Other neurological conditions

Question 1

cerebral palsy

Answer 1

neuromuscular disorder
spastic: hypertonia, hyperreflexia
dyskinetic: dystonia, athetosis, chorea
ataxic: cerebellum

monoplegia (one extremity), hemiplegia (half of body), paraplegia (both LEs), quadriplegia (all extremities), diplegia (greater LEs and some UEs)

complications: seizures, intellectual disabilities, contractures, language and cognitive deficits, dysarthria, visual impairments

Question 2

ataxia

Answer 2

lack of coordination while performing voluntary movements
clumsiness, inaccuracy, instability
not smooth, jerky

Question 3

chorea

Answer 3

brief, purposeless, involuntary movements of distal extremities and face

Question 4

dyskinesias

Answer 4

involuntary, non repetitive, stereotyped movements
writhing

Question 5

dystonia

Answer 5

abnormal postures and disruptions of ongoing movement

Question 6

hemiballismus

Answer 6

flinging motions of the extremities

Question 7

myoclonus

Answer 7

brief and rapid contraction of a muscle or group

Question 8

tremors

Answer 8

rhythmic, alternating, oscillatory movements produced by repetitive patterns of muscle contraction and relaxation

Question 9

parkinson’s

Answer 9

hypo kinetic CNS movement disorder
slowly progressive and degenerative pathways in basal ganglia (substantial nigra)
cardial signs: tremor, RIGIDITY, resistive motion, akinesia, festinating gait, falling

stage 1 - 5 (worst)

Question 10

spina bifida

Answer 10

failure of the spinal column to fully form to protect the neural tube

occulta: bony malformation; may not discover until late childhood, red birthmark or patch of hair
cystica: exposed pich of SC and meninges
- with meningocele: protrusion of a sac through the spine with fluid and meninges, but not the spinal cord
- with myelomeningocele: protrusion of a sac through the spine with spinal cord/nerve roots

Question 11

medical management of spina bifida

Answer 11

may not have many symptoms unless severe (such as tethered cord syndrome) and depending on what parts of the spine are involved

may change during growth spurts

during pregnancy, protect the sac from rupturing and from infections that could result in meningitis
shunt may be placed

Question 12

increase in intracranial pressure

Answer 12

could cause intellectual disability
could result in Arnold chiari syndrome (portion of cerebellum and medula oblongata slip down into the foramen magnum to the cervical spinal cord)

if a shunt is blocked or infected (s/s are headache, vomiting, vision/mem problems, inc head size - medical emergency)

Question 13

muscular dystrophies and atrophies

Answer 13

degenerative disorders resulting in mx weakness and decrease in mx mass
hereditary
due to absent mx protein - dystrophin and high creatine kinase

Question 14

Duchenne’s muscular dystrophy

Answer 14

sex linked, recessive, males
enlarged calves
weakness in proximal joints
ambulating with a trendelenburg (waddling) gait, frequent falls
Gower’s sign - use hands to crawl up to thighs to get up off the floor

die around 20s

Question 15

Becker’s muscular dystrophy

Answer 15

variant of duchennes
slower to progress, less severe, less predictable

survival can be in late adulthood if minimal cardiac involvement

Question 16

arthrogryposis multiplex congenita

Answer 16

deformities and joint contractures
may be stable, mild progressive, or improve
heart and spinal defects, torticollis, diaphragm involved
club feet, internal rotation of UEs

Question 17

other types of muscular dystrophy

Answer 17

1. limb-girdle: slow progression, pelvis/shoulder initially affected
2. fascioscapulohumeral: early adolescence involves face and UEs/scapula, relatively normal life expectancy
3. spinal: earlier the age of diagnosis, the greater of severity of functional deficits/shorter life expectancy
4. congenital myasthenia gravis: disorder of transmission of impulses, males
5. charcot-marie-tooth disease: peripheral nerves, distal leg muscles
6. myopathies: progress slower and better prognosis, weakness of face/neck/limbs

