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IPAP > Neuro Block 2 > Flashcards

Neuro Block 2 Flashcards

1
Q

Define Nystagmus

Define Syncope

A

Rapid involuntary movements of the eyes

LOC from insufficient blood flow to the brain

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2
Q

Define Postictal

Define Oscillopsia

A

After a sudden attack (epilepsy)

Visual disturbance where objects appear to oscillate

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3
Q

Define Hydrops

Define Dizziness

A

Edema/distension of a hollow organ w/ fluid

Whirling sensation in head w/ tendency to fall; encompasses vertigo, disequilibrium, light headedness

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4
Q

Define Vertigo

Define Prodrome

A

Sensation of motion where surroundings seem to whirl; indicative of vestibular pathway dysfunction

Premonitory symptom of a Dz

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5
Q

Define Myelopathy

Define Spacticity

A

Dz or D/o of the spine

Hypertonicity w/ inc tendon reflexes

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6
Q

Define Parkinsonims

Define Ataxia

A

Neuro d/o similar to parkinson’s

Inability to coordinate voluntary muscular movements that are Sx in CN D/o and injuries

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7
Q

Define Choreoform

Define Schwannoma

A

Movement d/o marked by spasmodic movements of limbs/facial muscles

Tumor of the tissue covering nerves, typically benign and most commonly vestibular

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8
Q

Define Labrynthitis

Define Sensorinueral hearing loss

A

Inflammation of the inner ear and nerves connecting the ears to the brain

Hearing loss due to damage to the inner ear or the nerve from the inner ear to the brain

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9
Q

What are the 3 types of feelings encompassed in the term Dizziness?

What are the 3 categories of Dizziness?

A

Vertigo
Disequilibrium
Light headed

Faint/Pre-Syncope
Vertigo
Miscellaneous head sensation

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10
Q

What 4 terms can be used semantically for dizziness?

What are 4 misleading words that can be used by PTs to describe dizziness?

A

Light headed, Faintness, Spinning, Giddiness

Confusion, Blurred vision, HA
Tingling

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11
Q

Define Disequilibrium

Define Light Headed

A

Describes feeling of being unsteady, about to fall and associated w/ abnormal gait

Sensation one is about to faint

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12
Q

Define Presyncope

Define Multiple Sensory Defect Dizziness

A

Describes transient cerebral hypoperfusion (orthostatic), usually a prodrome

AKA Benign Disequilibirum of aging
Mild light headed, impaired feet sensation and poor vision

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13
Q

Define Syncope

What are the 3 D/os of vascular tone?

A

Transient decrease in blood and/or O2 flow to the brain causing LoC

Vasovagal- neural mediated
Postural- OHOTN
Reflex- carotid sinus hypersensitivity, Situational, Glossopharyngeal neuralgia

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14
Q

Neurally mediates syncope includes ? 2

A

Vasovagal- sympathetic withdrawal (dilation) and inc of PNS activity (bradycardia)

Vasodepressor syndrome- SNS withdrawal alone, “Common Faint”

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15
Q

What are the S/Sxs present during a Neurally Mediated Syncope

How are they Tx?

A

Pale, Clonic jerks of face, Varied responsiveness, Maintained sphincter maintained, Brief Confusion <30sec

Supine w/ elevated feet, Tx underlying cause

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16
Q

Define OHOTN

A

Reduced SBP 20mm, DBP by 10mm w/in 3min of standing

Always associated w/ change of position and systematic fall of arterial blood flow while upright

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17
Q

What underlying issues are common causes of OHOTN?

A

Elderly w/ Poly-pharm- Anti-HTN/Depressants

PNS Dzs- DM, Nutrition deficits, Amyloid polyneuropathy

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18
Q

Define Carotid Sinus Hypersensitivity

A

Inc pressure on carotid baroreceptors, typically occurs after shaving/combing hair/turning head w/ tight collar on

Afferent nerve fibers activate efferent sympathetic nerve fibers in heart/vessels

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19
Q

Define Reflex Syncope

A

Abnormal autonomic control that involve cardio-inhibitory/vasodepressor response

SEEING BLOOD
Can be caused by Cough, Deglutition, Micturition, Defecation

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20
Q

Define Glossopharyngeal Neuralgia

A

Uncommon
Activation of afferent impulse in glossopharyngeal nerves that terminate in nucleus solitarius in medulla

Pain similar to trigeminal neuralgia

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21
Q

How is Glossopharyngeal Neuraliga Tx?

