Week 6- Additional Neurological Disorders Flashcards
(88 cards)
1
Q
PART 1: MYASTHENIA GRAVIS
A
PART 1: MYASTHENIA GRAVIS
2
Q
What is Myasthenia Gravis?
A
-A neuromuscular junction disorder characterized by progressive muscular weakness and fatigability on exertion.
3
Q
Myasthenia Gravis is a chronic progressive ____________ disease in which we have antibody-mediated attack on _____ receptors at NMJ.
A
- autoimmune
- ACh receptors at NMJ
4
Q
Myasthenia Gravis will worsen with _______ and improve with _______.
A
-worsen with activity, improve with rest
5
Q
What is the cause of Myasthenia Gravis?
A
Unknown
6
Q
Myasthenia Gravis Risk Factors:
- Average age of onset = ___ years
- ________ > _______
- Prior _________ disorder
A
- 59 years
- Female > Male (2:1)
- Prior autoimmune disorder
7
Q
What are the main S/Sx of Myasthenia Gravis?
A
- LMN Disorder
- WEAKNESS
- Diplopia and ptosis
- Larryngeal irritation
8
Q
- Weakness with Myasthenia Gravis worsens with _________ and improves with ______.
- Which muscles are affected the most?
- Patients have generalized weakness throughout the body.
A
- worsens with contraction, improves with rest
- muscles of face and throat (intercostals will also be affected)
9
Q
50% of patients with Myasthenia Gravis will have first symptoms be ______ in nature.
A
-ocular
10
Q
What does laryngeal irritation cause? (3)
A
- voice impairments
- dysphonia
- increased risk for choking/aspiration
11
Q
What are some exacerbating factors? (5)
A
- Fatgue
- Illness
- Stress
- Extreme Heat
- Some Medications (beta-blockers, calcium-channel blockers, some antibiotics)
12
Q
What are the subtypes of Myasthenia Gravis? (4)
A
- Ocular Myasthenia
- Mild Generalized Myasthenia
- Severe Generalized Myasthenia
- Myasthenic Crisis
13
Q
_______ Myasthenia only affects the muscles that move the eyes and eyelids. Can cause double vision, blurry vision, and ptosis.
A
-Ocular Myasthenia
14
Q
Myasthenic Crisis:
- Myasthenic Crisis = S/Sx of MG + ______________
- ___-___% of myasthenic patients are affected by a myasthenic crisis at least once in their lives.
- __-__ months is the median time to first myasthenic crisis from onset of MG.
- What are some potential complications from a myasthenic crisis?
- What does treatment include?
A
- respiratory failure (upper airway muscles and respiratory muscles)
- 15-20%
- 8-12 months
- fever, infection, DVT, cardiac complications
- IVIg, Plasmaphoresis
15
Q
Myasthenic Crisis Precipitating Factors.
A
- Physical Stressors
- Environmental Stressors
- Aspiration Pneumonia
- Infection
- Perimenstrual state
- Pregnancy
- Sleep deprivation
- Surgery
- Pain
- Temperature extremes
- Tapering of immune-modulating meds
16
Q
What are some tests performed for diagnosis of Myasthenia Gravis? (5)
A
- Edrophonium Test
- Blood Analysis
- Ice Pack Test
- Electrodiagnostic Testing (Repetitive Nerve Stimulation)
- Pulmonary Function Tests
17
Q
What is Edrophonium Test?
A
-Injection of edrophonium to look for sudden improvement in muscular strength temporarily.
18
Q
What do they look for with a Blood Analysis?
A
-Abnormal antibodies
19
Q
What is the Ice Pack Test?
A
-Cooling thought to improve neuromuscular transmission. Take ice pack and stick over eye and see if ptosis looks better (most common with ocular subtype).
20
Q
What is Electrodiagnostic Testing?
A
-Repetitive Nerve Stimulation
21
Q
What are the main ways Myasthenia Gravis is medically managed?
