Neuro + Autoimmune Flashcards
Multiple sclerosis
Demyelinating disease (destruction of myelin)
Parkinson’s disease
Decreased availability of dopamine
Myasthenia gravis
Impaired acetylcholine binding to muscle cells
Acetylcholine
Usually excitatory -
Major transmitter of the parasympathetic nervous system
Dopamine
Usually inhibitory-
Affects behavior + fine movements
MS
Signs+ symptoms
Fatigue (most debilitating) Pain Spasticity Cognitive changes (memory changes + decreased concentration) Ataxia + tremor Emotional lability + euphoria Bladder, bowel, + sexual dysfunction
Complications with MS
UTI constipation pressure ulcers contractures dependent edema pneumonia osteoporosis
Uhthoff’s Sign / Phenomenon
Worsening MS s/sx with an increase intemp.
Lhermitte’s sign
Electrical shock sensation moves down neck into spine
Romberg sign (cerebellar)
Standing w/ eyes closed, feet together + they sway or fall
Fatigue
r/t MS
Most debilitating symptom
Contributing factors - heat, depression, anemia, deconditioning, + medication
Pain
r/t MS
Contributes to social isolation
Caused by lesions on sensory pathways- paresthesia, dysesthesias, proprioception loss
Dysesthesias
Abnormal sensation
Spasticity
r/t MS
90% of PTs
Most often in LE + include loss of abd reflexes
Cognitive changes (r/t MS)
Memory loss + decreased concentration
Occur in about half of PTs
Severe cognitive changes w/ dementia rare.
Ataxia + tremor
r/t MS
Ataxia - Impaired coordination + movements
d/t involvement of cerebellum or basal ganglia
Emotional lability + euphoria
AND
Bladder, bowel, + sexual dysfunction
(r/t MS)
From loss of the control connections between cortex + basal ganglia
Incl. overactive bladder or trouble contracting to void
Diagnosis of MS
Evidence of damage in at least two separate areas of the central nervous system (CNS)
AND
Evidence that the damage occurred @ different points in time
AND
Rule out all other possible diagnoses
There are no symptoms, physical findings, or lab tests that can - by themselves- diagnose MS
After lumbar puncture, the CSF must be…
Hand carried to the lab
MS
There is NO cure for MS
MS - Disease-modifying meds…
Reduce frequency of relapse, duration of relapse + number and size of plaques seen on MRI in the RR form of MS
Not effective in the primary progressive form of MS
Interferon - Refib/Betaseron + Avonex copaxone Teriflunomide/fingolimod dimethyl fumarate mitoxantrone
MS- symptom management meds
- Baclofen, tizanidine, dantrolene (muscle relaxants/antispasmodics)
- Amantadine (dopamine promoter)
- Pemoline (stimulant)
- Dalfampridine (muscle strengthener) -Oxybutynin (Ditropan) (anticholinergic for urinary incontinence, relaxes bladder muscle to prevent contractions)
- Bethanechol (Urecholine) (cholinergic for neurogenic bladder, helps empty bladder)
Patients w/ MS are at risk for…
Aspiration
d/t swallowing difficulties
Myasthenia gravis (MG) is….
Purely a motor disorder -
No effect on sensation or coordination
