Disorders Of Motor System, Neuromuscular Diseases, And Cerebrovascular Disease

Front 1

Pyramidal Disease
1. location of damage
2. effect
3. causes

Back 1

1. frontal and upper tracts
2, rigidity and spasticity; UMN damage leaves terminal neurons attached to muscles so the remeain stimulated and do not atrophy
3. CVA (most common), tumor, congenital, cerebral palsy, a few systematic diseases

Front 2

Extrapyramidal Disease
1. location of damage
2. effect
3. classification

Back 2

1. basal ganglia: substantia (pars reticulata/pars compacta) nigra, striatum (caudate/putamen), globus pallidus, thalamus, subthalamus
2. inability to turn upper commands into coordinated action ("failure to execute correctly")
3. movement disorders: hypokinetic vs. hyperkinetic

Front 3

Parkinson's Disease
1. Archetypical . . .
2. pathogenesis
3. clinical presentation
4. causes
5. treatment

Back 3

1. Hypokinetic Movement Disoder
2. loss of dopamine producing cells in substantia nigra that project to caudate and putamen
3. quartet of tremor, bradykinesia, postureal instability, and rigidity
4. idiopathyic, dopamine blocking drugs (neuroleptics, metoclopramide), vascular parkinsonism, toxic parkinsonism (MPTP, CO)
5. carbidopa/levadopa (dopamine precursor), dopaminergics (pramipexole, bromocriptine), breakdown inhibitors (MOI B, selegline), DBS

Front 4

Hypokinetic Disorders

Back 4

1. Parkinson's (archetype)
2. diffuse Lewy body disease: symptoms of parkinson's (bradykinesia, tremor, rigidity) + severe dementia + vision problems
3. progressive supranuclear palsy: gait disturbances, parkinson's w/o tremor, lose voluntary but preserve reflex eye movements, dementia, neurofibrillary tangles
4. multisystem atrophy: glial0cytoplasmic inclusions containing alpha synuclein
**all are relatively unresponsive to levadopa/carbidopa

Front 5

Hyperkinetic Disoders
1. essential tremor
2. dystonia
3. Wilson's disease
4. Huntington's

Back 5

1. worse with concentration/action, symmetrical, inherited
2. sustained mm contractions causing abnormal posture and contortions; involve basal ganglia
3. new onset hyperkinesia in young adult, copper excess, measure ceruloplasmin level, Kayser-Fleischer rings in iris
5. CAG repeat disease, AD, truncal and upper limb chorea onset in 3rd decade of life (20-30yo), cognitive/behavior effects

Front 6

Multiple Sclerosis
1. pathogenesis
2. symptoms
3. diagnosis
4. treatment

Back 6

1. autoimmune demyelinating disease; perivascular infiltration by monocytes and lymphocytes cause demyelination in brain and white matter
2. unilateral vision loss (hemianopsia), double vision, pins and needles sensation, vertigo, fever, relapsing remitting (need more than one episode for dx)
3. CSF shows inc oligoclonal igG bands, antibody to MBP; MRI T2 shoes hypodense lesions enhanced with gadolinium), can't make Dx w/ MRI and anti-MBP alone
4. high dose corticosteroids, glatiramer (myelin analog), INF beta analogs (SEs), natalizumab (anti-integrin Ab taken off market for PML)

Front 7

Demyelinating diseases
1. MS
2. optic neuritis
3. acute transverse myelitis
4. acute disseminated encephalomyelitis

Back 7

1. auto-immune (anti-MBP)
2. partial or complete loss of vision in one or both eyes due to inflammation (50% progress to MS)
3. rapidly developing paraparesis or paraplegia due to inflammation; need to rule out compression disorder using MRI; may be symptom of MS
4. acute HA, multifocal neurologic signs and/or seizures 1-3 weeks after viral infection or immunization

Front 8

Middle Cerebral Artery Infarct
1. how often?
2. presentation
3. affected parts of body

Back 8

1. common; furthest from collateral circulation
2. contralateral hemipariesis, hemisensory
3. face/arm > leg

Front 9

Internal Carotid Artery Infarct
1. other arteries affected
2. presentation

Back 9

1. MCA is often worst affected, retinal a. (ipsilateral blindness)
2. variable depending on collateral circulation

Front 10

Vertebral/Basilar Artery Infarct
1. PCA
2. penetrating arteries off Basilar
3. complete occlusion of basilar a.

