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neurology > MS/huntington/tourette > Flashcards

MS/huntington/tourette Flashcards

1
Q

Double vision, nystagmus, blindness, blurry vision

A

MS

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2
Q 
Focal weakness
Gait difficulties – Ataxia
Fatigue and weakness
Numbness or tingling
Dizziness and Vertigo
Pain
Emotional Changes
Bladder dysfunction
Tremor
Headache
Seizures
A

MS

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3
Q

Lumbar puncture in MS

A

Lumbar puncture – may show evidence of chronic inflammation in the CNS including mild protein elevation, mild increase in leukocytes

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4
Q

MRI? in MS

A

MRI with gadolinium shows areas of demyelination

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5
Q

Evoked Potential Tests

A

Evoked Potential Tests – measure electrical signals sent by the brain in response to stimuli. It can be visual stimuli or electrical stimuli. Lesions and nerve damage to the optic nerves, brainstem or spinal cord can be detected.

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6
Q

To Treat MS attacks (3)

A 
Corticosteroids high dose (oral prednisone)
intravenous methylprednisolone (Solu-Medrol)
Plasmapheresis has been shown to be beneficial
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7
Q 
Beta interferons
Glatiramer acetate (Copaxone)
Fingolimod (Gilenya)
Natalizumab (Tysabri)
Mitoxantrone
Teriflunomide (Aubagio)
A

To Slow progress of MS

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8
Q

To Treat Symptoms

  • physical tx
  • an oral medication may improve walking speed
A

Physical therapy – will involve stretching and strengthening exercises and the use of devices that can make it easier to perform daily tasks.
Dalfampridine (Ampyra) an oral medication may improve walking speed

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9
Q

___ and ___ help with spasticity

___ helps with fatigue

A

Baclofen and Tizanidine (Zanaflex) help with spasticity

Amantadine helps with fatigue

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10
Q

what can be a precipitant of MS

A

viral infection

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11
Q

MS ages

A

18-45

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12
Q

sensory complaints in limbs followed by vision loss

A

MS

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13
Q

elevated immunoglobulin G index, oligoclonal bands, increased myelin basic protein

A

MS

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14
Q

optic neuritis tx

A

high dose IV corticosteroids

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15
Q

cyclophosamide or azathtioprine

A

immunosuppressive agent that may arrest course of secondary progressive form MS

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16
Q

Huntington’s disease

  • inherited?
  • chromosome?
  • offspring
  • age of symptoms
  • progressive?
A

Autosomal dominant inheritance pattern
Offspring have a 50% chance of inheriting the gene for Huntington’s found on chromosome 4
Symptoms typically do not appear until age 30
This is a progressive neurodegenerative disease

17
Q

progressive chorea and dementia

-mortality

A

Huntington’s disease

fatal within 15-20 years

18
Q

Huntington’s disease early mental changes

A

behavioral, irritability, moodiness, antisocial behavior that progress to an obvious dementia

19
Q

Huntington’s disease early physical signs

A

restlessness or fidgetiness but eventually severe choreiform movements and dystonic posturing occur

20
Q 
Fidgetiness
Restlessness
Chorea – jerky random uncontrolled movements
Rigidity
Writhing
Abnormal posturing
Difficulty swallowing
Difficulty speaking
A

Huntington’s disease

21
Q

Brain CT with Huntingtons

A

Brain CT may show cerebral atrophy and atrophy of the caudate nucleus

22
Q

MRI and PET scans with Huntingtons

A

shown decreased glucose metabolism in an anatomically normal caudate nucleus

23
Q

huntingtons tx

A

There is no cure and the disease is progressive. Life expectancy is typically 20 years following onset of symptoms.
Supportive care
Counseling
Speech therapy
Occupational therapy etc
Treatment for chorea
Typical and atypical neuroleptics -olanzapine, risperidone, haloperidol
Dopamine depleting agents – tetrabenazine

24
Q

Treatment for chorea

A

Typical and atypical neuroleptics -olanzapine, risperidone, haloperidol
Dopamine depleting agents – tetrabenazine

25
Q

Symptoms for Huntington’s disease typically begin after what age?

A

30

26
Q

A patient presents complaining of a tremor in his right hand that seems to go away after two beers. What is the likely diagnosis?

A

Essential Tremor

27
Q

how to control dyskinesia

-how to control behavioral disturbances

A

phenothiazines

haldol and clozapine

28
Q 
Tourette disorder
describe tics
age
Genetics 
gender
A 
Motor and vocal tics – sudden brief intermittent movements/ end at age 21
Coprolalia – involuntary swearing
Occurs between 2 and 15 years old
Causes
Genetics – Likely an inherited disorder
Brain abnormalities
boys
29
Q

tourettes- To rule out other conditions and secondary causes: 5

A

To rule out other conditions and secondary causes:
EEG – if tics and seizure activity exists
MRI – to rule out brain abnormalities
TSH levels – to rule out hypothyroidism, that cause tics
Urine drug screen
Serum Copper – to rule out Wilson’s disease

30
Q

tourettes tx

A

Treatment
Deep brain stimulation
Behavioral therapy
Habit reversal
Exposure and response prevention
Medication once behavior is interfering with social interactions or activities of daily living
Dopamine antagonists – fluphenazine, or pimozide
Haloperidol is historically the drug of choice

31
Q

tourettes meds

A

Dopamine antagonists – fluphenazine, or pimozide

Haloperidol is historically the drug of choice

32
Q

drug of choice for tourettes

A

haldol

33
Q

for diagnosis of tourettes…

A

tics must occur several times per day nearly everyday for at least 1 yr and vary in number, frequency, and nature

34
Q

ADHD, OCD, learning problems, behavior disordes

A

comorbidities with tourette

35
Q
  • motor tics occur in what% of pts with tourettes

- coprolalia

A

80

40

36
Q

tourettes CT and MRI

A

nml

37
Q

what can minimize SE of haldol long term use

A

clonazepam or clonidine

38
Q

What is the age range for the onset of Tourette syndrome?

A

2-15 years old

neurology (9 decks)

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