A

Carbamazepine
If meds fail, microvascular decompression Rhizotomy of CN9/10 (cutting of nerve near brain if PT has continuous pain/syncope)

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22
Q

What are CV D/o syncope usually related to?

CVD alone rarely cause syncope, most PTs also have Sxs of ?

A

Arrhythmia pre/post exertion without prodromes

Focal neuralgia ischemia
Extremety weakness
Diplopia
Ataxia
Dysarthria
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23
Q

What is a rare CV d/o that causes syncope in adolescents?

What does it suggest if a PT passes out while Upright/Sitting, Laying or Exercised induced

A

Basilar artery migraine

Upright/Sitting= OHOTN
Laying= cardiac event, seizure
Exercise-induced= CV etiology
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24
Q

What are the Dx Tests for syncope?

Presence of prodromal light headed or clear thinking upon recovery suggests?

Presence of typical aura of postictal state suggests?

A

ECG, Autonomic, Exercise stress test

Syncope

Seizure

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25
Q

Vertigo is either ? based or ? based and is associated with what S/Sxs?

A

PT vs Environment
Impulsion- body pulled through space
Oscillopsia- hallucination of moving back/forth or up/down
N/V, Gait ataxia

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26
Q

Vertigo can come from a disturbance from what 3 systems?

What is most often caused by?

A

Vestibular apparatus
Visual system
Somatosenosry

Asymmetry/imbalance between R/L vestibular systems

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27
Q

Vertigo must be differentiated between a ? or a ? cause

What does Otolith mean and what do they contain?

A

Central or peripheral

Ear rock- contain calcium carbonate crystal

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28
Q

What is the function of the Otolith organs?

What is the sensory epithelium of the urticle?

A

Sense static position and linear acceleration

Urticle macula- sense head position vertical to the ground

Sacular macula- vertically orientated

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29
Q

What are the functions of the semicircular canals?

What is the function of the otolith?

A

Perceiving angular rotation

Otolith- static head tilt and linear movement

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30
Q

What tests are encompassed in a vertigo exam?

A 
Orthostatic vs Nystagmus
Bruits
Cerebellar- Romberg, Wide gait, Tremor, Finger-Nose, Heel-Shin, RAMs
Weber/Rinne
Pos Dix-Hallpike maneuver
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31
Q

PT w/ unilateral conduction l deafness will have ? Weber/Rinne result?

PTs w/ unilateral partial deafness will have ? Weber result?

A

W- vibration in effected ear
R- doesn’t hear air vibrations

W- Vibration in normal ear
R- vibration in air after bone conduction is gone

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32
Q

Nystagmus is characterized by what 3 things?

What are the two types?

A

Position of gaze
Amplitude
Direction

Pendular- back and forth, slow and fast
Saccade/Pursuits- Fast/Slow

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33
Q

How to differentiate between Presyncope and Vertigo?

A

Pre: after prolonged standing, improved w/ laying/sitting

Vertigo: after head change, tinnitus, nystagmus, ataxia

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34
Q

What are the 4 types of physiological vertigo?

A

Intersensory mismatch- car sick
Unfamiliar/unadapted movement- sea sickness
Unusual positions- painting
Post spinning

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35
Q

What are the types of pathologic vertigo?

A

Lesion on stabilizing sensory systems
Visual vertigo
Peripheral neuropathy/myelopathy
Vestibular dysfunction- most common

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36
Q

Difference between Peripheral and Central vertigo?

