Nu 735: Neuro II Flashcards
Optic Neurtitis
Overview
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 **
**Optic neuritis **
**Assessment **
* Pain benind Eye: Exacerbated by Movements
- **Field of Vision Loss: **Central, Loss of Color
*** Severe Form: Neuromyelitis Optica
**Neuromyelitis Optica : **Extensive and B/L
Optic Nerve
TX
**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
MS
Overview
*** 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 **
**MS **
**Charactitis Findings **
- Chronic Inflammation
- Dymyelination
- Gliosis (plaques for scoring )
- Neuronal Loss
MS
Clinical Course
**Extremely Variable **
From Benigh Condtion TO
Incapacitating disease require profound adjustment **
MS
Risk Factors
- 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 )
MS
Clinical Findings
- 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 **
MS
Paroxysmal Symptoms
- 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
MS
Lhermitte’s Symptom
Electrical Shock sensation
- Radiates down back into legs
- Induced by flexonr or extension of neck
- Rarely radiates into arms **
MS
Trigemianal Neuralgia
**Demalination of Lesion
Involves 5th CN
Leads to fAcial pain
Pain episodes are often describes as sudden, severe, Electic shock like sensations
MS
Hemifaical pain
Lesion infolves 7th CN
MS
Glossopharyngeal Neuralgia
CN 9 lesions
Pain in oropharyngeal are through mandibular action
MS
Bladder Dysfunction
> 90 % of the pts **
Detrusor Hyperreflexia (urinary frequency, urgency, Nocturia, Incontinent)
> Detrusor Sphincter Dyssynergia: difficulty initiateting or stopping urinary stream
** Constipation : >30 of pts
MS
DX
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
MS
Lab
cBC
CMP
ESR, B12
ANA (antinuclear antibody test )
MS
MRI findings
Revolutionary in DX findings for MS
New focal white matter lesions
Enhancing lesion simultenously with
Non-enhancing lesions (asymptomatic location )
MS
CSF fluids
Mononuclear cell pleocytosis
Intratheracally synthesized IgG
MS
TX
Managmen acute attack
Management divided into categories
1. **Manage Actute Attacks **
Consult Neurology
Glucocoticodis > Methylprednisoen 500 to 1000 mg /QD IV 3 to 5 days no tapper
MS TX
2. Immune Modulators and Immune supressive agents
Interferon
Ocrelizumab
Do not tx and ABT or Antiviral
Dymelination _ prevent DO NOT EXist
MS> TX
3. Symtomatic Management
**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 **
Encephalitis
Overview
- **Inflammatio of the brain Parencymal **
- Viral infection ad Autoimmune process
- 20, 000 cases /year in USA
- **Majority cAses : ViRal **
Encephalitis
Type of Virusis
- Herpes Viruses
- Epstein Barr Virus
- Arbovirusis
- WNV with majarity in USA (West Nile virus transfer from mosquito to tick )
Encephalitis
clinical Findigns
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
