Neurologic Disease and Disorders Flashcards
What are the etiologies of a cerebrovascular accident (CVA) or stroke?
- (cerebral arethoma) fibrous atheromatous plaque occludes artery -> hypoxia
- (cerebral embolism) atrial fibrillation releases embolus, peripheral embolus, foreign body -> brain hypoxia
- (cerebral hemorrhage) aneurysm ruptures -> blood compresses local arteries
What are the clinical features of a cerebrovascular accident (or CVA)?
S/S:
- aphasia/dysphasia, confusion
- hemiparesis, dizziness, incoordination
- severe headache
- unequal pupils, diplopia
DIAGNOSTIC TESTS:
- MRI, CT, cerebral angriography, or EEG may be positive
What’s the treatment and prognosis for a cerebrovascular accident (CVA) or stroke?
TREATMENT:
- early aspirin or heparin
- cerebral angioplasty
- antiarrhythmic drugs
PROGNOSIS
- some permanent disability may remain
What are the etiologies of a transient ischemic attack (TIA)?
cholesterol emoblism, fibrin plaque embolism, aterial spasm, or minute blood clot -> temporary cerebral ischemia -> embolism broken down
What are the clinical features of a transient ischemic attack (TIA)?
S/S:
- aphasia/dysphasia, confusion
- hemiparesis, dizziness, loss of balance
- headache
- blurry vision, diplopia, unequal pupils
- lasts for <24 hrs
DIAGNOSTIC TESTS:
- MRI, CT, EEG. and carotid ultrasonography may show carotid embolus
What’s the treatment and prognosis for a transient ischemic attack (TIA)?
TREATMENT:
- aspirn, heparin
- possible cerebral angioplasty
PROGNOSIS:
- varies, but future CVAs may occur without lifestyle changes
What are the etiologies of an epidural and a subdural hematoma?
- (epidural) blunt force trauma -> ruptures blood vessels above dura mater
- (subdural) sudden acceleration or deceleration -> ruptures blood vessels between dura and arachnoid maters
What are the clinical features of an epidural hematoma and a subdural hematoma?
S/S:
- (epidural) drowsiness, possible coma, nausea, vomiting, hemiparesis, and headache within 3 hours
- (subdural) same as epidural, but delayed onset
DIAGNOSTIC TESTS:
- CT, MRI, and cerebral angiography may reveal hematoma
What’s the treatment and prognosis for an epidural hematoma and a subdural hematoma?
TREATMENT:
- craniotomy and/or trephination
PROGNOSIS:
- risk of brain hypoxia and death
What’s the etiology of a cerebral concussion?
direct blow to head -> shears neurons and interferes with membrane potential -> abnormal electrical
What are the clinical features of a cerebral concussion?
S/S:
- loss of consciousness with shallow breathing and slow pulse
- amnesia, irratbility, nausea, headache, diplopia, photophobia, irritability
DIAGNOSTIC TESTS:
- CT rules out contusion
What’s the treatment and prognosis of a cerebral concussion?
TREATMENT:
- quiet bed rest
PROGNOSIS:
- varies with insult
- risk of postconcussion syndrome
What’s the etiology of a cerebral contusion?
direct blow to head -> shearing force ruptures blood vessels
What are the clinical features of a cerebral contusion?
S/S:
- increasing drowsiness, irritability, hemiparesis, headache
DIAGNOSTIC TESTS:
- CT scan reveals hemorrhaging
What’s the treatment and prognosis of a cerebral contusion?
TREATMENT:
- craniotomy
PROGNOSIS:
- unpredictable
- complications of intellectual impairment, paralysis, and epilepsy
What are the etiologies of a depressed skull fracture?
ETIOLOGY:
1) direct blow to head -> depressed skull fracture (section pressing into brain)
What are the clinical features of a depressed skull fracture?
S/S:
- (unchanging) confusion, irritability, nausea, vomiting, hemiplegia, loss of balance, severe headache, visual disturbances
- battle sign, raccoon eyes, bleeding from ears, eyes, or nose
DIAGNOSTIC TESTS:
- cranial x-ray may reveal fracture
- CT may reveal cerebral edema
What’s the treatment and prognosis of a depressed skull fracture?
