Riesert Lectures Flashcards
“Having disturbed ambulation”
Dizziness
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
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
Drug used to tx Orthostasis=
Fludricortisone (mineralcorticoid)
Loss of buffers to remain conscious; what comes before syncope referred to as ‘prodrome’
Fainting
May be d/t arrhythmia/dysrhythmia; Heart block; aortic stenosis; medications (orthostasis)
Syncope-cardiac causes
Best tx to true cardiac syncope=
implantable cardiac defibrillator
Impaired vestibular system; may be d/t disturbance of inner ear; altered head position in space, via alteration of CN VIII (vestibulocochlear)
Vertigo
MC cause of orthostatic hypotension=
Dehydration
Dx of orthostatic hypotension=
Tilt-Table test*
Visual input, somatosensory input (skin, joints, muscles, spinal cord), Cerebellum, Cerebrum all involved with=
normal BALANCE maintenance
Alteration of eye movement; oscillation to lateral gaze; normal 2-3 beats, if more, consider abnormal
Nystagmus
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
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
MC cause of vertigo; includes acute labyrinthitis and vestibular neuritis
Idiopathic
Cochlear disease affecting ear mechanism; progressive hearing loss to low frequency; Tinnitus, dizziness; unknown etiology
Meniere’s disease
Tx for Meniere’s=
Diuretics (HCTZ); low salt restriction (
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)
D/t changes in head position; no clear known cause; may last months; Epley maneuver to tx!
Benign Positional Vertigo (BPV)
Tests to include for cardiac testing for syncope=
EKG, Echocardiogram, Holter monitor & Event monitor, exercise stress test, electrophysiologic study (EP study), Tilt table test
Meclizine, Dimenhydrinate, Promethazine=
Vestibular suppressants
Diazepam=
Benzodiazepines
Alteration is when the vestibular sense, visual sense, and somatosensory sense are NOT CONGRUENT; principal symptom is N/V
Sea sickness/motion sickness
” A paroxysmal event d/t abnormal CNS d/c with resultant manifestations depending on area involved”
Seizure disorder
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
