NeuroDz 2 Flashcards
MC degenerative dz of motor neuron system
ALS
amyotrophy
atrophy of muscle fibers
lateral sclerosis
changes in lateral columns of spinal cord as UMN axons degenerate and are replaced by scarring
risk factor for ALS
smoking
epidemiology of ALS
can begin young, highest risk 75-80
caucasians, M/F almost equal
ALS affects ____ neurons at _____ levels of the ____ network supplying _____ regions of the body
ALS affects motor neurons at 2+ levels of the motor neuron network supplying multiple regions of the body
neuron systems ALS affects (3 different areas affected)
- LMN
- corticospinal UMN
- prefrontal motor neurons
ALS effect on LMN
progressive weakness, wasting
loss of reflexes/muscle tone
ALS effect on corticospinal UMN
precentral gyrus
brisk reflexes and spasticity in upper
ALS and prefrontal motor neurons
plan and orchestrate UMN and LMNs
results in cognitive impairment
areas NOT affected by ALS
Sphincter control
EOMS
sensory function
clinical picture of ALS
insidious loss of function or slowly progressive painless weakness in 1+ region of body
w/o sensation change and w/o another cause
emotional and cognitive changes in ALS
involuntary laughing/crying
loss of executive function
behavioral changes
if LE involvement ALS clinical
slapping gait
tripping/stumbling w/running or walking
foot drop
if UE involved, ALS clinical pic
difficulties with FINE more tasks (buttons, keys)
atrophy of hand muscles
natural history of ALS
fatal, survival 3 yrs from time of apparent muscle weakness
ALS tx
supportive, multimodal
muscle spasms can be tx with antispasticity agents
riluzole/Rilutek
riluzole brand + indication
Rilutek
prolongs tracheostomy in ALS pts by 2-3 months
supportive care ALS
assisted respirations
PEG tube
CRPS is characterized by
pain, swelling, vasomotor dysfunction of extremity
pain is constant and disproportionate to injury
CRPS epidemiology
MC b/t 30-60yrs
no racial, gender differences
inciting effects of CRPS
trauma (penetrating or non penetrating)
surgery (carpal tunnel release, dentistry)
systemic illness (MI, CVA, pan coasts tumor)
local disease (tissue ischemia)
spontaneous
stages of CRPS
acute
subacute
chronic
acute CRPS
3 mo
burning pain that limits function of extremity
swelling (cool to tough, limits movement)
demineralization (due to disuse)
subacute CRPS
persistent severe pain and fixed edema
skin is cyanotic, blue, pale, dry
loss of function due to increased pain and fibrosis of the joints (chronic inflammation_
chronic CRPS
1 yr after onset
pain is more variable
edema subsides over time, leaving fibrosis of the joint
loss of function and stiffness
tx options for CRPS
prednisone
NSAIDS
synthetic blockage
IV Calcitonin
prednisone CRPS
daily taper (2-4 wks) improves mobility, pain, and stiffness
best in acute/subacute stage
Sympathetic blockade CRPS
lidocaine or bupivacaine +/- epi
blocks nerve impulse and allows movement of the extremity to prevent chronic fibrosis and inflammation
peripheral neuropathy
disorders that affect peripheral nerves, MC hands/feet/lower legs
cause pain, numbness, tingling, burning, weakness
etiologies of peripheral neuropathy
- vitamine deficiencies
- causative meds
- comorbitidies
- diabetes
diabetes peripheral neuropathy types
painful DM (LE painful to touch)
distal symmetric (stocking glove)
autonomic neuropathy (gastroparesis, urinary retention, ED, orthostatic HoTN)
isolated neuropathy (one area, Motor> sensory)
comorbidies that cause peripheral neuropathy
alcohol intake
celiac dz
CKD, HIV, amyloidosis
medications that cause peripheral neuropathy
chemo drugs
abx (metronidazole, fluorquinalones, isoniazid)
statins
phenytoin
peripheral neuropathy study of choice
EMG/NCS
mc inherited neuro disorder of neuropathy without metabolic cause
CMT
natural hx of CMT
first 20 yrs = tripping over feet, freq. falls, clumsiness
foot drop and stoppage gait
distal weakness, difficulty with motor tasks
s/s of CMT
wasting of muscles of legs (stork legs)
pes cavus, loss of DTRs, gait ataxia
pain/temp sensations intact