TREATMENT:
- craniotomy
PROGNOSIS:
- varies with insult, but best with prompt treatment
What are the etiologies of paraplegia and quadreplegia?
ETIOLOGY:
- (Paraplegia) vertical compression or hyperflexion of T1-L5 vertebrae
- (Quadriplegia) hyperflexion or hyperextension of C5-C7 vertebrae
What are the clinical features of paraplegia and quadriplegia?
S/S:
- (Paraplegia) paralysis and numbness below waist, loss of bowel/bladder/sexual function
- (Quadriplegia) trunk, upper limbs, and lower limbs paralyzed/numb, loss of bowel/bladder/sexual function, bradycardia and respiratory issues
DIAGNOSTIC TESTS:
- spinal radiography, MRI, and CT may reveal damage
What’s the treatment and prognosis of paraplegia and quadriplegia?
TREATMENT:
- spine board, corticosteroids, hypothermia of area
PROGNOSIS:
- outcome variable, but better with earlier treatment
What are the etiologies of degenerative disk disease?
ETIOLOGY:
1) aging leads to reduced fluid in disk -> mechanical friction of disk -> inflammation and possible nerve root canal stenosis
What are the clinical features of degenerative disk disease?
S/S:
1) intractable pain along dermatome, numbness and weakness, possible incontinence
DIAGNOSTIC TESTS:
- MRI and myelography may reveal disk status
- electromyography may reveal nerve function
What’s the treatment and prognosis of degenerative disk diseases?
TREATMENT:
- NSAIDs, lidocaine patches, opioids
- transcutaneous electrical nerve stimulation (TENS), or implantable spinal cord stimulator (SCS)
PROGNOSIS:
- variable
- possible sequlae of spinal stenosis
What are the etiologies of a bulging disk and a herniated disk?
age or trauma ->
(if bulging) annulus fibrosus compresses spinal cord
(if herniated) annulus fibrosis ruptures -> nucleus pulposus compresses spinal cord
What are the clinical features of a bulging disk and a herniated disk?
S/S:
- radiating pain down lower extremities, numbness or paresthesia, dermatome weakness
DIAGNOSIS:
- positive straight leg test
- MRI, CT, or myelography reveals condition
What’s the treatment and prognosis of a bulging or herniated disk?
TREATMENT:
- NSAIDs, corticosteroids
- percutaneous diskectomy, microdiskectomy, diskectomy, or laminectomy
PROGNOSIS
- degeneration unavoidable
- usually good with treatment
What are the etiologies of a sciatic nerve injury?
- (degenerative) osteoarthritis -> spinal stenosis and osteophytes
- (herniated or bulging disk) nucleus pulposus compresses sciatic nerve
- (trauma) body mechanics, gunshot, or stabbing leads to sciatic nerve damage
What are the clinical features of a sciatic nerve injury?
S/S:
- continuous/intermittent pain along lower back and legs, numbness, weakness
DIAGNOSTIC TESTS:
- positive straight leg test
- MRI, CT, or myelography may reveal stenosis
What’s the treatment and prognosis of a sciatic nerve injury?
TREATMENT:
- physical therapy, NSAIDs, corticosteroids, muscle relaxants, opioids
- (if herniating) percutaneous discectomy, microdiskectomy, complete diskectomy, lumbar laminectomy, or chemonucleolysis
PROGNOSIS
- varies with insult, but disk degeneration is unavoidable
What are the etiologies of Parkinson’s Disease?
ETIOLOGY:
- linked to death of substantial nigra and nerve endings -> insufficient dopamine and norepinephrine
What are the clinical features of Parkinson’s Disease?
S/S:
- tremors, dyskinesia (involuntary movements), shuffling gait, loss of coordination, gradual personality changes
DIAGNOSTIC TESTS:
- neurologic examination may suggest Parkinsons
What’s the treatment and prognosis of Parkinson’s Disease
TREATMENT:
- levodopa
- deep brain stimulation (DBS)
PROGNOSIS:
- death may occur 10 years after diagnosis
What are the etiologies of Huntingon’s Chorea?
autosomal dominant gene on chromosome 4 -> unclear mechanisms -> progressive neural death
What are the clinical features of Huntington’s Chorea?
