Neurology from PANCE Pearls Flashcards
(55 cards)
What is Parkinsonism
A disorder associated with tremor, bradykinesia, rigidity, and postural instability
It includes Parkinson’s Disease, Medications, Lewy Body Dementia and trauma
What is an essential tremor
Autosomal dominant inherited disorder of unknown etiology
Sx of Essential Tremor
Postural, bilateral action tremor of hands, forearms, head, neck or voice
Worsened with emotional stress and intentional movement
Tremor is shortly relieved with alcohol
No abnormal neurologic findings
Tx of Essential Tremor
None needed
Propranolol if severe
What is Parkinson’s Disease
Idiopathic dopamine depletion
Failure to inhibit acetylcholine in basal ganglia
See Lewy bodies and loss of pigment cells in substantia nigra
Sx of Parkinson’s Disease
Tremor: Resting tremor, pill rolling tremor
Bradykinesia: Slowness of voluntary movement and decrease of automatic movements, lack of swining of arms while walking/shuffling gait
Rigidity: Flexed posture
Instability: Postural instability
Face involvement: Imobibe face (fixed faces), widened palpebral fissures, seborrhea of skin, decreased blinking
Myerson’s Sign: Tapping the bridge of the nose repetitively causes a sustained blink
Tx of Parkinson’s Disease
Levodopa/Carbidopa (Levodopa is coverted to Dopamine)
Dopamine Agonists: Bromocriptine, Pramiprxole, Ropinirole (used in young patients to delay use of Levodopa/Carbidopa)
Anticholingergis: Block excitatory cholinergic effects (used in patients
What is Huntington’s Disease
Autosomal dominant neurodegenerative disease
Sx of Huntington’s
Sx usually start around 30yrs
Initially behavioral changes (personality, cognitive, intellectual, psych)
Chorea
Dementia
Dx of Huntington’s
CT shows cerebral and caudate nucleus atrophy
Tx of Huntington’s
No Cure
Control Chorea: Antidopamineric agents and Benzodiazepines
What is Guillain Barre Syndrome
Acute/Subacute inflammatory demyelination polyradiculopathy with symmetric Lower to Upper extremity WEAKNESS
ASCENDING WEAKNESS
What leads to Guillain-Barre Syndrome
Campylobacter or other antecedent respiratory or GI infeciton (CMV, EBV)
Demyleination and axonal degenation slows impulses which leads to symmetric weakness and parasthesias
Sx of Guillain Barre Syndrome
Symmetric weakness and parasthesias
Decreased DTR
Tachycardia, hypotension or HTN, breathing difficulties
Dx of Guillain Barre Syndrome
CSF: HIgh protein with normal WBC
Tx of Guillain Barre Syndrome
Plasmapheresis removes antibodies causing demyelination
IVIG suppresses harmful inflammation
What is Myasthenia Gravis
Autoimmune disorder of peripheral nerves
Common in young women
What causes Myasthenia Gravis
Autoimmune antibodies against acetylcholine post-synaptic receptor at neuromuscular junction leads to progressive weakness with repeated muscle use and recovery after periods of rest
Sx of Myasthenia Gravis
Ocular: Extraocular muscle weakness, Diplopia, Ptosis
Generalized muscle weakness, worse with repeated muscle use, relieved with rest, weakness with prolonged chewing, dysphagia
What makes this deadly is respiratory weakness leads to respiratory failure = Myasthenia Crisis
Dx of Myasthenia Gravis
Tensilon Test (Edrophonium): Rapid response to short acting IV edrophonium
Positive Ach-receptor Antibodies
Ice Pack Test
Tx of Myasthenia Gravis
Acetylcholinesterase Inhibitors: Pyridostigmine, Neostigmine
Immnosuppression with corticosteroids, Cyclosporine
Thymectomy if Thymoma present
What is Multiple Sclerosis
Autoimmune inflammatory demyelinating disease of CNS, axon degeneration of white matter of brain, optic nerves, and spinal cord
What are the different forms of Multiple Sclerosis
Relapsing-Remitting
Progressive
Secondary Progressive (relapse remitting pattern that becomes progressive)
Sx of Multiple Sclerosis (3 major categories)
Optic Neuritis
Sensory Deficits
Spinal Cord Sx
