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123 Cards in this Set
- Front
- Back
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What is myasthenia Gravis (MG) ?
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- chronic autoimmune disease
- IgG antibody is against acetyle choline receptors - weakness of eyes and throat muscles |
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What muscles go first with MG?
What sex/age is it more common in? |
little muscles- especially with repetitive motion
effects more ladies- tending to peak in the fourth to fifth decade. Neonatal is rare |
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Mortality of MG?
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only bad with respiratory problems (that can lead to myesthenia crises!), since we can treat with corticosteriods
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Ocular Muyesthenia Gravis aka-
discribe Dx? |
Ptosis-
When usually both eyes cannot open all the way. Opening the eyes is CN 3 Tensilon test: blocks anticholenesterace so the ACH can bind off |
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What disease favors repetitive motion?
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Eaton Lambert
(also increases risk of aids and cancer) |
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List some muscle symptoms of MG
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fascia weakness
ptosis diplopia difficulty breathing, talking, chewing, swallowing |
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What may trigger or maintain production of the antibodies in MG?
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thymus gland
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What factors make MG worse?
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fatigue
illness stress extremem heat beta blockers/ ca blockers |
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Some MG treatments
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1. cholenesterace blockers
2. corticosteriods 3. thymus removal 4. plasmapharesis (only during the crisis) |
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Myesthenic Crisis=
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respiratory failure, usually due to repiratory infections
- does not have to be fatal |
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EPSP=
results in what? |
excitatory post synaptic potential
results in a graded local current that depolarizes the membrane. *sodium rushes in |
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IPSP =
results in? |
inhibitory post synaptic potential
results in graded hyperpolarization. *CL iron rushes in |
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Inactivation of trasmitters:
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1. broken down by enzymes
2. defuse, recirculated |
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Divergence
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Kinda like amplication
1- 11- 111- 1111- 1111 |
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Convergence
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a number of primary neruons synapse on one secondary neuron, you LOSE acitu wtih this.
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Acutiy=
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ability to discriminate
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list and explain 3 times of potentials
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1. post-synaptic potentials
2. spatial summation - arrive on different places of the neruon at same time 3. temporal summation - arrive close to eachother in time |
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Modulation
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the activity of nerves can be changed or modulated by other nerves.
presynaptic facilitation VS presynaptic inhibition |
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Post synaptic inhibition
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the inhibitory neuron synapses on the same target as down the neuron being stimulated, hyperpoloarizing the post synaptic membrane
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Wallerian Degeneration
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occurs distal to the cut
- swelling appears - neurofiliments hypertrophy - myelins sheat shrinks and disintigrates - axon portion degenerates and dissappears |
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According to nerve injury and regeneration, what occurs proximal to the cut?
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- swelling and dispersal of substance
- metabolic acitivity increases - limited to myelinated axons |
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subtentorial verses infratentorial
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volition concious/ brainstem
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Consciousness=
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state of awareness of oneself and the envirnment
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arousal=
awareness= |
state of awakeness
(infratentorial) content of thought (supra and infra tentorial) |
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alterations in cognition are grouped by:
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location of lesion or pathology
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Alterations in Cognition can be caused by ...
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1. bilateral hemisphere damage by hypoxia
2. hypoglycemia 3. trauma, drugs, toxins 4. brainstem lesion that effects RAS 5. psychiatric issues |
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Purposeful motor responses=
requries= |
defensive withdrawl moevement of the limb to noxious stimuli
intact corticospinal system ***** important******* |
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Inapropriate/ non-purpusful motor responses=
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generalized movement
posturing grimacing groaning (evidence of severe dysfuction on the corticospinal system) |
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Righting reflex=
snout reflex= |
when you push someone off balance and they come back to normal
turn and suck |
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Decorticate Posturing is injury to
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corticospinal injury
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what is it called if you have decorticate right limbs, and decerebrate left?
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urbs palsy position
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Decorticate Posturing
looks like: serious? How can you position patients to decrease tone? |
arms flexed inward on chest, hands in fists
legs extended not as bad as decerebrate - supine favors extension - prone favors flexion - sidelying= neutral |
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Decerebrate Posturing looks like:
Injury to: |
extended arms
arched head extended legs (doesnt have to be both sides of bod and can alternated between decorticate and decerebrate) Brainstem |
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Clinical Manefestations of Arousal Alterations
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1. conscious changes
2. bad pattern of breathing 3. pupillary changes 4. ocular motor responses 5. motor responses |
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PHVA breathing is due to?
