Neuro Flashcards
Down Syndrome
WHICH CHROMOSOME
TRISOMY 21
Down syndrome
6 sxs!!!!!
ONE KEY THING RELATED TO!!
SXS:
- hypotonia
- poor moro reflex
- hypermobility of joints
- flattened facies
- excess skin on back of neck
- single transverse palmar crease SIMIAN crease
CAUTION: CARDIAC DISEASEIN 40%, ASD
Klinefelter syndrome (XXY)
4 characteristics
- initially tall thin become obese with scoliosis
- expressive language disorder and developmental delay
- male: small penis, scant pubic or facial hair
- females: eunich appearance (difficult to tell gender)
what is the chromosome issue with klinefelter syndrome?
XXY
Turner Syndrome
what is the issue genitically here?
MONOSOMY X
Turner Syndrome
4 characteristics of this
- webbed neck and short stature
- prominent ears with widely spaced nipples
- congenital lymphedema
- increased carrying angle
Cerebral Palsy
what is this?
3 options of presentation?
SXS
2
1
4
involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal posture or both
presentaiton:
- arm and leg on one side (hemiplegic)
FLOPPY OR SPASTIC HAND
WALKS ON TIP TOE OF EFFECTED SIDE
- both legs only (diplegic)
CONTRACTURES OF THE ANKLES AND FEET
-
both arms and both legs (quadriplegic)
- ARMS HEAD AND MOUTH MAY TWIST STRANGELY
- SEVERE BRAIN DAMAGE THEY CAN’T WALK
- KNEES PRESS TOGETHER
- LEG AND FEET TURN INWARD
migraineurs
8 things that can contribute/spark this and cause the migraine
- motion sickness with nausea/vomiting
- menstrual headaches
- headaches the worsen with physical activity including benign sex headaches
- post small amount of colored wine or liquor
- caffine withdrawal headaches
- water diving headaches
- altitude headaches
- chocolate, peanuts, and caffine
migraine pathophysiology
what is the end pathway that causes this?
what are 2 contributing factors?
end pathway: casuses activation of the sensory fibers that innervate the miningeal and cerebral blood vessels** that **arise in the TRIGEMINAL NERVER
inflammatory and vascular components
vasogenic theory
vs
neurogenic theory
what are the 2 theories?
which one is the more commonly believed theory?
VASOGENIC THEORY
a. intracranial internal carotid vasoconstriction causes the migriane aura
b. headache occurs from the rebound vasodilation of cranial vessels aka external carotid** which activate the **perivascular pain fibers of the trigeminal nerve
NEUROGENIC THEORY
a. brain activates or sensitizes trigeminal nerve fibers** which **initiates the headache from neurogenic inflammation
***theory believed by most neurologists**
**but keep in mind…we don’t actually know, but neurogenic more commonly believed**
serotonin in migraines
what is the role of serotonin?
what can be used to tx migraines because of this quality?
what does it bind with?
3 things the tx leads to aka why it works?
serotonin is a NT that activates pain fibers and contirbutes to both inflammation and vasodialation of the meningeal and dural blood vessels **(basically the same as what happens in a migraine!!)**
serotonin agonists used for migraine abortion:
when the 5-HT1 serotonin receptors on presynaptic terminal are agonized/activated inhibit the release of serotonin** and this leads to **VASOCONSTRICTION** and **PREVENTS ACITVATION OF THE TRIGEMINAL NERVE
- turn off release of serotonin
- vasoconstrict the dilated vessels
- turn off activation of the trigeminal nerve
aura
what is this? when does it occur?
what are 6 possible sxs?
what might it mimic?
transient 15-30 mins episodes of focal neurologic dysfunction before the headache phase begins
SXS:
- expanding scotoma (blind spot) with scintillating margin
***visual hallucinations, stars, sparks, and zig zags of light***
- visual field defects
3. unilateral paresthesias
4. numbness
5. weakness
6. dysphagia
***some may minic TIAs**
(typically wihout vertigo, ataxia, tinnitus, hearing loss)
migraine with aura
what is confusing about this?
what is aura thought to come from and how can you identify this?
some are explained with decreased blood flow while others aren’t
aura is contributed to by activation of wave of electrical activity** that spreads through the brain **depressing cortical activity** and results in **visual and other sxs
“spreading depression of Lao seen on PET SCAN*
migraines
what is the age of onset?
5 sxs commonly seen with these in general?
peaks 35-45
- lateralized to one side or generalized
2. throbbing and worse with physical activity
- develops gradually
- phonophobia
- photophobia
migraine tx
3 tx options
0
2
(what do they bind to, what do they cause/where, two things to remember about admin of these)
2
- ASA, NSAIDS if taken early
- tryptans-5-HT1 receptor agonists with high affinity to trigeminal nerve that cause vasoconstriction
- sumatriptan
- zolemitriptan
***autoinjection the most effective route of administration**
***make sure to take continuously untill migraine completely gone***
- narcotic ONLY in ED
- injectable dihydroergotamine
- merperidine
mirgraine prophylaxsis
who do you consider this in?
