Quiz 3 - Neuro II Flashcards by Piper Dobner

Generalized Seizures are correlated with?

metabolic disturbances
complete LOC
- seizure activity involving ENTIRE brain, entire cortex of both hemispheres

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what are the 5 generalized seizures

infantile spasms (RARE)
absence seizures (Petit Mal)
tonic-clonic seizures (Grand Mal)
atonic seizures
myoclonic seizures

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what are common symptoms of absence seizures?

no falling or convulsing

neuro and cognitive exams are usually normal

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what are common symptoms of tonic clonic seizures (grand mal seizures)

begin with OUTCRY, LOC, falling.

NO AURA

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what are common symptoms of typical absence seizures?

no falling or convulsing
eyelid fluttering (sometimes)
staring vacantly
neuro and cognitive exams are usually normal

usually 4-12 yr old w. FHx

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partial seizures are characterized by?

involvement of one cerebral cortex

- often from structural abnormalities

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what are the types of partial seizures, what do they indicate and what is 100% mandatory?!

Types: Motor and Sensory Seizures
Indicate: structural brain disease

the focal onset localizing the lesion: FULL INVESTIGATION IS MANDATORY

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what are the types of simple partial seizures, what do they indicate and what is 100% mandatory?!

Types: Motor and Sensory Seizures
Indicate: structural brain disease

the focal onset localizing the lesion: FULL INVESTIGATION IS MANDATORY

No LOC

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Simple Partial Motor Seizures arise where?

What is a Jacksonian Motor seizure?

arise in the frontal motor cortex with movements in the CONTRALATERAL face, trunk or limbs

Jacksonian motor seizure - a simple partial seizure - march of involuntary muscle movement from one muscle group to the next

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what are the types of simple partial seizures, what do they indicate and what is 100% mandatory?! KNOW THIS

Types: Motor and Sensory Seizures
Indicate: structural brain disease

the focal onset localizing the lesion: FULL INVESTIGATION IS MANDATORY

No LOC

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Simple Partial Sensory Seizures present how?

parasthesias or tingling in an extremity or face sometimes associated with a distortion of body image

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Complete partial seizures originate where?

temporal lobe

reduced but NOT complete LOC

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ssx of partial seizures, in general what should be expected?

preceded by an aura

1-2 min duration

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What are common causes of brain abscess?

direct extension of cranial infections:

mastoiditis
sinusitis

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ssx of partial seizures, in general what should be expected?

MAY BE preceded by an aura
1-2 min duration
followed by post-ictal state - sleepy, HA, confusion, soreness

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what is the etiology of encephalitis?

direct viral invasion

mosquito transmission, HSV, HIV

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what is helpful in dx of rabies?

suspected in ptsd with encephalitis or ASCENDING PARALYSIS and recent HX of animal bite or bat exposure

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what imaging would be ordered for imaging of suspected seizure patients?

EEG

- critical for dx, but normal EEG cannot necessarily r/o seizure

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what are 6 brain infections an individual can get?

brain abscess
encephalitis
rabies
helminthic brain infections
progressive multifocal leukoencephalopathy
subdural empyema

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what is the definition of prion disease?

progressive, FATAL, and UNTREATABLE BRAIN DISORDERS

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DX brain infections by?

MRI - multifocal, non-enhancing lesions w.o mass effect

CSF - look for JC virus DNA

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KNOW - What is the common etiology of subdural empyema?

SINUSITIS

Ear infections

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what are ssx of prion disease?

ssx:

memory loss
confusion
ataxia
startle myoclonus (provoked by noise or stimuli)

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how is Creutfeldt-Jakob Disease dxd?

Suspect in elderly patients with RAPIDLY progressing dementia, esp if accompanied by ataxia or myoclonus

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what are the ssx of meningitis?

headache fever nuchal rigidity (this may or may not be present)

a patient ptc with 3-5 days of progressive malaise, fever, irritability, vomiting.. what condition is this and what may develop?

acute bacterial meningitis meningeal sx may develop such as: fever, HA, seizures (40% kiddos)

how is acute bacterial meningitis dxd?

CSF | - increased WBCs (PMNs - highly active neutrophils), protein and decreased glucose

what are common causes of viral meningitis?

enterovirus (MOST COMMON) | or HSV

how is viral meningitis dxd?