S/S:
- loss of motor control, loss of balance, difficulty swallowing, gradual personality changes (behavioral, emotional, and memory changes)
DIAGNOSTIC TESTS:
- neurological examination suggests Huntingtons
- CT reveals brain atrophy
What’s the treatment and prognosis of Huntington’s Chorea?
TREATMENT:
- haloperidol, atypical antipsychotics, benzodiazepines
PROGNOSIS:
- death may occur 10 to 30 years after diagnosis
What are the etiologies of amyotrophic lateral sclerosis?
uncertain, but possibly autosomal traits -> degeneration of motor areas and neurons
What are the clinical features of amyotrophic lateral sclerosis (or ALS)?
S/S:
1) fasciculations, motor atrophy, dysphonia, dysphagia, dyspnea
DIAGNOSTIC TESTS:
- electromyography and muscle biopsy suggests ALS
What’s the treatment and prognosis of ALS?
TREATMENT:
- riluzole, muscle relaxants
PROGNOSIS:
- death may occur 6-10 years after diagnosis
What are the etiologies of peripheral neuropathy (or peripheral neuritis)?
nutritional deficiencies, infections, inflammatory conditions, metabolic disorders, chronic alcohol intoxication -> PNS degeneration
What are the clinical features of peripheral neuropathy?
S/S:
- numbness and weakness in hands and feet, muscular atrophy, loss of balance
DIAGNOSTIC TESTS:
- blood tests and radiography may help reveal underlying cause
What’s the treatment and prognosis of peripheral neuropathy?
TREATMENT:
- treat underlying causes
- anticonvulsants, tricyclic antidepressants
PROGNOSIS:
- relieved with treatment
What is the pathogenesis of poliomyeletitis and subsequently post-polio syndrome?
poliovirus enters through sinuses -> gastrointestinal tract -> reproduces in lymphoid tissue -> hematic spread to anterior horn cells of spinal cord
What are the clinical features of poliomyelitis and post-polio syndrome?
S/S:
- fever, malaise, nausea, muscle weakness, stiff neck, possible atrophy and paralysis
DIAGNOSTIC TESTS:
- positive throat or fecal culture
What’s the treatment and prognosis of poliomyelitis?
TREATMENT:
- prevent with Salk/Sabin vaccines
- analgesics
- mechnical ventilator
What are the etiologies of trigeminal neuralgia (or Tic Douloureox)?
multiple sclerosis, neoplasm compresses against nerve -> demyelination of trigeminal nerve -> abnormal activity
What are the clinical features of trigeminal neuralgia (or tic douloureox)?
S/S:
- transient intense pain along ophthalmic, maxillary, and/or mandibular branches triggered by stimulation
DIAGNOSTIC TESTS:
- signs/symptoms present
What’s the treatment and prognosis of trigeminal neuralgia (or tic douloureox)?
TREATMENT:
- carbamazepine
- surgical excision of trigeminal nerve
PROGNOSIS:
- varies with etiology
- possible spontaneous resolution
What are the etiologies of Bell’s Palsy?
inflammatino of bony canal -> entrapped CN VII
What are the clinical features of Bell’s Palsy?
S/S:
1) unilateral facial paralysis, impaired taste, pain or pressure behind ear
DIAGNOSTIC TESTS:
- presence of signs/symptoms suggest Bell’s Palsy
- imaging techniques must rule out stroke
What’s the treatment and prognosis of Bell’s Palsy?
TREATMENT:
- predisone
- electrotherapy to prevent atrophy
PROGNOSIS:
- complete recovery possible, but residual effects may remain
What are the etiologies of meningitis?
- (if bacterial) Streptococcus pneumoniae, Neisseria meningitidis, or Haemophilus infleunza
- (if viral) HSV or West Nile virus infection
- infection of dura and arachnoid maters
What are the clinical features of meningitis?
