neuro pt 3 Flashcards
multiple sclerosis
autoimmune disease of the CNS
demyelination, chronic inflammation, gliosis, neuronal loss
MS s/s
abrupt or insidious onset
sensory symptoms, optic neurosis, extremity weakness, facial weakness, spasticity, visual changes, ataxia, vertigo
bowel/bladder dysfunction, heat sensitivity, mood alterations, fatigue
MS clinical types
relapsing - 90%, discrete attacks but improvement btw attacks
secondary progressive - discrete attack, evolves into progressive course
primary-progressive - gradually progressive symptoms
MS diagnosis
2 or more relapses (dissemination in time) & MRI brain/spinal cord w contract evidence of damage in 2 CNS regions (dissemination in space)
LP often performed to R/O other cause - Oligoclonal bands indicate CNS inflammation
labs, expert neuro exam
MS flare tx
R/O concurrent illness
glucocorticoids - methylprednisolone & prednisone
plasma exchange
DMARDS
injectibles
oral meds
symptom mgmt
guillan-barre
autoimmune polyradiculoneuropathy provoked by infection, inoculation, or surgery
guillan-barre s/s
ascending, symmetric motor paralysis with or without sensory changes
loss of DTRs
progresses over hours to days
respiratory dysfunction, speech dysfunction, dysphagia, bowel/bladder dysfunction, autonomic dysfunction
guillan-barre diagnostics
descriptive diagnosis
Brighton criteria
CSF - high protein concentration with normal cell content
nerve conduction studies and needle electromyography
nerve biopsy
spirometry to determine need for hospitalization
guillan-barre treatment
NO steroids!!!!
IVIG x 5 days
plasmapheresis
admit all
monitor respiratory & autonomic status
neuro c/s
myasthenia gravis
chronic autoimmune muscle disorder of the postsynaptic membrane in skeletal muscle
weakness and fatigueability of skeletal muscles
myasthenia gravis s/s
muscle fatigue - worse w activity and improves w rest, better in morning
fluctuating skeletal muscle weakness
ocular ptosis
respiratory weakness
complications: thyme abnormalities, hyperthyrodism, respiratory impairment
myasthenia gravis diagnostics
ice pack test
serum acetylcholine receptor antibodies
electrophysiology/EMG studies
anticholinesterase test
20/30/40 rule
assess for ventilation need in guillan-barre and myasthenia gravis if:
vital capacity <20
maximal inspiratory pressure >-30
OR maximal expiratory pressure <40
myasthenia gravis treatment
pyridostigmine
steroids
thymectomy
PLEX or IVIG
intubation if needed
amyotrophic lateral sclerosis & presentation
upper and lower motor neuron degeneration leading to. muscle weakness, disability, and death
asymmetric limb weakness is most common presentation
cognitive, sensory, and bowel/bladder function maintained until late-stage
