NP Neuro – Flashcard
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myasthenia gravis vs. MS: lab findings
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MG: Ach receptor Ab+, edrophonium (Tensilon) test MS: may have CSF +protein, +IgG, ?WBCs
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mnemonic for recalling cranial nerve type: Sensory | Motor | Both
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Some Say Marry Money But My Brother Says Big Bras Matter Most
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CN I: name, function, type
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olfactory smell sensory
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CN II: name, function, type
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optic vision sensory
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CN III: name, function, type
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occulomotor most EOMs, opening eyelids, pupillary constriction motor
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CN IV: name, function, type
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trochlear down & inward eye movt motor
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CN V: name, function, type
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trigeminal chewing; scalp, face, nose, cornea & mucous membrane sensation both (sensory & motor)
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CN VI: name, function, type
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abducens lateral eye movt motor
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CN VII: name, function, type
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facial (think: squint) facial movt, close mouth & eyes, taste (ant. 2/3), saliva & tear secretion both
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CN VIII: name, function, type
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vestibulocochlear (auditory) hearing & balance sensory
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CN IX: name, function, type
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glossopharyngeal phonation, gag, swallowing, taste (post.) both
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CN X: name, function, type
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vagus talking, swallowing, carotid body sensation/reflex both
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CN XI: name, function, type
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accessory shrugging motor
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CN XII: name, function, type
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hypoglossal tongue movt motor
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most common headache type
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tension
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vise-like, tight HA, generalized, often head/neck/back, no neuro sx, several hrs
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tension HA
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migraines are divided into two categories
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classic (w/ aura) and common (w/out aura)
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unilateral, laterilized throbbing headache, lasting 2hrs - 3 days
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migraine
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migraine: onset
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~adolescence or early adulthood
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migraine: epidemiology
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F > M, often FHx
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migraine: triggers
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stress, lack/excess sleep, missed meals, foods, alcohol, menstruation, OCPs, foods w/ nitrites, weather changes
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scintillating scotoma
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prodromal sx of a migraine, a visual disturbance with flickering, shimmering, zig-zag lines, etc.
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numbness, speech disturbance, paraesthesia (5-60 mins)
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sx of aura (associated w/ migraines)
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name some 2° causes of HA
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temporal arteritis tumor ruptured aneurysm cerebral venous thrombosis fever
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Unilateral > bifrontal or global HA
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migraine
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HA: Gradual onset, crescendo pattern, moderate to severe, pulsating, aggravated by physical activity
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migraine
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HA: 4-72 hrs
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migraine
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HA: Nausea, vomiting, photo/phonophobia, +/- aura, focal neuro (i.e. visual disturbances, numbness, tingling)
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migraine
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HA: Nausea, vomiting, photo/phonophobia, +/- aura, focal neuro (i.e. visual disturbances, numbness, tingling)
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migraine
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migraine tx
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triptans (sumatriptan) ergots (ergotamine) antiemetics relaxation trigger avoidance
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bilateral waxing & waning HA, pressure
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tension HA
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mild HA w/ no prodromal sx or neuro findings
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~ tension HA
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what kind of meds do NOT work for cluster HAs?
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PO
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what HA is often assoc. w/ rhinorrhea and/or eye-redness ipsilateral to the HA?
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cluster
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unilateral, periorbital HA
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cluster
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TIA
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transient ischemic attack
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TIA is indicative of what?
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an impending CVA
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most TIAs resolve w/in ___ otherwise they are likely a ___
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3 hrs CVA
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ipsilateral monocular blindness w/ contralateral paresthesia
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TIA/CVA
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most TIA/CVA is from infarcts or bleeds?
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infarcts (80%)
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TIA is classified either by ____ or ____
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*vertebrobasilar* (inadequate blood flow from vertebral arteries) or *carotid* (carotid stenosis)
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best dx test to distinguish btwn hemorrhage vs. infarct vs. tumor
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CT
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if a CT scan for suspected CVA is negative and the pt is still symptomatic, what is the most likely etiology?
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infarct (since a CT will show a bleed)
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TIA management
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1. Aspirin 2. clopidogrel (Plavix) 75 mg PO QD 3. ticlopidine (Ticlid) 4. assess for HTN 5. carotid endarterectomy (if stenosis is >70-80%)
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seizure classification: 1 min or less, *no LOC*
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simple partial seizure
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seizure classification: 1 min or less, *followed by impaired LOC*
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complex partial seizure
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diff btwn *partial* and *generalized* seizures
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PARTIAL (focal, local): *~starts in one muscle group and spreads* to one entire side of the body
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absence (petit mal) seizure charactyerized by
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sudden absence of motor activity w/ blank stare, usually 1st noticed in children/adolescents
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tonic-clonic (grand mal) seizures are characterized by
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starting w/ *tonic* (repetitive) contractions ? LOC ? *clonic* (continuous) contractions ~2-5 mins, may have incontinence
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blown pupil, one is fixed and dilated
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sign that herniation is pending, emergency!
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what test is indicated for *new onset TIA*?
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CT scan
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what dx test can help classify/dx seizure?
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EEG
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seizure tx
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anti-seizure meds (benzos, phenytoin (Dilantin)
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common seizure prophylaxis meds
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carbamazepine (Tegretol) phenytoin (Dilatin) phenobarbitol, valproic acid (Depakene)
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what should you never do w/ anti-seizure meds?
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never abruptly withdraw (instead, always taper them down slowly)
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Parkinson's Dz is characterized by what hallmark s/sx?