S/S:
- high fever, headache, nausea and vomiting, stiff neck, photophobia, irritability, possible seizures
DIAGNOSTIC TESTS:
- postive Kernig Sign and Brudzinski Sign
- lumbar puncture reveals elevated WBCs in CSF
- positive CSF culture
What’s the treatment and prognosis of meningitis?
TREATMENT:
- IV antibiotics, glucocorticoids, NSAIDs
PROGNOSIS:
- varies on pathogen and therapeutic response
What are the etiologies of encephalitis?
Eastern Equine virus, Western Equine virus, West Nile virus, St. Louis ecephalitis virus transmitted via mosquito bite -> infects brain
What are the clinical features of encephalitis?
S/S:
- high fever, headache, stiff neck, nausea, photophobia, visual disturbances, seizures
DIAGNOSTIC TESTS:
- lumbar puncture reveals elevated CSF WBCs
- positive CSF culture
- CT scan shows cerebral swelling
What’s the treatment and prognosis of encephalitis?
TREATMENT:
- NSAIDs, antipyretics, anticonvulsants
PROGNOSIS:
- unpredictable, risk of residual brain damage
What are the etiologies of a brain abscess?
staphyloccal, streptococcal, or pneumococcal bacteria invades through direct wound or through circulation
What are the clinical features of a brain abscess?
S/S:
- severe headache, fever, nausea and vomiting, nuchal rigidity, seizures
DIAGNOSTIC TESTS:
- EEG or CT reveals abscess
- diagnosis through lumbar puncture contraindicated
What’s the treatment and prognosis of a brain abscess?
TREATMENT:
- IV antibiotics, glucocorticoids, surgical drainage
PROGNOSIS:
- varies with location, size, and etiology of abscess
- danger of increased intracranial pressure
What are the etiologies of Guillain-Barre syndrome?
respiratory or gastrointestinal infection -> suspected autoimmune activity with demyelination
What are the clinical features of Guillen-Barre syndrome?
S/S:
- (1-3 weeks after infection) peripheral paresthesia, muscle pain and weaknes -> ascending paralysis, possible dyspnea or dysphagia
DIAGNOSTIC TESTS:
- lumbar puncture reveals elevated CSF protein levels with normal WBCs
What’s the treatment and prognosis of Guillen-barre syndrome?
TREATMENT:
- plasmapharesis
- IV immune globulin
PROGNOSIS:
- complete recovery common
What are some possible causes of transient global amnesia (or TGA)?
cold-water immersion, sexual intercourse, driving a motor vehicle, intense emotional or physical events
What are the clinical features of transient global amnesia (or TGA)?
S/S:
- failure to retrieve recent or previous events, possible headache (wanes after about 6-12 hours)
DIAGNOSTIC TESTS:
- neurologic examination negative for stroke and seizure
What’s the treatment and prognosis for transient global amnesia (or TGA)?
TREATMENT:
- comfort and support patient
PROGNOSIS:
- spontaneously resovling, unlikely to recur
What are some possible etiologies of migraines?
suspected hereditary factors -> vasoconstriction followed by vasodilation
What are the clinical features of migraines?
S/S:
- (precedes attack) visual auras (partial darkness, flashing lights), fatigue, irritability
- intense headache, nausea, sensitivity to light and sound
DIAGNOSTIC TESTS:
- MRI, CT, and EEG rule out other conditions
What’s the treatment and prognosis of migraines?
TREATMENT:
- bed rest, vasoconstrictors, antiemetics
- calcitonin gene-related peptide (CGRP) inhibitors
PROGNOSIS:
- good with compliance to treatment
What are some possible etiologies of epilepsy?
genetic factors, OR drug toxicity, hypoglycemia, neoplasms, or strokes (hypoxia-induced)
-> abnormal electrical activity of brain
What are the clinical features of epilepsy?
S/S:
- (if localized) abnormal activity of specific muscle groups, behavioral disturbances, or visual disturbances
- (if generalized) absent seizure or tonic-clonic activity
DIAGNOSTIC TESTS:
- EEG and FMRI reveal abnormal activity
- CT or skull radiography may reveal structural causes
- serum tests may reveal metabolic or chemical causes
What’s the treatment and prognosis for epilepsy?
