Flashcards in Large Group 3 -Clark Deck (21):
What are some tests you can do to help dx Myasthenia Gravis?
- ACh receptor antibody test
- Tensillon test
- Ice pack test (ptosis resolves w/ice pack if MG)
What should you check for and how in a pt w/MG?
Thymoma using a chest CT
What is the tx for a myasthenia crisis?
- IVIG or plasma exchange
- ACh esterase inhibitors
- +/- steroids
What is the tx for maintenance of MG?
- ACh esterase inhibitors
64 yo male presents w/soft and dysarthric speech, left leg and B/L UE atrophy, scattered muscle weakness, hyperreflexia, positive Babinski, normal sensation, normal CNs and inappropriate affect. What does he have?
Amyotrophic Lateral Sclerosis (ALS)
What is a fasciculation?
Small, involuntary muscle twitch
What is the tx for symptoms of ALS?
- Riluzole (glutamate transmission modulator; delays progression by ~ 2 months) to block the presynaptic release of glutamate
-dextromethorphan and quinidine for the pseudo bulbar affect
- Supportive/symptomatic care
What other neurologic condition can be associated w/ALS?
Frontotemporal dementia (hence pseudo bulbar affect)
38 yo male presents to clinic for evaluation for diplopia. Presents w/nystagmus, clumsiness of left arm. States that 2 weeks ago his right leg felt week, but it resolved after a few weeks. What does he have?
Multiple Sclerosis (MS)
What is the tx for MS?
1000 mg IV Solumedrol for 3 days +/- Prednisone taper
Impaired removal of what from synapses plays a role in ALS?
(causes excitotoxic injury)
What is Myasthenia Gravis?
Autoimmune disorder with a postjunctional defect of Acetylcholine receptor
Who is at risk for MG?
Young women and old men
What are some sxs of MG?
Fluctuating weakness, fatigue in cranial, limb or trunk muscles (usually involve the eye, ptosis, diplopia, blurred vision)
What is Lambert-Eaton Myasthenic Syndrome (LEMS)?
Rare paraneoplastic or autoimmune disease resulting from antibodies directed against presynaptic junction
What are some sxs of LEMS?
Chronic fluctuating weakness of limbs, especially the legs (cranial nerve muscles spared)
What is the tx for LEMS?
- Sxs may resolve after cancer (if there is one) is treated
- Pyridostigmine may improve sx
What are some sxs of Botulism?
- Rapid onset of ocular sxs (diplopia, ptosis, blurred vision) and bulbar sx (dysarthria, dysphagia)
- Descending paralysis
What is the most common motor neuron disease in adults?
What are the UMN and LMN signs seen in ALS?
UMN: stiffness, spasticity, clumsiness, hyperactive reflexes, + Babinski
LMN: weakness, wasting, fasciculations, decreased or absent reflexes
NO loss of EOM or B/B function