Neurology 2 Flashcards
resting tremor?
Parkinson’s disease
tremor at rest, goes away with movement
What are the 2 types of action tremor?
physiologic = catecholamin’es, caffeine, nicotine, anxiety, ritalin, drug (overuse)
essential (genetic) = tremor with movement
What diseases have intention tremor? Describe it?
MS, cerebellar disease, CVA/brain injury
-tremor increases in severity as the hand moves closer to target
Treatment for resting tremor?
treat parkinson’s
- balance dopamine and acetylcholine
- levodopa/carbidopa
treatment for action tremor?
remove offending agents
treatment for essential tremor?
propranolol and primidone
patient comes in and has not been able to move very quickly, he has difficulty arising from a seating position, and difficulty with handwriting.. you suspect Parkinson’s… what are other symptoms?
- resting tremor (pill rolling)
- bradykinesia (slow, shuffling gait)
- rigidity (cogwheel)
- postural instability
- expressionless (masked facies)
Treatment for Parkinson’s disease?
65 = levodopa/carbidopa
What is the pathophys of Parkinson’s disease?
degeneration of basal ganglia cells in the substantial nigra
-deficiency of dopamine and imbalance of dopamine and acetylcholine
How does levodopa work? Why combine with carbidopa?
for Tx parkinsons
-circulates in plasma to BBB where it crosses & is decarboxylated to dopamine
=we can’t give dopamine because it does not cross BBB
combine with carbidopa to lower doses of levodopa and reduce ADR
Amantadine?
mild anticholinergic
-helpful for mild parkinson’s symptoms
What class of drugs breaks down dopamine?
monoamine oxidase B inhibitor
selegiline
What are catecholamine-O-methyltransferase (COMT) inhibitors used for?
Parkinson’s
- reduce metabolism of levodopa
- (ex. tolcapone and entacapone)
rapid involuntary, non-repetitive or rhythmic movement involving the face, trunk, and limbs
chorea
huntington’s disease
What is the inheritance pattern for Huntington’s disease?
autosomal dominant
Treatment for Huntington’s Disease?
- no known cure
- symptomatic
Chorea: tetrabenazine
Chorea + psychosis = olanzapine, risperidone, haloperidol
PT/OT/ speech
What are symptoms of Huntington’s Disease?
Neurologic = chorea, dystonia, hyperreflexia
Cognitive = poor judgement, loss of insight, memory loss
Psych = aggression, delusion, anxiety, depression, disinhibition
DDX of choreiform disorder?
- Huntington’s Chorea
- Tardive dyskinesia = after use of antipsychotic drug and metoclopramide (N/V drug)
- Extrapyramidal syndrome = after antipsychotic like haldol (treat with benadryl)
Diagnosis and treatment for Tourette Syndrome?
tic (motor or phonic) occur several times per day for 1 year
treat symptoms
- fluphenazine, pimozide, haloperidol
- behavior therapy
symmetrical extremity weakness that began in the legs and ascents, DTR are decreased,
autonomic dysfunction (tachycardia, urinary retention)
Guillain- Barre
What is often the cause of Guillain-Barre?
infectious = campylobacter jejuni (most common)
other causes: minor infection, immunization, surgery
When does Guillain-Barre become life threatening?
when affects muscles of respiration or swallowing = resp failure!
How do you diagnose Guillain-Barre?
lumbar puncture = elevated CSF protein with normal WBC
Treatment for Guillain-Barre?
IVIG = plasma exchange (plasmapheresis)
-hospitalized to monitor resp status
patient presents with ptosis, diplopia, difficulty chewing, limb weakness, easily fatigue
weakness with everyday activities (brushing hair), improve with rest
myasthenia gravis
young women (20-30) old man (70-80)
What is the pathophys of myasthenia gravis?
antibodies directed against the acetylcholine receptor on the muscle surface cause an increased rate of receptor destruction = leads to weakness
How do you diagnose myasthenia gravis?
administer short-acting anti cholinesterase (edrophonium)
antibodies = autoantibodies acetylcholine receptor, autoantibodies to tyrosine kinase (MuSK)
Treatment of myasthenia Gravis?
give cholinesterase inhibitor = pyridostigmine
-thymectomy if
Drugs that cause myasthenia gravis?
-aminoglycoside ABX (neomycin, gentamicin, streptomycin, tobramycin)
- magnesium sulfate
- penicillamine
- interferon-alpha
patient first has visual problems, then complains of sensory loss and weakness in limbs, ataxia and paresthesias
-intention tremor
multiple sclerosis
what is the first sign of multiple sclerosis?
optic neuritis and vision changes
What is the pathophys of multiple sclerosis?
inflammation associated with multiple foci of demyelination in the CNS white matter
Diagnose multiple sclerosis?