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*tremors* ("the shakes" esp. in extremities at rest), *bradykinesia* (difficulty with or impaired responsiveness in movt, slow movt), *rigidity* ("robot-like" movt)
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status epilepticus
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a *series* of *tonic-clonic* (grand mal) seizures *;10 mins duration* (medical emergency, most life-threatening of seizures) where the victim *remains unconscious inbetween attacks*
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Parkinson's: ~ age of onset?
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45-65 yo
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what is an esp. concerning Parkinsons Dz sx in the elderly?
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dysphagia (aspiration risk)
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Myerson's sign
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repeated tapping on the bridge of the nose produces a sustained blink response (pt is unable to resist blinking); this sign may suggest Parkinson's or other neurological disorder
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Parkinson's Dz: labs? dx?
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none
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Parkinson's Dz: pathophysiology
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a lack of *dopamine* (Dopamine depletion from the basal ganglia results in major *disruptions in the connections to the thalamus and motor cortex*, and leads to parkinsonian signs such as bradykinesia)
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Parkinson's Dz: tx
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carbidopa-levodopa (Sinemet) anticholinergics (help reduce tremors ; rigidity)
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myasthenia gravis and multiple sclerosis are both ____ diseases
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autoimmune diseases
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myasthenia gravis: pathophysiology
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autoimmune disorder resulting in ?acetylchoinergic receptors at the NMJ
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myasthenia gravis and multiple sclerosis are both ____ diseases
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autoimmune diseases
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myasthenia gravis: pathophysiology
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autoimmune disorder resulting in ?acetylchoinergic receptors at the NMJs
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classic s/sx of myasthenia gravis
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*fluctuating skeletal muscle weakness* (esp. after exercise, worse later in the day), ptosis and/or diplopia (;50% pts), respiratory difficulties, dysphagia... BUT DTRs and sensory are WNL
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myasthenia gravis: less common s/sx
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dysarthria, dysphagia, chewing fatigue (15% pts)
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85% of pts w/ myasthenia gravis (generalized type) have what in their blood?
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acetylcholine receptor Ab (AChR-Ab)
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what test can help differentiate myasthenia gravis from a cholinergic crisis (sx: flaccid paralysis)?
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edrophonium (Tensilon) test
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if giving a Tensilon (edrophonium) test to a pt w/ myasthenia gravis, what is the expected result?
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pt will see improved muscle strength (but in a cholinergic crisis, muscle strength is worsened)
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myasthenia gravis mngmt
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*anticholinesterases* (i.e. pyridostigmine bromide (Prostigmin)), *immunosupressives ; plasmapheresis* neurology referral!
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multiple sclerosis: epidemiology
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~presents in early adulthood, F ; M, W. European
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multiple sclerosis: characteristic s/sx
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intermittent presentations/relapses of numbness, weakness, loss of muscle coordination, visual loss/diplopia/nystagmus, problems w/ bladder control
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multiple sclerosis: dx
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MRI, mild ?CSF protein, ?CSF IgG, mild lymphocytosis (note that diagnosis is not possible by labs alone)
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multiple sclerosis: mngmt
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steroids (acute episodes), *antispasmodics ; interferon therapy*, *immunosupressives ; plasmapheresis* neurology referral!
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abrupt onset unilateral facial paralysis (even w/in 24 hrs), sensation intact, can't fully close eyelids, difficulty chewing/swallowing
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Bell's palsy
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does Bell's palsy resolve on its own?
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usually, yes
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which cranial nerve is affect in Bell's palsy?
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CN VII (facial)
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Bell's palsy: etiology
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viral (HSV possibly), autoimmune, or pressure from tumor/vessel, or idiopathic
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strokes usually impair the ____ but NOT the ____
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mouth but NOT the eyes and forehead (exception: if a stroke does impair upper and lower face, there will also be other focal neuro findings) RATIONALE: The upper face is controlled by fibers from cranial nerves from BOTH sides of the brain, whereas the lower face is controlled strictly by the contralateral (OPPOSITE) side. CENTRAL NS damage to the motor cortex (i.e. ischemic stroke) will damage the lower face (i.e. weak smile) but not the upper face (eyes, forehead). i.e. such pts have a weak smile but can wrinkle their forehead and close eyes tightly. This is often called "central" facial weakness d/t damage to the cerebral cortex, part of the CENTRAL NS. Damage to the facial nerve (or after it exits the brain stem) causes ipsilateral facial weakness to BOTH the upper AND lower face, thus such a pt can NOT wrinkle forehead, close eyes or smile on ONE SIDE ONLY
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Bell's palsy: tx
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hi-dose steroids (Prednisone) tapered ? over 10 days, Acyclovir (if HSV involvement suspected), eye lubricant drops (for corneal protection from inability to close eyelids)
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sudden severe, stabbing, electric-shock-like pain in parts of the face
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trigeminal neuralgia
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what comorbid conditions can be assoc. w/ trigeminal neuralgia?
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MS
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what can cause trigeminal neuralgia? so what test should be ordered?
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tumor, so rx MRI
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trigeminal neuralgia: tx
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anti-seizure meds (i.e. carbamazepine (Tegretol), phenytoin (Dilantin)), muscle relaxants, TCAs
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is a ? number of neurons and neurotransmitters a normal part of aging?
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YES!
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name some common effects from an aging nervous system
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? thermoregulation ; sense of touch, ? pain tolerance, ? balance ; coordination, ? muscle strength, ? nerve response time, ? DTRs, blunted or absent fever response, slowed cognitive processing (but memory decline is NOT normal), ? r/o sleep disorders, delirium, falls, neurodegenerative conditions, impaired ADLs