CSR? |
co2 pressure in blood- abnormal if it happens with volition
this is cheyene stokes- depth of respiration keeps increasing until it stops and then the cycle repeats. |
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put coma, vege and minicons in order from least to greatest
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mini con
vege (wakeful unconscious) coma |
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Coma is produced by either:
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1. bilateral hemispshere damage or suppression
2. brain stem lesions or metabolic dereangement that damages or supresses the reticular activiating system. |
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After a stroke (which is most ocmomn in middle cerebral artery) has its best return in what time span?
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first 6 months
(so yes, time is a factor) |
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Cerebral death =
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irreversible coma due to damageof the cerebral hemispheres (brainstem can still maintain interal homeostasis)
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Describe the Vegetative State
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- periods of eye opening
- potential for subcortical responses - return of somatic autonomic functions(sleep wake cycle) - occasional eye movements without tracking |
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How can you recover from CNS damage?
Rules say ______ of being in a coma you fucked |
new pathways, no healing
2 weeks |
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what state has purposful eyes tracking?
What state has some wake periods but NO eye tracking State: no periods of wakefulness, rare to open eyes |
MINI
VEGE COMA |
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What test DOESNT find brain death?
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2 point
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Levels on conconsiousness in order form least to greatest=
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confusion
disorientation lethargy (easily aroused) obtundation (yell awake) stupor (need sternal rub) coma |
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AAo1 =
AAo2 = AA03 = |
lost place and time
Lost time lost person place and time |
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ecilalia =
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repeated same word/phrase over and over again
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what is the glascow coma score?
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rating of consciousness between 3- 15 (3 being the worst)
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what decreases the size of pupils
what increases it? what is a positive doll eye response? |
opiates (para symp)
brain damage (hypoxia) (symp) brain damage |
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Brain death=
Cerebraal death= |
no homeostasis
Cerebral death= no contact with envirnement, no brainstem, irreversible coma. |
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dellusion VS hallucination
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some basis in reality
VS No reality basis |
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IF in coma with no ocular responses after 24 hours what is the mortaility rate?
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90% death
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Define seizure
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explosive disorderly discharge of cerebral neurons characterized by a transient alteration in brain function
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Second most common neurological disorder?
whats first? |
seizures
stroke |
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aura=
prodroma= what starts the seizure? |
partial seizure exeriences as a peculiar sensation preceeding the onset of a generalized seizure
early clinical manisfestations that occur hours/days before the osnet of a seizure epileptogenic focus - (hypersensitive cells) |
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tonic phase=
clonic phase= postictal state= |
exessive muslce contraction
state of altering contraction and relaxation time period immediatly following seizure activity - hyporesponsive - low tone - tired |
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Partial seizures=
Generalized seizures= Red flag seizure call 911= |
local region
can be simple or Complex(loc) bilateral symmentry can be tonic/clonic or only loc status epilepticus (lasting longer than 30 minutes) |
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what doubles suicide risk?
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epilepsy
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sensory inatentiveness=
Dysmesia= Is dysmnesia permanent? |
able to recognize imput to the effected side, but ignores the effected side when the stimulus is being presented bilaterally.
retrograde amnesia and inabiltiy to form new memories can be temporary(epileptic) or permanent (ETOH) |
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Agnosia=
Dysphasia= Aphasia= |
dysfunction with association area, cant see patterns, and other senses
"tip of the tongue" impairment of comprehension or production of language same as dysphasia but a COMPLETE LOSS, not an impairment - USUALLY LEFT HEMISPHERE PROBLEM |
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dysfascia is associated with what pathologically?
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Left MCA lesions
clot in the middle cerebral artery |
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concept disorders -
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like eating disorder
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what is b12 for?
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- nerve myelination
- help in cognition |
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what is : The progressive failure of cerebral functions characterized by reduction in cognition?
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Dementia
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azleheimers disease is associated with a lack of?