A

Peripheral: Intense short episodes, typically affected by head positions
Horizontal nystagmus is always present, never vertical
Inner ear Sxs
Acoustic Sxs

Central: long episodes of unchanging dizziness, not affected by head position/movement, possible nystagmus of either type
Motor sensory deficit
Hyperreflexia
Extensor plantar response
Ataxia
Dysarthria
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37
Q

What are examples of Peripheral Vertigo

A 
Benign Paroxysmal positional vertigo
Peripheral vestibulopathy
Menieres Dz
Acoustic Neuroma
Gentamycin ototoxicity
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38
Q

What are examples of Central Vertigo

A 
ETOH intoxication
Wernicke's encephalopathy
MS
Alcoholic cerebellar degeneration
TIA/Stroke
Cerebellar ataxias
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39
Q

Peripheral vertigo d/os involve lesions where?

What are the S/Sxs?

A

Outside of the brain

Sudden onset of intense vertigo that is worsened by head movement and lasts for days
No findings on PE

40
Q

Define Vestibular Neuronitis

A

Paroxysmal vertigo
Usually as a single attack
Pure= preserved auditory*
Labyrinthitis- combined w/ unilateral hearing loss

41
Q

What will be seen on PE of Vestibular Neuronitis during the acute phase?

How is it Tx?

A

Nystagmus
Absent response to caloric testing

Diazepam
Meclizine
Vestibular therapy if not completely resolved
ABX- only if fever/infxn

42
Q

What is the most common cause of vertigo after a head concussion?

What does a chronic post-traumatic form result from?

A

Labyrinthine Concussion- Traumatic Vertigo

Cupulolithiasis- causes excessive cupular deflection w/ head movement causing episodic position vertigo

43
Q

What is the triad of Meniere’s Dz?

What other Sxs can be seen?

A

Unilateral deafness
Episodic/paroxysmal vertigo
Unilateral low freq tinnitus

Vertigo, N/V, Sensorineural hearing loss that gets worse as vertigo gets better

44
Q

What is the theorized pathology behind that cause of Meniere’s Dz?

How is this Dx?

A

Secondary to excess fluid in inner ear

Audiometry for all
Vestibular testing
MRI

45
Q

How is Meniere’s Dz treated?

A 
Diet- avoid salt, caffeine, alcohol, nicotine, MSG
Diuretics- HCTZ
Meclizine/Scopolomine/Valium
Hearing Aid
Gentamicin injection into ear
46
Q

Meniere’s Dz is AKA ?

What causes Perilymphatic Fistula

A

Endolymphatic Hydrops

Trauma/Pressure that causes leaking perilymphatic fluid from inner ear that drips into tympanic cavity

47
Q

How is Perilymphatic fistula treated?

What is the most common cause of acuter peripheral vertigo?

A

Bed rest
Head elevation
Avoid any straining
Persistence= surgery referral

Benign Paroxysmal Positional Vertigo

48
Q

What causes BPPV?

What PE finding is always present?

A

Calcium carbonate crystals in the semicircular canal

Positional nystagmus

49
Q

How can BPPV Sxs be reproduced?

How is it managed/Tx?

A

Dix-Hallpike Test, AKA Barany Maneuver

Epley reposition maneuver
Meclizine, Valium, Scopolomine patch

50
Q

Cervical vertigo is AKA ?

This form usually develops when?

A

Cervical Proprioceptive Dysfunction- causes vertigo w/ certain head positions

Head injury w/ hyperextension or DJD of cervical spine

51
Q

How is Cervical Vertigo Tx?

A

PT- neck exercises
Neck collar
Muscle relaxer

52
Q

Define Vestibular Vertigo

How is it Tx?

A

Episodic vertigo temporarily related to HA similar to Meniere’s Dz

Migraine Tx/prophylaxis
Diet
Anti-emetics

53
Q

Central vertigo is due to lesions located ?

How does it present and what is different?

A

Cerebellum, Pons

Slow onset of Ataxia, Vertigo, Nystagmus w/ little/no change w/ head movement

54
Q

Central disorders are often associated w/ what other adverse things?

How are central d/os disequilibrium based on location?

A

Hemorrhage/Ischemia in cerebellum, vestibular nuclei, brain stem

Cerebllum= incoordination
Basal ganglia= impaired posture reflexes
Sensory tract/receptors= impaired proprioception

55
Q

What can cause acute central vertigo?

What can cause chronic central vertigo?

A

Infarct, AVM, Tumor

MS, ETOH, Hypothyroid, Genetics

56
Q

What are 6 common causes of central vertigo?

