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108 Cards in this Set
- Front
- Back
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four cardinal features of nacrolepsy |
1. excessive day time sleepiness with "sleep attacks" 2. cataplexy (sudden loss of tone) 3.sleep paralysis (you wake up and you cant move-- body is still in REM) 4. hypnagogic (hallucinations-- continued dream when you are awake) |
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what does polysomnogram of narcolepsy show? |
short sleep latency with REM onset (REM sleep occuring during wakefulness) |
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obstructive sleep apnea symptoms? risk factors? tx? |
obstruction of upper airway during sleep with preservation of respiratory effort
risk factors: age, obesity, ethanol use symptoms: excessive daytime sleepiness, snoring, cessation of breathing during night, mornng headaches, cognitive complaints
tx: CPAP, weight loss |
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insomnia |
difficulty getting to sleep or staying asleep, or non refreshing sleep at least 1 month |
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restless leg syndrome |
urge to move legs, usually during periods of rest or inactivity, typically in the evening (crawling sensation that gets worse when legs remain still and are relieved by moving them) |
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what is RLS associated with? |
iron deficiency anemia |
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what is restless leg syndrome treated with? |
dopamine agonists |
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REM sleep behavior disorder |
loss of normal skeletal muscle atonia during REM sleep, associated with acting out dreams |
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night terrors |
sudden unexplained bouts of terror/fear occurring in stage 3 or 4 sleep. common amongst chidlren who often can neither be awakened or consoled last for 10 minutes onset usually in first cycle of sleep |
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sleepwalking |
common, more frequent in children no memory of doing it, difficult to arouse |
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bruxism |
common sleep disorder where you grind your teeth, can lead to dental erosion |
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syncope |
transient loss of conscoiusness and postural tone that results from brain hypoperfusion, lasts seconds |
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pre-syncope |
light headedness, visual changes, buckling of knees, cognitive slowing, neck pain, headache |
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cardiogenic syncope |
MI, arrhythmias, valvular outflow obstruction |
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orthostatic syncope |
autononomic failture (SC injury or diabetic neuropathy) volume depletion (blood loss, dehydration) medications (anti-hypertensives and antidepressants)
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vasovagal syncope |
normal variant, most common cna be caused by pee/poop/cough carotid sinus hypertesensitivity can be triggered by noxious stimuli (hearing bad news, seeing blood, strong emotion its a PARASYMPATHETIC response |
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which kind of syncope is most common? |
vasovagal-- exaggeration of normal reflex |
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tx of vasovagal syncope |
avoidance of triggers |
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tx of orthostatic syncope |
if due to orthostatic hypotension, discontinue BP meds, tight stockings, blocks under head of bed, hydrate, more salt, avoid prolonged standing or fast transitions |
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seizure |
symptom-- pathological discharge of of neurons that results in stereotypical behavior or sensation (the symptoms depend on where seizure is) |
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epilepsy |
chronic condition of recurent UNPROVOKED epileptic seizures - if your seizure happens everytime after a certain stimulus, it is not epilepsy |
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status epilepticus |
rare emergency where someone has seizures for more than 30 minutes-- great morbidity and mortality |
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simple partial motor seizure |
recurrent stereotypic motor event (lift your hand over your head) focal onset consciousness intact |
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simple partial sensory seizure |
weird vision, smells, numbness in one arm focal onset consciousness intact |
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complex partial seizure |
focal onset involves limbic or cognitive structures affects cognition, speech, memory impairment (others notice it, bu you dont remember bc of impaired hippocampus) |
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can a partial onset seizure become a generalized seizure? |
yes, partial onset seizure can secondarily spread and become a generalized tonic clonic seizure |
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generalized onset seizures: absence tonic-clonic infantile spasms atonic |
absence: subtle- kids stare into space, fine afterwards (no postictal confusion) tonic-clonic: typical seizures you think of infantile spasms: baby does weird thing with arms, you see if on EEG atonic: drop attacks (usually have to wear headaches bc when you fall out you can harm head) |
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how can you tell if its generalized onset seizure? |
on EEG, all cortical neurons begin to fire simultaneously, and if its focal the abnormal discharges start in one place (and may or may not spread) |
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febrile seizures |
most common-- 4% of population seizures only occur with fever (generalized onset seizure) only in small children |
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absence epilepsy |
