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CPD III > Quiz 3- Neurological Disorders Part 2 > Flashcards

Quiz 3- Neurological Disorders Part 2 Flashcards

1
Q

a seizure typically causes

A

altered awareness, abnormal sensations, focal involuntary movements or convulsions (widespread violent involuntary contractions of muscles)

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2
Q

definition of types of seizures

A

epilepsy (recurrent unprovoked seizure. often idiopathic)
nonepileptic (seizure provoked by a temp disorder)
symptomatic (due to a known cause)
psychogenic (no electrical discharge in the brain)

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3
Q

what are a few etiologies for seizures emphasized during class?

A

CNS infxn
brain trauma
metabolic disturbances

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4
Q

generalized seizure
involves which parts of brain?
LOC?
from?

A

involves entire cortex of both hemispheres
complete LOC
from metabolic disturbances

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5
Q

partial seizure
involves which parts of brain?
LOC?
from?

A

involve one cerebral cortex
either no LOC (simple partial) or partial LOC (complex partial)
from structural abnormalities

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6
Q 
absence seizures (aka Petit Mal)
what population does it affect?
what type of seizure is it?
A

children

generalized

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7
Q

what does an absence seizure look like?

A 
occurs many times throughout the day 
5-30 sec LOC 
eyelid fluttering 
no falling or convulsing 
occurs when patient is sitting quietly, pt stares vacantly, may abruptly stop activity and just as abruptly resume it 
neuro and cognitive exams are normal
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8
Q

Tonic clonic seizures (aka Gran Mal)
who does it affect?
what type of seizure is it?

A

doesn’t say, think adults

general seizure

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9
Q

Tonic clonic seizure is characterized by?

A
  1. begin with outcry
  2. LOC and falling
  3. tonic contraction then clonic motion of muscles
    sometimes: urinary or fecal incontinence, tongue biting, frothing at the mouth
    NO AURA
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10
Q

Simple partial (a type of partial seizure) is characterized by?

A

cause motor, sensory, or psychomotor sxs without LOC

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11
Q

the types of simple partial

A

MOTOR - INDICATE STRUCTURAL BRAIN DZ
SENSORY - INDICATE STRUCTURAL BRAIN DZ
the focal onset localizing the lesion- full investigation is mandatory

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12
Q

motor (a simple partial seizure)

A 
arise in the frontal motor cortex with movements in the contralateral face, trunk and limbs 
jacksonian march (involuntary muscle movement from one muscle group to the next)
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13
Q

sensory (a simple partial seizure)

A

arise in the sensory cortex

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

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14
Q

complex partial (a type of partial seizure) is characterized by?
LOC?
Originates where?
preceded by what?

A 
reduced but not complete LOC 
originate in temporal lobe
often preceded by an aura
during seizure patients may stare 
automatsims (oral or limbs)
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15
Q

what are some risk factors for seizures?

A 
prior head trauma or CNS infxn
known neurological disorders
drug/alcohol withdrawal
nonadherence to anticonvulsants 
family hx of seizures or neurological disorders
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16
Q

rare triggers of seizures

A 
repetitive sounds
flashing lights
video games
touching certain body parts
sleep deprivation
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17
Q

imaging to dx seizure?

A

EEG - critical for DX but normal EEG cannot necessarily r/o seizure disorder

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18
Q

what 3 common ssx (vomiting, fever, h/a) might be something more serious, for instance ______?

A

brain abscess

might also present with focal neurologic deficits and seizures

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19
Q

what common infections can turn into a potential brain abscess?

A

mastoiditis and sinusitis

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20
Q

encephalitis is inflammation of which part of the brain?

what viruses cause it?

A

parenchyma
mosquito-borne arboviral encephalitides
HSV
HIV

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21
Q

SSX of encephalitis?

sounds similar to which other condition?

A

fever, h/a, altered mental status, seizures, focal neurological deficits
sounds a lot like brain abscess, minus vomiting

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22
Q

rabies is a type of encephalitis transmitted by

A

saliva of infected bats or mammals

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23
Q

SSX of rabies

A 
depression
fever
agitation
excessive salivation
hydrophobia
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24
Q

when should you suspect rabies?

