RLS/guillan barre/myasthenia gravis/RSD Flashcards
RLS
- gender
- % of population
women usually
3-30%
primary and secondary RLS
usually primary.
can be secondary to peripheral neuropathy, uremia, pregnancy, iron deficiency
symptoms of RLS
frequent involuntary movements during sleep and rest’ sleep disturbance is common
RLS
- drug of choice
- can also add what
- last choice
dopamine agonists(pramipexole, ropinole)
can add benzos
last choice is opiods
Guillain-Barre’s syndrome
- etiology
- dangerous?
Autoimmune disease that often occurs after an infection or surgical procedure
- assoc with recent campylobacter jejuni infection
May become life threatening if respiratory muscles become involved
Guillain-Barre’s syndrome sx
-progression duration?
**Ascending paralysis – weakness in hands and feet and now my whole legs feel weak (rubbery legs)
Muscle pain
Progression is rapid taking hours to days
Rapidly ascending muscle weakness Absence of deep tendon reflexes Change in temperature and pain sensation No fever Lumbar puncture shows what Electromyography shows what
guillain barre
Lumbar puncture – elevated protein > 55
Electromyography – slow nerve conduction velocities
guillain barre tx
Supportive care
Plasmapheresis to filter antibodies
IV immunoglobulins
In most cases improvement begins at about 4 weeks and they go on to a complete recovery(85%)
Guillain-Barre can be from what preceding infection
preceding infection of lungs or GI tract
what organism is the most common precipitant with gullain barre
campylobacter jejuni
tachycardia cardiac irregularities labile blood pressure disturbed sweating impaired pulmonary function spinter disturbances paralytic ileus
gullain barre significant autonomic dysfunction
gullain barre recovery %
60% make a full recovery within a year; mortality rate in 1 year is 5%
RSD
- definition
- begins when
- affects what systems
- age
- gender
Chronic disease
Usually begins with a surgery or trauma. It is an inappropriate response of the nervous system to injury
It is a systemic disease affecting both the central and peripheral nervous system
The average age of diagnosis is 42 though it may occur at any age
Females are more likely to be affected than males
I had surgery/trauma and now I’m having severe pain all the time and even with just light touch. “Even having a sheet on at night hurts” Burning Throbbing Searing Muscle spasms Red or reddish violet skin color Swelling
RSD
Pain out of proportion to injury
Changes in temperature in a limb either warm or cold
Reddish violet skin color
Normal EMG
RSD
tx for RSD
Physical therapy Occupational therapy Medications(NSAIDS, Steroids, Gabapentin, Beta blockers, Bisphosphonates) Local anesthesia and nerve blocks Amputation
what med for RSD can prevent bone resorption
calcitonin
Clinically you suspect a patient may have RSD based on the severity of their pain 2 months post-op. What simple physical exam finding will help your diagnosis?
Check the temperature of the skin
Myasthenia Gravis
Myasthenia Gravis
Things you should know
An autoimmune disorder where acetylcholine receptors are blocked by antibodies
Acetylcholine normally causes an excitatory effect at the neuromuscular junctions
Fatigability – Increasing weakness which improves with rest
Ptosis (Droopy eyelids)
Diplopia (Double vision)
Difficulty chewing and swallowing
Change in the voice
Difficulty breathing, leading to respiratory failure
Myasthenia gravis
Fatigability – Increasing weakness which improves with rest
Ptosis (Droopy eyelids)
Diplopia (Double vision)
Difficulty chewing and swallowing
Change in the voice
Difficulty breathing, leading to respiratory failure (myasthenic crisis)
Often Normal exam
Easy Fatigability, weakness improving after rest and worsening again on repeat exertion
Normal reflexes and feeling of sensation
Myasthenia gravis
Myasthenia gravis tests -\_\_\_ antibody test - Ice test why -Edrophonium is what CXR / CT / MRI Nerve Conduction Studies Electromyography Pulmonary function tests \_\_\_ biopsy
Acetylcholine receptor antibody test
Ice test – applying ice causes an increase in strength
Edrophonium is a short acting anticholinesterase which may aid in the diagnosis
CXR / CT / MRI – to identify a tumor or thymoma
Nerve Conduction Studies
Electromyography – results will present muscle fibers to be unresponsive to stimuli
Pulmonary function tests
Muscle biopsy
Treatment
Medication for myasthenia gravis
- Acetylcholinesterase inhibitors
Neostigmine and pyridostigmine – slows down the natural enzyme cholinesterase that degrades acetylcholine in the motor end plate. - Immunosuppressive drugs
Prednisone, cyclosporine, mycophenolate, and azathioprine - Use in combination with an acetylcholinesterase inhibitor.
myasthenia gravis
- emergency tx
- surgery
Plasmapheresis and IVIG – in an emergency to remove antibodies
Surgery
Thymectomy
