Neuro- GBS, MG, Critical Illness polyneuropathy, PD

Question 1

What is Guillian Barre Syndrome

Answer 1

GBS: The clinical syndrome is classically characterized by ascending weakness, distal paresthesias, and areflexia.

Classically, GBS follows a viral infection, vaccination, or surgery, but in many instances, no prodrome is identified.

Question 2

GBS path:

Answer 2

GBS results from an attack of peripheral myelin or axons mediated by autoantibodies originally generated in response to an infection that typically precedes the onset of neuropathy symptoms by days to weeks. These antibodies cross-react with the myelin or nodal axolemma antigens via molecular mimicry.

Question 3

GBS presentations

Answer 3

progressive, symmetric ascending paralysis.

hypoactive or absent reflexes

Sensory symptoms, such as paresthesias(tingling) in the hands and feet, are often present,

Pain in the back, hips, and thighs

Question 4

Diagnostic tests for GBS

Answer 4

Lumbar puncture

Question 5

The CSF protein in GBS is usually

Answer 5

elevated

Question 6

GBS treatment

Answer 6

Plasma exchange (PLEX) and IV immunoglobulin (IVIG)

Question 7

What’ is Myasthenia Gravis?

Answer 7

an autoimmune disorder that involves antibody- mediated postsynaptic dysfunction of the neuromuscular junction of skeletal muscle resulting in fatigable weakness

Question 8

Myasthenia gravis presentation:

Answer 8

• fluctuating weakness that is worse after exercise or prolonged activity and improves with rest.

Presenting signs include ptosis, diplopia (double vision), dysarthria, dysphagia (difficulty swallowing), extremity weakness, and respiratory difficulty.

Question 9

Diagnostics for MG

Answer 9

Serum AChR binding antibodies are detected in 85%–90%

MuSK antibodies are detected in about 30%–70% of AChR antibody– negative MG patients.

Chest CT is indicated to screen for a thymoma.

Question 10

Treatment for MG

Answer 10

Plasmapheresis and IVIG are both used to treat MG

Pyridostigmine should be started at 30–60 mg PO tid–qid and titrated for symptom relief.

Question 11

What is Parkinson’s disease

Answer 11

a chronic, progressive neurodegenerative disease characterized by at least two of three cardinal features: resting tremor, bradykinesia, and rigidity.

Question 12

presentation of Parkinson’s disease

Answer 12

resting pill rolling tremor (3–7 Hz) that is often asymmetric.

Bradykinesia is characterized by generalized slowness of movement, especially in finger movement dexterity and gait (often shuffling).

Cogwheel rigidity

Question 13

Diagnostic testing for Parkinsons disease

Answer 13

MRI Brain

Question 14

first line treatment for parkinsons disease

Answer 14

Carbidopa–levodopa

Dopamine agonists (pramipexole, ropinirole) can be used as monotherapy or in combination with other PD medications.

Question 15

Second line treatment for parkinsons disease

Answer 15

Amantadine and catechol-O-methyl transferase inhibitors

Question 16

Third line treatment for parkinsons disease

Answer 16

Deep brain stimulation and Duodopa (intestinal infusion of carbidopa/levodopa gel) have benefit in PD patients who progress to develop motor fluctuations and dyskinesias unresponsive to oral medications.

Question 17

The sudden withdrawal of levodopa or dopamine agonists and following exposure to neuroleptics or other antidopaminergic drugs can cause

Answer 17

neuroleptic malignant syndrome (NMS)

Question 18

Serotonin syndrome can occur when monoamine oxidase inhibitors (MAOIs) are combined with

Answer 18

TCAs or SSRIs.

Question 19

Critical Illness Polyneuropathy

Answer 19

is the acute or subacute onset of extensive symmetric weakness in critical ill patients , usually with sepsis, respiratory failure, multisystem organ failure, or septic inflammatory response syndrome (SIRS).

Question 20

Critical illness polyneuropathy presentation

Answer 20

distal extremity weakness, wasting, and sensory loss, as well as paresthesia and decreased or absent deep tendon reflexes

Question 21

Gold standard for the diagnosis of critical illness neuropathy

Answer 21

nerve conduction studies and needle electromyography.

EMG is the best way to of making a diagnosis of CIP