Flashcards in Neuro Lecture 2 Deck (97):
What cells support the CNS?
What cells support the PNS?
Ganglionic satellite cells
Damage to the peripheral neurons and their supporting structures
What are the four main patterns of peripheral neuropathies?
Affects isolated nerves but they are in single places.
Most common causes of a mononeuropathy (4)
Why are peripheral nerves often affected?
tiny artieries supplying area
far away from cell body
Most common causes of mononeuritis multiplex?
What is a symmetric or contiguous multifocal neuropathy, usually starting distally?
Most common causes of polyneuropathy?
other metabolic/ toxic disturbances
A type of polyneuropathy, affecting the autonomic nervous system.
What are some manifestations of autonomic neuropathy?
bladder incontinence, urine retention
disturbances of heart rate
How does diabetes mellitus cause peripheral neuropathy?
DM affects the blood supply and has toxic effects
List 3 other conditions besides diabetes mellitus for peripheral neuropathy.
Systemic lupus erythematosis
Too much ____ can cause peripheral neuropathy.
__________ cause permanent peripheral neuropathies.
What are some other not as common diseases that cause neuropathy.
What are some treatments for peripheral neuropathy?
Gabapentin/ Pregabalin/ Valproate
Opiates (will turn off sensation, not 1st choice)
Carpal tunnel syndrome is a ________ mononeuropathy.
CTS results in Intermittent numbness & paræsthesias of the _______________
1st, 2nd, 3rd and radial half of the 4th digit of an upper extremity.
What can chronic CTS lead to?
Permanent nerve damage and denervation and atrophy of the thenar muscles
Can light repetitive tasks cause CTS?
What is first line treatment of CTS?
Put an arm in a splint at night so they are extended
What is the hand elevation test?
Raise hands above head for at least 30 seconds
What meds can be used for CTS?
steroids (oral, phonopharesis, injected)
What is done surgically for curing CTS?
Surgical release of the transverse carpal ligament
What will you be at risk for after having a transverse carpal ligament?
Who is more likely to have CTS?
>30 years old
What nerve does cubital tunnel syndrome affect?
Will fell in 5th finger and ulnar part of 4th
What is believed to cause Bells palsy?
Where will you lose taste with Bells Palsy?
anterior 2/3 of the tongue
For Bells Palsy if the insidious onset (>2 weeks) or forehead sparing what do you need to get?
How do you treat Bell Palsy?
Mild- don't do anything
Prednisone effective when started early
Acyclovir may be effect if caused by herpes virus
What do you need to protect with Bell palsy?
Lubricating eye drops and ointments
How long does it take to improve with bell palsy?
Usually improve within 2 weeks
Full recovery usually within 3-6 months
Who are more likely to have Bell Palsy?
Peripheral neuropathy that ascends, rapid onset, autoimmune disorder.
What will a demylinating disease look like on CSF?
Ton of protein in CSF but not many cells.
Guillian-Barre is immune response to foreign antigens, creating antibodies to
What will be absent with Guillian Barre?
What will NCS show with Guillain-Barre
Prolonged distal latencies
Will the CBC show increased WBCs in Guillain Barre?
How do you treat Guillain Barre?
Plasmapharesis and/or IV immunoglobulins
When does recovery usually start with Guillain-Barre?
After the 4th week.
80% of peoplw ill recover from Guillain-Barre within how long?
Autoimmune neuromuscular disease causing intermittent/fluctuating weakness and fatiguability.
What muscles are most commonly affected with myasthenia gravis?
When does a myasthenic crisis occur?
Respiratory muscles are affected
What will a person with MG look like on physical exam?
Fatigability with upward gaze/ blinking
Slowed speech with counting
MG is usually caused by autoimmune antibodies against the ____________, but can also be caused by antibodies againt _________/
nicotinic acetylcholine receptors,
muscle-specific kinase (MuSK)
10% of patient with MG will have a _____
thymoma; will be cured with removal of the thymus
How do you treat MG?
AchE inhibitor (neostigmine, pyridostigmine)
and an immunosuppressant drugs
What can be used in severe cases MG?
Plasmaphoresis and IVIG
What is the prognosis for MG?
Usually a lifelong problem
No progressive though
some patients see improvement in 3-5 years
WHat are 5 lifestyle things that can cause secondary headaches?
Lack of Exercise
What is the most common primary headache?
When do tension-type headache peak?
What usually precipitates tension-type headaches?
Stress or hunger
Where do tension-type headaches occur?
Occipital, frontal, or both
Are muscle relaxants helpful with tension type headaches?
What do you use to treat tensin-type headaches?
OTC pain medications
Triptans can be helpful
Can you use opiates to treat tension-type headaches?
What antidepressants can be helpful in tension-type headahces?
Tricyclic/ tetracyclic antidepressants
as well as SNRIs and anticonvulsants
What are repeated episodes of excruciatingly severe unilateral headache lasting 15 minutes to 3 hours?
What is pain accompanied with in cluster headaches?
Ipsiltareal ptosis, miois, conjunctival injection, lacrimation and rhinorrhea
Sometimes facial flushing, edema, or diaphoresis
What may trigger a cluster headahce?
ETOH use and nitrates
During a cluster headache attack what is seen on a PET scan?
Increase metabolic activity in the hypothalamus
How do you treat cluster headache?
High flow oxygen mask
Who are more affected by cluster headaches?
blue or hazel eyes
rugged "lionized" facial features
heavy smokers/ drinkers
Unilateral, thrombbing pressure lasting 1 hour to 3 days.
Before puberty, migraines are more common in ____
What are the autonomic synmptoms of a migraine?
pallor, sunken eyes
LIst the 4 stages of migraine
Postdrome (hours to days after)
What happens horu to days before a migraine. Indicated by a change in mood, crvaing for certain foods, pain, etc.
What is a classic migraine?
Migraine with aura
Is migrain aura typically black and white or colorful?
Black and white (seizure is coloful)
What occur during an aura?
Numbness, tingling, pins and needles
Does a migraine necessarily include a headache?
Stage where patients feel aching where headache was. May feel tired europhoric.
What is likely the direct cause of pain with migraine?
Vasodilation (sense pain in stretch of blood vessels)
Migraine where you can't move your eye
migraine where you can't move 1/2 your body
migraine where people have a change in mental status state
What is a childhood periodic syndrome with abdominal pain with or without headhace?
Bouts of severe nausea and vomiting that last for hours to days, alternating with symptom-free intervals. Each episode look identical from day to day.
Cyclic vomitting syndrome
What are some migraine triggers?
MSG, nitrites, aspartame
Aged cheeses (tyramine)
ETOH (red wine), caffeine
What is the first set of medication preventitive therapies for migraines?
Calcium channel blockers
What other therapies are there for migraines?
some anticonvulsants (VPA/ TPM)
rTMS (repetitive transcranial magnetic stimulation)
What are some therapies that are vitamins that can prevent migraines?
Magnesium supplements (if levels were low)
What is a "natural" therapy that can reduce the frequency of migraines?
progesterone-based contraception can be helpful
What meds can used to help headaches but can also cause medication overuse therapies.
APAP and NSAIDs
2 meds that can help migraine but cause vasospams so shouldn't be used in those with aura (or those with high stroke or CV risk)
Triptan and ergots
Are opiates used for migraine?
What double the rsk of ischemic stroke, even more in patients with stroke?
Migraine with aura
A deficiency in what vitamins can cause peripheral neuropathy?
B1, B12, A, E
What drugs can cause peripheral neuropathy?
Fluoroquinolones, phenytoin, vincristine, metronidazole, statins, isoniazid, nitrofurantoin, chemotherapy