Neuro: Autonomic disorders & Childhood disorders Flashcards
Autonomic disorders ?
Neurogenic syncope
Postural orthostatic tachycardia syndrome
Neurogenic syncope Pathophysiology ?
Afferent trigger creates reflex vasodilation and bradycardia
Neurogenic syncope common types ?
Vasovagal (covered previous)
Pulmonary - bronchiolavage
Urogenital - foley in
Gastrointestinal - bowel movement with C
Carotid - new PA student,
massage carotid
Ocular - face in cold water
Neurogenic syncope demographic ?
F>M
Neurogenic syncope RF ?
Family history positive
Neurogenic syncope H and P: Predominant features ?
diaphoresis, pallor, palpitations, nausea, hyperventilation, and yawning
Neurogenic syncope Diagnostic Studies ?
CBC
CMP
EKG
Consider
CT head
Neurogenic syncope Treatment ?
Avoid stimuli
Fludrocortisone
steroid - CCS help with Increasing BP and they might have some mineralocortico capability - aldosterone - Na retention = expanding blood volume
Neurogenic syncope H and P ?
Premonitory features
diaphoresis, pallor, palpitations, nausea, hyperventilation, and yawning
Dizziness/ lightheadedness
Loss of postural tone, LOC
-May have proximal and distal myoclonus
eyes typically remain open and usually deviate upward
**they sense it coming **
Postural orthostatic tachycardia syndrome (POTS) pathophysiology ?
Unclear
Postural orthostatic tachycardia syndrome (POTS) possible etiology ?
Hypovolemia
Deconditioning
venous pooling
impaired brainstem regulation
β-receptor supersensitivity
POTS demographic ?
Age 15-50
Female to male 5:1
POTS History ?
Symptomatic when moving from sitting or lying to standing
- Lightheadedness
- Weakness
- blurred vision
- Palpitations
- Tremulousness
- nausea
POTS Physical ?
increase in heart rate with standing
to >120 beats/min or an increase of 30 beats/min
- *usually around 140 increase of 30 is really dx
- *
POTS Diagnostic studies ?
Clinical diagnosis
Consider
- CBC
- CMP
- EKG
POTS complications ?
Limitation of daily activities
POTS Treatment ?
Fluid expansion
Postural training - don’t suddenly stand up
POTS tx considered ?
Midodrine - alpha stimlant - vasoconstriction to maintain BP
Fludrocortisone - expanding BV
Phenobarbital
beta blockers - help HR
Childhood disorders types ?
Cerebral palsy
Cerebral palsy pathophysiology ?
Cerebral injury before birth, during delivery, or in the perinatal period
chronic impairment of muscle tone, strength, coordination, or movements
Cerebral palsy prevalence ?
Some degree in 0.2% of births
Cerebral palsy demographic ?
Birth and early childhood identified
Cerebral palsy RF ?
Intrauterine hypoxia
Birth hypoxia
Intrauterine bleeding Infections (CMV) Toxins congenital brain malformations Kernicterus neonatal hypoglycemia metabolic disorders genetic syndromes
Cerebral palsy PE: motor ?
spasticity (75% of patients)
unintentional
lack of coordination
fine motor difficulties
Ataxia
Lethargy
Hypotonia
Dystonia
Cerebral palsy PE: sensory ?
Hearing
Vision
Sensation
Cerebral palsy Diagnostic Studies ?
MRI
May show lesion, infarct, or infection
**loss of brain tissue **
Cerebral palsy complications ?
Seizures (50%)
mental retardation (50%)
Cataracts
Retinopathy
congenital heart defects
Cerebral palsy Treatment typical patient ?
Therapy
Cerebral palsy tx. if spasticity ?
Skeletal muscle relaxants
**Baclofen - centrally acting muscle relaxant **
Cerebral palsy’ tx. If seizures ?
anticonvulsants
Cerebral palsy patient education ?
PT / OT / ST
Cerebral palsy pharmacology ?
Anticonvulsants
- Carbamazepine (Tegretol)
- Phenytoin (Dilantin) - older
- Valproic acid (Depakote)
Skeletal muscle relaxants
Centrally acting preferred (baclofen)
Cerebral palsy Kramer story ?
difficulty child birth
cord was wrapped around neck and he was blue and he survived and he has seizures and hemiparesis and significant developmental delays = debilitating
main drive why people dont want to go into obstetrics anymore ( very high risk stuff) 18 years
its like a stroke for babies - hypoxia for the brain and cord around neck cutting off supply , ingestion of placental fluid and now they cant breathe