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ACH
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Dementia is cahracterized by:
pathophysiology includes dengeneration caused by: |
whats causeing it
genetics, inflammation, athersclerosis, trauma or compression. |
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the diagnosis for _____ is often wrong becuase people are just on two many meds
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dementia
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what blocks ACH?
whats the prpoblem with myesthenia gravis? |
anticholenesterace
antiobodes are targested at the ach receptors so the ach has no effect .... only some receptors are good and so you arent paralizysed or anything) |
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MG is a build up of ACH- so what do you do?
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tensilon- BLOCKS cholenesterace(the enzyme that breaks down ach)
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wilsons disease=
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copper toxicity (body cant metabolize copper properly)
- 90% have the keiser fleisher ring- can be treated if caught eary. |
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LMNL is associated with=
UMNL is associated with= |
- hypotonia (decreased excitibility of nerusons and spindle activity)
atrophy to fat - GBS (nerve root and down) - hypErtonia (passive movement of muscle occurs with resistance) - MS - CNS and spinal cord problem |
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4 tpyes of hypertonia
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1. spasticity- clonus of stretch reflex
2. gegenjalten(paratonia) resistance varies in direct proportion to force 3. rigigity= tonic reflec activity (cogwheel= jerky releases as muscle starts to weaken). very severe like the decoriticate stuff. 4. dystonia- sustained involuntary twisitng, like terets and chorea. |
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how do you evaluated spasticy?
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fast dorsiflexion of ankles and count how many spasms happen.
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how do you DX alzheimers?
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1. by ruling out dementia
2. autopsy |
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what is normal intracranial pressure?
what could in crease this? how will this show up on an X-ray? |
5-15 mmHg
tumor, growth, edema, extra csf, bleeding the cenral fissure will not be at the midline |
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Infratentorial herniation=
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cerebellum goes through foramen magnum.
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types of cerebral edema
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vasogenic
cytotoxic ischemic interstitial (more protein in intersticial space) |
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hydrocephelus is caused by-
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interuption in CSF flow
- decreased reabsorption - increased production - obstruction in ventriclar system= causes noncommunication |
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what is at the decussation of the brain
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corticospinal crosses (motor)
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occular palsy is a sign of-
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brainstem issue
hydrocephalus |
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first obviouse sign of hydrocephalay
what a sign of severe uncontrollable hydrocephally |
alteration in conciousness
-then will see respiration problems, papillodema sunsetting eyes |
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what is a BAD combo of vital signs?
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high blood pressure
low heart rate |
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where is the olfactory?
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frontal lobe
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paresis VS plegia
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paresis= WEAKNESS
plegia= paralysis |
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what is spinal shock?
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a period of flaccid paralysis post damage, not usually seen if destruction occurs slowly. Can take up to a year to come out of, and after that usually develope spasticity
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most patients have incomplete quadraplegia
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this is seen in UMNS
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Lower Motor Neuron Syndromes:
Lower Motor Neuron Syndromes: |
- flaccid/ peripheral
- fibrillation, gamma neuropathies - GBS has this - amyotrophies (wasting of muscle tissues) - spasticity CNS |
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Ataxia
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- cerebellum problems
- lack of dynamic coordination |
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besides dementia- what is caused by too much meds?
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tarditive dysfkinesia
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cause of Huntingtons
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severe degenereation of basal ganglia and frontal cerebral cortex (depletion of GABA)
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what disease is hypokinesia associated with?
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parkinsons (also degeneration of the basil ganglia. corpus stratium
- also has "primary depression" |
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hallmark of severe TBI
(traumatic brain injury) two types of TBI most common cause |
loc >6 hours
although most are mild! (and FYI concussions are less than 6 hours) closed open- dura is breached motor vehicle accidents causing contrcoup injuries to the frontal bone. 90% have arterial hematoma |
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Give 1st, 2nd, 3rd injury concerning a TBI
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1. impact, increased vascular permeability
2. cerebral edema, increased pressure 3. organ failure, apnea |
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what injury is the result of shaking forces?
