Whaba notes 2 Flashcards
Why can someone with MG p/w cholinergic crisis?
They’re on anti-AchEs
Presenting features of a cholinergic crisis in MG?
Increased salivation Increased lacrimatin Vomiting Abdominal pain Diarrhea Sweating Pupillary constriction Fasiculation Worsening weakness (in extreme cases)
3 major features of Wernicke syndrome?
Acute global confusional state Abnormal eye movements Ataxic gait (mostly truncal)
Timeline of Wernicke synd?
Evolves over days-wks
5 major cognitive features of Wernicke syndrome?
Inattentiveness Indifference Decreased spontaneous speech Impaired memory Lethargy
Serious complication of wernicke synd?
Progression to coma
2 major ANS signs a/w Wernicke synd?
Tachycardia, orthostatic hypoTN
Loss of pupillary reactivity common or uncommon w/ Wernicke syndrome?
Uncommon
Describe the basics of Korsakoff syndrome
Chronic amnestic disorder, anterograde and retrograde
What are 3 important cognitive features preserved in Korsakoff?
Alertness
Attentiveness
Behavior
Which responds to tx- Wernicke or Korsakoff?
Wernicke
Underlying etiology of W-K syndrome?
Thiamine deficiency
Name 3 things other than alcoholism that can lead to W-K syndrome
Chronic hemodialysis
Drugs for obesity
HyperTH
3 features of tx of W-K synd?
Thiamine 50-100 mg daily
MVI
Bed rest (2/2 ANS sx)
In Wernicke-Korsakoff syndrome, you’ll see lesions in which 4 areas?
Medial thalamus
Hypothalamus
PAG of MB
Mammillary bodies
Describe the 5 features essential to Dx of botulism
- Hx ingestion home-canned foods or honey (infants)
- Rapid onset of ocular symptoms (diplopia, ptosis, blurry vision)
- Bulbar sx (dysarthria, dysphagia)
- Descending pattern of weakness
- Dilated pupils (no psNS)
Describe pathophys of botulism poisoning
Ingest toxin–> blood
Toxin irreversible binds to presynaptis nerve endings of PNS and CNS–> internalization of toxin–> blocks Ach release by cleaving polypeptides essential for docking of vesicles
In food borne botulism, what do you ingest that causes Sx?
Preformed toxin
Describe Sx of food-borne botulism
N/V/D w/in 2-26 hr of ingestion Constipation (once neuro sx present) Early neuro: oculobulbar Sx Respiratory weakness Unreactive pupils Areflexia
Describe the oculobulbar Sx of botulism (6)
Dry mouth Blurry vision Diplopia Dysarthria Dysphagia Dysphonia
3 general (non-neuro) s/s of infantile botulism
Constipation (early in dz course)
Weak cry
Poor feeding
As infantile botulism progresses, what Sx appear following constipation/weak cry/poor feeding? (5)
Progressive weakness Poor suck Loss of head control Hypotonia Decreased movement
3 ANS features of infantile botulism?
HypoTN
Tachycardia
Dry mouth
For diagnosis of botulism, what can you test for in blood? Stool?
Blood: Toxin
Stool: Toxin and C. botulinium
What do you see on electrodiagnostic testing in botulism?
Small CMAP in response to supramaximal stimulus
Botulism can present very similarly to MG. However, which one has much blurrier vision?
Botulism
What may you need to do to control respiratory weakness in botulism?
Intubate
Beside supportive care, what are 2 drugs you can give in botulism?
Trivalent botulinium antitoxin
Guanidine HCl
Trivalent botulinium antitoxin: when should you give it, what are its benefits, and what’s its major ADE?
Must give early while toxin is still in blood
It decreases severity of disease and overall mortality
Anaphylaxis
What is the role of anti-Ach drugs in botulism?
Controversial
What is a literal paraphasia?
Substitution of one letter for another (wife vs wafe)
What is a semantic paraphasia?
Substitution of one word for another (wife vs mom)
What type of aphasia is caused by a lesion of the arcuate faciculus of the supramarginal gyrus?
Conduction aphasia
Describe fluency, comprehension, and repetition in conduction aphasia
Fluent (w/ paraphesias)
Good comprehension
Loss of repetition
Conduction aphasia: how are writing, naming, and reading? How common is hemiparesis?
Writing- poor
Naming and reading- variable
Hemiparesis- infrequent
What sort of repetitions can you see in conduction aphasia?
Repetitions of substitutions
For Wernicke’s aphasia, name the:
- Broadmann’s area:
- Location in the brain:
- Arterial supply
- BA 22
- Posterior superior temporal lobe on dominant (left) side
- Posterior division of MCA
Wernicke’s aphasia: describe fluency, comprehension, naming, repetition, writing, reading, frequency of hemiparesis
Fluent, paraphesic
Poor: comprehension, naming, repetition, writing
Variable reading
Infrequent hemiparesis
Do you see repetitions of substitutions in Wernickes or Broca’s aphasia?
Wernickes
Broca’s aphasia, name the:
- Broadmann’s area:
- Location in the brain:
- Arterial supply
- BA 44
- Inferior frontal gyrus
- Anterior division of MCA on dominant (left) side
Describe speech in Broca’s aphasia
Initially mute, then will start saying short sentences
Under what circumstances can people with Broca’s aphasia read?
If they avoid the hemianopic part of their vision
Broca’s aphasia: describe fluency, comprehension, naming, repetition, writing, reading, grammar, and frequency of hemiparesis
Nonfluent Intact comprehension Poor naming, repetition, writing Variable reading Disordered grammar Hemiparesis common
