Misc Neurologic behaviors Flashcards
What is Tourettes
Repetitive stereotyped, involuntary movements and vocalizations
What is a simple tic in Tourettes
Sudden, brief, repetitive movement involving limited muscle groups
What is a complex tic in Tourettes
Distinct, coordinated patterns of movement involving several muscle groups and may appear purposeful
Which type of tic are you concerned for self harm
complex
What is echolalia
Repeating others words
What is coprolalia
Inappropriate swearing
What is a premonitory urge in Tourettes
Urge/sensation in muscle prior to onset of tic…could make tic more complex than it is
Which gender and age group are most commonly diagnosed with Tourettes
Boys
pediatrics.. around age 6
What type of inherited disease is Tourettes
autosomal dominant
At what age do tics increase in frequency and severity
8-12y/o
When will improvement in tics be seen
adolescents.. could be tic free
Can tics change over time
yes
What are the three main tic disorders
tourettes
persistent
provisional
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
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
What type of tics do provisional tic patients have and for how long
motor or vocal or both
Present for LESS than a year
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
What else are Tourettes patients often diagnosed with
at least 1 mental health, behavioral, or developmental disorder
-OCD
-ADHD
Asthma
What is the focus for treatment of Tourettes
tic suppression
What are common drugs used to treat Tourettes (only approved drugs)
Neuroleptics
-haloperidole
-pimozide
-aripiprazole
Which type of treatment will be utilized before medications
Therapy
-biofeedback (for 2nd emotional problems)
-habit reversal
-CBT
What is another name for ALS
Lou Gehrig’s disease
What is ALS
Neurological disease affecting control of voluntary muscle movement
What pattern does ALS effect your body
Starts distally and works centrally until you are no longer able to breathe or speak
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
no
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
