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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
Vertigo is either ? based or ? based and is associated with what S/Sxs?
PT vs Environment Impulsion- body pulled through space Oscillopsia- hallucination of moving back/forth or up/down N/V, Gait ataxia
26
Vertigo can come from a disturbance from what 3 systems? What is most often caused by?
Vestibular apparatus Visual system Somatosenosry Asymmetry/imbalance between R/L vestibular systems
27
Vertigo must be differentiated between a ? or a ? cause What does Otolith mean and what do they contain?
Central or peripheral Ear rock- contain calcium carbonate crystal
28
What is the function of the Otolith organs? What is the sensory epithelium of the urticle?
Sense static position and linear acceleration Urticle macula- sense head position vertical to the ground Sacular macula- vertically orientated
29
What are the functions of the semicircular canals? What is the function of the otolith?
Perceiving angular rotation Otolith- static head tilt and linear movement
30
What tests are encompassed in a vertigo exam?
``` Orthostatic vs Nystagmus Bruits Cerebellar- Romberg, Wide gait, Tremor, Finger-Nose, Heel-Shin, RAMs Weber/Rinne Pos Dix-Hallpike maneuver ```
31
PT w/ unilateral conduction l deafness will have ? Weber/Rinne result? PTs w/ unilateral partial deafness will have ? Weber result?
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
32
Nystagmus is characterized by what 3 things? What are the two types?
Position of gaze Amplitude Direction Pendular- back and forth, slow and fast Saccade/Pursuits- Fast/Slow
33
How to differentiate between Presyncope and Vertigo?
Pre: after prolonged standing, improved w/ laying/sitting Vertigo: after head change, tinnitus, nystagmus, ataxia
34
What are the 4 types of physiological vertigo?
Intersensory mismatch- car sick Unfamiliar/unadapted movement- sea sickness Unusual positions- painting Post spinning
35
What are the types of pathologic vertigo?
Lesion on stabilizing sensory systems Visual vertigo Peripheral neuropathy/myelopathy Vestibular dysfunction- most common
36
Difference between Peripheral and Central vertigo?
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 ```
37
What are examples of Peripheral Vertigo
``` Benign Paroxysmal positional vertigo Peripheral vestibulopathy Menieres Dz Acoustic Neuroma Gentamycin ototoxicity ```
38
What are examples of Central Vertigo
``` ETOH intoxication Wernicke's encephalopathy MS Alcoholic cerebellar degeneration TIA/Stroke Cerebellar ataxias ```
39
Peripheral vertigo d/os involve lesions where? What are the S/Sxs?
Outside of the brain Sudden onset of intense vertigo that is worsened by head movement and lasts for days No findings on PE
40
Define Vestibular Neuronitis
Paroxysmal vertigo Usually as a single attack Pure= preserved auditory* Labyrinthitis- combined w/ unilateral hearing loss
41
What will be seen on PE of Vestibular Neuronitis during the acute phase? How is it Tx?
Nystagmus Absent response to caloric testing Diazepam Meclizine Vestibular therapy if not completely resolved ABX- only if fever/infxn
42
What is the most common cause of vertigo after a head concussion? What does a chronic post-traumatic form result from?
Labyrinthine Concussion- Traumatic Vertigo Cupulolithiasis- causes excessive cupular deflection w/ head movement causing episodic position vertigo
43
What is the triad of Meniere's Dz? What other Sxs can be seen?
Unilateral deafness Episodic/paroxysmal vertigo Unilateral low freq tinnitus Vertigo, N/V, Sensorineural hearing loss that gets worse as vertigo gets better
44
What is the theorized pathology behind that cause of Meniere's Dz? How is this Dx?
Secondary to excess fluid in inner ear Audiometry for all Vestibular testing MRI
45
How is Meniere's Dz treated?
``` Diet- avoid salt, caffeine, alcohol, nicotine, MSG Diuretics- HCTZ Meclizine/Scopolomine/Valium Hearing Aid Gentamicin injection into ear ```
46
Meniere's Dz is AKA ? What causes Perilymphatic Fistula
Endolymphatic Hydrops Trauma/Pressure that causes leaking perilymphatic fluid from inner ear that drips into tympanic cavity
47
How is Perilymphatic fistula treated? What is the most common cause of acuter peripheral vertigo?
