PRELIMS: GBS, MS, Bell's Palsy Flashcards
What is Guillain-Barré Syndrome?
Acquired symmetrical polyneuropathy, often beginning in the lower extremities and progressing to total body paresis.
What are common initial symptoms of Guillain-Barré Syndrome?
Paresthesias in toes and fingertips, ascending weakness.
Which muscles are typically involved in Guillain-Barré Syndrome?
Facial and oropharyngeal muscles.
Which muscles are typically spared in Guillain-Barré Syndrome?
Extraocular muscles and sphincters.
What type of reflexes are usually affected in Guillain-Barré Syndrome?
Muscle stretch reflexes are absent or severely decreased.
What is a common pain symptom in Guillain-Barré Syndrome?
Deep aching pain in the back, buttocks, and posterior thighs
What are some common etiological factors for Guillain-Barré Syndrome?
Viral or bacterial infections, immunization, or surgery.
What is the common agent associated with Guillain-Barré Syndrome?
Campylobacter jejuni.
What are some disorders included in Motor Neuron Disease?
Spinal muscular atrophy (SMA), Amyotrophic lateral sclerosis (ALS), Primary lateral sclerosis (PLS), Progressive muscular atrophy (PMA), Progressive bulbar palsy (PBP).
Where do upper motor neurons (UMNs) originate?
Motor cortex, premotor areas, temporal cortex, and sensory cortex.
What do upper motor neurons (UMNs) synapse with?
Cells in the brainstem nuclei and the ventral horn of the spinal cord, which are lower motor neurons (LMNs).
What are the clinical features of Primary Lateral Sclerosis (PLS)?
Spasticity usually starting in the lower extremities, urinary incontinence, spastic dysphagia.
What is the common onset age for Primary Lateral Sclerosis (PLS)?
Between 20 to 60 years old.
What is Lathyrism and what causes it?
A condition caused by excessive consumption of chickling pea (Lathyrus sativus), leading to neurotoxic effects.
What does “amyotrophy” refer to in ALS?
Atrophy of muscle fibers.
What is the gender prevalence for ALS?
Males are affected more than females, with a ratio of approximately 2:1.
What are the clinical features of Classic Amyotrophic Lateral Sclerosis (ALS)?
Weakness, atrophy, fasciculations, spasticity, spastic dysarthria, and typically sparing of bowel, bladder, and sensation.
What is another name for Amyotrophic Lateral Sclerosis (ALS)?
Lou Gehrig’s Disease or Charcot’s Disease.
What is a common cause of death in ALS patients?
Respiratory failure and aspiration.
What are some common features of Pseudobulbar Affect in ALS?
Emotional lability, inappropriate laughter or crying, and emotional outbursts.
What chromosomal defect is commonly associated with ALS?
A 15% defect in Chromosome 21q12.1.
What are the survival rates for ALS based on age of onset?
2.5 years survival for onset at 62 years, vs. 8 years for early onset.
Describe the typical progression of weakness in ALS.
Starts as dysfunction or weakness in one part of the body and gradually spreads to other parts.
What is a key diagnostic criterion for ALS?
The presence of both upper motor neuron (UMN) and lower motor neuron (LMN) signs in more than two regions.
What cognitive impairments are associated with ALS?
: Issues with executive function, visual attention, working memory, cognitive flexibility, problem-solving, and verbal fluency.
What are typical treatment strategies for spasticity in ALS?
Stretching, positioning, Baclofen, Tizanidine.
What diagnostic tests are used for ALS?
EMG-NCV (fibrillation and fasciculation potentials), CT scan/MRI (degeneration of tracts).
How is Bell’s Palsy diagnosed?
iagnosis is mainly by exclusion, ruling out other causes of facial paralysis.
What are the typical findings in electromyography (EMG) for ALS?
Fibrillations, fasciculations, unstable motor units, increased duration/amplitudes in slowly progressing ALS, low-amplitude polyphasic motor unit potentials.
What is a common issue with muscle biopsy in ALS?
Denervation atrophy.
What are some commonly affected muscles in ALS?
Weakest: wrist extensor, finger extensor, hand intrinsics. Spared: wrist & finger flexor, elbow extensors.
Name a medication used to decrease glutamate and extend life in ALS patients.
Rilutek (Riluzole).
What are some adaptive strategies for feeding in ALS?
Soft solids > liquids, using adaptive utensils, and feeding tubes if necessary.
What are the levels of injury in Bell’s Palsy and their effects?
Stylomastoid Foramen: Facial Muscles
Chorda Tympani: Salivation & taste loss
Stapedius: Hyperacusis
Geniculate Ganglion: Lacrimation
Internal Auditory Meatus: Deafness, tinnitus, balance loss
Pons: Marcus Gunn phenomenon, marin Amat, and CN V, VI, IX, X involvement
What are some special considerations for communication in ALS?
Dysarthria, sialorrhea, and the use of communication aids or devices.
What are some common medications used to manage ALS symptoms?
What are some common medications used to manage ALS symptoms?
What is Bell’s Palsy?
Bell’s Palsy is a common neurologic disorder characterized by abrupt, unilateral, peripheral facial paresis or paralysis without a detectable cause.
What is Ramsay Hunt Syndrome?
It is a type of facial paralysis associated with herpes zoster virus infection, presenting with severe otalgia, facial paralysis, and vesicular eruption.
What are some common physical therapy interventions for ALS?
Maintenance of range of motion, prevention of contractures, low-impact aerobic exercise, use of splints & gait aids.
What are the main symptoms of Bell’s Palsy?
Sudden onset facial weakness, hyperacusis, decreased tear production, altered taste, facial or retro-auricular pain, and potential hearing loss.
What are common risk factors for Bell’s Palsy?
Increased risk in pregnancy, diabetes, and a history of upper respiratory infections.
What is the typical age of onset for Multiple Sclerosis?
The mean age of onset is 32 to 34 years old.
What are the main treatments for Bell’s Palsy?
Treatments include corticosteroids, antiviral medications, eye care, physical therapy, and psychological support.
What is Multiple Sclerosis (MS)?
MS is an inflammatory disease of the CNS characterized by areas of demyelination leading to functional and cognitive impairments.
What factors are associated with poor prognosis in MS?
Progressive course of onset, male gender, onset before age 40, cerebellar involvement at onset, and multiple system involvement.
What are some bad prognosis factors for Bell’s Palsy?
Complete facial palsy, no recovery by three weeks, age over 60 years, severe pain, Ramsay Hunt syndrome, and severe facial nerve degeneration.
What are common clinical presentations of MS?
Weakness, paresthesias, gait difficulty, visual disturbances, diplopia, ataxia, vertigo, and urinary bladder dysfunction.
What are the types of MS?
Relapsing-Remitting MS
Secondary Progressive MS
Primary Progressive MS
Plateaued MS
Benign MS
Malignant MS
What are the primary diagnostic tools for MS?
Cerebrospinal Fluid Examination, Magnetic Resonance Imaging (MRI), and Evoked Potential Recordings.
What are the major types of MS treatment?
Steroids
Immunosuppressive drugs
Disease-modifying treatments (e.g., Interferon, Copaxone)
4-Aminopyridine
What is the role of 4-Aminopyridine in MS treatment?
It blocks K+ channels, prolonging nerve action potentials and restoring conduction in demyelinated fibers.
What are some emerging therapies for MS?
Alemtuzumab, Cladribine, Fingolimod, and Teriflunomide.
What are some common problems and challenges faced by MS patients?
Cognitive and psychiatric problems, neurogenic bladder and bowel, spasticity, ataxia, sexual dysfunction, and difficulties with ADLs.