A

with ascending paralysis and recent hx of animal bit or exposure to bats

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25
subdural empyema is what
a collection of pus between dura mate and arachnoid
26
what's the etiology for subdural empyema?
usu a complication of sinusitis | ear infxn
27
prion disease aka
transmissible spongioform encephalopathies
28
transmission of prion disease
person to person as in kuru | animal to person as in CJD
29
Creutzfeldt-Jakob Disease (CJD)- types
Sporadice (sCJD) accounts for 85% of cases | Variant (vCJD) comes from people eating meat from cattle with bovine spongioform encephalopathy
30
SSX for CJD
memory loss (similar to dementia in terms of loss of volume of brain) confusion incoordination and ataxia startle mycoclonus (jerky muscle movements brought on by sudden noise or other stimuli) onset >40 YO
31
when should you suspect CJD?
suspect in elderly patients with rapidly progressing dementia esp. if accompanied by ataxia or myoclonus
32
what to know about Kuru?
disorder of TSE (transient spongiform encephalopathy) that has been extensively studied in Papua New Guinea and is spread from man to man through cannibalism
33
all types of meningitis share some of the same ssx. which ones?
h/a fever nuchal rigidity
34
PE's for meninigitis
(+) Kernig (+) Brudzinski difficulty touching chin to chest with mouth closed
35
DX for meningitis
CSF
36
Acute bacterial meningitis pathophysiology ssx dx
-hematogenous spread or nearby infected structures: sinuses, middle ear -feeling unwell for 3-5 days (malaise, fever, irritability, vomiting) then meningeal sxs may develop (h/a, fever, photophobia, changes in mental status- lethargy, obtundation, nuchal rigidity, seizures) DX -CSF: Incr WBCs (PMNs), incr protein, dec glucose -CBC with diff: shift to the left -Blood culture
37
Viral Meningitis causes ssx dx
``` *less severe than bacterial meningitis enteroviruses (most common), HSV - begin with: h/a, fever, GI or Resp sxs -follow by: h/a, fever, nuchal rigidity) DX: -CSF: Inc WBCs (lymphcytes), protein slightly incr (less than bacterial meningitis), glucose normal ```
38
what causes recurrent meningitis?
HSV would see: ≥3 episodes of fever, nuchal rigidity, and CSF with inc. lymph; episodes last 2-5 days and resolve spontaneously
39
what might cause subacute meningitis?
fungi | develops over days to a few weeks - hard to eradicate
40
how to dx subacute meningitis?
clinical findings are non-specific | CSF may not provide indicative info and may need more invasive testing like brain bx
41
compare physiologic tremor to pathologic tremor
physiologic - fast in rate, occurs while maintaining a posture pathologic - slow in rate, occurs while at rest or with movment
42
essential tremor
action tremor (occurs with movement) 20X more common than Parkinson dz (good to keep in mind) alchohol alleviates sxs (reduces the overactivity of the cerebellum)
43
what things should you cover in hx in someone with a tremor?
onset of tremor? body parts affected? ROS: wt loss? dec appetite, diarrhea, palpitations, heat intolerance (hyperthyroidism) muscle rigidity, gait and postural problems, slowness of movement (Parkinson dz or other forms of Parkinsonism) sudden onset of motor weakness, difficulty with speech (stroke)
44
PE for tremor
Vitals HEENT- any signs of exopthalmus or eyelid lag? Thyroid - enlarged thyroid gland? Cardio - tachycardia? Extensive neuro exam - extend arms out in front of them to look for tremor, spiral hand drawings (with action tremor will have difficulty, not with Parkinsonian tremor)
45
What are the red flags for someone with a tremor? | know these
- abrupt onset | - onset in ppl
46
what's the most common form of intellectual disability in males?
Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS)
47
Huntington Disease pathology ssx dx
-neuronal loss in basal ganglia SSX -dementia or psych disturbances may precede movement disorders -chorea (uncontrolled twisting and writhing movements) -tics DX -clinical eval confirmed by genetic testing -neuro imaging
48
``` Parkinson Disease pathophysiology etiology ssx dx ```
-loss of neurons mainly in the stubstantia nigra and the presence of Lewy bodies -genetic and/or environmental factors (smoking, herbicides, carbon dioxide) SSX -mask-like facies (little to no expression on face because of muscle rigidity) -coarse tremor (occurs at rest and improves with movement and sleep) -rigidity (of flexors of neck and trunks resulting in flexed posture) -bradykinesia -shuffling gate -dementia (in 30%) DX - unilateral resting tremor that disappears during finger to nose coordination test
49
MS | SSX
paresthesias in one or more extremity, in the trunk, or on one side of face weakness or clumsiness of a leg or hand visual disturbances urinary incontinence (neurogenic bladder)
50
whats the clinical course for MS?
1. Relapsing-Remitting Pattern usu occurs in early course exacerbations alternate with remissions 2. Primary Progression Pattern disease progresses rapidly without remission 3. Secondary Progression Pattern initially begins with relapsing-remitting course, but later evolves into progressive course 4. Progressive Relapsing Pattern disease progresses gradually with sudden relapses (rare)
51
MS PE DX
reflexes- exaggerated repetitie knee jerk | MRI- most sensitive test for MS, reveals many plaques (# of plaques does not correlate with sx/dz severity)
52
myasthenia gravis definition
condition that causes episodic muscle weakness and easy fatigability cause by immune destruction of acetylcholine receptors
53
myasthenia gravis | SSX
fatigability (muscle weakness after use of the affected muscle), weakness resolves with rest eyes - ptosis and diplopia resp - recurrent pneumonia (can't cough things out)
54
myasthenia gravis | DX
Bedside test- tensilon (should see dramatic improvement in muscle weakness) & Ice-pack tests (improved neuromuscular transmission at lower temps, effect on ptosis immediately observed) Confirmed by - Serum Anti-AchR Abs & EMG
55
Guillain-Barre Syndrome (GBS)
antibody and cell-mediated rxns to peripheral nerve myelin involved
56
SSX of Guillain-Barre Syndrome
motor impairment is > sensory a. sensory sx to begin: parasthesia of feet then hands b. then, rapid onset of severe muscle weakness (after a surgery, infection, or vaccination) - usu weakness is symmetric and begins with legs and progresses to arms -respiratory paralysis may occur -at its worst: total flaccid quadriplegia Prognosis: 50-90% complete recovery
57
PE for GBS
DTRs are lost completely
58
What's the DDX for GBS?
-Myasthenia Gravis: weakness, early ptosis, opthalmoplegia; DTRS are retained -MS: doesn't resolve, hyperreflexia Diabetes: glove and stocking parasthesia but DTRs retained
59
ssx of a brain tumor
h/a (esp new onset, worsened by sleep
60
What's a primary tumor (glioma) that develops in younger patients?
Astrocytomas
61
What's a benign tumor of the meninges that can compress the adjacent brain tissue?
Meningiomas
62
A patient with a pituitary tumor will manifest which sx?
h/a | visual manifestations
63
Spinal cord tumors - what's the sx you'll see all the time that you should be thinking "is the a spinal cord tumor?"
progressive back pain that's unrelated to activity and worsened by recumbency (highly unusual)

CPD III (7 decks)

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