Bed rest Head elevation Avoid any straining Persistence= surgery referral Benign Paroxysmal Positional Vertigo
48
What causes BPPV? What PE finding is always present?
Calcium carbonate crystals in the semicircular canal Positional nystagmus
49
How can BPPV Sxs be reproduced? How is it managed/Tx?
Dix-Hallpike Test, AKA Barany Maneuver Epley reposition maneuver Meclizine, Valium, Scopolomine patch
50
Cervical vertigo is AKA ? This form usually develops when?
Cervical Proprioceptive Dysfunction- causes vertigo w/ certain head positions Head injury w/ hyperextension or DJD of cervical spine
51
How is Cervical Vertigo Tx?
PT- neck exercises Neck collar Muscle relaxer
52
# Define Vestibular Vertigo How is it Tx?
Episodic vertigo temporarily related to HA similar to Meniere's Dz Migraine Tx/prophylaxis Diet Anti-emetics
53
Central vertigo is due to lesions located ? How does it present and what is different?
Cerebellum, Pons Slow onset of Ataxia, Vertigo, Nystagmus w/ little/no change w/ head movement
54
Central disorders are often associated w/ what other adverse things? How are central d/os disequilibrium based on location?
Hemorrhage/Ischemia in cerebellum, vestibular nuclei, brain stem Cerebllum= incoordination Basal ganglia= impaired posture reflexes Sensory tract/receptors= impaired proprioception
55
What can cause acute central vertigo? What can cause chronic central vertigo?
Infarct, AVM, Tumor MS, ETOH, Hypothyroid, Genetics
56
What are 6 common causes of central vertigo?
``` Vertebrobasilar ischemia Vertebrobasilar TIA/Stroke Acoustic neuroma Toxic vestibulopathies MS Vestibulocerebellum neurodegenerative conditions ```
57
When does a Dx of Vertebrobasilar ischemia need to be considered? What is the vertigo usually accompanied by
Older PT w/ isolated and new onset vertigo w/out obvious cause Diplopia, Dysarthria, Ataxia, Numbness
58
Vertebrobasilar TIA/Stroke is usually caused by an infarct in ? branch of the ? What is a common cause of this?
Medial branch of PICA DM
59
When working up a Vertebrobasilar TIA/Stroke, what needs to be rule out? What is the preferred imaging modality for this?
Anemia, Pregnancy, Glucose derangement MRI but usually after a CT
60
How is a Vertebrobasilar TIA from central cause, Wernickes and MS handled?
Central- referral to surgery Wernicke's- Thiamine replacement MS flare- prednisone
61
# Define Acoustic Neruoma What S/Sxs does it present with?
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
What tumor accounts for 80% of all cerebellopontine angle tumors Commonly found on CN8, where else can it be found?
Acoustic neruoma CN5 and CN7
63
What is the pathology of Acoustic Neuromas? What PT population are these usually found in?
Spindle cells from palisades called Verocay Bodies Middle aged female
64
What image modality is used to search for Acoustic Neuromas? How are they Tx?
MRI w/ contrast If <3cm- removal w/ stereotactic radio surgery
65
What are 4 substances that can cause toxic vestibulopathies?
Gentamycin Salicylates Quinine Cis-Platium
66
How is Cerebellar Ataxia Dx? What PT position is a must and what two movements are essential?
Finger to Nose test Sitting up Pronation and supination w/ encouragement to go faster
67
What test is done to test the position sense? Balance is maintained by what 3 factors?
