Nu 735: Neuro II Flashcards

1
Q

Optic Neurtitis
Overview

A

Inflammatory Disease CNII

**Vision Recovery: **
* Single episode, Without TX
* Visual acuity improves with 2 to 3 wks

**Isolate Optic Neuritis: **
* Probably MS - MRI advisoble
* 2 or mor lesion - TX to decrease further demalization

  • Acute Stage: Norma optic nerve 2/3 cases
  • * Late Stage
    Swollen optic disc
    Parapillary Hemmorhages : **Papillates **
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2
Q

**Optic neuritis **
**Assessment **

A

* Pain benind Eye: Exacerbated by Movements

  • **Field of Vision Loss: **Central, Loss of Color

*** Severe Form: Neuromyelitis Optica

**Neuromyelitis Optica : **Extensive and B/L

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3
Q

Optic Nerve

TX

A

**Methylprednisone ( medical Prednisone ) **
1gm QD x 3 days (it’s high dose ) OR

Break it DOWN to : 250 mg Q 6 hrs IV

Prednisone taper PO

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4
Q

MS
Overview

A

*** Autoimmune disease **
**Affects central nervous system **
Relapsing develop at different times and diffrent CNS locations
Plaques develop at diffreent times and differen CNS locations
Approximatyl 900,000 individual
**Demyelination pathological hallmark **

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5
Q

**MS **
**Charactitis Findings **

A
  • Chronic Inflammation
  • Dymyelination
  • Gliosis (plaques for scoring )
  • Neuronal Loss
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6
Q

MS
Clinical Course

A

**Extremely Variable **
From Benigh Condtion TO
Incapacitating disease require profound adjustment **

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7
Q

MS
Risk Factors

A
  • More common in women x3 folds then man
  • Age onse 20 to 40 old
  • Genetic Predisposition
  • Vitamin D deficiency
  • EBV eXposure (Infection of Mononucleosis found with MS)
  • Cigarette smoking (animal model )
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8
Q

MS
Clinical Findings

A
  • Onset: can be abrup or slop creeping uP
    **Sensory symptoms : Variable **
  • Paresthesia and Hyoesthesia (decrease sensatio )
    * Pain: pain associated >50% can be any where in a boy and changing location al the time
    ** Optic Neuritis: **Diminshed visual acuity
    **
    Fatique: **90% pt . Most common reason for work relatd disability Fatique can be with elevated tem, depression, or sleep disturbances
    * Weakness of limps: loss of strenght, speep, dexterity or fatique;
    Weakness induced exercise
    *** Facial Bells Palsy: Due to lesions on Palms
    **Not associated with loss of taste sensation **

**Spasticity **
Spontaneous and movement inducted muschles spasms
>30% have moderate to severe spasticity of legs

**Ataxia **
**associate w cerebellum tremors **
can involve head and trunk
Characteritic **cerebellar dysathria **
**
Visual blurring or double vision

**Vertigo: **
may appear suddently form brain step lesion
May reseble Acute Labyrinthritis (inner ear inflammation)

DO NOT MISS DX Labyrinthritis **

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9
Q

MS
Paroxysmal Symptoms

A
  • Brief duratio (10 sec to 2mints)
  • High Frequency 5 to 40 episodes per day
  • No altered LOC usually self limited
  • Precipitated by Hypreventilatio or movement
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10
Q

MS
Lhermitte’s Symptom

A

Electrical Shock sensation

  • Radiates down back into legs
  • Induced by flexonr or extension of neck
  • Rarely radiates into arms **
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11
Q

MS
Trigemianal Neuralgia

A

**Demalination of Lesion
Involves 5th CN
Leads to fAcial pain
Pain episodes are often describes as sudden, severe, Electic shock like sensations

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12
Q

MS
Hemifaical pain

A

Lesion infolves 7th CN

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13
Q

MS
Glossopharyngeal Neuralgia

A

CN 9 lesions
Pain in oropharyngeal are through mandibular action

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14
Q

MS
Bladder Dysfunction

A

> 90 % of the pts **
Detrusor Hyperreflexia (urinary frequency, urgency, Nocturia, Incontinent)
> Detrusor Sphincter Dyssynergia: difficulty initiateting or stopping urinary stream
** Constipation :
>30 of pts

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15
Q

MS
DX

A

No single DX test for MS

  • Require documentation of 2 or more episoes of symptoms (MRI)
  • Two or more pathological sign
  • Symptoms last >24 hrs
  • Occur as distinct episodes
  • Separated by a month or more
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16
Q

MS
Lab

A

cBC
CMP
ESR, B12
ANA (antinuclear antibody test )

17
Q

MS
MRI findings

A

Revolutionary in DX findings for MS
New focal white matter lesions
Enhancing lesion simultenously with
Non-enhancing lesions (asymptomatic location )

18
Q

MS
CSF fluids

A

Mononuclear cell pleocytosis
Intratheracally synthesized IgG

19
Q

MS
TX
Managmen acute attack

A

Management divided into categories
1. **Manage Actute Attacks **
Consult Neurology
Glucocoticodis > Methylprednisoen 500 to 1000 mg /QD IV 3 to 5 days no tapper

20
Q

MS TX
2. Immune Modulators and Immune supressive agents

A

Interferon
Ocrelizumab
Do not tx and ABT or Antiviral
Dymelination _ prevent DO NOT EXist

21
Q

MS> TX
3. Symtomatic Management

A

**Bladder Dysfunction: **
Oxybutynin 5 to 15 mg
Detrol 2 to 4 mg
Terazosin 1 to 20 mg
**UTI **
constipation
**Zoloft 50mg QD : Depression

**Provigil 100 to 400 mg _ day time tirness **

22
Q

Encephalitis
Overview

A
  • **Inflammatio of the brain Parencymal **
  • Viral infection ad Autoimmune process
  • 20, 000 cases /year in USA
  • **Majority cAses : ViRal **
23
Q

Encephalitis
Type of Virusis

A
  • Herpes Viruses
  • Epstein Barr Virus
  • Arbovirusis
  • WNV with majarity in USA (West Nile virus transfer from mosquito to tick )
24
Q

Encephalitis
clinical Findigns

A

Acute febrile Illness ( 1st present like Meningeal Involvement )

  • Altered level of consciousness (Mild letheragic to comma state )

* Psychological Changes
Hallucinations
Agitation
Personality change
behavioral disturbances
**Neurologic Deficit ( focal most common one )
Aphasia
Ataxia
upper or lower weakness
involuntary movement
CN deficit
Hypothalamus -pitiitary Axis
Temperature dysrgulation
DM Insipidus
SIADH

25
Q

Encephalitis
Lumbar Puncture

A

LP should perfromed with every pt suspected Encephalitis
Contraindicated increae ICP
* Lymphcytic Pleocytosis
* Mildly elevated Protein concentration
* Normal glucose concentration
* persistent neutrophilia

consider Bacteria : Significan RBC ( non traumatic tab )
Hemorrhagic Encehalitis could be seen in HSV
Decrease cSF glucose: (very unusual ) in viral infectin … Consider Bacteria

In this case : Bacterial, fungal TB, or parasitic

Bacteria , fugal , TB parasitic : RBC, Low Glucose

26
Q

Encephalitis
MRI

A

Increase signal intensity

27
Q

Encephalitis
CT and EEG

A

CT:
**
can be used if pt cannot have MRI
focal areas of low absorption
mass effect
consrast enhansment

**EEG **
Helps to distinguish focal **encephalitis VS Encephalopathy **

28
Q
A