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Flashcards in Neuro Lecture 2 Deck (97):
1

What cells support the CNS?

Oligodendrocytes
astrocytes

2

What cells support the PNS?

Schwann cells
Ganglionic satellite cells

3

Damage to the peripheral neurons and their supporting structures

Peripheral neuropathies

4

What are the four main patterns of peripheral neuropathies?

Mononeuropathy
Mononeuritis multiplex
Polyneuropathy
autonomic neuropathy

5

Affects isolated nerves but they are in single places.

Mononeuritis multiplex

6

Most common causes of a mononeuropathy (4)

compression
ischemia
infection
inflammation

7

Why are peripheral nerves often affected?

tiny artieries supplying area
far away from cell body

8

Most common causes of mononeuritis multiplex?

Diabetes
vasculitis
immune-medicated dseases
Infection

9

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

Polyneuropathy

10

Most common causes of polyneuropathy?

DM
other metabolic/ toxic disturbances
demyelination
infection

11

A type of polyneuropathy, affecting the autonomic nervous system.

Autnonomic neuropathy

12

What are some manifestations of autonomic neuropathy?

bladder incontinence, urine retention
GI symptoms
disturbances of heart rate

13

How does diabetes mellitus cause peripheral neuropathy?

DM affects the blood supply and has toxic effects

14

List 3 other conditions besides diabetes mellitus for peripheral neuropathy.

Hypothyroidism
Tobacco use
Systemic lupus erythematosis

15

Too much ____ can cause peripheral neuropathy.

Vitamin B6

16

__________ cause permanent peripheral neuropathies.

Fluoroquinolones

17

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

Shingles
HIV
Lyme disease
Leprosy
Lightning strikes

18

What are some treatments for peripheral neuropathy?

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

19

Carpal tunnel syndrome is a ________ mononeuropathy.

Entrapment

20

CTS results in Intermittent numbness & paræsthesias of the _______________

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

21

What can chronic CTS lead to?

Permanent nerve damage and denervation and atrophy of the thenar muscles

22

Can light repetitive tasks cause CTS?

No

23

What is first line treatment of CTS?

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

24

What is the hand elevation test?

Raise hands above head for at least 30 seconds

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