Spinal Cord, sleep disorders, movement disorders Flashcards
where is artery of adamkiewicz?
at T10 major source for lower cord
do polyneuropathies have a truncal sensory level?
no that’s what makes spinal lesions different
what is lhermitte sign?
electric like sensation extending down back and into arms with neck flexion
(seen with focal cevical lesions most notably demyelinating)
what important dysfunction is very prominent in spinal cord lesions?
urinary urgency/incontinence
kernig vs. brudinski?
kernig- painful knee extension/resistance with hips and knees flexed
brudinski- involuntary lifting of legs with neck flexion in spine position
what is- initial flaccid paraplegia or quadriplegia depending on location of artery occlusion followed by the flaccidity converting to spasticity with increased reflexes and Babinski signs. Sensory loss is dissociated with loss of pain and temperature and sparing of vibration, position sense, and partially touch. Bladder and bowel function are impaired.
anterior spinal artery syndrome
is anterior spinal artery syndrome or posterior spinal artery syndrome more common?
anterior spinal artery
Classically, presents with pain and temperature loss in cape distribution, weakness/atrophy in arms, and, ultimately, corticospinal and dorsal column dysfunction below lesion?
syringomyelia- cavity within the cord, sometimes with chiari 1
what is progressive involvement of corticospinal tracts and dorsal columns with increased reflexes, Babinski signs, and loss of position and vibration? what are the 3 most common causes?
subacute degeneration
- vitamin B12- anemia post gastric surgery
- copper deficiency- post gastric surgery or zinc toxicity
- Vitamin E deficiency- post gastric, CF, abetalipoproteinemia
what is hereditary spacstic paraparesis? autosomal dominant or recessive or x-linked
degeneration of distal corticospinal axons and dorsal column degeneration and manifested primarily by slowly progressive spastic paraparesis
what do patients with hereditary spastic paraparesis?
spasticity, hyperactive reflexes and babinski signs
What are key points of friedreich ataxia?
autosomal recessive, degeneration of the most of the parts of the spinal cord, childhood onset
-ataxia, sensory loss, dysarthria, areflexia, and babinski
what associated clinical findings can be found with ALS?
frontotemporal dementia and parkinson disease
what is progressive spastic paraparesis due to the transmission of a type C oncovirus by semen, blood, breast milk and shared needles. It is endemic in the Caribbean and South America?
HTLV-1 myelopathy
what occurs late in the course of theAIDS systemic illness. Major symptoms are spastic paraparesis, weakness, painless vibratory and position sense loss and sensory ataxia?
AIDS associated vacuolar myelopathy
where does polio attack? what characterizes it?
anterior horns
-flaccid weakness,
primary/idiopathic movement disorders may start unilaterally, but?
usually become bilateral overtime
acute onset unilateral movements are frequently secondary and should prompt brain imaging
T of F- the tardive syndromes can persist for many years after the offending drug has been discontinued?
true
substania nigra inclusion bodies are called what in parkonsins?
lewy bodies
sensory ataxia usually comes from what? how do you tel difference?
dysfunction of large-fiber sensory nerves and/or posterior columns in the spinal cord
patients will not have position or vibration senses
patients with sensory ataxia should be assessed for what?
B12
where does CO poisoning attack
globu pallidus .parkinsonism
primary or idiopathic movement disorders have what type of onset?
slow and progressive
lack of progression of a syndrome with an acute onset is suspicsious of what?
secondary structural lesion
what medication classes are important to look into for movement disorders
anti-psychotics
anti-GI like reglan
and antiepileptics
what are the 4 feautres of parkinsonism?
resting tremor, bradykinesia, rigidity, loss of postural reflexes- need 2 with bradykinesia required
dementia with lewy bodies has parkinsonism and dementia, but what else is common
visual hallucinations
what is the difference in initial presentation of parkinsons in older vs. younger
younger more tremor, older more rigidity
what are the non motor problems with PD?
anosmia, constipation, REM behavior disorder, depression, cognitive or autonomic problems
what are the mainstay medications for parkinson’s
- levodopa/carbidopa
- dopamin agonists- pramipexole, ropinirole, rotigotine
- MAOb inhibitors, COMT inhibitors (entacopone)
- amantidine
- anticholinergics
what are other treatments for PD than medicine?
deep brain stim- more in younger healthier patiens
when does the intention tremor significantly worsen?