CSF - increased WBC (lymphocytes), protein is slightly increased, less than bacterial, and glucose is generally normal, or slightly decreased

which virus is most commonly the cause for recurrent meningitis?

HSV

what are the movement disorders?

``` tremor fragile x-associated tremor/ataxia syndrome (FXTAS) Huntington's disease Parkinson's Disease Tic Disorders Restless Leg Syndrome ```

when do tremors occur? what typically alleviates sx?

during voluntary movement, typically bilateral alcohol alleviates sxs Fhx is pertinent in 50% of cases

what are red flags of tremors?

abrupt onset | onset in people

what is the definition of Parkinson's Disease? what is present pathologically?

bardykinesia RESTING tremor cogwheel rigidity postural reflex impairment lewy bodies

what are common signs and symptoms of parkinson's disease

``` mask-like facies coarse tremor rigidity bradykinesia shuffling gate ```

what is a common tic disorder?

tourette syndrome

when do tremors occur? what typically alleviates sx?

during voluntary movement, typically bilateral ALCOHOL ALLEVIATES sxs Fhx is pertinent in 50% of cases

when do tremors occur? what typically alleviates sx?

during voluntary movement, typically bilateral ALCOHOL ALLEVIATES sxs 20x more common than Parkinson's Fhx is pertinent in 50% of cases

compare physiologic tremor vs pathologic tremor

physiologic - fast rate - enhanced by fatigue, anxiety, drugs - non-disabling pathologic - slow rate - socially and physically disabling

what symptoms are associated with huntington disease?

``` choreic movements (dance) dementia ```

what are common signs and symptoms of parkinson's disease

``` mask-like facies RESTING tremor cogwheel rigidity bradykinesia - slow movement shuffling gate ``` approx. 10% have genetic predisposition.

what symptoms are associated with huntington disease?

``` choreic movements (dance) dementia ```

what clinical symptom helps with diagnosis of Parkinsons?

unilateral resting tremor

what is the most sensitive test for MS?

MRI of brain/spinal cord | -reveals plaques

What are common ssx of Myasthenia Gravis?

immune destruction of an acetylcholine receptor - fatigability - eyes - ptosis, diplopia

what is the confirmatory lab work done of myasthenia gravis

serum Anti-AchR Abs** | EMG

what is the difference in GBS and MS?

GBS is peripheral nerve myelin | MS is central nerve myelin

Guillain-Barre syndrome presents with what symptoms, progress to what? ?

sensory sx begin: paresthesia of feet and hands then, rapid onset of severe muscle weakness usually weakness is SYMMETRIC and begins with legs and progresses to arms MOST CONCERNING: - respiratory paralysis may occur - at it's worse: total flaccid quadriplegia DTRs are lost. (LMN)

what is the difference in GBS and MS?

GBS is peripheral nerve myelin | MS is central nerve myelin

what is the DDX for GBS?

Myasthenia Gravis - weakness, early ptosis, DTRs retained MS - no resolve, hyperreflexia DM - glove and stocking prothesis, DRTs retained, elevated glucose

multiple sclerosis presents in what gender at what age range? what is the typical clinical course?

women, typically 20-40 y/o - relapsing-remitting pattern - primary progressive pattern - secondary progressive pattern - progressive relapsing pattern

what is the DDX for GBS?

Myasthenia Gravis - weakness, early ptosis, DTRs retained MS - no resolve, hyperreflexia DM - glove and stocking prothesis, DRTs retained, elevated glucose

ALS is? who is at greater risk? what are the SSX?

amyotrophic lateral sclerosis random asymmetric - weakness, muscle atrophy of hands and feet (foot drop) fasiculations, spasticity, hyperactive DTRs

how is ALS dx'd?

Clinically - requires BOTH UMN and LMN disorders in MULTIPLE areas

how is ALS dx'd?

Clinically - requires BOTH UMN and LMN disorders in MULTIPLE areas

intracranial and spinal tumors present with what ssx?

HEADACHES!!! - made worse by sleep. different HA than they are used to. Very persistent. or new seizures..

which type of glioma is the most common? what age group are we expecting to see?

astrocytomas - tend to develop in younger patients

for pituitary tumors, what are common ssx?

- headache | - visual manifestations

which structure do pineal tumors compress?

hypothalamus

spinal cord tumors present with?

progressive back pain, unrelated to activity and worsened by RECUMBENCY