Neuro Lecture 2 Flashcards
What cells support the CNS?
Oligodendrocytes
astrocytes
What cells support the PNS?
Schwann cells
Ganglionic satellite cells
Damage to the peripheral neurons and their supporting structures
Peripheral neuropathies
What are the four main patterns of peripheral neuropathies?
Mononeuropathy
Mononeuritis multiplex
Polyneuropathy
autonomic neuropathy
Affects isolated nerves but they are in single places.
Mononeuritis multiplex
Most common causes of a mononeuropathy (4)
compression
ischemia
infection
inflammation
Why are peripheral nerves often affected?
tiny artieries supplying area
far away from cell body
Most common causes of mononeuritis multiplex?
Diabetes
vasculitis
immune-medicated dseases
Infection
What is a symmetric or contiguous multifocal neuropathy, usually starting distally?
Polyneuropathy
Most common causes of polyneuropathy?
DM
other metabolic/ toxic disturbances
demyelination
infection
A type of polyneuropathy, affecting the autonomic nervous system.
Autnonomic neuropathy
What are some manifestations of autonomic neuropathy?
bladder incontinence, urine retention
GI symptoms
disturbances of heart rate
How does diabetes mellitus cause peripheral neuropathy?
DM affects the blood supply and has toxic effects
List 3 other conditions besides diabetes mellitus for peripheral neuropathy.
Hypothyroidism
Tobacco use
Systemic lupus erythematosis
Too much ____ can cause peripheral neuropathy.
Vitamin B6
__________ cause permanent peripheral neuropathies.
Fluoroquinolones
What are some other not as common diseases that cause neuropathy.
Shingles HIV Lyme disease Leprosy Lightning strikes
What are some treatments for peripheral neuropathy?
Tricyclic antidepressatns SNRIs Gabapentin/ Pregabalin/ Valproate Cannabinoids Opiates (will turn off sensation, not 1st choice) TENS
Carpal tunnel syndrome is a ________ mononeuropathy.
Entrapment
CTS results in Intermittent numbness & paræsthesias of the _______________
1st, 2nd, 3rd and radial half of the 4th digit of an upper extremity.
What can chronic CTS lead to?
Permanent nerve damage and denervation and atrophy of the thenar muscles
Can light repetitive tasks cause CTS?
No
What is first line treatment of CTS?
Put an arm in a splint at night so they are extended
What is the hand elevation test?
Raise hands above head for at least 30 seconds
What meds can be used for CTS?
NSAIDs
steroids (oral, phonopharesis, injected)
What is done surgically for curing CTS?
Surgical release of the transverse carpal ligament
What will you be at risk for after having a transverse carpal ligament?
Trigger thumb
Who is more likely to have CTS?
Women
>30 years old
What nerve does cubital tunnel syndrome affect?
Ulnar nerve
Will fell in 5th finger and ulnar part of 4th
What is believed to cause Bells palsy?
Inflammation
Where will you lose taste with Bells Palsy?
anterior 2/3 of the tongue
For Bells Palsy if the insidious onset (>2 weeks) or forehead sparing what do you need to get?
A MRI
How do you treat Bell Palsy?
Mild- don’t do anything
Prednisone effective when started early
Acyclovir may be effect if caused by herpes virus
What do you need to protect with Bell palsy?
The eye
Lubricating eye drops and ointments
How long does it take to improve with bell palsy?
Usually improve within 2 weeks
Full recovery usually within 3-6 months
Who are more likely to have Bell Palsy?
Pregnant women
Diabetics
Peripheral neuropathy that ascends, rapid onset, autoimmune disorder.
Guillain-Barre syndrome
What will a demylinating disease look like on CSF?
Ton of protein in CSF but not many cells.
Guillian-Barre is immune response to foreign antigens, creating antibodies to
gangliosides
What will be absent with Guillian Barre?
DTRs
No fever
What will NCS show with Guillain-Barre
Prolonged distal latencies
Will the CBC show increased WBCs in Guillain Barre?
No
How do you treat Guillain Barre?
Plasmapharesis and/or IV immunoglobulins
breathing support
physical rehabilitation
When does recovery usually start with Guillain-Barre?
After the 4th week.
80% of peoplw ill recover from Guillain-Barre within how long?
A year
Autoimmune neuromuscular disease causing intermittent/fluctuating weakness and fatiguability.
Myasthenia gravis
What muscles are most commonly affected with myasthenia gravis?
Extraocular
Facial
Mastication
Pharyngeal muscles
When does a myasthenic crisis occur?
Respiratory muscles are affected
What will a person with MG look like on physical exam?