MRI: McDonald Criteria
CSF = oligoclonal bands
Treatment for multiple sclerosis?
- interferon Beta-1a
- glatiramer acetatone
- IV glucocorticoids
- immunosuppressive (cyclophosphamide)
What is the etiology of cerebral palsy?
-cerebral injury before birth, during delivery, or in perinatal period (hypoxia/ischemia)
Patient presents with spasticity, lack of coordination, suppressed primitive reflexes (dyskinetic), ataxic
cerebral palsy
Treatment for cerebral palsy?
supportive = PT/OT/Speech
if bilateral = at risk for hip dysplasia and monitor regularly
Types of meningitis (5)?
- bacterial
- aseptic (viral)
- encephalitis
- granulomatous
- brain abscess
Causes for aseptic (viral) meningitis?
1 = enterovirus (coxsackievirus)
travel = Tb rodent = CMV Ticks = lyme, rock mountain spotted fever Mosquitos: west nile virus Sexual activity: HIV, syphilis, HSV
fever, nuchal rigidity (brudzinski and kernig), and headache
bacterial meningitis
Cause of bacterial meningitis?
Streptococcus pneumonia; N meningitidis
Group B strep and e coli =
meningitis with petechial rash
N. Meningitidis
Diagnose Meningitis?
- Lumbar puncture
- CSF analysis
- elevated protein, WBC (neutrophils)
- decreased glucose
Bacterial Meningitis Treatment?
- ABX = don’t delay!
- neonate = ampicillin and cefotaxime
- infant to 3 month = same combo
- immmunocompetent = cefotaxime + vancyomycin
- adult >55 = ampicillin + cefotaxime + vanco
-dexamethasone = most everyone get this
signs of meningitis in neonates?
- fever
- hypothermia
- irritability
- poor feeding
- bulging fontanella
- nuchal rigidity
- +CSF culture
CSF findings for viral meningitis?
- normal opening pressure
- WBC low = lymphocytes or monocytes
- normal protein, glucose, blood
neurologic infection with change in mental status?
encephalitis (pt appear confused, agitated, obtunded, seizures)
bite from an infected animal = present with hydrophobia, acrophobia, pharyngeal spasm
rabies = encephalitic form
negri bodies on a patient who was bit by a dog?
rabies
Treatment for rabies?
- rabies immunoglobulin passive immunization
- rabies vaccine active immunization
patient had the flu and then started vomiting/confusion, seizure (encephalopathy) in a child after exposure to salicylates (aspirin/pepto-bismol)?
diagnosis?
Treatment?
reye’s syndrome
hepatomegaly
labs = elevated aminotransferase activity, increased PT, hyperammonemia, hypoglycemia, metabolic acidosis
treatment = supportive
Altered Mental Status Causes?
AEIOU-TIPS
- alcohol/AAA
- electrolyte/encephalopathies, endocrine problem
- insulin - hypoglycmeia
- opiates or overdose
- uremia
- trauma, temp, toxemia
- infection (sepsis, meningitis)
- psychogenic or PE
- space occupying lesion/stroke/shock/seizure
What is delirium?
acute syndrome - caused by medical condition, substance intoxication or withdrawal, medication ADR = causes temporary confusion and altered mental status
-short term and reversible
Examples of delirium?
- sepsis
- sun downing
- etoh withdrawal
- opiate withdrawal
- sun stroke
- inhalation of fumes/smoke
What is dementia?
disorder characterized by impaired memory + aphasia, apraxia, agnosia, executive function
irreversible altered mental status
What are some types of dementia?
- Alzheimer (most common)
- Vascular (multi-infarct)
- frontotemporal (Pick)
- with lewy bodies
older patient, steadily progressive memory loss = disorientation, language difficulties, inattention,
alzheimer disease
memory loss and difficultly with problem solving
What are pathologic findings for Alzheimers?
- neurofibrillary tangles (intracellular)
- plaques (extracellular)
Treatment of Alzheimer’s?
- acetylcholinesterase inhibitors = donepezil, galantamind, rivastigmine, tacrine
- add memantine (NMDA antagonist to regulate glutamate)
- antipsychotics for agitation
Phenytoin ADR?
- gingival hypertrophy
- teratogenicity
- nystagmus
Carbamazepine ADR?
- bone marrow suppression
- rash (SJS)
- teratogenicity (NTD)
Valproic Acid ADR?
- hepatotoxicity
- teratogenicity (NTD)
MOA of triptan drugs?
vasoconstriction
- selective agonist for serotonin receptors
- inhibit release of vasoactive peptides
