👩🏾🎓- Neuro, HIV, Immunity Test Flashcards
Autonomic NS
Regulates involuntary body functions
Further broken down into sympathetic and parasympathetic NS
Monro-kellie doctrine of hypothesis
Brain tissue, blood and CSF occupy the skull, when one increases the other components must decrease to maintain equilibrium
Sympathetic NS
Fight or flight
- Elevates ❤️ rate
- Increased respiratory rate, dilates pupils, shunts blood to the skeletal muscles and skin
- slows digestion
Parasympathetic NS
- slows ❤️ rate
- lowers BP, decreases respirations, shunts blood from the periphery to internal organs
- constricts pupils and digest food
Rest and digest
Myasthenia gravis
Epidemiology, causes, triggers
Epidemiology- motor disorder characterized by fluctuating, localized skeletal muscle weakness and fatigue
Causes- may have familial link, thymus gland abnormalities, hyperthyroidism link, drug induced
Triggers- medications, alcohol, stress, infection, heat, surgery, cathartics
Myasthenia gravis key features
- progressive proximal muscle weakness
- weakness improves with rest
- occulAr changes (ptosis, diplopia, incomplete eye closure)
- poor posture
- respiratory compromise
- loss of bowel/bladder control
Bulbar symptoms
Clinical manifestation of myasthenia gravis
Symptoms involving cranial nerves that emerge from the medulla of the brain stem
CN IX, X, XI, XII
Results in difficulty with phonation, chewing and swallowing
Cranial nerves IX X XI XII
IX glossopharyngeal - controls some muscles used in swallowing and taste
X vagus- sensory, motor and autonomic functions of viscera (glands, digestion, heart rate)
XI spinal accessory- controls muscles used in head movement
XII hypoglossal- controls muscles of tongue
Repetitive nerve stimulation
Evaluates neuromuscular transmission & measures action potential after repeated nerve stimulations
In MG decreased muscle response with repetitive stimulation
Name two medications contraindicated in MG patients
Magnesium and CA channel blockers
Cholinesterase inhibitors (anticholinesterase)
Tensilon
Prostigmin (IV)
Mestinon (oral)
How do you administer meds for patients with MG
Give medications on time
Provide food 1 hour AFTER meds
Myasthenia crisis vs cholinergic crisis
Myasthenia crisis
Not enough Ach. Presents as ⬆️❤️ rate, flaccid muscles, pale/cool skin. Treat by administering cholinesterase inhibitors
Cholinergic crisis
Too much Ach causes muscle fatigue. Presents as ⬇️❤️ rate, fasciculations, sweating, pallor, excessive secretions, small pupils. Treat by holding cholinesterase inhibitors and give anticholinergics
Tensilon rest results
Muscle strength improvement = myasthenia crisis
Fasciculations & weakness = cholinergic crisis
Causes of Guillain-Barré syndrome
Campylobacter jejuni is most frequent cause
Cytomegalovirus , Epstein-Barr virus , mycoplasma pneumonia and haemophilus influenzae
Paroxysmal
Sudden recurrence of intensification or symptoms
Tic douloureux
Risk factors, triggers, management
Trigeminal neuralgia
Pain in the distribution of the trigeminal Nerve
Risk factors- increased BP and MS
Triggers- touching an area of skin or brushing the teeth, drinking a beverage, smiling, talking, cool air
Management- gabapentin, carbamazepine, antiepileptic drugs
baclofen in patients with MS acts as a muscle relaxant
Spondylolysis bs spondylolisthesis
Spondylolysis- structural abnormality of vertebral facet
Spondylolisthesis- proximal vertebrae slides forward
Radiculopathy
Acute nerve root compression
Herniated nucleus pulposus
Pathophysiology, complications, surgical management
Pathophysiology- weakening of or a tear in the annulus fibrosus. Radiculopathy
Complications- numbness/weakness, loss of bowel and bladder control, saddle anesthesia
Surgical management- laminotomy, microdisectomy, spinal fusion, bone graft, artificial disk replacement
Multiple sclerosis
Pathophysiology, manifestations
Pathophysiology- immune system attacks the brain and spinal cord
Manifestations- numbness or weakness in limbs, partial or complete vision loss, tingling or pain, tremor, lack of coordination, unsteady gait, fatigue and dizziness
MS key features
- muscle weakness and spams
- fatigue
- dysmetria
- ataxia
- hypgesia
- dysarthria
- scotomas
- vertigo
- tinnitus & heading loss
- sexual dysfunction
- cognitive changes (late)
Define the following terms
Hypalgesia, dysmetria, dysarthria, scotomas
Hypalgesia- decreased sensitivity to painful stimuli
Dysmetria- inability to judge distance or scale
Dysarthria- difficulty speaking
Scotomas- partial loss of vision or a blind spot
Multiple sclerosis
Triggers, complications
Triggers- extreme temperatures, overexertion, stress, humidity, infections
Complications- muscle stiffness or spasms, paralysis often in the legs, problems with bladder/bowel/sexual dysfunction, mental status changes (memory loss, problems concentrating) depressions, seizures
Amyotrophic lateral sclerosis
Pathophysiology, manifestations
Pathophysiology- affects voluntary muscle control. Progressive degenerative disease of motor neurons in the brain and body
Manifestations- muscle cramp or stiffness, muscle weakness, slurred speech and difficulty swallowing
Upper motor vs lower motor neuron
Upper motor neuron - damage associated with spasticity. The nerves within the cord that carry messages from the brain to the spinal nerves
Lower motor neuron - damage associated with flaccidity. Spinal nerves that branch out from the spinal cord to specific areas of the body
What does the phrenic Nerve innervate
The diaphragm
Anterior cord syndrome
Kept/lost
Kept- touch, position, vibration
Lost- motor, pain, temp
Posterior cord lesion
Kept/lost
Kept- motor
Lost- vibration, touch, position
Central cord syndrome (most common)
Kept/lost
Kept- position, vibration, touch (variable)
Lost- motor function (loss is more extensive in upper extremities)
Brown sequard syndrome
Ipsi/contra-lateral
Occurs when one lateral half of spinal cord is affected
Lost ipsilateral- motor, position, vibration, deep touch
Lost contralateral- pain, temperature, light touch
Ipsilateral vs contralateral
Ipsilateral- on the same side as the injury
Contralateral- on the opposite side of the injury
Cervical, thoracic, lumbar SCI
Cervical- inability to breathe and quadriplegia
Thoracic- paraplegia
Lumbar- decreased control of legs, bowel/bladder function and sexual function
Positive vs negative inotropes
Used in sci
Positive- strengthen the force of the ❤️ beat
Negative- weaken the force of the ❤️ beat