A 
Vertebrobasilar ischemia
Vertebrobasilar TIA/Stroke
Acoustic neuroma
Toxic vestibulopathies
MS
Vestibulocerebellum neurodegenerative conditions
57
Q

When does a Dx of Vertebrobasilar ischemia need to be considered?

What is the vertigo usually accompanied by

A

Older PT w/ isolated and new onset vertigo w/out obvious cause

Diplopia, Dysarthria, Ataxia, Numbness

58
Q

Vertebrobasilar TIA/Stroke is usually caused by an infarct in ? branch of the ?

What is a common cause of this?

A

Medial branch of PICA

DM

59
Q

When working up a Vertebrobasilar TIA/Stroke, what needs to be rule out?

What is the preferred imaging modality for this?

A

Anemia, Pregnancy, Glucose derangement

MRI but usually after a CT

60
Q

How is a Vertebrobasilar TIA from central cause, Wernickes and MS handled?

A

Central- referral to surgery
Wernicke’s- Thiamine replacement
MS flare- prednisone

61
Q

Define Acoustic Neruoma

What S/Sxs does it present with?

A

Benign tumor from the sheath of CN8 in the internal auditory canal

Insidious hearing loss, tinnitus, HA, vertigo and facial weakness/pain
Unilateral sensorineural hearing loss on exam w/ “machine like/hissing” sound

62
Q

What tumor accounts for 80% of all cerebellopontine angle tumors

Commonly found on CN8, where else can it be found?

A

Acoustic neruoma

CN5 and CN7

63
Q

What is the pathology of Acoustic Neuromas?

What PT population are these usually found in?

A

Spindle cells from palisades called Verocay Bodies

Middle aged female

64
Q

What image modality is used to search for Acoustic Neuromas?

How are they Tx?

A

MRI w/ contrast

If <3cm- removal w/ stereotactic radio surgery

65
Q

What are 4 substances that can cause toxic vestibulopathies?

A

Gentamycin
Salicylates
Quinine
Cis-Platium

66
Q

How is Cerebellar Ataxia Dx?

What PT position is a must and what two movements are essential?

A

Finger to Nose test

Sitting up
Pronation and supination w/ encouragement to go faster

67
Q

What test is done to test the position sense?

Balance is maintained by what 3 factors?

A

Romberg- since it takes 2 of the 3 systems for balance, closing eyes limits balance to 1 system

Visual, Proprioception, Vestibular

68
Q

Define Seizure

Define Epilepsy

A

D/o characterized by excessive/over synchronized discharges of cerebral neurons

Group of d/os characterized by recurrent seizures

69
Q

A seizure is defined by ? and whether or not it ?

Define Ictus

A

Part of brain involved
Affects consciousness or not

Seizure

70
Q

Define Convulsion

Define provoked seizure

A

Seizure caused by abnormal muscle contraction

Seizure occuring in otherwise normal brain from alteration of Glucose, Na or Drugs

71
Q

Define Status Epilepticus

What types of conditions have a high likelihood of resulting in chronic seizures?

A

Continuous/recurring seizures without return of normal consciousness

Penetrating head wounds
Blasts

72
Q

What are the 2 key features of seizure d/os?

What are the 3 etiologies of seizure disorders?

A

Aura and Postical confusional state

CNS dysfunction, Underlying systemic dz
Drug induced

73
Q

The risk for a seizure from low glucose increases if levels are below ?

The risk for a seizure from low Na increases if levels are below ?

A

30mg

120meq

74
Q

What are two hyperosmolar states that can lead to seizures?

When Ca levels are below ? the chance of seizures are increased

A

Non-ketotic hyperglycemia
Hypernatremia

<9.2

75
Q

What use does an EEG have in a seizure work up?

EEG must be done under what conditions?

A

Confirms if pos, does not rule out if neg

Physiological stress/sleep deprivation

76
Q

Imaging is a must for initial seizures, which modality is preferred?

Why is the second modality ordered?

A

MRI
In the ER- non contrast CT

R/o infection, mass and bleeds

77
Q

How to tell between a focal or a generalized seizure has occurred?

