Motor Deficit conditions Flashcards
What is multiple sclerosis
Multiple sclerosis (MS) is a chronic and progressive autoimmune condition - destroys myelin sheath causing patchy demyelination in the central nervous system.
Initial Sx of multiple sclerosis
Tingling
Parasthesias
Numbness
OPtic neuritis - pain in one eye worse with movement - acute vision loss follows pain
Acute focal motor weakness - foot drop
Balance difficulties
Later symptoms of multiple sclerosis
Tingling
Parasthesias
Numbness
Worsening chronic focal motor weakness
Balance difficulties
Urinary urgency, frequency and incontinence
Constipation
Sexual dysfunction
Cognitive loss
Debilitating fatigue
MRI findings for MS
Focal demyelination of white matter (causes bright white patch) in more than one region of the brain
How to diagnose MS
Neuro exam
History
MRI
CSF
Types of MS
Relapsing - remitting (pt return to normal between attacks)
Secondary progressice - relapsing remitting but steadily progressive
Primary progressive - progressive from onset
Transverse meylitis - demyelinating lesions of spinal cord
Chronic treatment for MS (medical and supportive)
First-line injectables such as beta-interferon and glatiramer
New oral agents such as dimethyl fumarate, teriflunomide and fingolimod
Biologics such as natalizumab and alemtuzumab
Medications for symptoms e.g. urinary incontinence (anticholinergics) , depression (SSRIs) , sexual dysfunction (sidenafil)
Physical/occupational therapy
Acute treatment of multiple sclerosis
Glucocorticods - IV methylprednisolone
What is guillain barre syndrome?
ACUTE inflammatory demyelinating polyneuropathy characterised by a RAPID PROGRESSIVE, ascending SYMMETRIC weakness, often preceded by INFECTION
causes bilateral and symmetric limb weakness
Key signs of guillain barre syndrome
acute, rapidly progressive and symmetric weakness in both arms and legs
areflexia
bilateral facial muscle involvement
elevated CSF protein - not needed tho
Treatment for guillain barre syndrome
Emergency - admit to hospital
IV immunoglobulins or plasmapheresis
Cardiac monitory
Pain control - gabapentin or opiates
Physical therapy
Name chronic inflammatory demyelinating polyneuropathy conditions
Myaesthenia Gravis
Bells Palsy
Motor Neurone disease
Amytrophic lateral sclerosis
Name acute inflammatory demyelinating neuropathy
Guillan Barre
Multiple sclerosis
Difference between acute inflammatory demyelinating neuropathy and chronic inflammatory demyelinating neuropathy
Chronic
- more insidious and over longer time (months instead of days/weeks)
- doesn’t cause cardiac or resp failure
- same treatment but also requires long term immunosupression
What does Motor neurone disease affect
Peripheral and central motor nerves = upper and low motor neurone signs
Voluntary muscles affected = speaking, walking, breathing and swallowing affected
What is amyotrophic lateral sclerosis
Progressice neurodegenerative disease
- attacks both upper and low motor neurones leading to muscle weakness and atrophy
Upper motor neurone signs
vs lower motor neurone signs
UMN
- Weakness
- No atrophy or fasiculations
- Reflexes and tone increased
LMN
- Weakness
- atrophy and fasiculations
- reduced reflexes and tone
Amyotrophic lateral sclerosis symptoms
Weakness in arms/legs
Weakness in facial muscles - trouble speaking, swallowing, chewing, coughing, drooling
Fasciculationg/twitching
Stiffness
Weight loss - muscle atrophy
Worsening fatigue
Hyper reflexia
NO PAIN!!!!
No sensory symptoms
No loss of bowel or bladder control
No difficulties with ocular movements!
Treatment of amytrophic lateral sclerosis
Riluzole
Symptomatic treatment
Poor prognosis - die due to resp failure from weak diaphragm
What is myasthenia gravis
autoimmune condition affecting the neuromuscular junction (due to antibodies produced against nicotinic acetylcholine receptors)
It causes muscle weakness that progressively worsens with activity and improves with rest.
Sx of myasthenia gravis
Muscle fatigue with repetition of movements
Facial weakness (due to above)
Weakness in proximal ar muscles
Ptosis
Diplopia (also due to eye movements)
Myasthenia gravis diagnosis
Serologic testing for acetyl choline receptor antibodies
Repetitive stimulation EMG
Myasthenia gravis treatment
Mestinon (acetylcholineesterase inhibitor)
Immunosuppression (azothiprine, methotrexate)
Prednisolone
Plasmaphresis or Intravenous immunoglobulin in severe cases
What is Bell’s Palsy
damage to CN VII (facial nerve)
- may be caused by lyme disease of herpes simplex or EBV
Bell’s palsy symptoms
Facial muscle weakness over day - weeks (chronic compared to stroke)
Forehead not spared (unlike stroke)
No symptoms in arms and legs (unlike stroke)
Dry eyes / mouth
Hyperacusis - intolerance to loud sounds
Ear pain
Bell’s Palsy treatment
Steroids and aciclovir
Symptomatic treatment - eye patch/tape with artificial tears (ocular lubricants) and pain control (gabapentin)
Inflammatory myopathies / mysoitis
Autoimmune diseases that attack muscles and cause weakness
- polymyositis
- dermatomysositis
- polymyalgia rheumatica
- metabolic myopathies
Treatment of inflammtory myopathies / myositis
Immunosupression
steroids
