ALS, Aphasia, Bell's palsy, Trigeminal neuralgia, and pseudotumor cerebri Flashcards

1
Q

What is the only system ALS affects

A

Motor system

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2
Q

Which nerves are specifically affected in ALS

A

1.) Anterior horn cells - LMN’s, corticobulbar muscles2.) Corticospinal tract - UMN’s

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3
Q

What is the usual onset for ALS

A

50 to 70

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4
Q

Does ALS have familial inheritance

A

Yes, only 10%, rest are sporadic

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5
Q

What is the mortality rate of ALS at 5 and 10 years

A

5 years = 80%10 years = 100%

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6
Q

What is the hallmark feature of ALS

A

Progressive muscle weakness - starts in arms/legs, then spreads

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7
Q

What is end-stage ALS

A

Respiratory failure

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8
Q

What is not affected in ALS

A

1.) Bladdar/bowel control2.) Sensation3.) Cognitive function4.) Extraocular muscles5.) Sexual function

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9
Q

What should you do to help aid in the diagnosis of ALS

A

1.) EMG - fibrillations and fasciculations at rest as result of LMN injury (if myopathy, should have no electrical activity at rest but then amplitude decreases with continued use)2.) Nerve conduction studies - If decreased nerve conduction, probably demyelination (MS, guillian), if repetitive stimulation causes fatigue, then myasthenia gravis

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10
Q

What is treatment for ALS

A

Supportive, maybe riluzole (glutamate blocking agent - delays death by 3 to 5 months)

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11
Q

Where is aphasia affecting brain most of the times

A

In the dominant hemisphere (right handed = 95% on left hemisphere, left handed = 50% on left hemisphere)

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12
Q

Four causes of aphasia

A

1.) Stroke - most common2.) Trauma to brain3.) Brain tumor4.) Alzheimers disease

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13
Q

Four types of aphasia

A

1.) Wernicke’s aphasia2.) Broca’s aphasia3.) Conduction aphasia4.) Global aphasia

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14
Q

Difference between wernicke’s and broca’s aphasia

A

Wernicke’s: Receptive, fluent but impaired comprehension of written/spoken languageBroca’s: Expressive, nonfluent with slow speech with good comprehension, usually has right hemiparesis and hemisensory loss

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15
Q

When do patients improve with aphasia, and when is the best time to give speech therapy

A

Spontaneously recover within first month, and speech therapy only helpful in first few months

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16
Q

What is the pathophysiology of bells palsy

A

Hemifacial weakness/paralysis of bottom and upper face via CN 7 due to swelling

17
Q

What is the prognosis of bells palsy

A

Good - 80% recover

18
Q

What are the causes of bells palsy

A

Possibly viral (herpes simplex), upper respiratory infection often preceedes it

19
Q

What is the differential when bells palsy is there

A

Trauma of temporal bone, lyme disease, tumor, guillain barre (palsy bilateral), and herpes zoster

20
Q

What should you not administer when lyme disease is suspected, especially in endemic areas

A

Steroids - do not give

21
Q

What should you do if bells palsy remains for more than 10 days

A

EMG

22
Q

What should be used for treatment of bells palsy

A

Prednisone and acyclovir, with eye patch at night to avoid corneal abrasion

23
Q

What should you do if bells palsy’s paralysis keeps progressing

A

Surgical decompression of CN 7

24
Q

What is trigeminal neuralgia

A

Idiopathic condition with intense pain without motor or sensory paralysis, relapsing/remitting course that becomes more refractory to treatment

25
Q

How to diagnose trigeminal neuralgia

A

Clinically, but do MRI to rule out cerebellopontine angle tumor

26
Q

Order of treatments for trigeminal neuralgia

A

1.) Medical - carbamezapine with baclofen and phenytoin2.) Surgical decompression if meds fail

27
Q

What group of people does idiopathic intracranial HTN (pseudotumor cerebri) affect

A

Young, obese women

28
Q

What is the classic triad of symptoms seen in IIH

A

Headache, vision changes, pulsatile tinnitus with papilledema

29
Q

What four modalities would you use to diagnose IIH

A

1.) Ocular exam2.) MRA/MRV3.) LP (even though they have papilledema, they need an actual reason for it to be a contraindication - i.e. mass lesion, hydrocephalus)

30
Q

What is diagnostic of LP in IIH

A

Opening CSF pressure > 250

31
Q

What is the first line treatment for IIH

A

Azetolamide - inhibits carbonic anhydrase so CSF decreases

32
Q

What is second line treatment for IIH and what should you bridge to get there

A

Optic nerve sheath decompression or lumbar peritoneal shunting, bridge with corticosteroids and serial LPs