Neuro 2. P 9 Degen Disorders and more Flashcards
Progressive muscle weakness with viral meningitis is what?
THINK POLIO
Lewi bodies?
In parkinsons, halo around eosinophilic inlcusion
Parkinson pathogen
Substantia nigra: loss of dopamine producing cells. dopa needed for melanin so that is why negra.
Relative increase in ACh (WHY YOU USE BENZTROPIN, it is anticholinergic)
MPTP is what?
A meth ingredient that puts you at risk for parkinsons
Mask like facies is b/c of what
Hypokinesia of face, so expressionless
Carbidopa does what?
Less break down in outer body
What is selegiline?
MAO b inhibiro in brain to prevent breakdown of dopamine
Neuroprotective!!!
Ends in tropine? what mechanism is it?
anticholinergic, like atropine!
*** Amantadine increases dopamine release
So can be used short term in parkinsons
C’s of huntingotns?
CAG disorder on chromosone Cuatro
Caudate atrophy on MRI aCetylcholine and gaba decreased Cognitive decline Chroeiform Cuarenta age of onset
Tx for huntington?
Tetrabenazine (thing tetra for 4 or cuatro for C’s of hungtingtongs!)
also atypical antipsychotics
ALS is 4 star topic
What are presenting symptoms?
Assymetric weakness
Dysarthria (motor speech) or Dysphagia (bulbar dysfunction)
UMN lesions in ALS?
LMN?
Slow stiff movements. Incoordination. SPASTIC HYPERREFLEXICE
LMN is anterior horn. FLACCID AND MUSCLE ATROPHY AND FASCICULATION
ALS dx?
EMG to show denervation widespread
Drug for ALS? mnemonic
RILUZOLE by reducing glutamate cytotoxicity
riLUzole for LU Gehrig disease
Presentation of MS?
Woman 20-40 years old with multiple defects that are intermittent: vision, paresthesia, sensory, weakness
Eye finding with MS? NEED TO KNOW
Unilateral optic neuritis
Inflammation of optic nerve. Eye pain with movement. ACUTE. Central vision loss
Internuclear ophthalmoplegia. Damage to medial longitudinal fasciculus. MLF. Helps eyes to track together. Ipsilateral eye can’t adduct on lateral gaze. MEDIAL RECTUS!
Eye pain worse with movement with central vision loss?
optic neuritis. IT IS MS
Will have afferent pupillary defect. Marcus Gun pupil
*** Internuclear ophthalmoplegia
M’s in MLF
MLF blocked so no Medial rectus in MS
So affected eye cannot look toward nose
Contralateral nystagmus
Normal conversion
MS labs. IMPORTANT LAST THING!
CSF: more protein. Mildly up WBC
Oligoclonal bands!!!!
MS is clinical diagnosis but MRI helps
oh
NMO is neuromyelitis optica, similar to MS on presentation. How do you tell them a part?
NMO is bilateral optic neuritis
NMO spares brain on MRI
NMO IgG is present if on test
MS is unilateral
MS has white lesions on MRI
Tx of MS that is acute?
Corticosteroids! High dose!
Tx of MS maintenance?
Interferon beta (THAT IS THE MAIN THING), avoid stress
Natalizumab
What if syringomyelia is big? What is affected?
LMN in anterior horn, so weakness and flaccid paralysis!
Tx of syringomyelia?
Decompression. or shunting if recurrent
Workup for dementia? What are big things to consider!
CMP, CBC, UA, TSH, RPR, B12!!!,
HIV, MRI or CT
HIV is biggie! syphillis too, don’t forget it for the tests!
Amyloid plaques, neurofibrillary tangles and neuronal atrophy is in what?
Alzheimer A for amyloid plaques!
What genetic disease is risk for alzheimer?
Trisomy 21 b/c APP gene is on chromosome 21
Alzheimer dx?
Dx of exclusion! Do the workup and rule out other causes with H and P and stuff.
Cortical atrophy is on MRI but not diagnositc
Alzheimer tx? mnemonic for it?
Anticholinesterase!!! Slows progression
Donepezile Galantamine Rivastigmine
DONE FORGETTING Guzman and Rivas! Mymen! (memantine)
Memantine helps too
Dementia with visual hallucinations think what?
Lewy body dementia. YOU SAW THIS!
also have syncope
Also have parkinsoninism
What do you see with frontotemporal dementia?
AKA Picks on you! they make sense
Inappropriate social behavior (they Pick on you!) (frontal lobe is inhibition)
Progressive aphasia
Tx of wet, wobbly and wacky?
4 STAR
dementia, gait disturbance/hard to lift up. Incontinence
Dilation of ventricles. Need shunt it
Big clue dementia vs delerium?
Delerium is acute. Think meds like benzos or anticholinergic!
Steroids can cause it too.
UTI
Hypoxia!!!!
Delerium workup?
Electrolytes UA Pulse Ox Meds CT of brain (at the end)
*** Delerium tx?
Reorient. Lights, Blinds, interact with patient.
Avoid restraints make it worse
Haloperidol can reduce agitation or if danger to themselves
Myasthenia gravis associations?
History?
Thymoma. Thymus neoplasm. Thyrotoxicosis! So CT!
Weakness worsening to the day, Ptosis and diplopia
Unexpected Tx of myasthenia gravis?
Thymectomy! Plasmapheresis
And of course neostigmine and pyridostigmine
Prednisone and azathioprine
Refractory myastenia gravis tx?
IvIg
Lambert Eaton syndrome?
What is affected?
Who has it?
Resembles myasthenia.
Presynaptic volted gated Ca++
It is a paraneoplastic syndrome so small cell cancer (so smokers)
Myasthenia graves vs lambert eaton?
Weakness worth with use in MG and LE is better with use!
Facial paralysis, think about what 2 things?
Guillain barre and lyme disease!
Guillain barre has what affect on sensation?
None
Thank campylobacter jejune, HIV, EBV or immuniation!!
Dx of guillain barre?
Clinical presentation or CSF analysis.
Albuminocytologic dissociation. High proteins and normal WBCs
EMG is demyelination
Tx guillain barre?
What do you need to know for sure?
May need ventilation, watch for ileum.
Telemetry
IV IG OR PLASMAPHERESIS IS BIGGIE
What autoimmune neuro syndrome do steroids not help in?
GUILLAIN BARRE. Instead do IVIG or plasmapheresis
Dx of bell palsy?
Clinical. Entire face b/c lower motor nerve problem. Bells palsy looks worse than stroke on the face!
Cortical stroke is only bottom half of face
What do you need to rule out with lyme disease in bell palsy?
History!
FAKE key lyme
Facial Arthritis, kardiac block, Erythema migrants
Bell palsy tx?
Eye car. So artificial tears and patch overnight
Glucocorticoids
Valacyclovir may or may not help!
DONT STUDY COMPLEX REGIONAL PAIN SYNDROME
SU 191
Tx of hemiballismus? What causes it?
Subthal nucleus stroke
Haloperidol is tx
*** Tics tx?
Tourrette, OCD, ADHD
Fluphenazine, Pimozide, Tetrabenazine
Think anti dopamine, So tetrabenazine just like huntinton, pimozide and fluphenazine just like high potency neuroleptics
