1. tingling/parasthesias 2. severe radicular back pain 3. weakness! (mild/complete) -mostly legs, face, swallowing SYMMETRIC, AREFLEXIC, varying sensory loss CSF and EMG/NCS

REVIEW 2: CNS PNS, SCI Flashcards by Rebecca Nam

ALS MEDS

riluzole
edaravone
tofersen

How well did you know this?

Not at all

Perfectly

sialorrhea meds

Amitriptyline/nortriptyline, atropine drops
levsin
scopalamine patch
ALS treatment of excess drooling

How well did you know this?

Not at all

Perfectly

pseudobulbar palsy treatment

neudexta
ALS, MS

How well did you know this?

Not at all

Perfectly

ALS meds for fatigue

BIPAP, Modafinil
stimulant!!!

How well did you know this?

Not at all

Perfectly

ALS meds for pain/cramps

Mexiletine
Quinine
gabapentin (mm relaxant)
baclofen
opioids
PT/OT

How well did you know this?

Not at all

Perfectly

how can you tell its a radiculopathy? and not LMN lesion?

mm weakness
radicular pain in dermatome
atrophy
decrease reflexes

(reflex, myotome, dermatome)

How well did you know this?

Not at all

Perfectly

how can you tell its a plexopathy?

1 limb, painful, symptoms in more than 1 nerve/1 root
(from trauma, tumor, thoracic outlet)

How well did you know this?

Not at all

Perfectly

autonomic neuropathy symptoms

Orthostatic hypotension
Arrhythmias
Severe constipation, urinary retention, erectile dysfunction
Abnormal sweating
Early satiety, lightheadedness with meals (gastroparesis)

How well did you know this?

Not at all

Perfectly

demyelinating polyneuropathy

weak, not atrophy
length doesnt matter
patchy
asymmetric

How well did you know this?

Not at all

Perfectly

axonal polyneuropathy

distal, LE, weak AND ATROPHY EARLY

How well did you know this?

Not at all

Perfectly

AIDP symptoms

tingling/parasthesias
severe radicular back pain
weakness! (mild/complete)
-mostly legs, face, swallowing

SYMMETRIC, AREFLEXIC, varying sensory loss

CSF and EMG/NCS

How well did you know this?

Not at all

Perfectly

AIDP/GBS treatment

NOT STEROIDS
plasma and IVIG
*watch for RR and ANS dysfunction

How well did you know this?

Not at all

Perfectly

CIDP presents as

MOTOR
SYMMETRIC weakness prox and distal
decreased reflees
*sensory loss mainly in legs

How well did you know this?

Not at all

Perfectly

what meds to treat neuropathic pain?

– Tricyclic antidepressants -> Cymbalta
– Gabapentin -> Lyrica – -Tramadol (messy opioid)
– Topical capsacin

How well did you know this?

Not at all

Perfectly

DM neuropathy presents as

distal, symmetric, sensory
stocking, glove
then autonomic changes
NO WEAKNESS

How well did you know this?

Not at all

Perfectly

DLRPN or diabetic amyotrophy

ACUTE
sharp/aching pain, hip/thigh, then leg/foot (prox to distal)
pain, then weak, then distal weak.
*weight loss!

How well did you know this?

Not at all

Perfectly

charcot marie tooth is a

motor and sensory neuropathy
hereditary
LD sensory loss
distal weakness/atrophy
foot deformities
decreased reflexes
CHRONIC

How well did you know this?

Not at all

Perfectly

which drugs are worse for myasthenia gravis

penicillamine
IFN alpha
botox
succinylcholine
magnesium salts

How well did you know this?

Not at all

Perfectly

how do you treat MG

pyridostigmine (mestinon) Ach esterase inhib
-acute: IVIG/PLEX
-STEROIDS
-thymectomy

signs of MG

weak, fatigue, atrophy
myalgia (mm PAIN), cramp, contractures, PSEUDOHYPERTROPHY, stiffness, myoglobinuria

how do myopathies present?

GOWERS prox weakness
sensation intact
DTRs normal or slightly reduced

are polymyositis/dermatomyositis acute or subacute/chronic?

subacute/chronic onset of PROX WEAKNESS
(pulm or cardiac involvement)
malignancy**
autoimmune or HIV

inclusion body myositis

males over 50!
slow, prog weakness (prox leg, distal arm)
asymmetric, atrophy, dysphagia

acute transverse myelitis symptoms

back pain
sensory level
sphincter disturbance
paraparesis
(SC!)

optic neuritis symptoms

pain with eye mvmt loss of color (RED) poor acuity afferent pupillary defect

you have increased risk of MS if you are

female young multiple MRI lesions! previous sensory symptoms

risk factors (environmental) for MS

EBV, low sun, obesity, smoking

4 types of MS

1. relapsing-remitting 2. secondary progressive 3. primary progressive 4. progressive-relapsing

main symptoms of MS

fatigue, cognition, depression eyes: nystagmus, diplopia, optic neuritis speech: dysarthria throat: dysphagia MSK: UMN weak/spasticity, ataxia SENSORY: pain, hypo/paraesthesias BOWEL: incontinence, diarrhea or constipation URINARY: incont/freq/retention

what are the motor symptoms of MS

UMN spastic weakness (corticospinal and corticobulbar) ataxia, tremor, scanning speech, incoordination (cerebellar)

what is main sensory symptom of MS?

ALST! pain/temp *Lhermitte's

what are brainstem symptoms of MS?

nystagmus, diplopia, face weakness, vertigo, dysphagia TRIGEMINAL NEURALGIA *can't adduct ipsi eye (INO)

intranuclear ophthalmoplegia is seen in

MS *cant adduct ipsi eye, contra eye has nystagmus

what do you use to diagnose MS

Uhthoff's phenomenon MRI* Evoked potentials CSF: high protein or WBC but for sure oligoclonal bands

what do you use to treat acute RRMS?

steroids or plasma ex

PML

severe demyelinating CNS disease-fatal JC virus

treatment of spasticity (meds) *MS*

MM RELAXANT Baclofen (oral, intrathecal) – Tizanidine (Zanaflex) Dantrolene Botox injections PT-stretching!

spastic bladder in MS: meds

– oxybutynin (Ditropan), tolterodine (Detrol), botox – Limit fluids at night – Schedule voiding

flaccid bladder in MS

terazosin (Hytrin), doxazosin (Cardura) – Chronic intermittent catheterization

tremors meds (FOR MS)

Propranolol: B blocker – Primidone: barbituate – Gabapentin: pain – wrist weights, assistive devices

meds for neuropathic pain in MS

– gabapentin (Neurontin) – pregabalin (Lyrica) – duloxetine (Cymbalta): pain – amitriptyline (Elavil)

med for ataxia in MS

PT :)

Ampyra is what

med for walking speed for MS

symptoms of NMO

area postrema syndrome (hiccups, nausea, vomiting) -acute brainstem syndrome (vomit, hiccups, pruritus, hearing loss, CN3) narcolepsy cerebral lesions

MOG is what

all ages (usually young adults/children) optic neuritis TM ADEM like CNS lesions