A

Focal- one hemisphere, consciousness is preserved

Generalized- both hemispheres, consciousness is lost

78
Q

What are the 4 types of generalized seizures?

How are focal seizures further broken down?

A

Myloclonic/Minor motor
Absence
Tonic-Clonic
Atonic

W/ or w/out dyscognitive features

79
Q

Define Absence Seizure

A

Petit Mal, short periods of staring/zoning out usually in kids

80
Q

Define Focal Seizure w/out Dyscognitive features

A

No LoC

Abnormal sensation- aura, smell, clonic movement

81
Q

Define Focal Seizure w/ Dyscognitive features

A

Loss of awareness with confusion and staring

Motor:
Hand rubbing, lip smacking, arm positioning, uncontrolled shouting, swallowing

Olfactory hallucination
Deja vu sensation- usually w/ origin in temporal lobe

82
Q

Define Tonic Clonic Seizure

A

Grand mal seizure

PT falls to ground and jerks, loses awareness and possibly loses bowel/bladder function

83
Q

What are the 3 phases of a Tonic Clonic seizure and what happens during each phase

A

Tonic/Opisthotonos- 10-20sec w possible apnea, tongue biting

Clonic- muscle contraction/relaxation, lasts 1min w/ sphincter relaxation

Recovery- normal neuro exam w/ postictal confusion, HA, fatigue and Todd Paraylsis- transient unilateral weakness in postictal period

84
Q

Define Myoclonic seizure

A

Sudden muscle jerk in part or whole body

Is a common occurrence when falling asleep
Pathologic when associated w/ metabolic d/o, degenerative CNS dz or anoxic brain injury (hanging attempt)

85
Q

Normal seizure threshold is at ?

PTs w/ epilepsy have a threshold at ?

A
  • 55 mV

- 60 mV

86
Q

PTs w/ epilepsy may be required to have a seizure free period of how long prior to being able to drive again?

What is the mainstay of seizure Tx?

A

3-18mon

Antiepileptic meds

87
Q

A side effect of antiepileptic meds is that all anti-convulsants can lead to ? or ?

What monitoring is needed for PTs on these drugs?

A

Hematologic or Hepatic toxicity

CBC, LFTs @ 2wks, 1mon, 3mon, 6mon and Q6mon

88
Q

What derm issue must be watched for in PTs taking anti-convulsant meds?

What meds can be used in the acute setting for post-seizures?

A

New rash from Stevens-Johnson Syndrome

Carbamazepine
Phenytoin
Valproic acid

89
Q

What drug can be used in absence seizures?

What are the Tx options for Focal Seizures?

A

Valproic acid
Ethosuximide- may cause marrow suppression

First:
Lamotrigine
Carbamazepine
Oxcarbazepine
Phenytoin
Levetiracetam

Second:
Valproic acid
Topiramate
Gabapentin

90
Q

What meds are used in Generalized Tonic-Clonic serizures?

A

First:
Lamotrigine
Valproic acid

Second:
Carbamazepine
Phenytoin
Topiramate
Zonisamide
Oxcarbazepine
91
Q

Define Status Epilepticus

What 3 issues can develop?

A

Continuous seizure lasting 5min or more

Cardiorespiratory dysfunction, hyperthermia, metabolic derangement

92
Q

What are common causes of Status Epilepticus?

A 
Anti-convulsant withdrawal
Metabolic- hypoglycemia
Drug toxicity
CNS infection/tumor
Refractory epilepsy
Head trauma
93
Q

What is the medical therapy for Status Epilepticus?

If a first drug achieves partial control, but recurrent seizures continue, what is the next step?

A

1st= Lorazepam/Diazepam
Phenytoin w/ ECG
No anesthesia, use Midazolam, Propofol or Ketamine

Topiramate
Zonisamide
Lacosamide
Tigabine

94
Q

Confusion can be branched out into what 3 issues?

A mini mental status exam can be done and test what things?

A

Derlirium
Dementia
Amnestic d/o

LoC, Orientation, Speech/Language, Memory

95
Q

What score on a mini mental status exam is concerning?

Define Global Aphasia

A

Max of 30, 23 or less is concerning

96
Q

Stopped at `41:24

A

Lect 2

IPAP (212 decks)

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