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Z - Clinical Med - Final > 2 - Neurologic Disorders > Flashcards

2 - Neurologic Disorders Flashcards

1
Q

Neurologic method - how to assess

-where is the lesion (CNS, PNS, both)

A

CNS - cortex, midbrain, spinal cord, meninges

PNS - motor/sensory nerves, NMJ/muscle

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2
Q 
Neurologic method - how to assess
-what is the lesion
—grey matter
—white matter
—metabolic/degenerative
A

Grey = primary neuronal
-early cognitive disturbances, movement disorders, seizures

White
-motor, sensory, VISUAL, cerebellar

Met/degen
-symptoms are progressive and symmetric

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3
Q

Neurologic method - how to assess

-lab assessment (3)

A

Blood and CSF tests

Focused neuroimaging

Electrophysiologic studies

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4
Q 
Seizures and epilepsy
-seizure
—define
—what
—who
A

Transient sign/symptom of abnormal excessive or synchronous neuronal activity in the brain

Not a disease, but a symptom

5-10% of the population will have at least one

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5
Q 
Seizures and epilepsy
-epilepsy
—define
—what
—process
A

Condition in which a person has a risk of recurrent seizures
(“Chronic seizure disorder”)

Not a specific disease, but a condition

Chronic, underlying process

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6
Q

Seizures

-determining type of seizure is essential for (3)

A

Determining cause

Treatment

Long-term prognosis

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7
Q

Seizures

-focal vs generalized onset

A

Focal

  • limited to one brain region
  • usually structural abnormalities of the brain

Generalized

  • distributed across both hemispheres
  • cellular, biochemical, or widespread structural abnormalities
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8
Q 
Seizures
-factors
—endogenous
—epileptogenic
—precipitating
A

Genetic

Severe penetrating head trauma (also stroke, etc.)

Stress, exposure to toxins, certain meds, etc.

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9
Q 
Seizures
-predominance
—childhood
—adolescence and early adulthood
—older adults
A

Well-defined epileptic syndromes present (idiopathic or genetic)
Developmental disorders, CNS infection (esp viral encephalitis)

Secondary to acquired CNS lesions
Head trauma, brain tumor, illicit drug use, alcohol withdrawal

Cerebrovascular and degenerative diseases

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10
Q

Seizures - general medical approach

-shortly after a seizure, priorites are

A

Attention to vital signs

Respiratory and cardiovascular support

Recognize and manage life-threatening condns such as CNS infection, metabolic derangement, drug toxicity

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11
Q

Seizures - general medical approach
-when pt is not acutely ill
—no hx of seizures
—prior seizures or known epileptic

A

Determine if episode was actually a seizure
Determine cause
Decide if anticonvulsant therapy is required, treat any underlying illness

ID underlying cause and precipitating factors
Determine adequacy of current therapy

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12
Q

Seizures and epilepsy - diagnosis

  • history
  • exam
  • labs
  • EEG
A

Truly a seizure?

  • syncope more likely if provoked by emotional stress
  • greater than 15 seconds more characteristic of a seizure

All pts require complete neurological exam

Routine blood studies, toxin screen, lumbar puncture (if suspicious of meningitis/encephalitis)

ASAP

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13
Q

Seizures and epilepsy - treatment

  • underlying condns
  • avoiding precipitating factors
  • anti-epileptic meds
  • surgery
A

Metabolic, drugs/meds, structural

SLEEP DEPRIVATION, alcohol, etc

50%+ can eventually discontinue
1/3 need multiple meds

20-30% cannot be controlled with meds alone

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14
Q

Managing pts during a seizure

-calling 911

A

Usually do not require emergency medical attention

Call if:

  • first time
  • difficulty breathing/waking after
  • lasts >5 min
  • has another soon after
  • person is hurt or in water
  • pt has DM, heart disease, is pregnant
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15
Q

Managing pts during a seizure
-first aid for tonic-clonic/grand mal
—what to do

A 
Ease to the floor
Turn gently onto one side
Clear area to prevent injury
Put something soft/flat under head
Remove glasses
Loosen necktie/anything around neck
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16
Q

Managing pts during a seizure
-first aid for tonic-clonic/grand mal
—what NOT to do

A

Do NOT:

  • hold them down/try to stop movements
  • put anything in their mouth
  • attempt mouth-to-mouth
  • offer food/water until fully alert
17
Q

Dementia

-define

A

Acquired degeneration in cognitive abilities that impairs the successful performance of activities of daily living

18
Q

Dementia

  • cognitive ability most commonly lost/main thing noticed with dementia pts
  • strongest risk factor
  • causes
A

Episodic memory

Increasing age

Alzheimer’s is most common cause in Western countries
Vascular disease (atherosclerosis) 2nd most
Also assoc with Parkinson’s, alcoholism, drugs/meds

19
Q

Alzheimer’s

  • who
  • vs dementia
A

~5% over age 70, over half of those with significant memory loss

A causes D (Alzheimer’s is a disease, dementia is a group of symptoms)

20
Q

Alzheimer’s - clinical manifestations

-cognitive changes

A

Tend to follow characteristic pattern: beginning with memory loss and progressing
~20% present with other problems, such as visual processing dysfunction

21
Q

Alzheimer’s - clinical manifestations

  • early stages
  • middle stages
A

Early - memory loss may go unnoticed, be ascribed to benign forgetfulness, eventually interfere with daily living

Middle - unable to work, easily lost/confused, require daily supervision

22
Q

Alzheimer’s - clinical manifestations

  • late stages
  • end stages
A

Late - some remain ambulatory, wandering aimlessly
-loss of judgement and reasoning inevitable
-delusions prevalent
—common themes = theft, infidelity, misidentification

End - rigid, mute, incontinent, bed-ridden
-death most commonly from aspiration > malnutrition, secondary infections, pulmonary emboli, heart disease

23
Q

Alzheimer’s - differentials

  • imaging
  • simple, useful clinical cues
A

To R/O other disorders

Slowly progressive
-vs tumor: early onset of focal seizure

24
Q

Alzheimer’s - epidemiology

  • age
  • genetics
  • sex
  • history
  • systemic
A

> 70 (prevalence 20-40% of pop >85)

Positive family history

Females

Hx of head trauma

DM incr risk 3x

25
Q

Alzheimer’s - pathology and genetics

  • brain atrophy
  • microscopically
  • genetics
A

Begins in medial temporal lobe and spreads

Widespread neural plaque containing amyloid beta
Neurofibrillary tangles/tau filaments

Several genes play important role - APP gene on xsome 21

26
Q

Alzheimer’s - treatment

-focus

A

On long-term amelioration of assoc behavioral/neurological problems and providing caregiver support

27
Q 
Alzheimer’s - treatment
-meds
—mild efficacy with SE
—unsuccessful so far
—black box warning, sometimes necessary
—vigilantly avoid
A

Cholinesterase inhibitors, memantine, etc.

Estrogen replacement, ginkgo biloba, vaccination

All antipsychotics

Anticholinergics (sleep aids, incontinence tx - even OTC)

28
Q

Neurological disease

-implications for ODs (3, not meds)

A

What we do regularly covers a large part of standard neuro exam

Neuro disorders are common, will affect how we care for our pts

We will be co-managing

29
Q

Neurological disease

-implications for ODs (2 meds examples)

A

Bigabitrin/sabril = VF restrictions

Topiramate = AC narrowing -> bilateral angle closure -> pressure spike (40s/50s)
-secondary to choroidal effusion

Z - Clinical Med - Final (6 decks)

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