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Neuro Lecture 2 Flashcards

1
Q

What cells support the CNS?

A

Oligodendrocytes

astrocytes

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2
Q

What cells support the PNS?

A

Schwann cells

Ganglionic satellite cells

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3
Q

Damage to the peripheral neurons and their supporting structures

A

Peripheral neuropathies

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4
Q

What are the four main patterns of peripheral neuropathies?

A

Mononeuropathy
Mononeuritis multiplex
Polyneuropathy
autonomic neuropathy

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5
Q

Affects isolated nerves but they are in single places.

A

Mononeuritis multiplex

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6
Q

Most common causes of a mononeuropathy (4)

A

compression
ischemia
infection
inflammation

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7
Q

Why are peripheral nerves often affected?

A

tiny artieries supplying area

far away from cell body

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8
Q

Most common causes of mononeuritis multiplex?

A

Diabetes
vasculitis
immune-medicated dseases
Infection

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9
Q

What is a symmetric or contiguous multifocal neuropathy, usually starting distally?

A

Polyneuropathy

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10
Q

Most common causes of polyneuropathy?

A

DM
other metabolic/ toxic disturbances
demyelination
infection

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11
Q

A type of polyneuropathy, affecting the autonomic nervous system.

A

Autnonomic neuropathy

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12
Q

What are some manifestations of autonomic neuropathy?

A

bladder incontinence, urine retention
GI symptoms
disturbances of heart rate

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13
Q

How does diabetes mellitus cause peripheral neuropathy?

A

DM affects the blood supply and has toxic effects

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14
Q

List 3 other conditions besides diabetes mellitus for peripheral neuropathy.

A

Hypothyroidism
Tobacco use
Systemic lupus erythematosis

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15
Q

Too much ____ can cause peripheral neuropathy.

A

Vitamin B6

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16
Q

__________ cause permanent peripheral neuropathies.

A

Fluoroquinolones

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17
Q

What are some other not as common diseases that cause neuropathy.

A 
Shingles
HIV
Lyme disease
Leprosy
Lightning strikes
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18
Q

What are some treatments for peripheral neuropathy?

A 
Tricyclic antidepressatns
SNRIs 
Gabapentin/ Pregabalin/ Valproate 
Cannabinoids 
Opiates (will turn off sensation, not 1st choice) 
TENS
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19
Q

Carpal tunnel syndrome is a ________ mononeuropathy.

A

Entrapment

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20
Q

CTS results in Intermittent numbness & paræsthesias of the _______________

A

1st, 2nd, 3rd and radial half of the 4th digit of an upper extremity.

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21
Q

What can chronic CTS lead to?

A

Permanent nerve damage and denervation and atrophy of the thenar muscles

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22
Q

Can light repetitive tasks cause CTS?

A

No

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23
Q

What is first line treatment of CTS?

A

Put an arm in a splint at night so they are extended

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24
Q

What is the hand elevation test?

