Riesert Lectures Flashcards by Casey Emge

“Having disturbed ambulation”

Dizziness

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Change in BP and cerebral blood flow d/t transient low BP; alteration in normal response to standing; may occur w/ aging d/t LOSS OF VASOCONSTRICTION (w/ standing, blood falls to feet, and you get dizzy/pass out)

Orthostasis

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Lie for 10 min, stand for at least 2 min; Fall in systolic BP>20mmHg; Fall in diastolic BP>10mmHg; increase in HR 10-25 BPM; symptoms of cerebral hypoperfusion

Orthostasis

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Drug used to tx Orthostasis=

Fludricortisone (mineralcorticoid)

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Loss of buffers to remain conscious; what comes before syncope referred to as ‘prodrome’

Fainting

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May be d/t arrhythmia/dysrhythmia; Heart block; aortic stenosis; medications (orthostasis)

Syncope-cardiac causes

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Best tx to true cardiac syncope=

implantable cardiac defibrillator

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Impaired vestibular system; may be d/t disturbance of inner ear; altered head position in space, via alteration of CN VIII (vestibulocochlear)

Vertigo

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MC cause of orthostatic hypotension=

Dehydration

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Dx of orthostatic hypotension=

Tilt-Table test*

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Visual input, somatosensory input (skin, joints, muscles, spinal cord), Cerebellum, Cerebrum all involved with=

normal BALANCE maintenance

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Alteration of eye movement; oscillation to lateral gaze; normal 2-3 beats, if more, consider abnormal

Nystagmus

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Abnormal input to stabilize (ie Car sickness); unfamiliar head position (i.e. sea sickness); unusual head position (i.e. painting a ceiling); spinning

Vertigo-physiologic

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Disturbance of vision, somatosensory system, vestibular system; CNS tries to correct (homeostasis is disrupted)-abnormal head sensation; worse w/ rapid head movement; nausea and ataxia

Vertigo-Pathological

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MC cause of vertigo; includes acute labyrinthitis and vestibular neuritis

Idiopathic

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Cochlear disease affecting ear mechanism; progressive hearing loss to low frequency; Tinnitus, dizziness; unknown etiology

Meniere’s disease

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Tx for Meniere’s=

Diuretics (HCTZ); low salt restriction (

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Involved w/ sound and balance; Acoustic neuroma pushes on this (unilateral hearing loss, tinnitus, schwannoma or meningioma); MRI is diagnostic test***

Cranial nerve VIII (vestibuluocochlear nerve)

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D/t changes in head position; no clear known cause; may last months; Epley maneuver to tx!

Benign Positional Vertigo (BPV)

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Tests to include for cardiac testing for syncope=

EKG, Echocardiogram, Holter monitor & Event monitor, exercise stress test, electrophysiologic study (EP study), Tilt table test

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Meclizine, Dimenhydrinate, Promethazine=

Vestibular suppressants

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Diazepam=

Benzodiazepines

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Alteration is when the vestibular sense, visual sense, and somatosensory sense are NOT CONGRUENT; principal symptom is N/V

Sea sickness/motion sickness

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” A paroxysmal event d/t abnormal CNS d/c with resultant manifestations depending on area involved”

Seizure disorder

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Defines a pt with recurrent seizures=

Epilepsy

Type of seizure; deranges area of cerebral cortex often d/t a structural anomaly-consciousness is preserved

Partial seizure

Type of seizure; diffuse region of brain firing simultaneously; often d/t a widespread problem (cellular d/o, biochemical disruption, structural issue)

Generalized Seizure

Type of seizure; may be motor, sensory, autonomic, psychic but WITHOUT loss of consciousness; often clonic with repetitive flexion/extension; EEG shows abnormal impulses in focal area of brain

Simple Partial Seizures

Simple partial seizure; motor activity begins DISTALLY, like fingers, and spreads to whole extremity; EEG shows spike waves

Jacksonian March

Simple partial seizure; local paresis lasting minutes to hours

Todd's paralysis

Simple partial seizure; continues hours to DAYS

Epilepsia partialis continua

Changes in somatic sensations (paresthesisas), change in vision (flashing light, hallucinations), changes in equilibrium (falling, vertigo), autonomic changes (flushing, sweating)

Symptoms of simple partial seizures

Focal activity progresses to loss of contact with environment (ictal stage)-STARE, AMNESIA; often begins with an aura stereotypical for the pt "feel funny";

Complex partial seizures

Electrical d/c spread and both hemispheres become involved; results in tonic-clonic seizure; common when partial seizures in frontal lobe

Partial seizures with secondary generalization

Arise in both cerebral hemispheres simultaneously; look like focal seizure that secondarily generalized though not associated with a specific focal onset event ; includes absence seizures and tonic-clonic seizures

