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59 Cards in this Set
- Front
- Back
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S/S of Bell's palsy
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Loss of taste, hyperacusis, increased or decreased tearing.
There is acute onset of unilateral facial weakness/paralysis. Both upper and lower parts of the face are affected. |
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apraxia
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loss of the ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements.
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agnosia
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the inability to identify objects, people, etc
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Bell's palsy involves muscles innervated by what nerve?
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CN VII
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Guillain-Barré Syndrome clinical features
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Weakness usually progresses from distal to central muscles.
o If generalized paralysis is present, it can lead to respiratory arrest. * Extremities may be painful, but sensory loss is not typical. * Sphincter control and mentation are typically spared. * Autonomic features (e.g., arrhythmias, tachycardia, postural hypotension) are dangerous complications. |
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Guillain-Barré Syndrome diagnosis
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* CSF analysis—elevated protein, but normal cell count
* Electrodiagnostic studies—decreased motor nerve conduction velocity |
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Treatment of Guillain-Barré Syndrome
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1. hospitalize - watch respiratory status, may need intubation
2. #Administer IV immunoglobulin if the patient has significant weakness. If progression continues, plasmapheresis may reduce severity of disease. #3 Do not give steroids. They are usually harmful and never helpful in Guillain-Barré syndrome. |
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what Autoimmune disorder— Autoantibodies are directed against the nicotinic acetylcholine receptors of the neuromuscular junction, which leads to a reduced postsynaptic response to acetylcholine and results in significant muscle fatigue.
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Myasthenia gravis
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peak incidence of myasthenia gravis
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women is age 20 to 30; in men, 50 to 70. It is more common in women.
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Treatment of myasthenia gravis
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* The mainstay of therapy is administration of a cholinesterase inhibitor, such as pyridostigmine, which produces a transient improvement in strength.
* Thymectomy often leads to improvement of symptoms. * Corticosteroids, immunosuppressive agents, IV immunoglobulin, and plasmapheresis are effective in patients with refractory disease. |
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other name for Tic Douloureux
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trigeminal neuralgia
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major risk factors for stroke
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Smoking, HTN, hypercholesterolemia, oral contraceptives, heavy EtOH use, AIDS, diabetes, elevated blood homocysteine levels
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Hemorrhagic strokes are usually secondary to?
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HTN
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Strokes involving the anterior choroidal, anterior cerebral, or middle cerebral arteries are associated wiht hemispheric s/s or?
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aphasia, apraxia, hemiparesis, hemisensory losses, visual field defects.
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Strokes involving the posterior circulation (vertebral and basilar arteries), show evidence of brainstem dysfunction such as?
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coma, drop attacks, vertigo, nausea, vomiting, ataxia
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Essential tremor treatment
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B-blockers and/or anti-seizure medications/benzodiazepines
frequently a family history c. is usually progressive, but not associated with other neurological problems |
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Essential tremor characteristics
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higher frequency, lower amplitude, worse with sustained posture
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Drug induced tremor -common drugs
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valproic acid, amiodarone, cyclosporine, interferon, lithium
albuterol, tacrolimus, tamoxifen, thyroxine |
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Cerebellar Tremor is associated with?
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a. Multiple Sclerosis
b. Stroke, tumor involving cerebellum, red nucleus, inferior olive |
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Parkinsons disease Cardinal Features
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a. Bradykinesia
b. Tremor, rest c. Rigidity d. Postural Instability |
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Other symptoms of Parkinsons disease
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a. depression
b. dementia c. constipation (undertreatment), d. diarrhea (overtreatement) |
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Pathology of Parkinsons disease
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a. Progressive loss of neurons that produce and utilize dopamine as a neurotransmitter
b. Nigrostriatal tracts (related to movement) c. Mesolimbic tracts (related to mood and cognition) |
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Treatment of Parkinsons disease
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a. dopamine replacement
b. dopamine agonists c. anticholinergics d. dopamine extenders |
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Alzheimer's disease Clinical definition
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insidious onset and progressive nature of dysfunction in more than one domain of cognition, with memory dysfunction being prominent.
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What are essential studies you should run if you suspect Alzheimer's?
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B12 level
head CT thyroid studies |
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FDA approved treatments for the symptoms of Alzheimer's? There is no cure.
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anticholinesterase inhibitors (donepezil) and NMDA inhibitors (memantine)
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3 Types of Non-Alzheimers dementia
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Frontotemporal Dementia
Dementia with lewy bodies Vascular dementia |
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Common symptoms (patient observations) of MS
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Dizziness, vertigo, imbalance
Fatigue Heat sensitivity Lhermitte’s sign Numbness, tingling, pain Bladder dysfunction Visual impairment weakness |
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L'hermitte's sign:
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an electrical sensation that runs Sudden transient electric-like shocks extending down the spine triggered by flexing the head forward.