Ptosis
Opthalmoplegia/ nystagmus
Fatigability with upward gaze/ blinking
Slowed speech with counting
MG is usually caused by autoimmune antibodies against the ____________, but can also be caused by antibodies againt _________/
nicotinic acetylcholine receptors,
muscle-specific kinase (MuSK)
10% of patient with MG will have a _____
thymoma; will be cured with removal of the thymus
How do you treat MG?
AchE inhibitor (neostigmine, pyridostigmine) and an immunosuppressant drugs
What can be used in severe cases MG?
Plasmaphoresis and IVIG
What is the prognosis for MG?
Usually a lifelong problem
No progressive though
some patients see improvement in 3-5 years
WHat are 5 lifestyle things that can cause secondary headaches?
dehydration Poor nutrition Sleep deprivation Lack of Exercise Stress
What is the most common primary headache?
Tension-type headache
When do tension-type headache peak?
40s
What usually precipitates tension-type headaches?
Stress or hunger
Where do tension-type headaches occur?
Occipital, frontal, or both
Are muscle relaxants helpful with tension type headaches?
No
What do you use to treat tensin-type headaches?
OTC pain medications
Triptans can be helpful
Can you use opiates to treat tension-type headaches?
No
What antidepressants can be helpful in tension-type headahces?
Tricyclic/ tetracyclic antidepressants
as well as SNRIs and anticonvulsants
What are repeated episodes of excruciatingly severe unilateral headache lasting 15 minutes to 3 hours?
Cluster headache
What is pain accompanied with in cluster headaches?
Ipsiltareal ptosis, miois, conjunctival injection, lacrimation and rhinorrhea
Sometimes facial flushing, edema, or diaphoresis
What may trigger a cluster headahce?
Smoking
ETOH use and nitrates
During a cluster headache attack what is seen on a PET scan?
Increase metabolic activity in the hypothalamus
How do you treat cluster headache?
High flow oxygen mask Triptans Melatonin Lithium Anticonvulsants
Who are more affected by cluster headaches?
men
blue or hazel eyes
rugged “lionized” facial features
heavy smokers/ drinkers
Unilateral, thrombbing pressure lasting 1 hour to 3 days.
Migraine headache
Before puberty, migraines are more common in ____
males
What are the autonomic synmptoms of a migraine?
pallor, sunken eyes
N/V
photophobia, phonophobia
lightheadedness, vertigo
LIst the 4 stages of migraine
Prodrome
Aura
Pain/headache phase
Postdrome (hours to days after)
What happens horu to days before a migraine. Indicated by a change in mood, crvaing for certain foods, pain, etc.
Prodrome
What is a classic migraine?
Migraine with aura
Is migrain aura typically black and white or colorful?
Black and white (seizure is coloful)
What occur during an aura?
Scintillating scotoma
Zigzagging lines
Numbness, tingling, pins and needles
Hemianopsia
Does a migraine necessarily include a headache?
No
Stage where patients feel aching where headache was. May feel tired europhoric.
Postdrome
What is likely the direct cause of pain with migraine?
Vasodilation (sense pain in stretch of blood vessels)
Migraine where you can’t move your eye
ophthalmoplegic migraine
migraine where you can’t move 1/2 your body
hemiplegic migraine
migraine where people have a change in mental status state
confusional migraine
What is a childhood periodic syndrome with abdominal pain with or without headhace?
Abdominal migraine
Bouts of severe nausea and vomiting that last for hours to days, alternating with symptom-free intervals. Each episode look identical from day to day.
Cyclic vomitting syndrome
What are some migraine triggers?
MSG, nitrites, aspartame
Aged cheeses (tyramine)
fluroescent lighting
ETOH (red wine), caffeine
What is the first set of medication preventitive therapies for migraines?
Beta-blockers
Calcium channel blockers
ACE inhibitors
What other therapies are there for migraines?
tricyclic antidepressants
SNRIs
some anticonvulsants (VPA/ TPM)
rTMS (repetitive transcranial magnetic stimulation)
What are some therapies that are vitamins that can prevent migraines?
Riboflavin (B2) Magnesium supplements (if levels were low)
What is a “natural” therapy that can reduce the frequency of migraines?
Coenzyme Q-10
rTMS
progesterone-based contraception can be helpful
What meds can used to help headaches but can also cause medication overuse therapies.
APAP and NSAIDs
2 meds that can help migraine but cause vasospams so shouldn’t be used in those with aura (or those with high stroke or CV risk)
Triptan and ergots
Are opiates used for migraine?
No
What double the rsk of ischemic stroke, even more in patients with stroke?
Migraine with aura
A deficiency in what vitamins can cause peripheral neuropathy?
B1, B12, A, E
What drugs can cause peripheral neuropathy?
Fluoroquinolones, phenytoin, vincristine, metronidazole, statins, isoniazid, nitrofurantoin, chemotherapy
What are the 2 childhood periodic syndrome migraines?
Abdominal migraine
Cyclic vomiting syndrome