A
- IVIg, Plasmapheresis
- Cholinesterase Inhibitors
- Corticosteroids
- Immunosuppressants
22
Q
What is IVIg and Plasmapheresis mainly used for?
A
-Myasthenia Crisis (but may be used even if someone isn’t in crisis)
23
Q
What are the 2 ways Myasthenia Gravis is surgically managed?
A
- Videothoracoscope
- Tracheostomy
24
Q
What is surgical management mainly used for?
A
-Secondary sequelae related to MG.
25
What dietary changes are made to help manage MG? (5)
- Reduce protein (10% of diet, plant > animal proteins)
- No milk/milk products (substitute Ca+)
- Increased fruits and vegetables
- Eliminate polyunsaturated vegetable oils, margarine, vegetable shortening, all partially hydrogenated oils, trans-fatty acids
- Add ginger into diet
**DONT NEED TO KNOW**
26
What are the (4) main things looked at during examination of MG patients?
- Cranial Nerves
- Respiratory Function
- Muscle Strength
- Functional Mobility
27
- With MG, are proximal or distal muscles more involved?
- _________ is typically poor.
- Common functional difficulty with stairs, sit to stand, and lifting.
- Proximal more involved than distal
| - Endurance
28
MG Prognosis:
- Life expectancy = ________
- ___-___% of patients will require inpatient rehab after Myasthenic Crisis.
- Even with moderately severe cases, with appropriate treatment people can continue to work and live independently between exacerbations
- Life expectancy = normal
| - 25-50%
29
MG PT Goals:
- ________ strengthening
- _______ ________ techniques
- ________ exercises and strategies
- Monitor changes in patient’s condition for complications, vital signs, respiration and swallowing
- Functional strengthening
- Energy conservation techniques
- Breathing exercises and strategies
- Monitor changes in patient’s condition for complications, vital signs, respiration and swallowing
30
PART 2: HYDROCEPHALUS
PART 2: HYDROCEPHALUS
31
What is Hydrocephalus?
Abnormal buildup of CSF in the ventricles which leads to ventricular enlargement and places excessive pressure on surrounding brain tissue.
32
- In what age groups is hydrocephalus most common?
| - Hydrocephalus can be ________ or _________.
- infants and older adults
| - congenital or acquired
33
What are the (3) subtypes of hydrocephalus?
- Communicating Hydrocephalus
- Non-Communicating Hydrocephalus
- Normal Pressure Hydrocephalus
34
What is the difference between Communicating and Non-Communicating Hydrocephalus?
- Communicating = CSF flow blocked after leaving ventricles. (Able to get around block)
- Non-Communicating = CSF flow blocked along one or more of the narrow passages connecting the ventricles. (No way to get around block)
35
Does Communicating or Non-Communicating Hydrocecephalus show more S/Sx more quickly? Why?
-Non-Communicating, no way to get around block.
36
What is the most common subtype of Hydrocephalus?
-Normal Pressure Hydrocephalus
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Normal Pressure Hydrocephalus can be either idiopathic or a result of what?
-Bleeding in brain's CSF (subarachnoid or intraventricular hemorrhage), head trauma, infection, tumor, or a complication of surgery.
38
- What is the main difference between Normal Pressure Hydrocephalus and Communicating/Non-Communicating Hydrocephalus?
- Normal Pressure Hydrocephalus has a much ______ progression.
- Rate of progression
| - slower progression
39
What is the biggest diagnostic difference between Normal Pressure Hydrocephalus and Communicating/Non-Communicating Hydrocephalus?
-Normal ICP
40
What is the clinical triad of symptoms associated with Normal Pressure Hydrocephalus?
- Altered mental status
- Gait disturbance
- Urinary incontinence
41
Altered mental status is often acquainted with mild _________ and has the following S/Sx; disorientation, confusion, apathy, personality changes, decreased attention span, reduced processing speeds, motor slowing most affected.
-mild dementia
42
What is the specific gait disturbance that we will see with Normal Pressure Hydrocephalus?
-shuffling "magnetic" gait
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Urinary incontinence appears _______ than gait and cognitive impairments in Normal Pressure Hydrocephalus.