4 tx options for this?
consider if:
1. migraines limit activities 3 or more times a month
2. complex migraines
TX:
- BETA BLOCKER-propanolol, metoprolol that cross BBB
- tricyclic antidepressant-amitripylene
- anticonvulsants- topiramate
- botulinum toxin A injected into the scalp
tension headache
what to remember about this type of headache?
when does it occur in life?
4 skey sxs?
5 associated findings?
most common type of headache
3rd decade, patho poorly understood
sxs:
- symmetric tightness/pressure, band like
- mild-mod steady aching without throbbing pain mins to days
- DO NOT WORSEN WITH PHYSICAL ACTIVITY
- NO NAUSEA VOMITING OR OTHER NEURO SXS
aka no photophobia, phonophobia, vision changes
- associated findings
- poor concentration
- stress
- fatigue
- noise
- depression
tension headaches
2 medication tx?
1 prevention strategy?
- acetominophen
- NSAIDS
PREVENTION:
- RELAXATION TEHCNIQES
cluster headache
what is this called?
who does it occur in?
where does this occur?
what are 4 other sxs that appeare with this?
when and how frequently do they occur?
MIGRAINEOUS NEURALGIA
males more than females, 3-6th decade of life
SXS:
- intense unilateral, orbital, supraorbital, or temporal head pain along with ipsilateral partial cervical sympathetic paralysis
a. conjunctival injfeciton
b. lacrimation
c.rhinnoreah
d. eyelid edema
- 15 mins-2 hours and recur daily for days to weeks
cluster headache
what is the best treatment for this?
3 medical tx for acute attacks?
- 100% O2 for 15 mins- VERY EFFECTIVE for 1-2 hour duration HA
- acute attacks
ergotamine tartrate
sumatriptan
butorphanol
cluster headache
2 prophylaxsis medication options
- verapamil
- ergotamine
what are 3 common triggers for cluster headaches?
- ETOH
- stress
- foods
substance use activates which system?
dopaminergic
what screening test do you use to look for alcohol or substance use disorders?
CAGE screening
what are the stages for alcohol withdrawal and their time frame?
4 things
- withdrawal 6-18 hours
- nausea/vomiting 8-12 hours
- HALLUCINATIONS within 2 days
- DELERIUM TREMONS 2-3 days after cessation but can be up to a week after
what are 4 things you use to treat alcohol addiction?
- benzos
- thiamine
- folic acid
- multivitamin
- haldoperiol for alocholic hallucinosis
opioid addiction
what are the 4 sxs of this and the 2 tx options?
SXS:
slurred speech, bradycardia, hypotension constricted pupils
TX:
- naloxone
- slow taper methadone clonidine or buponorphine
Attention Deficit Disorder or Attention deficit hyperactivity disorder
5 sxs? 2 key ones
how to dx?
1. hyperactivity before 7 y/o
2. impulsitivity/inattentiveness before 7 y/o
3. emotional liability
4. poor social skills
5. explosive at home, don’t follow rules
DX:
teacher and parent rating scales CONNORS SCALE
Attention Deficit Disorder or Attention deficit hyperactivity disorder
TX? 2 first like 2 SE
- CNS STIMULANTS methylphenidate, amphetamine/dextroamphetamine FIRST LINE
caution weight loss and growth retardation
Autistic disorder
what is this?
imparied social interaction,
communication, and repetitive stereotypes behavior
tourette disorder
what is this?
4 dx of criteria?
age of onset?
inherited neurobehavioral disorder characterized by sudden involuntary, repetitive muscle movements and vocalizations
DX CRITERIA:
- multiple motor or one or more vocal tics at some time during the disorder
- tic episodes several times a day, almost every day or periodically during period over a year
- change in type, severity, complexity, frequency,
- sxs before 18
sxs onset: 2-15 y/o
50% have sxs but age 7
***SXS BEFORE !***
tourettes
motor tics
initlal sxs
secondary sxs
- initially
blinking
face twitch
head jerk
shrug
neck stretch
sniffing
- over time
squatting
jumping
repetitive touching
deep knee bends
smelling things
spinning
echopraxia: meaningless repetitiion or imitation of the movements of others
tourettes
vocal tics
simple tics
advance tics
- simple tics
grunts
throat clearing
sigh
bark
hiss
snort
sniff
- advanced tics
repeating words or phrases out of context
palilalia-repeating ones own words
echolalia-repeating heard words
coprolalia (common mainstream depictions) “dropping the F bomb”
course of tourette progression
4
waxing and waning course
usually combination of motor and verbal tics
few to many times a day often in clusters
lifelong but sxs decrease or resolve in adolescence or adulthood
what are the associated sxs of tourettes?
4
obsessive compulsive behaviors 25%
attention deficit 50-80%
rage/poor impulse control 30%
anxiety 25%
tourettes
4 tx options
do IF they present a problem
- dopamine antagonists/antipsychotic
haloperidol
fluphenazine
risperidone
- antianxiety
benzodiazepine
buspirone
- antidepressants-ssri
- alternatives
botox into involved muscles
habit reversal training
biofeedback relaxation training
what are the 3 take homes of tourettes?
- TX GOAL: FUNCTION PRESERVATION
- MANY WILL HAVE OTHER PSYCHIATRIC ISSUES
- MEDS CAN BE USEFUL BUT DON’T FORGET BEHAVIOR MODIFICATION THERAPY