Generalized seizures

Brief LOC without postural control; few seconds; No post ictal confusion; eye blinking, chewing, clonic movement of hands; childhood onset

Absence seizures (Petit mal)

MC type when seizures are d/t metabolic derangement; sudden onset

Generalized Tonic-Clonic Seizures (Grand Mal)

T-C seizure variation; 1-2sec lose motor tone; brief LOC; no post-ictal confusion; risk after head injury

Atonic seizures

T-C seizure variation; brief contraction or jerk (when you fall asleep & twitch); seen in brain injuries

Myoclonic seizures

Type of epilepsy seen in children; Multiple different types of seizures, particularly tonic (stiffening) and atonic (drop) seizures; associated with CNS disease (developmental delay, trauma, infection, neural injuries)

Lennox Gastuat Syndrome

MRI shows hippocampal sclerosis=

Mesial temporal lobe epilepsy

Shifts in balance of excitations and inhibition in the CNS

Seizures

Burst of electrical activity; influx of extracellular calcium & sodium; spike d/c; inhibitory neurons overwhelmed by calcium and potassium; channel problems

Seizures

May occur from infection (otitis media, respiratory infection, gastroenteritis); can be simple (one event) or complex (repeated activity); NOT EPILEPSY

Febrile Seizures

Key to diagnosing seizure disorders=

EEG*

Non-epileptiform behaviors that resemble seizures; can be seen with stress/conversion reaction

psychogenic seizures

Common first line meds for seizures=

Phenytoin, Valproic acid, carbamazepine

Goal of pharmacotherapy is to block activity of ion channels or neurotransmitters in treating____

seizures

Blacks voltage dependent calcium channels, modulating excitatory NT release; binds alpha 2 delta subunit of calcium channels reducing NT release producing anti-nociceptive and anti seizure effects

Gabapentin & pregabalin

Continuous seizure; may range from T-C seizure to more subtle; Medical emergency (CV implications, hyperthermia, metabolic derangements, CNS injury);

Status epilepticus

Temporal lobectomy, Focal lesion removal, Corpus callosotomy=

surgical tx of seizures

Play a bipolar electrode in left vagus nerve; generator delivers a pulse ; may increase seizure threshold

vagal nerve stimulator

An acute confusional state with decreased attention

delirium

AKA confusion, encephalopathy, acute brain failure, acute confusional state=

delirium

Decrease attention key; change in sleep awake cycles, hallucinations, delusions, ANS changes s/a HR or BP problems, hypo or hyperactive status

delirium

Usually d/t diffuse cerebral dysfunction; low Ach levels? may mimic Alzheimer's, Lewy body dementia; high dopamine levels possible too

Delirium

Elderly w/ delirium that gets worse at night

sundowning

Acute alcohol withdrawal syndrome; agitation, tremor, hallucinations, ANS instability (incr BP, pulse, resp), seizures

Delirium tremens

Tx with Benzodiazepines, Phenobarbital, Antipsychotics

Delirium Tremens

Continuum of diseases with memory loss, speech and language difficulties, impaired judgement, mood issues

Dementia

Changes in cerebral circuits; nerve loss; changes in NT (Ach, Serotonin, Glutamine)

Dementia

Memory loss subtle; progressive over years; Neuritic plaques ("senile plaques"), amyloid deposition in arterial walls of neurons, neurofibrillary tangles in the cytoplasm of the neurons

Alzheimers type dementia

Multi-infarct dementia (classically hypertensive pts); diffuse white matter disease (Binswanger's dz or leukoaraiosis); lg or sm infarcts, lacunar infarcts; more sudden onset; Looks like AD, may have amyloid, with incr risk of hemorrhage

Vascular dementias

Includes Huntington's chorea (dementia), Pick's disease, progressive supra nuclear palsy; memory loss later is dz; aphasias seen

Frontotemporal dementias

Autosomal dominant inheritance (chromosome 4, fam hx); results in writhing movements (chorea, dancing); symptoms include motor and cognitive problems

Huntington's chorea

Involuntary movements; look like jerks or tics, but can't control; mood changes, cerebral atrophy; after 10yrs+, looks like parkinson-bradykinesias, rigidity, dystonia

Huntington's chorea

Anterior frontal and temporal cerebral cortex; intracellular inclusions stain with silver stain*

Pick's disease

Parkinson like; falls; gaze paralysis (can't look down); rigidity; dementia; death in 5-10 years

Progressive supra nuclear palsy

Intraneuronal cytoplasmic inclusions that stain with PAS staining

Lewy bodies

Gate ataxia; dementia; urinary incontinence; imaging shows large ventricles; shunting is tx

Normal pressure hydrocephalus (NPH)

Can't recall recent memory despite immediate memory retention

Korsakoff's syndrome

Not a dementia; awake and fine, then later forget a moment of time

Transient global amnesia