looking like a few second staring spell returns immediately to normal know its going on bc of EEG |
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infantile spasms |
child has generalized onset associated with developmental regression also associated with tuberis sclerosis |
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lennox-gasteaux syndrome |
presents in first decade, associated with developental regression |
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juvenile myoclonic epilepsy |
adolescents generalized onset seizure, suddenly drop tooth brush, knock over drink in young, healthy people (normal development) threshold lowered by drinking, no sleep, etc |
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temporal lobe epilepsy |
seizures are either simple partial (deja vu, transient sense of fear, unpleasant olfactory experience) or complex partial-- above sensations followed by confusion and speech problems that last second to minutes, followed by amnesia of event and post ictal cognitive changes (dont feel great) |
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where do temporal lobe seizures arise from? |
hippocampus or amygdala (medial temporal lobe) can see changes on MRI |
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who is prone to get temporal lobe epilepsy? |
most likely if you had seizures as a kid, hit your head as a kid, had a high fever (usually some factor precedes it) |
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how is epilpesy evaluated? |
on EEG to identify type of epilepsy and then MRI to see if there is an underlying cause |
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what are normal brain waves? |
beta: consciously alert agitated alpha: physical and mental relaxation (normal) theta: somnolence with reduced consciousness delta: unconciousness or deep sleep |
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what does an abnormal EEG with epileptiform discharges show? |
characterizes epilepsy syndrome, guides management with medication |
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abnormal EEG with diffuse slowing |
can confirm presence of encepalopathy |
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normal EEG-- what does that help with? |
does NOT exclude any diagnosis |
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evoked postentials |
derivative of EEG, measure the brain waves teh are evoked by an electrical stimulus in teh limbs-- used for intra-operative monitoring during spine surgery |
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polysomnograms |
derivative of EEG in combo with other meausurements, useful in IDing sleep disorders |
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mild cognitive impairment |
memory loss noted by patient or family in which detailed tesitng shows abnormal memory patients have no functional impairment and do not meet criteria for dementia between normal age related decline in cog and dementia-- higher rate of progression to dementia |
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delerium |
acute mental status disorder characterized by normal and fluctuating attention- disturbance in level of awareness and reduced ability to focus, sustain attention (SYMPTOM, not disease) |
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where is delerium most common? |
post surgical and ICU settings
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key features of delerium |
acute onset of mental status change, attentional deficits, confusion (also altered level of consciousness, illusion/halluc, disturbed sleep/wake cycle, disorientation, memory impairment, behavioral changes)
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predisposing factors to delerium |
advanced age, dementia, deyhdration, medical illness, infeciton, polypharmacy, drug/alc abuse, sensory deprivation, depression, surgery, bladder catheters elderly: medication, infection, metabolic disturbance young: drugs, alcohol |
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what investigations to do you for delirium? |
electrolytes, renal function, LFTs, blood count, thyroid, B12, drug levels, urine analysis, CXR, pulse ox then head CT then lumbar puncture if meningitis/enceph EEG if seizures MRI if stroke or intracranial lesion |
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what do you do with delirium? |
STOP all meds! avoid restraints and other predisposing factors |
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dementia |
acquired, persistent, usually progressive impairment of intellectual function with compromise in many cognitive domains (usulaly memory)- deficits must be significant decline, must interfere with work or social life |
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what are 3 neurodegenerative pathologic processes we discussed? |
alzheimers, lewy body dementia, fronto-temporal |
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how are neurodegenerative diseases characterized clinically? |
dementia, loss of movement control, paralysis and pathologically defined by loss of neurons -- progressive
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what is the most common degenerative disease? |
alzheimers (women affected more than men) then parkinsons then ALS, huntingtons, friedrichs ataxia |
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which lobes are affected in alzheimers? |
symmetric atrophy of temporal, parietal, frontal lobes occipital lobes can be sparedw |
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hich protein is accumulated in alzheimers? |
neuritic plaques are extracellular accumulations of polymerized beta amyloid centrally with a rim of dystrophic neuritic processes and neurofibrillary tangles-- intracytoplasmic accumulation of tau protein |
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frontotemporal dementia (picks disease) - which lobes are affected? -what are the behavioral changes? |
