neuro Flashcards
what is Parkinson’s disease?
due to a depletion of dopamine and its a progressive neuro disorder
What are the three main symptoms of Parkinson’s?
bradykinesia- slowing of pts movement- most debilitating- see it in shuffling of steps
rigidity- muscle becomes inflexible, stiff, and tight over time
resting tremor- a tremor that occurs even when the pt is at ease
essential tremors vs. parkinsons (resting) tremors
essential tremors- pts go to reach for an item and they tremor
parkinsons occurs at rest
essential can use beta blockers to control tremors
regular physical activity and alcohol- can make damage tremors
sexual activity and caffeine can make it worse
1st treatment of parkinsons
no cure
we try to slow progression
tackles motor symptoms such as tremor and rigidity
dopamine agonist- ropinerole- use it before carbidopa and levodopa or in conjunction
2nd treatment of parkinsons
levodopa/ carbidopa
tries to control bradykinesia
like to delay taking levo/carbo
eventually “wearing off phenomenon”- symptoms worsen before next dose of med
usually happens after 3-5 years of med
multiple sclerosis
disease process where demyelination in the CNS (brain and spinal cord)- very unpredictable
remissions and exacerbations of symptoms
multiple sclerosis symptoms
muscle weakness
balance concerns
bladder or bowel incontinence
immense fatigue
vision complaints
age of onset of multiple sclerosis
20-40 years
first sign of multiple sclerosis
blurry vision- leads to dx
once you have MS
going to put you at a higher risk of other conditions such as trigeminal neuralgia
managment in primary care
refer to rheumatology to handle treatment such as steroids and DMARDS (which will delay the prgressions)
so important to recognize the symptoms and refer them out to get the proper treatment
Absence seizures
commonly diagnosed in childhood
can last 20-30 seconds
may appear as if the child is daydreaming
could cause fluttering of eyelids
no recollection
Most will outgrow absence seizures
can be started on xerontin, valproic acid, lamictal
Diagnosis of seizures can be difficult
diagnoses with EEG but seizure has to be captured on EEFG- will try to capture seizure with sleep deprivation or flashing lights
managment in primary care
refer to rheumatology to handle treatment such as steroids and DMARDS (which will delay the progression)
so important to recognize the symptoms and refer them out to get the proper treatment
tonic-clonic seizures
tonic stiffening
clonic- jerking
pt loses LOC
be acutely aware of pts safety- often fall to floor can bite tongue
The biggest concern with seizures?
safety: get pt lying down, turn on side to prevent aspiration.
dont put anything in mouth
last 3 minutes
call 911 if > 5 minutes
common no recollection
treatent of seizures
lamictal
valproic acid
keppra
topamax
key is to work with neurology
Biggest key safety concerns and education points
- Multiple sclerosis characteristics Symptoms
*
Fatigue (95% of patients)
* Episodes of visual loss, diplopia, nystagmus, and optic neuritis
* Vertigo
* Walking/balance problems/Ataxic gait
* Weakness of the legs/Foot drop
* Paresthesias of extremities
* Bowel or urinary dysfunction
* Electric shock-like sensation runs down the back when bending neck forward
* Muscle spasms, stiffness/weakness
Multiple sclerosis characteristics Tests
- Tests
- Get a good H&P (key)
- For the dx to be made, 2 or more areas of the CNS must be involved at 2 different periods of time (Vision, speech, strength, coordination, balance, position)
- MRI of brain, spine may show lesions
- LP-eval for lymphocytes and IgG bands)
- McDonald criteria (H&P, lesions or lab tests, MRI)
Multiple sclerosis characteristics treatment
- Treatment
- 3 major goals: delay progression, manage symptoms, treat acute flares)
- Glucocorticoids are the mainstay of treatment for acute exacerbations
Can also use IV Depomedrol and/or oral prednisone - Refer to neurology
- Disease-modifying therapies (B-Interferon)
Parkinson’s symptoms
tremor.
rigidity (stiffness)
slowness of movement.
mild memory and thinking problems.
sleep problems.
pain.
mental health problems, including anxiety and depression.