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Paroxysmal Symptoms in MS
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Trigeminal neuralgia and other neuralgias
Dysarthria Hemifacial spasm Itching Paroxysmal kinesogenic choreoathetosis |
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Signs of MS
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Tremor
Dysmetria, lack of coordination Decreased strength Hyperreflexia, spasticity, babinski’s sign Poor balance Impaired vision nystagmus |
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Who gets Multiple Sclerosis?
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Usually persons between the ages of 20 and 45
It has been observed in persons less than 1 year old Twice as many women are affected as men Northern European descent Persons in northern latitudes |
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HA pain of the scalp and face is transmitted via what nerve?
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Trigeminal
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most common type of stroke
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ischemic
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Causes of ischemic stroke
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a. embolic
b. thrombotic c. lacunar d. vasospasm e. septic emboli |
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Transient Ischemic Attack (TIA) symptoms last?
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<24 hours
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Reversible Ischemic Neurological Deficit (RIND) symptoms last?
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fewer than 48 hours
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Diagnostic criteria of tension headache
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i. At least 10 prior episodes
ii. Duration 30 minutes to 7 days iii. Characteristics: pressing, not "severe", bilateral, not aggravated by activity iv. No nausea/vomiting, photophobia/phonophobia v. No evidence for organic disease |
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Treatment of tension headache
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(NSAIDS, steroids, narcotics (avoid narcotics) physical therapy, rule out visual problems
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Migraine, common (without aura) Diagnostic criteria
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i. At least 5 attacks
ii. Duration 4 to 72 hours iii. Characteristics: unilateral, pulsating, moderate to severe, aggravated by activity iv. At least on of: nausea/vomiting, photophobia and/or phonophobia v. No evidence of organic disease |
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Diagnostic criteria of Migraine, classic (with aura)
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i. At least 2 attacks
ii. At least 1 fully reversible aura iii. Not lasting more than 60 minutes iv. Headache following aura by no less than 60 minutes v. no organic cause |
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Migraine treatment
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nonpharmacologic treatment
pharmacological treatment i. preventative therapies (topiramate, valproic acid, propranolol, amitriptyline) ii. Abortive therapies (tryptan class,steroids, dihydroergots, narcotics, neuroleptics, antidepressants) |
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Methysergides mechanism of action
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blocks 5-HT2A and 5-HT2C receptors, but appears to have partial agonist activity in some preparations
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Methysergides approved uses
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Migraine, depression, schizophrenia
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Ergotamine approved uses
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Abort or prevent vascular headaches, such as migraine, and cluster headaches
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Ergotamine mechanism of action
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Has partial agonist and/or antagonist activity against tryptaminergic, dopaminergic and alpha-adrenergic receptors depending upon their site; is a highly active uterine stimulant; it causes constriction of peripheral and cranial blood vessels and produces depression of central vasomotor centers
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Cholinoceptor-activating drugs mechanism of action
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Ciliary muscle contraction, opening of trabecular meshwork; increased outflow
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Cholinoceptor-activating drugs approved uses
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glaucoma
Pilocarpine, carbachol, physostigmine |
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Cholinesterase-inhibiting drugs mechanism of action
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Neostigmine, pyridostigmine (mestinon), Donepezil (Aricept)
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Cholinesterase-inhibiting drugs approved uses
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Glaucoma, myasthenia, Alzheimer's
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Cholinoceptor blockers approved uses
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Parkinsons, peptic ulcer, hypermotility, asthma, pupil dilation, DO NOT use in glaucoma
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mechanism of action of Antinarcoleptic meds
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exact mechanism of action unknown
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Cholinesterase regenerators approved uses
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poisoning caused by organophosphate cholinesterase inhibitors used as pesticides (e.g., diazinon, malathion, mevinphos, parathion), in chemical warfare (e.g. the “nerve gas” sarin). 2-PAM is not effective against the chemically different "carbamate" type cholinesterase inhibitors (such as neostigmine and pyridostigmine)
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Most common drugs used for narcolepsy
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modafinil (Provigil)
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Anticholinergic/Antiparkinsonian mechanism of action
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antagonizes acetylcholine and histamine receptors
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Anticholinergic/Antiparkinsonian approved uses
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Parkinsonism, extrapyramidal rxns, dystonic rxns, acute
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Acetylcholinesterase inhibitors mechanism of action
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reversibly binds to and inactivates acetylcholinesterase (cholinesterase inhibitor)
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Acetylcholinesterase inhibitors approved usage
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myasthenia gravis, Alzheimer's, Lewy body dementia
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DDAVP mechanism of action
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synthetic arginine vasopressin (antidiuretic hormone) analogue; exerts antidiuretic effects and increases plasma factor VIII and von Willebrand factor levels
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