-later
44
Main ways Hydrocephalus is diagnosed? (4)
- Neurological Exam
- MRI/CT
- Lumbar Puncture
- ICP Monitoring (when applicable)
45
Main ways Hydrocephalus is managed? (2)
- Monitoring
| - Surgical Interventions (shunt placement, endoscopic third ventriculostomy)
46
What is a shunt?
-Surgically inserted tube that helps CSF drain system better by draining into chest cavity or abdomen to be reabsorbed.
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- What is endoscopic third ventriculostomy?
| - What type of hydrocephalus is this not performed on?
- Make a tiny hole in bottom of 3rd ventricle to divert CSF out to relieve pressure.
- Not performed on Normal Pressure Hydrocephalus.
48
Shunt Failure S/Sx:
- HA
- Diplopia
- _____sensitivity
- N/V
- _____/________ soreness
- Seizures
- _______/________along shunt tract
- Low-grade fever
- Excessive __________/__________
- Reoccurrence of hydrocephalus symptoms
- photosensitivity
- neck/shoulder soreness
- redness/tenderness along shunt tract
- excessive sleepiness/exhaustion
49
Hydrocephalus Prognosis:
- If left untreated, can be fatal!
- ______ dagnosis + successful treatment = great chance of recovery (life expectancy = ________)
- Do patients make full recoveries?
- Do patients have a more favorable outcome when their first S/Sx are mental deterioration or gait disturbances?
- Multiple surgeries may be needed to repair or replace a shunt throughout a person’s lifetime.
- early diagnosis + successful treatment = great chance of recovery (life expectancy = normal)
- Yes, many patients make close to or full recovery from shunt placements. (Lingering symptoms still possible and increase with age/disease progression)
- gait disturbances
50
PART 3: INFECTIONS AND SEIZURES
PART 3: INFECTIONS AND SEIZURES
51
What are 3 common CNS infections?
- Brain Abscess
- Encephalitis
- Meningitis
52
- What is a Brain Abscess?
| - Brain Abscesses are caused by bacteria or fungi and are typically preceded by ________ or severe ________.
- Pus-filled swelling in brain.
| - infection or severe TBI
53
Symptoms of Brain Abscess are _________-dependent and progresses quickly.
-location-dependent
54
What are the common S/Sx often seen with Brain Abscess?
- HA, AMS, focal weakness, seizures, visual disturbances
| - Fever & chills with coinciding neck stiffness
55
What are the 2 main ways Brain Abscesses are treated?
- Antibiotic/antifungal
| - Drainage
56
What are some common complications seen with Brain Abscess?
- recurrence
- brain damage
- seizures
- meningitis
57
When do PTs get involved with treatment of Brain Abscesses?
-When they are recurrent or caused by traumatic incident.
58
What is Encephaltis?
-Inflammation of brain tissue caused by viral infection.
59
What will an exam of Encephalitis look for?
-Exam will look for sores around lips or genitals, mosquito bites, ticks. Complete neurologic exam, blood test, CT scan or MRI, spinal tap, brain biopsy.
60
Encephalitis presents with ____-like signs and symptoms.
-flu-like signs and symptoms
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Mild Encephalitis symptoms last __-__ weeks and include things such as fever, fatigue, sore throat, vomiting, HA, confusion, irritability, unsteady gait, drowsiness, visual sensitivity.
-2-3 weeks
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Encephalitis Severe S/Sx:
- ________
- Muscle weakness
- Paralysis
- _______ loss
- Sudden impaired judgement
- Seizures
| - Memory loss
63
Despite often mild symptoms, encephalitis can be life threatening if undiagnosed. For example, untreated herpes encephalitis 50-75% of people die within ____ months.
-18 months
64
When do PTs get involved with treatment of Encephalitis?
-More severe cases.
65
What is Meningitis?
-Inflammation of meninges in brain or spinal cord.
66
- Meningitis main causes are _________ and ________ while fungal, parasitic, and amebic are less common.