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Diffuse Brain Injury- depends on amount of sheering forces to the brainstem.
also the worst grade of a concussion |
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list and discribe 3 types of Hematoma
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1. sundural= venous, slow to develope
2. extradural- arterial 3. intracerebral- usually arterial, coup, contracoup |
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Grades of Concussions:
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1= confusion, momentary amnesia
2= momentary confusion and retrograde amnesia taht developes over 5-10 min 3= retrograde and antegrade for several minutes 4= classic cerebral concussion- same as 3, loc less than 6 hours, and possibly focal brain injury 5= diffuse axonal injury |
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what percentage of moderate DAI survivors have deficits?
what about severe? |
93%
this is primary brain stem injury and all of the patients if they survive , 40% will remain at LOC |
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Post Concussive Syndrome=
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no matter how mild, it can persist to weeks or months.
anxiety, headache, cant concentrate, |
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what injury has shown patterns of life changes?
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post concussive syndrome
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is LOC correlated to severity of a concussion injury?
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NO! but it is correlated to rotational or shearing forces
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what will an athelete deal with if they have a concussion? (Im not asking about punch drunk)
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no competition until 1 week sign free. Also depends on sport.
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what do you need to know about "horner" for the test?
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Type of Spinal cord Trauma
autonomic damage to sympathetic ganglion - ptosis is also a sign - different color eye |
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most common spinal cord trauma
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central cord syndrome
- worse in upper extremeites - some sensory loss below the injury - occurs most with hyperextension after cervical spondylosis |
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brown-sequard
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lateral hemisection of spinal cord- paralysis and ataxia
- lesion in UMNpathway |
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a quad patient may look a lot like LMNL but really....
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its spinal shock
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autonomic hyperreflexia is..
happens in people with... a common symptom= Associated with= |
a medical emergycy- that tends to develope in rehab, not acutly. (uncontrolled firing in the ANS)
paryoximal hypertension- causing a blood vessel to blow) poudning headache leasions above T6 after spinal shock resolves distention of bladder less comennly with pressure sore. |
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Autonomic Hyperreflexia
Intervention= |
- check for kinked cathater
- dial 911 - dont lay down - pull down ted hose, take off abdominla binder, anything to decrease pressure |
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digenerative disk disease often leads to-
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rediculopathy (nerve root irritation)
dermatomes= pain myotomes= weakness |
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spondylosis=
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- defect in lamina between superficial and inferior facets
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spondylolisthesis=
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more in MEN
anteriordisplacement of L5S1 1-2= nonsurgical grade |
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spinal stenosis=
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narrpowing due to *osteophytes*, or bulging annulus. common in cervical spine.
- worse with neck position (fyi- impingement of blood to LE has a predictable walking distance) - aquired or congenital |
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1% of people with LBP have-
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siatica
(sensory deficeits generally precede motor) |
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opposite of pyroxemial dyskinesia?
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parkinsons
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osteochondrosis=
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family of diseases doe to avascular necrosis to bone.
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what direction does the vertibra tend to collapse
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ventrally
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Scheuermanns disease is a type of
what happens- |
osteochondrosis
- vertibral bodies dont grow right, interupt blood supply. - hunch back- wedge puts a bigger bend in the kyphosis |
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Gaba in the CNS does
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hyperpolerization
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where does LBP come from?
the pain increases with when do you do surgery? You shouldnt get surgery if.. |
innervated structures- since the nucleus pulposis isnt innervated, muscle spasm, or herniated disk.
- vary with amount and location of prolapse - increased intrathecal pressure ex) cough - when motor changes occur, bad prognosis though. if you smoke! |
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how do you know redicular pain is improving?
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pain becomes more localized and central
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50% of people admitted with neuroloic problems have a
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cerebrovascular disorder
(either ischemia or hemmorrhage) - third leading cuase of death in america - leading disabilityin america |
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incidence of CVA and risk factors
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over 65 years
genetic ladies asian 15% chance of recurrence within one year HTN smoking elevated blood lipids hormones a fib not enough folate too many RBD (polycythemia) |
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whats natural progression of TIA
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80% have reoccurance in a year without aggressive treatment
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embolisms are most common in-
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MCA
- plaques often arise from bifurcation of carotid. |
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types of CVA
treatment? |
thrombotic
embotic hemmrrhage lacunar ( scattered moon like infarcts) reversal of ischmia must begin within 6 hours. fyi- a lot of people who do coke (more ladies too) get anuerisms. and 5% of the general public has an asymptomiatic one. |