neurodegenerative disorder that affects the frontal and temporal lobes (asymmetrically) cause personality change-- apathy, disinhibition, loss of insight and emotional control and globcal cognitive decline presents between 45-65 personality change happens first |
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which protein accumulates in frontotemporal dementia? |
pick bodies (tau-ositive spherical intracytoplasmic nuronal inclusions) |
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lewy body dementia |
dementia with lewy bodies is the second most common cause for dementia -cog impairment, parkinsonism, prominent visual hallucinations, other psych symptoms (sleep disorders too) -- brain has lewy bodies in neocortex, limbic system, and brainstem-- synuclein proteinopathy |
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what are the non-degenerative pathologies that are progressive? |
vascular, alcoholic, CJD |
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describe features of vascular dementia |
stepwise decline in cognitive function with focal neuro symptoms and signs on exam patho: small microinfarcts or strategic infarcts (ex: affect hippocampus) |
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tx of vascular dementia |
treat hypertension to prevent other end-organ disease antiplatelet agents can help to reduce further strokes |
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alcoholic dementia |
wernicke-korsakoff syndrome traumatic lesions including chronic subdurals (inc risk of falls and trauma in alcoholism) can have alzheimers pathology, vascular disease like vascular dementia |
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wernicke-korsakoff |
due to thiamine deficiency classic triad: confusion, opthalmoplegia (paralysis of eye movements), and gait ataxia anatomical distribution: mamillary bodies, hypothalamus, thalamus, periaquaductal gray matter, colliculi, floor of 4th ventricle |
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what is administered to patients at risk for wern-korsakoff? |
glucose given with thiamine bc acute thiamine deficiency can be precipitated by IV glucose admin or carb loading (administering thiamine causes rapid reversal of opthalmoplegia within hours, recovery from ataxia and confusion is slower) |
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korsakoff syndrome |
follows repeated bouts of encepalopathy-- as it subsides, patient has amnestic disorder-- ANTEROGRADE and RETROGRADE amnesia (cant make new memories-- makes them up (confabulation) altertness, attention, social behavior and cog function are preserved lesions of diencephalon and temporal lobes |
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creutzfeldt-jakob disease (CJD) |
prion disease-- proteinaceous infectious particles with no nucleic acids sporadic-- middle aged/old people-- causes dementia, myoclonus, ataxia, etc familial: AD variant: mad cow disease-- consumption of meat products contaminated by iatrogenic: contaminated growth hormone cadaver extracts spongiform encephalopathy |
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which dementias are potentially reversible? |
B12 deficiency, hypothyroidism, HIV, syphilis, normal pressure hydrocephalus, treatable mass (subdural hematoma and benign tumor)q |
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define concussion what is it called when you get repeated concussions? |
continuum of brain injury raising from mild cases where you are dazed to persistant neurological abnromalities and structural changes traumatic encepalopathy |
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pathologically, what happens in a concussion? |
loss of neuro function due to axonal dysfunction (axonal distortion or stretching-- eflux of K into extracellular space, influx of Ca, release of glutamade-- excitotoxic cascade reversible neuronal depression to permanent diffuse axonal damage |
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chronic traumatic encepalopathy-- brain changes? |
atrophy, dilatation of lateral and 3rd ventricles, thinning of corpus callosum, neuronal loss and tau deposition (neurofibrillary tangles) and in astrocytes involves cerebral cortex, white matter, deep nuclei, brainstem |
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what is hippocampus involved in? |
memory storage lesion: poor new learning (anterograde amnesia) |
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what are mammilary bodies involved in? |
memory processing, memory of odors lesion: anterograde amnesia, wernicke korsakoff syndrome |
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amygdala |
coordination of emotional states, esp anger and aggression, with somatic responses kluver-bucy syndrome (change in aggression, sexuality, hyperorality) decresaed conditioned fear response inability to receognize facial and vocal expression of anger in others |
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orbitofrontal cortex |
front of frontal lobe defer certain immediate gratifications and suppress certain emotions in order to get long term benefits control over biologic drives/reward circuit lesion: disinhibition and inappropriate behavior poor judgement, lack of inhibition or remorse |
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lateral prefrontal cortex |
choose course of behavior by letting us assess various alternatives mentally planning for future action if lesion: decreased motivation and attention, disorientation, mood disturbances |
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ventromedial cortex |
experience emotions and meanings of things control of movement lesion: apathy, decreased spontaneous movmement, gait disturbance, incontinence |
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global aphasia |
cant be fluent, comprehend, or repeat |
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mixed transcortical aphasia |
cant be fluent or comprehend, but can repeat |
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transcortical motor aphasia |
cannot be fluent, but can comprehend and repeat (like brocas but you can repeat words) |