- Can Meningitis also be caused by injuries, CA, and certain drugs?
- bacterial and viral
| - Yes
67
Which type of Meningitis is the most life threatening?
-Bacterial
68
What are the (3) hallmark symptoms of Meningitis?
- HA
- Fever
- Neck Stiffness
69
What are some other S/Sx of Meningitis?
- N/V
- confusion/difficulty concentrating
- seizures
- sleepiness/difficulty waking up
- light sensitivity
- lack of interest drinking/eating
- skin rash
70
What are the 2 main ways to prevent Meningitis?
- Childhood vaccinations
| - Hygeine
71
What does treatment of Meningitis include?
- Antibiotics/antifungals
| - Steroids
72
What are the 2 signs that can help with diagnosis of Meningitis? Explain them.
- Kernig's Sign = Patient supine, with hip flexed 90 degrees. Knee cannot be fully extended.
- Brudzinski's Sign (Neck Rigidity) = Passive flexion of neck causes flexion of both legs and thighs.
73
CNS Infection General Treatment Guidelines:
- Depending on the severity of disease and how long it takes to get diagnosed and managed, patients may fully recover without need for PT or will be left with neurological damage.
- ________ management
- Initiate PT once medical _____ has been established
- symptom management
| - POC
74
What are Seizures?
Sudden, uncontrolled electrical disturbance in the brain that may or may not have preceding aura.
75
With Seizures, a preceding aura is more common with _________.
-epilepsy
76
What is the primary cause of seizures?
-Epilepsy
77
What are some common secondary causes of seizures?
- 2/2 Trauma
- Infection
- Inflammation
- Meds
78
Seizures result in motor, cognitive, and autonomic manifestations and can lead to alterations in _______________.
-consciousness
79
- Seizures are often followed by a "_______ state".
- This state usually lasts __-__ minutes but can last longer with more severe seizure episodes.
- This state is characterized by what?
- "Postictal State"
- 5-30 minutes
- Characterized by drowsiness, confusion, nausea, HA, HTN.
80
What are the 2 types of seizures?
- Focal
| - Generalized
81
Focal seizures can occur with or without _______.
-LOC
82
What are the (6) subtypes of Generalized Seizures? Describe each.
- Abscence = Characterized by staring off into space or subtle body movements. (common in children)
- Tonic = Muscle stiffening.
- Atonic ("Drop seizures") = Sudden loss of muscle tone/control, causing patient to drop to the ground.
- Clonic = Repeated or rhythmic, jerking muscle movements.
- Myoclonic = Sudden, brief jerks or twitches of arms/legs.
- Tonic-clonic = Body stiffening, shaking, abrupt LOC. Often with bladder incontinence and/or biting of tongue.
83
What are the (3) ways seizures are medically managed?
- Medications
- Surgery
- Monitoring
84
- What types of medications are seizure patients prescribed? What one is the most common?
- What are the common side effects?
- Anticonvulsants (Keppra)
| - Drowsiness, ataxia, vertigo, cognitive dysfunction (mild)
85
What are some surgical procedures performed on seizure patients?
- Focal resections
- Lesionectomy
- Laser Interstitial Thermal Therapy
- Hemispherectomy
- Corpus callostomy
- Radiosurgery
- Neurostimulation Device Implantations
86
What does monitoring of seizures include?
-Continuous electroencephalogram (cEEG)
87
What to do when a patient has a seizure?!?!?!
- STAY CALM, and ASAP call for help.
- Ensure patient in safe position (supine vs side-lying).
- Ensure adequate ventilation.
- DO NOT put hand in mouth.
- Evaluate for any postictal S/Sx.
88
Seizure General Treatment Guidelines:
- General rule of thumb for generalized seizures: 🚫 PT for ___ hours after a seizure or until doctor clearance.
- Patients often ____________ between seizures.
- More severe seizure disorders may have lingering signs & symptoms (often largely cognitive), treat symptoms as they appear.
- Patient education on auras and triggering factors.
- 24 hours
| - asymptomatic