Question 18

progressive supra nuclear palsy

Answer 18

later middle life
loss of voluntary but preserved reflexive eye movements, bradykinesia, rigidity, axial dystonia, pseudo bulbar palsy, dementia

Question 19

huntington’s chorea

Answer 19

onset 30-50
choreiform movements and progressive intellectual deterioration
psychiatric disturbance
progressive

Question 20

ALS

Answer 20

progressive degeneration of corticospinal tracts (LMN)
onset around 50s
treatment aimed at secondary complications - spasticity, preventing aspirations, contractures, pain

Question 21

Brachial plexus disorder

Answer 21

Erb’s palsy: paralysis of C5+6 cervical nerves, partial C7, cannot raise arm, weak elbow flexion, weak scapula, “waiter’s tip”
Klumpke’s palsy: C7+8 + T1 cervical nerve paralysis, no hand/wrist movements, Horner’s syndrome (mitosis, ptosis, sweating)

Question 22

Guillain-Barre syndrome

Answer 22

recovery is 2-4 weeks after symptoms
s/s:acute, rapidly progressive polyneuropathy, symmetric mx weakness, mild sensory loss distally, painful extremities, loss of deep tendon reflexes

prognosis: mild/residual neurological deficits, most are ambulatory within 6 mo

Question 23

myasthenia gravis and how is it confirmed

Answer 23

autoimmune attacks on neuromuscular receptors
very rare
episodic muscle weakness, usually muscles innervated by cranial nerves
ptosis, diplopia, muscle fatigue after exercise, dysarthria, dysphagia
sensation and deep tendon reflexes intact

**confirmed by response to anticholinesterase drugs

Question 24

multiple sclerosis

Answer 24

20-40 yrs
- degeneration of myelin sheath in brain and spinal cord
- CNS lesions, varied neurological symptoms, remissions and exacerbations and/or progressive
deficits in: muscles, sensation, vision (double and acuity), emotion, balance, bladder, cognition, spasticity

Question 25

seizures

Answer 25

primary generalized: widespread involvement of both sides of the brain
partial: smaller, localized area (can spread)

Question 26

generalized seizures

Answer 26

1. tonic-clonic/grand mal (starts with aura, then LOC/stiffeneing, then rigidity and relaxation of muscles
2. myoclonic-akinetic: loss of tone, jerking
3. petit mal: absence

Question 27

partial focal seizures

Answer 27

simple and complex
simple - sudden movement in 1 body part and no change in vital signs

Question 28

lennox-gastaut syndrome

Answer 28

severe seizures, intellectual disability, specific EEG pattern
brain disorders

Question 29

landau-kleffner syndrome

Answer 29

acquired epileptic aphasic
progressive encephalopathy

Question 30

simple febrile seizures

Answer 30

precipitated by a fever
lasts under 10 min
LOS and jerking
do not cause damage/lead to epilepsy

Question 31

status epilepticus

Answer 31

prolonged seizures
can sometimes be triggered when medication is stopped abruptly
can be life threatening, medical emergency
remove dangerous objects, place them in sidling, allow seizure to happen, protect head from injury from shaking

Question 32

GBS – residual paresthesia and pain

Answer 32

educate the pt on sensory deficits and related ADL adaptive strategies (hot packs are contraindicated, massage will not remedy the hands)

Question 33

other symptoms of MS

Answer 33

Early MS adaptation in classroom teaching – high stool to compensate for LE weakness (this is the most common symptom in early stages)

Heat intolerance is a symptom of multiple sclerosis that may be exacerbated in a client who works in a kitchen. Recommending a cooling vest is a solution to decrease this risk of overheating.

Question 34

post concussion syndrome

Answer 34

occurs when symptoms of a mild traumatic brain injury last longer than expected after an injury. These symptoms may include headaches, dizziness, and problems with concentration and memory. They can last weeks to months

typically exacerbated by exercise

Question 35

call for medical help with seizure if

Answer 35

• first seizure
• in water
• has a second one
• no consciousness within 5-10 min
• if it lasts over 5 min
• diabetic or pregnant