (for 2nd emotional problems)
-habit reversal
-CBT

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What is another name for ALS

Lou Gehrig’s disease

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What is ALS

Neurological disease affecting control of voluntary muscle movement

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What pattern does ALS effect your body

Starts distally and works centrally until you are no longer able to breathe or speak

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At what age is ALS most common

55-75y/o (most common in men)

Which type of patients are at a higher risk of developing ALS

Military vets

How long from onset of symptoms will patients die and what do they die from

3-5yrs from onset respiratory failure

What is the most common type of ALS

Sporadic

What are some known factors with ALS development

poor protein recycling changes in RNA

If you develop familial ALS, how many genes need to be mutated

more than 12 -autosomal dominant -dementia will be in the family

What are some common signs/symptoms of ALS

Fasiculation in arm, leg,shoulder, tongue Muscle cramps spasticity difficulty chewing/swallowing painless, progressive muscle weakness

What is limb onset of ALS

Sxs in arms or legs (younger patients)

What is bulbar onset of ALS

Sxs onset with speech/ swallowing concerns or changes (older patients)

What in a physical exam strongly suggests ALS

Presence of upper and lower motor neuron involvement

What two diseases need to be ruled out before diagnosing someone with ALS

Polio MS

What medications can be used to try to control the symptoms of ALS

Riluzole Edaravone

What non-medicine treatments can help control the symptoms of ALS

PT OT Speech therapy Nutritional support

What is multiple sclerosis

Auto immune process directed at the CNS

What occurs in the body with MS

Inflammation damages myelin and myelin producing cells damaged areas scar

What type of immunologic response is MS

T-cell mediated -T-regulatory cells fail to shut off -Cytotoxic T cells target the myelin and myelin producing cells

What else do t-cells activate in the body

B-cells -produce antibodies and proteins causing more CNS damage

What are some infection factors that occur with MS

Measles Canine distemper EBV HSV-6 Chlamydia pneumonia

What is the geographical gradient with MS

The further from the equator, the more likely you are to get MS

What are some disproven theories for MS causation

Environmental allergies Household pets Heavy metals Aspartame

Is MS hereditary

What are the common symptoms of MS

Fatigue Paresthesia vision problems bladder problems cognitive changes

What are some less common symptoms for MS

Speech problems swallowing problems tremor seizure breathing problem hearing loss

What is the most common form of MS

Relapsing-remitting MS

What are the types of MS

Clinically isolated syndrome Relapsing remitting MS Secondary progressive MS Primary progressive MS

What is often a first sign of MS

Spontaneous retinal detachment (see lighting bolts)

What generally causes the first episode of symptoms in CNS with MS

Inflammation/demyelination of CNS -Symptoms must last >24hours -brain lesions need to be seen on MRI

Which type of treatments can delay MS

DMARDs

What symptoms describe RRMS

Relapse-clearly defines attacks of new and increasing neuro sxs Remission periods of partial/complete recovery No apparent progression during remission

What characteristics are seen with SPMS

Eventual transition from initial RRMS Unique to each patient

What characteristics are seen with PPMS

Worsening accumulation of disability from onset of sxs without early relapse or remission

What is the diagnostic criteria for MS

Evidence of damage in 2+ areas of CNS Evidence damage occurred at different points in time Brain MRI and Spinal MRI CSF- +oligoclonal bands may sub for DIT Rule out differentials

What type of drugs are used for treatment of MS

immunosuppressants

What is the most common cause of death in patients with MS

Secondary complications, not the MS itself

What is normal pressure hydrocephalus

Too much CSF in ventricles

What may cause normal pressure hydrocephalus

head injury stroke/cerebral bleed Meningitis brain tumor/surgery

Who generally gets NPH

adults >60y/o

The brain areas that are affected by NPH generally effect which areas of the body

legs (gait similar to parkinsons) Bladder (incontinence) Cognitive process (sxs like dementia)

What walking symptoms will a patient with NPH

Feeling of getting stuck or freezing trouble initiating first step

If a patient comes in with complaints of urinary incontinence, walking difficulty, and dementia, what should you be concerned for

NPH

What may and LP be helpful with, in NPH

May demonstrate the benefit of a surgical shunt

What type of surgical treatments can be preformed with NPH

Shunt placed to drain excessive CSF

is a patient comes in with complaints of feeling weak that worsens with activity and improves with periods of rest, what is this a hallmark sign for

myasthenia Gravis

What is Myasthenia gravis

Chronic autoimmune dx causing weakness in skeletal muscles

When will myasthenia gravis generally present in women

Before 40

When will myasthenia gravis generally present in men

greater than 60

What cause myasthenia gravis

Interruption at the NMJ -block/alter/destroy ACh Thymus -remains large = more T-cell production

What is lymphoid hyperplasia

Large thymus

Which muscles are most frequently effected with myasthenia gravis

Eye/eyelid movement (noticed first) facial expression swallowing dysphagia/ slurred speech

What is ptosis

drooping of eyelid

What is dysarthria

impaired speech

What are the symptoms of myasthenia gravis

ptosis diplopia dysphagia SOB Dysarthria

What is the most sensitive test for Myasthenia gravis

Single fiber EMG

What test may be helpful to diagnose myasthenia gravis

Edrophonium test (for ocular muscle weakness) Blood work (anti-MuSK antibodies) Single fiber EMG Imaging for thymus PFT

What are some treatments for Myasthenia gravis

Thymectomy (cure for some patients) Anti-cholinesterase med: pyridostigmine Immunosuppressive agents Plasmapheresis IVIG

What is myasthenia crisis

Respiratory muscles are so weak they require ventilator support

How do you treat myasthenia crisis

IVIG Plasmapheresis

What may trigger a myasthenia crisis

infection stress surgery adverse drug reactions