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transcortical sensory aphasia |
like wernickes but can repeat (so they are fluent, cannot comprehend, but can repeat) |
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conduction aphasia |
can comprehend, and be fluent, but cannot repeat |
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anomic aphasia |
only have trouble naming |
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hemineglect |
most often with right parietal or frontal lobe infarcts/lesions -- neglect of contralateral half of world and body happens more often on LEFT side of view bc left world only has 1 hemisphere paying attention to it (language takes up a lot of space in left brain) and right world has 2-- so if you have lesion on right, left will not compensate) |
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what do you need for consciousness? what causes coma? |
one of your two cerebral hemispheres AND the reticular activating system (turns "on" the brain) coma is un-arousalbe unresponsiveness that is caused by focal lesions that affect both hemispheres or the RAS and diffuse problems affecting the entire brain |
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what composes the reticular activating system? |
locus coeruleus, periaquaductal grey, thalamus |
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what are the treatable causes of a coma? |
hypoglycemia drug intoxication meningitis subarachnoid hemorrhage status epilepticus increased ICP (hyperventilation, mannitol, decompressive surgery) |
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what are the top culprits for coma? |
drug poisoning, hypoxia after arrest and resuscitation, trauma, non-traumatic bleeding, stroke
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compare coma and locked in syndrome |
in locked in: pt appears unresponsive, but cognition is preserved coma is unarousable, where as locked in syndome is arousable both dont have purposeful movements of limb or face with coma you dont purposefully move eyes and with LI you can look up on command and blink coma: no sleep cycle LI: normal sleep cycle
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what causes locked in syndrome? |
lesion of bilateral ventral pons taking out the bilateral cortical spinal and cortical bulbar tracts, but not RAS |
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what does the glasgow coma scale measure? what is the range? |
measures eye opening, verbal response, and motor response |
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decorticate? decerebrate? |
decorticate is flexion-- less dreadful bc rubrospinal tracts are working decerebral is extension-- it means the lesion is below red nucleus |
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how do you check cranial nerves in person with coma? what other things do you check? |
funduscopic exam pupillary response eye deviation: left hemipheric lesion affects frontal eye fields, left pontine lesion affects CN 6 and descending corticospinal tract (midline gaze) vestibular ocular reflex: dolls head maneuver corneal reflex (CN 5 and 7) gag reflex: CN 9 and 10 check for abnormal respiratory patterns, abnormal brain stem reflexes, motor posturing |
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what do you do for treatment of coma? |
Airway, breathing, ciruclation give naloxone (opioid overdose)/glucose/thiamine treat specific cause |
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definition of brain death |
coma of KNOWN cause no hypothermia, drug intoxication, electrolyte disturbance, acid base disturbance no motor response or brainstem reflex apnea |
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how is peristant vegetative state different than a coma? |
in PVS, you have sleep/wake cycles, withdrawal from noxcious stimuli and non-purposeful movement you respond to startle auditory and visual (whereas in coma you have only reflex and postural motor function, no auditory or visual function), |
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what evaluation is done for coma? |
PE and history, basic labs, head CT if cause still unclear-- LP, EEG, MRI |
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reactive attachment disorder |
"extreme insufficient care" at least 2 behvarois-- minimal social and emotional reponsiveness to tohers, limited pos. affect, episodes of unexplained irrit, sad, fearful onset of 9 mo-5 yrs need to rule out autism
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disinhibited social engagement disorder |
"extreme insufficient care" at least 2 behaviors-- will willingly interact with unfamiliar adults or go off with unfamiliar adult, overly familiar social behavior, diminished checking back with caregiver onset between 9 mo- 5 yr |
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acute stress disorder |
exposure to trauma 3 days-1 month 9 symptoms across 5 categories: intrusion, negative mood, dissociative, avoidance, arousal |
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milestone for 2 month old-- motor and speech |
hold head up 45 degree and smiles |
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4 month milestone |
grasp objects (pull hear, earrings), bear weight on legs laughs and squeals
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6 mo milestone |
pass objects hand to hand, sit with minimal support imitates speech sounds, single syllables |
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9 mo milestone |
pincer grasp, sits without support da/ma/ba jabbers (also stranger anxiety around here) |
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12 mo milestone |
stand alone, dada/mama specific, responds to name |
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15 months milestone |
walk alone, follow simple commands such as STOP |
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18 months milestone |
walks up steps, 6 word vocab |
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24 months milestone |
runs, combines words |