TREATMENT:
- anticonvulsants
- vagus nerve stimulator (VNS)
PROGNOSIS:
- varies, but manageable with therapy
- poor if status elipticus
What are some suspected causes of restless leg syndrome?
being more than 50 years old, anemia, stressful life events
What are the clinical features of restless leg syndrome?
S/S:
- uncomfortable sensation in legs at night or while sitting
- sensation relieved by movement
DIAGNOSTIC TESTS:
- (if anemic) blood tests may reveal low iron levels
- drugs and secondary causes ruled out
What’s the treatment and prognosis of restless leg syndrome?
TREATMENT:
- manage anemia or stress
- cold compress and regular exercise
PROGNOSIS:
- condition is lifelong and may worsen with age
What are some possible causes of a headache?
- (if tension) strain of neck, scalp, and facial muscles
- (if vascular) edema of cerebral arteries -> vascular headache
- (if cephalgia) underlying condition
What are the clinical features of a headache?
S/S:
- mild to severe pressure pain, throbbing pain, or penetrating pain in occipital, temporal, and frontal regions
DIAGNOSTIC TESTS:
- patient history may identify an underlying cause
What’s the treatment and prognosis of headaches?
TREATMENT:
- analgesics, mild tranquilizers, muscle relaxants
PROGNOSIS:
- good, but uncertain if intractable headache
What are the risk factors and etiologies of an intracranial tumour?
RISK FACTORS:
- inherited cancer syndromes and prior ionizing radiation therapy (but more risk factors suspected)
ETIOLOGY:
- (glioma) glial cell proliferation
- (meningioma) arachnoid cell proliferation
- (embyronal) pluripotent stem cell malignancy during childhood
What are the clinical features of an intracranial tumor?
S/S:
- (varies on site of tumor) headache, nausea and vomiting, seizures, cognitive dysfunction, visual dysfunction, somatosensory or motor dysfunction, aphasia
DIAGNOSTIC TESTS:
- MRI and PET may detect tumor
- biopsy may identify histology and malignancy
What’s the treatment and prognosis for an intracranial tumor?
TREATMENT:
- surgical resection followed by chemoradiation therapy
- anticolvusants
- corticosteroids to reduce edema
PROGNOSIS:
- varies greatly with histology, location, and size
- gliomas have a 5.5% 5-year-survival rate
What are the etiologies of cerebral palsy (CP)?
inadequate blood or oxygen supply to brain (via infection, trauma, placental insufficiency) from fetal development to age 9
What are the clinical features of cerebral palsy (CP)?
S/S:
- (if spastic) rapid muscle contractions
- (if athetoid) dyskinesia with muscle atonicity
- (if ataxic) poor control of voluntary movements
- possible cognitive, learning, hearing, or visual impairment
DIAGNOSTIC TESTS:
- neurologic examination
What’s the treatment and prognosis of cerebral palsy?
TREATMENT:
- orthopedic intervention
- physical therapy, possible speech and/or education therapy
PROGNOSIS:
- generally most children survive into adulthood
What are the etiologies of spina bifida?
folic acid deficiency, vitamin A deficiency, ionozing radiation therapy - > neural tube developmental defect
What are the clinical features of spina bifida?
S/S:
- (if occulta) asymptomatic, possible tuft of hair
- (if meningocele) visble sac, possible rupturing
- (if myelomeningocele) visible sac, musculoskeletal malformation and paralysis
DIAGNOSTIC TEST:
- spinal radiography -> electromyography if myelomeningocele
What’s the treatment and prognosis of spina bifida?
TREATMENT:
- surgical intervention
PROGNOSIS:
- good if occulta
- good with treatment if meningocele
- permanent nerve damage is probable if myelomeningocele
What are the etiologies of hydrocephalus?
- (if communicative) infection, hemorrhage or blood clot impairs subarachnoid CSF circulation -> accumulation of CSF
- (if obstructive) congenital defect or lesion of ventricular circulation -> accumulation of CSF in ventricles
What are the clinical features of hydrocephalus?
S/S:
- bulging fontanels, nausea and vomiting, intense pain (crying in infants)
DIAGNOSTIC TESTS:
- skull radiography shows ventricular or subarachnoid swelling
What’s the treatment and prognosis for hydrocephalus?
