Neuro Potpourri

Question 1

Guillan-Barre syndrome is an acute idiopathic ______________ condition that sometimes follows acute infection such as GI, ______________, jejuni, _______________ or ____________. Clinical manifestations are ________________ that ascends bilaterally but usually beginning in the _______________ but may also involve arms, face. It may affect muscles of respiration and swallowing. Autonomic symptoms may occur and can be life threatening.

Answer 1

polyneuropathy
campylobacter
immunization
surgery
weakness
legs

Question 2

In guillan barre, these symptoms begin in the lower extremities and ascends bilaterally
1.
2.
3.
progressing to paralysis

Answer 2

1. weakness
2. ataxia
3. bilateral paresthesia

Question 3

In Guillain-Barre syndrome, the _____________ reveals high level of protein HOWEVER these changes may not develop for ____________. _______________ studies reveals changes.

In terms of treatment, _____________ and ______________ are the mainstays. Corticosteroids may prolong recovery time. Supportive treatment, including intubation for respiratory complications.

Answer 3

CSF
2-3 weeks
EEG
plasmapheresis
IVIG

Question 4

Myasthenia gravis is a chronic autoimmune _______________ disease. It is characterized by varying degrees of ___________________. These patients have weakness all over. They will be fine in the morning and as the day progresses it gets worse. Age of onset in females tends to be 20’s-30’s while for males it is 70-80s with _____________ most affected.

Answer 4

neuromuscular
weakness of skeletal muscles
males

Question 5

Myasthenia gravis is caused by defective ______________________. ________________ is the neurotransmitter involved.

Answer 5

neuromuscular transmission
Ach

Question 6

What are the changes involved in myasthenia gravis?
As a result of these changes, ach is reduced. The effect is greatly reduced or blocked stimulation of ________________. The ______________ gland plays a role in MG.Lymphoid hyperplasia allows interaction of B cells with helper T cells to form antibodies

Answer 6

antibodies block or destroy ach receptors on the muscle end-plate . In MG, the post synpatic membrane loses its normal convoluted shape. The number of ach receptors is reduced

nerve contraction.

Thymus

Question 7

What are the classic symptoms of myasthenia gravis?
_________ is a common symptom. This becomes more severe as the day progresses. Rest will temporarily improve muscle weakness

Answer 7

ptosis, diplopia, dysphagia, dysarthria

muscle weakness

Question 8

In myasthenia gravis, ___________________ is used to detect ach receptor antibodies. _________________ is the most sensitive test of neuromuscular transmission. Positive finding in MG is increased ________________. Test is abnormal in nearly all patients with MG

Answer 8

antibody testing
single fiber EMG
jitter

Question 9

The average patient with myasthenia gravis is on ________________ which impairs the degradation of Ach. Prednisone often provides rapid improvement of symptoms. A _____________ is an absolute indication

Answer 9

anticholinesterase drugs (Mestinon).
thymoma

Question 10

Amytrophic lateral sclerosis (ALS) is a progressive and degenerative motor neuron disease that involves both _______________ and ______________. The incidence is higher in _________. Onset is from teens to 8th decade. Earlier diagnosis is likely to lead to long term survival.

Answer 10

upper and lower motor neurons.
men

Question 11

In ALS, what are the upper and lower motor neuron signs?

Answer 11

upper: increased tone, hyperactive reflexes, positive babinski
lower: weakness, decreased tone, fasciculations, areflexia

Question 12

What are the treatment options for ALS

Answer 12

1. Rilouzole
   reduces neuronal damage by decreasing glutamate levels
2. Endaravone
   anti-oxidant properties which reduces presence of free radicals

Question 13

Bell’s palsy is a sudden onset of facial paresis caused by ________________________________. It is idiopathic however it has been theorized to be caused by reactivation of ______________ or _____________. It is more common in patients with ______________ and in _____________.

Answer 13

inflammatory response involving the facial nerve
HSV1 Varicella
DM
Pregnancy

Question 14

Signs and Symptoms of Bells Palsy:
1.
2.
3.
4.
5.
6.
7.
8.

Answer 14

1. abrupt facial paralysis that gradually worsens
2. ear pain on affected side
   3.numbness sensation
3. difficulty eating
4. excessive tearing
5. difficulty closing ipsilateral eye
6. poor facial movements
7. inability to wrinkle brow

Question 15

In bells palsy, there is ______________ and _______________

In stroke there is just ____________ present. It is forehead sparing.

Answer 15

forehead, lip droop
lip droop

Question 16

In patients with bell’s palsy, labs/diagnostic imaging are not necessary for diagnosis unless clinical suspicion of an underlying cause. ______________ do have an impact: 2 week taper.

Answer 16

steroids

Question 17

Peripheral neuropathies can be subdivided into
1.
2.

Answer 17

1. mononeuropathies
2. polyneuropathies

Question 18

Mononeropathies result from injury to the nerve along its course or by ____________, _________________ or _______________ of the nerve.

Entrapment neuropathies occur when the nerve course passes through ______________________.

Answer 18

compression, angulation, stretching

a narrow anatomical space

Question 19

What is radial nerve palsy?

Answer 19

compression of the radial nerve in the spiral groove of the humerus. This is self resolving

Question 20

What is CTS?

Answer 20

compression of the median nerve. pain, burning, tingling in the medial nerve distribution

Question 21

Atrophy to the thenar eminence can occur later. The risk factors include
1.
2.
3.
4.
5.

Diagnosis is clinical with support from ______________ and ______________.

Treatment includes splinting, NSAIDs, corticosteroid injections, surgery

Answer 21

1. repetitive motions of hands
2. pregnancy
3. DM
4. RA
5. hyperparathyroidism

EMG, NCT

Question 22

What do polyneuropathies lead to?

May be broadly classified as hereditary, metabolic(most common) or toxic

Answer 22

symmetric sensory, motor, mixed deficit.

Question 23

_______________ is an autosomal dominant inheritance and is the most commonly inherited peripheral neuropathy.

These patients often present with
1.
2.
in early childhood or early adulthood. This progresses to _________________ and _______________

Answer 23

Charcot-marie-tooth

1. foot deformities- hammer toes, high arch
2. gait disturbance

distal weakness and sensory loss.

Question 24

Diabetic neuropathy commonly occurs in a ______________ distribution.

What are the positive and negative symptoms?

Answer 24

stocking- glove

positive: persistent burning or dull pain, paroxysmal electric shock type of stabbing, painful paresthesias, evoked pain

negative: numbness, hypoalgesia, hypoaesthesia, anaesthesia

Question 25

Toxic neuropathies may result from exposure to various agents, including ____________, heavy metals, certain drugs (phenytoin, isoniazid, nitrofurantoin)

Answer 25

organophosphates

Question 26

What are some pharm treatments for neuropathy?

Answer 26

NSAIDs, antidepressants, anti-epileptics(neurontin, lyrica, carbamazepine), opioids in severe pain.