Neuro Flashcards
leading cause of neurological disability in young adults and in whom
MS, women
clinical symptoms of MS
hand cramps, double vision, slurred speech, ataxia, depression, cog dysfunction, blurry vision
Lhermittes phenomenon
tingling in extremities with neck flexion d/t cervical cord lesion in MS
Internuclear ophthalmoplegia (INO)
lesion in brainstem, patient will have lack of adduction of one eye with nystagmus in the other eye (eyes don’t align)
white matter lesions are present in which illness
MS
4 Core features of PD
Tremor, Rigidity, Akinesia/bradykinesia, Postural instability associated with flexed posture
non-motor signs of PD
Constipation sleep disorders depression olfactory impairment (happens early-10 yrs prior) Dysphagia Autotomic dermatitis (late) Orthostatic hypotension
motor signs of PD
freezing dyskinesia micrographia (small handwriting) shuffling gait hypophonia (soft speech)
micrographia
small cramped handwriting
Bradykinesia
slowness of movement
Hypophonia
soft speech
DaTSCAN
measures dopamine in the brain
PD is the loss or gain of what?
dopamine
usual age onset of PD?
45-65 years old
second most common neurodegenerative disorder?
PD
first most common neurodegenerative disorder?
Alzheimers
what meds can induce parkinsonism?
Haldol, high doses of CCB, SSRIs
Myersons sign
repetitive tapping over the bridge of the nose may cause blinking
when is an MRI done in PD?
to rule out other causes of symptoms
what symptoms indicate vascular parkinsonism?
isolated shuffling gait and step-wise progression of symptoms
does PD have early difficulties with falls?
no
Stages of PD
1- one side affected, no impairment
2-Both sides affected, no impairment
3- Both sides affected, mild posture and balances affected, still independent
4-Both sides affected, disabling instability, can’t live alone
5-Both sides affected, restricted to bed
what are you at greater risk for with Carbidopa/levodopa?
long-term motor complications like dyskinesia
what are you at greater risk for with Dopamine Agonists (Requip, Permax)?
impulse disorders (sex, gambling)
Dopamine Agonists (Requip, Permax) side effects
hallucinations, delusions, nightmares, leg edema, daytime somnolence
Amantadine is added for problems with what symptom of PD
good for motor symptoms and dyskinesia
Dyskinesia vs bradykinesia
bradykinesia=slow movements
Dyskinesia=uncontrolled, involuntary movements
What 4 meds are mostly use in PD?
MAO inhibitors, Dopamine agonists and carbidopa/levodopa, amantadine
If PD patient has constipation, what meds should you assess?
anticholinergic (antihistamines, trycyclic antidepressants, CCB)
can MOI inhibitors be give alone or needed to be given with another med for PD?
either
MOI inhibitor examples for PD
Seligiline, Eldepryl
Seligiline, Eldepryl
MAO inhibitor examples for PD
Dopamine agonist examples
Requip, Permax
Carbidopa/levodopa med doses
10/100, 25/100, 25/250
usual starting dose for Carbidopa/levodopa
1/2 tab-1 tab TID, can go up to 2 tabs QID
Before a referral to neuro, should you try a therapeutic trial before hand?
no because it can mask diagnostic findings
options for levodopa dyskinesia?
- ) decrease levodopa dose and give more frequently and/or increase dopamine agonist
- ) reduce dose of any MAO inhibitor
- ) add amantadine
what are anticholinergic meds used for with PD
in younger patients with tremor. (Not used often)
off time vs wearing off in PD
off time are periods during the the day when the medication is not working well, causing worsening of Parkinsonian symptoms.
wearing off may occur predictably and gradually. Need to change med regime
AD hallmark signs on MRI
- Amyloid plaques and neurofibrillary tangles (NFTs)
- Oxidative stress
- Sytsemic inflammation
typical screening test for AD
montreal cog assessment
medication classes for AD
Cholinesterase inhibitors, NMDA receptor antagonist
Cholinesterase inhibitors
used for AD; Rivastigmine (exelon) and Galantamine (Razadyne)
Rivastigmine (exelon) and Galantamine (Razadyne) are used for which illness and what drug class
AD; Cholinesterase inhibitors
Galantamine (Razadyne) what problem should you avoid this in? give with food or without food? side effects?
avoid if patient has hx of syncope; give with food;
side effects: GI, bronchonstriction, wt loss, anorexia
Rivastigmine (exelon) side effects
syncope, wt loss
NMDA receptor agonist medication
Memamantine (Namenda)
Memamantine (Namenda) side efects
steven johnson, wt gain, aggression, somnolence
AD typical age
> 65
who is more at risk for AD?
first degree relative, depression, APOE42 gene, patients with cardiovascular risk factors
what meds are used with AD when patient has behavioral probs?
SSRIs
what meds should not be used with aggressive behaviors of AD?
anticonvulsant unless they have a hx of bipolar
what is an independent risk factor for delirium?
Dementia
Treatment of acute relapse of MS
IV methylprednisolone 1g IVx3-5 days, no oral steroid taper
AD stages
Stage 1-no changes
Stage 2-Very mild- minor forgetting
Stage 3-Mild-forgetting names, not retaining reading material, losing objects, can be diagnosed, cog changes seen in office
Stage 4-moderate-cant preform complex tasks, reduced personal hx, can’t remember recent occasions
Stage 5-moderate severe-major gaps in memory, confused about location, date, need help choosing clothing
Stage 6 and 7-dependent care
6 Cognitive domains of dementia
Complex attention, executive function, Learning and memory, language, perceptual motor, social cognition
executive function (one of the cognitive domains of dementia)
can’t do multiple tasks, they put shoes in fridge
Perceptual motor (one of the cognitive domains of dementia)
visual issue-readings different, they can’t interpret things
Social cognition (one of the cognitive domains of dementia)
react inappropriately in a social situation ex: funeral and laugh
Relapsing remitting MS
symptoms get worse then recover, found in early diagnoses, disease does not get worse
secondary progressive MS
you don’t get symptoms that come and go like in RRM, symptoms just get gradually worse
primary progressive MS
no obvious relapsing, symptoms just get worse
primary progressive MS vs secondary progressive MS
primary progressive MS does not experience the relapsing remitting phase of MS like secondary progressive MS people did
Pseudo-Relapse in MS
something causes you to flare like getting a fever, infection, hot weather.
MS remission
you return to the previous phase before the relapse