Back 10

1. visual changes (perfuse occiptal lobes)
2. vertigo, ataxia, nausea (perfuse cerbellum)
3. lock-in syndrome- quadriplegia only communicating w/ vertical eye movements, or death (perfuses brainstem)

Front 11

Basic Management of Cerebrovascular Disease
1. imaging
2. avoid...
3. tx of edema
4. secondary prevention
5. tPA

Back 11

1. non contrast CT first (rule out hemorrhagic stroke), MRI later
2. rapid reduction of BP (overwhelms autoregulation) and heparin (unless valvular etiology; inc risk of hemorrhage)
3. hyperventilation, manitol, or rarely surgery
4. antiplatelet therapy, look for carotid leasions
5. thrombolisis can save life; increases risk for hemorrhage CVA, only good if given w/in 3hrs of onset

Front 12

Transiet Ischemic Attack
1. presentation
2. indication for . . .
3. greatly increases risk for

Back 12

1. brief episode of neurological or retinal dysfunction lasting less than 1 hour
2. antiplatelet therapy, sometimes heparin (if cardiac/valvular origin)
3. future, more severe/permanent CVA

Front 13

Treatment of TIA
1. anterior circulati
2. cardioembolic
3. posterior circulation

Back 13

1. initial ASA...if echo shows emodynamic stenosis..do angiography...>70% stenosis give CEA vs ASA for <70%
2. do TEE... give warfarin if thrombus present...if no thrombus do home? monitoring...if Afib give warfarin...if no Afib consider IC disease or vasculitis
3. initial heparin...do MRA...if no vertebrobasilar stenosis stop heparin give ASA...if VB stenosis present do angiography...if stenosis confirmed give warfarin

Front 14

Intracerebral Hemorrhage
1. incidence/presentation
2. causes
3. pathogenesis
4. more likely during...
5. diagnosis

Back 14

1. 20% of CVAs, "worst HA of my life", focal defects at site of bleed, diffuse effects from inc ICP, higher risk of seizure
2. HTN, amyloid, AV malformation, tumor, berry aneurysm (85% of SAH- marfan's/PKD) or mycotic aneurysm
3. HTN produces microaneurysms at sites of putamen, thalamus, and lobar white matter
4. strenuous activity causing inc BP
5. MRI/MRA or CT angiography; if negative do LP to look for xanthochromia (takes 6 hrs to lyse)
6. 50% die, BP management, evacuation of large clots, endovascular coil for unruptured aneurysms

Front 15

Anterior Horn Cell Disease
1. example
2. presentation
3. diagnosis

Back 15

1. amyotrophic Lateral sclerosis (Lou Gehrigg's); most common acquired motor neuron disease
2. painless/progressive weakness (asymm limb or bulbar), marked atrophy, fasiculations/cramps, variable effect on reflexes, no sensory
3. EMG is best

Front 16

UMN vs. LMN disease
1. similarities
2. UMN
3. LMN

Back 16

1. weakness
2. inc DTRs, spasticity, externsor plantar
3. dec DTRs, dec tone, atrophy, fasiculations

Front 17

Peripheral Nerve Disorders
1. common mononeuropathies
2. common polyneuropathies
3. distribution of weakness, motor vs. sensory, reflexes

Back 17

1. carpal tunnel, meralgia paresthetica, bell's palsy, mononeuritis multiplex
2. GB (immune-med/post-infections, symm LE weakness, early DTR loss, inc CSF protein, tx w/ plasmapheresis and IV Ig); POEMS syndrome, Charcot-Marie Tooth (hereditary; stocking/glove), diabetic, alcohol
3. symmetric distal weakness with motor and sensory abnormalities; reflexes decreased out of proportion to weakness

Front 18

NMJ Disorders
1. myasthenia gravis
2. lambert eaton
3. drug induced

Back 18

1. AChR autoAbs, assoc w/ thymoma, dx with edrophonium, tx with anti-AChesterases/thymectomy/steroids/plasmapheresis/IV Ig
2. calcium channel autoAbs, assoc with SCC of lung, Prox limb/trunk weakness w/ sparing of EO and bulbar muscles, force increases then decreases with sustained contraction

Front 19

Inflammatory Myopathies: DM vs. PM vs. IBM
1. preferential gender
2. age of onset
3. pattern of weakness
4. creatinine kinase
5. tx with steroids
**symm weakness over weeks to months, CK high/ESR normal, muscle bx

Back 19

1. F, F, M
2. child/adult, adult, elderly (>50)
3. proximal >distal, prox > distal, prox and distal (finger flexors and knee ext)
4. >50x normal, >50x normal, <10x normal
5. respond, respond, refractory