worsens or appears when reaching a target- SUGGESTS CEREBELLAR ORIGIN
what metabolic syndrome may suggest/lead to enhanced physiologic tremor?
hyperthyroid
what is the big self medication for essential tremor?
alcohol
what are the best medications for essential tremor?
propranolol and primidone (then maybe, topirimate, gaba, benzos)
what is the last resort for essential tremor?
thalamic DBS
what is a is a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both.
dystonia- often twisting
The presence of what with dystonia is very unique to it and very helpful from a diagnostic viewpoint?
sensory tricks- touching it helps it go away
T-F- the appearance of involuntary movement only with specific activities is unique to dystonia?
true
what is the treatment of choice for focal/dystonia?
botulunum toxin
generalized dystonia can be treated with what?
anticholinergics
all children presenting with idiopathic dystonia should receive a trial of what?
levodopa (due to a genetic condition known as dopa-responsive dystonia
what systems are needed for coordination?
cerebellum, proprioception, vestibular
how do we tell if it is a cerebellar or sensory gait ataxia….
tuning fork- also sensory is worsen when eyes are closed and cerebellar is bad all the time
if we see hemiballism acute onset think what?
cerebro vascular event to contra subthalamic nucleus
is asterixis a negative or positive myoclonus?
negative
unlike chorea, what is Tics?
sudden abrupt repetitive, PREDICTIVE and COORDINATED gestures
are tics involuntary?
no unvoluntray or semivoluntary- patients volitionally do these due to an urge or very uncomfotable feelng
TICS IN CHILDRENS MEANS WHAT? TICS IN ADULTS MEANS WHAT?
TOURRETS
ADULT-ONSET TIC DISORDER
what brain region primarily generates output for process C circadian rhythm?
suprachiasmatic nuclesu in the anterior hypothalamus- cycles in a period just longer than 24 hours
damage to what needs to take place to dissable the circadian rhythm from happening?
optic nerve
what is process S and what accumulation starts it?
metabolic activity of itself that promotes sleep, accumulation of adenosine– cholinergic neurons of basal forebrain project to ant. hypothalaums and inhibit sleep, adenosine receptors on them stops their inhibitory effects
how does caffeine stop sleep
blocks the effect of adenosine on the basal forebrain neurons
what is a chosen pattern in which individuals set a schedule in which they are getting an inadequate amount of sleep?
behaviorally induced insufficient sleep syndrome
how many OSA patients aren’t obese
about 1/3- a lot in children
what confirms OSA diagnosis?
polsomnogram showin an apnea-hypopnea index or respiratory disturbance index showin at least 5 events per hour of sleep.
patients who remain excessively sleepy despit proper CPAP can use what drugs?
modafinil and armodafinil.
what associated symptom is often seen in narcolepsy?
cataplexy (emotional paralysis), hypnogogic hallucinations, and sleep paralysis
what is narcolepsy due to?
absence or marked reduction in the number of hypocretin (orexin) neurons in the lateral hypothalamus
how can we diagnose narcolepsy?
mean sleep latency on five day naps
what are mainstays of narcolepsy treatment?
modafinil and mehtylphenidate
TCAs and SSRI suppress ancillary symptoms of REM sleep during wakefulness.
what drug helps to control cataplexy?
sodium oxybate
40% of people being evaluated for insomnia have what?
Axis I psychiatic diagnosis- most often ancxiety disorder
what is is a manifestation of conditioned behaviors usually seen in an individual with an intense, perfectionistic personality and a long history of being a poor or “light” sleeper, who experiences some kind of precipitating event (e.g., loss of job, divorce) and then develops perpetuating behaviors that continue the sleeplessness.
psychophysiologic insomnia
what is the mainstay of treatment for anxiety person with insomnia?
CBT- which can be superior to hypnotic medication therapy alone after 6 months
what is the most common used z drugs for anxiety sleep insomnia?
zolpidem, zaleplon, aszopiclone– bind GABA receptors with alpha-1 subunit
what is unusual sleep behavior? what are they?
parasomnias
- expression of the reality that elements of sleep and wakefulness can co-exist like sleep walking
what sleep level is parasomnias?
N3 deep and REM parasomnias (rem later in the night)
when can sleep related epilepsy and enuresisoccur?
any stage
what are parasomnias treated with?
clonazepam
