Neuro Flashcards
Chorea
Abnormal involuntary movements
Think Huntingtons
Dystonia
Twitching
Repetitive muscle contractions cause twitching (usually bilateral) can progress to DYSTONIC STORM (STATUS DYSTONICUS) involving eyes, face, nose, lips, jaw, neck, arms, legs… Looks like a seizure but comes on gradually, perhaps with eye twitching and progresses down the body.
Benedryl, Diazapam and Benztropine sometimes help
Seen in Parkinsons, Drug overdoses, Trauma, Birth disorders….
Masked Facies/Hypomimia
Reduced Facial Expression
Parkinson’s
masked facies, micrographia, decreased arm swing, shuffling gait and monotonous speech.
Parkinson’s (where it is caused by motor impairment)
or
Psychological Disorders where it is caused by lack of emotion
Quetiapine
What is it
Who takes it
What do you need to monitor in those who take it?
ATYPICAL Antipsychotic
For: Schitzophrenia, BiPolar & Major Depression, Parkinsons Psychosis
Quetiapine has low incidence of tardive dyskenesia/ extrapyramidal side effect
Blocks Dopamine, Serotonin, H1 and Epi/Nor
It is a powerful sedative
Causes hyperglycemia + OBESITY, big time
Monitor A1C
Not good for DM pts
Pines make you fat, Dones make you twitch
Saddle Anesthesia
What is it?
What should you expect if you find it?
Saddle Anesthesia is loss of sensation in S3 to S5 Dermatomes.
Suspect Cauda Equina Syndrome, especially if there is bladder or bowel incontinence and gait disturbance (d/t S2 dermatome running down the back of the leg)
Cauda Equina Syndrome
Lesion below L2 caused often by botched lumbar puncture or spinal anesthesia.
Signs are Saddle Anesthesia, Loss of rectal tone, bladder + bowel incontinence, gait disturbance along S2.
Vertebral fracture fragments or penetrating trauma below L1/L2
Spinal Stenosis (Padgets Dz of the bone)
Rx is Spinal Decompression if pressure is the problem, surgical removal of debris if trauma
PT is important
Recovery depends on severity and length of impairment and ability of nerves to regrow.
Optic Neuritis
Inflammation of the optic nerve often caused by Demyelination.
Often a presenting sign of MS
Sudden loss of vision (usually blurriness) preceded by PAIN in the affected eye are common presentations.
Loss of color vision is particularly specific
MRI is the image of choice, may detect MS though might need serial MRIs as optic neuritis may be an early symptom
Coriticosteroids are the Rx right now
Might consider some D3/K2 just in case it is MS, though that is certainly a controversial D issue.
Describe Babinski Test
A Babinski test is performed by stroking the lateral aspect of the sole from the heel to the ball of the foot, the great toe dorsiflexes and the other toes fan in a positive test.
Babinski is naturally + in babies as their spinal nerves aren’t yet fully myelinated and the cerebral cortex doesn’t yet suppress the reflex.
If present in adults, it indicates an upper lesion
It’s often + in advanced MS and is used to gauge progression of the disorder.
Kernig’s Sign?
Kernig’s sign (of MENINGITIS) is positive when pain is noted on straightening the knee after flexing both the hip and knee.
BRUDZINSKI’S SIGN?
Brudzinski’s (OF MENINGITIS) sign occurs with neck flexion resulting in resultant flexion of the hips. It is a sign of meningeal irritation.
GOWER’S SIGN
A positive Gower’s sign is noted in certain types of MUSCULAR DYSTROPHY and is described as children rising to stand by rolling over prone and pushing off the floor with arms while the legs remain extended.
Early MS Signs
Optic Neuritis - demyelination of the optic nerve causes inflammation. An early MS finding signs of which include blurred vision preceded by pain.
Babinski Reflex - is a more serious sign of demyelination found in advancing MS
MS usually has Sensation Loss and weakness
MS often has bladder incontinence issues
Amyotrophic Lateral Sclerosis
ALS (Lou Gehrig’s disease)
A progressive bilateral muscle disease which causes fasciculations (lower motor neuron), and hyper-reflexia, plantar reflexes (upper motor neuron) and dysarthria.
Sensation is normal as is bladder function. It might look like MS as MS also may have dysarthria, but reflexes are normal, sensation is impaired and bladder function is frequently affected.
Spasticity, Hyper-reflexia
Upper Motor Neuron lesion- From Brain to spinal cord. Upper motor neurons INHIBIT so when they’re damaged, reflexes increase.
Babinski will return in adults
MS