Romberg- since it takes 2 of the 3 systems for balance, closing eyes limits balance to 1 system Visual, Proprioception, Vestibular
68
# Define Seizure Define Epilepsy
D/o characterized by excessive/over synchronized discharges of cerebral neurons Group of d/os characterized by recurrent seizures
69
A seizure is defined by ? and whether or not it ? Define Ictus
Part of brain involved Affects consciousness or not Seizure
70
# Define Convulsion Define provoked seizure
Seizure caused by abnormal muscle contraction Seizure occuring in otherwise normal brain from alteration of Glucose, Na or Drugs
71
# Define Status Epilepticus What types of conditions have a high likelihood of resulting in chronic seizures?
Continuous/recurring seizures without return of normal consciousness Penetrating head wounds Blasts
72
What are the 2 key features of seizure d/os? What are the 3 etiologies of seizure disorders?
Aura and Postical confusional state CNS dysfunction, Underlying systemic dz Drug induced
73
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 ?
30mg 120meq
74
What are two hyperosmolar states that can lead to seizures? When Ca levels are below ? the chance of seizures are increased
Non-ketotic hyperglycemia Hypernatremia <9.2
75
What use does an EEG have in a seizure work up? EEG must be done under what conditions?
Confirms if pos, does not rule out if neg Physiological stress/sleep deprivation
76
Imaging is a must for initial seizures, which modality is preferred? Why is the second modality ordered?
MRI In the ER- non contrast CT R/o infection, mass and bleeds
77
How to tell between a focal or a generalized seizure has occurred?
Focal- one hemisphere, consciousness is preserved Generalized- both hemispheres, consciousness is lost
78
What are the 4 types of generalized seizures? How are focal seizures further broken down?
Myloclonic/Minor motor Absence Tonic-Clonic Atonic W/ or w/out dyscognitive features
79
Define Absence Seizure
Petit Mal, short periods of staring/zoning out usually in kids
80
Define Focal Seizure w/out Dyscognitive features
No LoC | Abnormal sensation- aura, smell, clonic movement
81
Define Focal Seizure w/ Dyscognitive features
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
Define Tonic Clonic Seizure
Grand mal seizure | PT falls to ground and jerks, loses awareness and possibly loses bowel/bladder function
83
What are the 3 phases of a Tonic Clonic seizure and what happens during each phase
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
Define Myoclonic seizure
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
Normal seizure threshold is at ? PTs w/ epilepsy have a threshold at ?
- 55 mV | - 60 mV
86
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?
3-18mon Antiepileptic meds
87
A side effect of antiepileptic meds is that all anti-convulsants can lead to ? or ? What monitoring is needed for PTs on these drugs?
Hematologic or Hepatic toxicity CBC, LFTs @ 2wks, 1mon, 3mon, 6mon and Q6mon
88
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?
New rash from Stevens-Johnson Syndrome Carbamazepine Phenytoin Valproic acid
89
What drug can be used in absence seizures? What are the Tx options for Focal Seizures?
Valproic acid Ethosuximide- may cause marrow suppression ``` First: Lamotrigine Carbamazepine Oxcarbazepine Phenytoin Levetiracetam ``` Second: Valproic acid Topiramate Gabapentin
90
What meds are used in Generalized Tonic-Clonic serizures?
First: Lamotrigine Valproic acid ``` Second: Carbamazepine Phenytoin Topiramate Zonisamide Oxcarbazepine ```
91
# Define Status Epilepticus What 3 issues can develop?
Continuous seizure lasting 5min or more Cardiorespiratory dysfunction, hyperthermia, metabolic derangement
92
What are common causes of Status Epilepticus?
``` Anti-convulsant withdrawal Metabolic- hypoglycemia Drug toxicity CNS infection/tumor Refractory epilepsy Head trauma ```
93
What is the medical therapy for Status Epilepticus? If a first drug achieves partial control, but recurrent seizures continue, what is the next step?
1st= Lorazepam/Diazepam Phenytoin w/ ECG No anesthesia, use Midazolam, Propofol or Ketamine Topiramate Zonisamide Lacosamide Tigabine
94
Confusion can be branched out into what 3 issues? A mini mental status exam can be done and test what things?
Derlirium Dementia Amnestic d/o LoC, Orientation, Speech/Language, Memory
95
What score on a mini mental status exam is concerning? Define Global Aphasia
Max of 30, 23 or less is concerning
96
Stopped at `41:24
Lect 2

IPAP (212 decks)

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