- Parkinson’s characteristics, diagnostic tests, and treatment
- s/s: TRIAD (rest tremors, muscular rigidity, bradykinesia); also masked face.
- > 50 y/o, more common in men
- Treatment
- 1st line: Sinemet TID 25/100mg PO TID with meal or snack to avoid nausea
Start low and titrate slowly - For essential tremors: propranolol 60-320mg daily or long-acting (Inderal LA)
- Tests
- No specific tests
- Get a good H&P, look for s/s and red flags
- Myasthenia gravis s/sx*
Autoimmune dx caused by an error in the transmission of nerve impulses to muscles
* s/s: muscle fatigue, weakness with use, eye movements and speech are affected
* weakness of the eye muscles, drooping of the eyelid, blurred vision, change in facial expressions, dysphagia, dyspnea, dysarthria
* s/s are usually worse later in the day, may subside with rest
- Myasthenia gravis Tests
- *
Tensilon test: Tensilon drug is injected into the muscles which prevents the breakdown of Ach (neurotransmitter that nerve cells release to stimulate your muscles)
A positive test for MG if their muscles get stronger after the injection
* EMG (electrymyography)-electrodes used to monitor muscle activity
* Serum antibodies (IgG)
Myasthenia gravis Treatment
- Symptomatic and supportive treatment
- Meds
Mestinon/pyridostigmine is the drug of choice
Steroids
Immunosuppressants
IVIG
Plasmapheresis - All pts should be screened for thymoma; thymectomy can be curative
- Seizure disorder characteristics
- *
Caused by a sudden burst of electrical activity from a collection of cerebral cortex neurons which affect motor, sensory, and cognition
* Generalized seizures are associated with a complete loss of consciousness, whereas partial seizures preserve wakefulness; involuntary twitching or stiffness in the body
* Focal (affecting just one part of the brain):
* Complex partial-impairs LOC
* Simple partial-LOC not impaired (motorsensory is affected)
* generalized (affecting the entire brain)
* tonic-clonic/”grand mal”-sudden stiffening of muscles/contractions
* absence sz-“blank stare” or brief interruption in activity
* myoclonic-sudden, brief, shock-like contractions, usually during sleep
* tonic-sudden muscle stiffening, sudden without warning and can lead to injury
* atonic-sudden loss of muscle control , sudden without warning and can lead to injury
Seizure disorder Treatment:
- No medication recommended for 1st time seizure
- Choice of med depends on type of sz, comorbities, etc
- Monotherapy is preferred (achieve best control of sz with least meds possible)
- Focal Seizures
1st line: Carbamazepine (Tegretol) or lamotrigine (Lamictal) - Generalized
1st line: valproic acid for all types - Status epilepticus
Be sure to secure airway and assess cardiac/resp function 1st and check BG levels
1stline: Buccal midazolam
2nd line: rectal diazepam
- Brain tumor characteristics, differential diagnosis, treatment
- Symptoms: New onset HA (mild-severe), throbbing, progressively worse, unexplained n/v, blurred/double vision, gradual loss of sensation of movement in extremities, off-balance, slurred speech
- Differential dx: CVA, MS, SAH, meningitis, optic neuritis, AVF, brain abscess, neurosyphilis
- Treatment: surgery, radiation, chemo, meds/steroids
- Suicide risk factors
- Ages 15-24 and > 60 y/o
- Older people who have recently lost a spouse (death or divorce)
- Plan involving a gun or other lethal weapon/firearms in the house
- Hx of attempted suicide and/or family hx of suicide
- Mental illnesses (depression or bipolar)
- Hx of sexual, emotional and/or physical abuse
- Terminal illness, chronic illness/chronic pain
- Alcohol/substance abuse
- Stressful life issues (financial or relationship problems)
- Medical professionals/public service
- American Indian and Alaskan native youth/middle age have the highest risk
- Blacks have the lowest risk