TREATMENT:
- peritoneal or right-atrial shunt
PROGNOSIS:
- most children function normally in society
What is the etiology of Reye syndrome?
(unclear, affected children) linked with aspirin use during influenza A/B or chickenpox infections -> disruption in uric cycle
What are the clinical features of Reye syndrome?
S/S:
1) lethargy, irritability, vomiting
2) hyperventilation, convulsions, hepatic dysfunction
3) organ changes and coma
4) deeper coma, loss of cerebral functions
5) seizures and respiratory arrest
DIAGNOSTIC TESTS:
- blood tests show elevated NH3
What’s the treatment and prognosis of Reye syndrome?
TREATMENT:
- hospitalize patient, possible mechanical ventilation
PROGNOSIS:
- early treatment significantly reduces mortality rate
What are the etiologies of neuroblastoma?
currently unknown, but maternal and gestational factors involved -> malignancy of SNS (usually in abdomen) during childhood
What are the clinical features of neuroblastoma?
S/S:
- fever, weight loss, abdominal mass, abdominal pain, bone pain, possible hypertension, periorbital ecchymosis (raccoon eyes)
DIAGNOSTIC TESTS:
- serum tests may reveal elevated catecholamine levels
- biopsy reveals histology
- CT may assist in staging
What’s the treatment and prognosis of neuroblastoma?
TREATMENT:
- surgical resection
- chemotherapy with or without radiation therapy, possible HSCT
PROGNOSIS:
- better if earlier onset
What’s the etiology of rabies?
rabies virus transmitted via mammal bite, scratch, or urine -> virus travels along PNS to CNS, incubates from 1 month to a year
What are the clinical features of rabies?
S/S:
- (occurs during late course) fever, headache, agitation, hydrophobia, difficulty swallowing, partial paralysis
What’s the treatment and prognosis of rabies?
TREATMENT:
- immunoglulin injections with 5 vaccinations
PROGNOSIS:
- fatal if symptoms occur
What’s the etiology of botulism?
anaerobic Clostridium botulinum transmitted via eating home-canned foods, puncture wounds -> releases botulinum toxin that inhibits motor neurons
What are the clinical features of botulism?
S/S:
- atonicity, dysphagia, dysphonia, dyspnea, nausea and vomiting,
DIAGNOSTIC TESTS:
- botulism antibodies found through blood test
What’s the treatment and prognosis of botulism?
TREATMENT:
- botulinum antitoxin
- possible mechanical ventilation
PROGNOSIS:
- best with earlier treatment
What are the etiologies of fibromyalgia?
(unclear) linked to increased substance P, decreased seretonin, and decreased REM -> abnormal CNS pain processing
What are the clinical features of fibromyalgia?
S/S:
- chronic aching in muscles, fatigue, poor concentration, irritability, depression, possible GI or urinary distress
DIAGNOSTIC TESTS:
- blood testing rule out other pathologies
What’s the treatment and prognosis of fibromyalgia?
TREATMENT:
- anticonvulsants, antidepressants, NSAIDs
- physical exercise and stress reduction
PROGNOSIS:
- good with treatment, musculoskeletal deformity not expected
What are the diagnostic tests you would perform for meningitis?
- Brudzinksi test
- Kermit test
- Lumbar tap (check for elevated WBCs and bacterial/viral culture)
What’s the suspected etiology of multiple sclerosis?
genetic factors -> autoantibodies produced against myelin in reponse to viral infection
What are the clinical features and types of multiple sclerosis?
S/S:
- weakness and numbness, vision problems, dysphonia, dysphagia, emotional disturbances, vertigo
- may be relapsing-remitting, primary progressive, secondary progressive, or progressive-relapsing
DIAGNOSTIC TESTS:
- cerebral or spinal plaque found through MRI
What’s the treatment and prognosis of multiple sclerosis (or MS)?
TREATMENT:
- corticosteroids and immunosuppressants
- muscle relaxants, vitamin B supplements, orthopedic interventions
PROGNOSIS:
- bad if male, late onset, and progressive disease