A

Raise hands above head for at least 30 seconds

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25
What meds can be used for CTS?
NSAIDs | steroids (oral, phonopharesis, injected)
26
What is done surgically for curing CTS?
Surgical release of the transverse carpal ligament
27
What will you be at risk for after having a transverse carpal ligament?
Trigger thumb
28
Who is more likely to have CTS?
Women | >30 years old
29
What nerve does cubital tunnel syndrome affect?
Ulnar nerve | Will fell in 5th finger and ulnar part of 4th
30
What is believed to cause Bells palsy?
Inflammation
31
Where will you lose taste with Bells Palsy?
anterior 2/3 of the tongue
32
For Bells Palsy if the insidious onset (>2 weeks) or forehead sparing what do you need to get?
A MRI
33
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
34
What do you need to protect with Bell palsy?
The eye | Lubricating eye drops and ointments
35
How long does it take to improve with bell palsy?
Usually improve within 2 weeks | Full recovery usually within 3-6 months
36
Who are more likely to have Bell Palsy?
Pregnant women | Diabetics
37
Peripheral neuropathy that ascends, rapid onset, autoimmune disorder.
Guillain-Barre syndrome
38
What will a demylinating disease look like on CSF?
Ton of protein in CSF but not many cells.
39
Guillian-Barre is immune response to foreign antigens, creating antibodies to
gangliosides
40
What will be absent with Guillian Barre?
DTRs | No fever
41
What will NCS show with Guillain-Barre
Prolonged distal latencies
42
Will the CBC show increased WBCs in Guillain Barre?
No
43
How do you treat Guillain Barre?
Plasmapharesis and/or IV immunoglobulins breathing support physical rehabilitation
44
When does recovery usually start with Guillain-Barre?
After the 4th week.
45
80% of peoplw ill recover from Guillain-Barre within how long?
A year
46
Autoimmune neuromuscular disease causing intermittent/fluctuating weakness and fatiguability.
Myasthenia gravis
47
What muscles are most commonly affected with myasthenia gravis?
Extraocular Facial Mastication Pharyngeal muscles
48
When does a myasthenic crisis occur?
Respiratory muscles are affected
49
What will a person with MG look like on physical exam?
Ptosis Opthalmoplegia/ nystagmus Fatigability with upward gaze/ blinking Slowed speech with counting
50
MG is usually caused by autoimmune antibodies against the ____________, but can also be caused by antibodies againt _________/
nicotinic acetylcholine receptors, | muscle-specific kinase (MuSK)
51
10% of patient with MG will have a _____
thymoma; will be cured with removal of the thymus
52
How do you treat MG?
``` AchE inhibitor (neostigmine, pyridostigmine) and an immunosuppressant drugs ```
53
What can be used in severe cases MG?
Plasmaphoresis and IVIG
54
What is the prognosis for MG?
Usually a lifelong problem No progressive though some patients see improvement in 3-5 years
55
WHat are 5 lifestyle things that can cause secondary headaches?
``` dehydration Poor nutrition Sleep deprivation Lack of Exercise Stress ```
56
What is the most common primary headache?
Tension-type headache
57
When do tension-type headache peak?
40s
58
What usually precipitates tension-type headaches?
Stress or hunger
59
Where do tension-type headaches occur?
Occipital, frontal, or both
60
Are muscle relaxants helpful with tension type headaches?
No
61
What do you use to treat tensin-type headaches?
OTC pain medications | Triptans can be helpful
62
Can you use opiates to treat tension-type headaches?
No
63
What antidepressants can be helpful in tension-type headahces?
Tricyclic/ tetracyclic antidepressants | as well as SNRIs and anticonvulsants
64
What are repeated episodes of excruciatingly severe unilateral headache lasting 15 minutes to 3 hours?
Cluster headache
65
What is pain accompanied with in cluster headaches?
Ipsiltareal ptosis, miois, conjunctival injection, lacrimation and rhinorrhea Sometimes facial flushing, edema, or diaphoresis
66
What may trigger a cluster headahce?
Smoking | ETOH use and nitrates
67
During a cluster headache attack what is seen on a PET scan?
Increase metabolic activity in the hypothalamus
68
How do you treat cluster headache?
``` High flow oxygen mask Triptans Melatonin Lithium Anticonvulsants ```
69
Who are more affected by cluster headaches?
men blue or hazel eyes rugged "lionized" facial features heavy smokers/ drinkers
70
Unilateral, thrombbing pressure lasting 1 hour to 3 days.
Migraine headache
71
Before puberty, migraines are more common in ____
males
72
What are the autonomic synmptoms of a migraine?
pallor, sunken eyes N/V photophobia, phonophobia lightheadedness, vertigo
73
LIst the 4 stages of migraine
Prodrome Aura Pain/headache phase Postdrome (hours to days after)
74
What happens horu to days before a migraine. Indicated by a change in mood, crvaing for certain foods, pain, etc.
Prodrome
75
What is a classic migraine?
Migraine with aura
76
Is migrain aura typically black and white or colorful?
Black and white (seizure is coloful)
77
What occur during an aura?
Scintillating scotoma Zigzagging lines Numbness, tingling, pins and needles Hemianopsia
78
Does a migraine necessarily include a headache?
No
79
Stage where patients feel aching where headache was. May feel tired europhoric.
Postdrome
80
What is likely the direct cause of pain with migraine?
Vasodilation (sense pain in stretch of blood vessels)
81
Migraine where you can't move your eye
ophthalmoplegic migraine
82
migraine where you can't move 1/2 your body
hemiplegic migraine
83
migraine where people have a change in mental status state
confusional migraine
84
What is a childhood periodic syndrome with abdominal pain with or without headhace?
Abdominal migraine
85
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
86
What are some migraine triggers?
MSG, nitrites, aspartame Aged cheeses (tyramine) fluroescent lighting ETOH (red wine), caffeine
87
What is the first set of medication preventitive therapies for migraines?
Beta-blockers Calcium channel blockers ACE inhibitors
88
What other therapies are there for migraines?
tricyclic antidepressants SNRIs some anticonvulsants (VPA/ TPM) rTMS (repetitive transcranial magnetic stimulation)
89
What are some therapies that are vitamins that can prevent migraines?
``` Riboflavin (B2) Magnesium supplements (if levels were low) ```
90
What is a "natural" therapy that can reduce the frequency of migraines?
Coenzyme Q-10 rTMS progesterone-based contraception can be helpful
91
What meds can used to help headaches but can also cause medication overuse therapies.
APAP and NSAIDs
92
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
93
Are opiates used for migraine?
No
94
What double the rsk of ischemic stroke, even more in patients with stroke?
Migraine with aura
95
A deficiency in what vitamins can cause peripheral neuropathy?
B1, B12, A, E
96
What drugs can cause peripheral neuropathy?
Fluoroquinolones, phenytoin, vincristine, metronidazole, statins, isoniazid, nitrofurantoin, chemotherapy
97
What are the 2 childhood periodic syndrome migraines?
Abdominal migraine | Cyclic vomiting syndrome

Old DOOS (21 decks)

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