Neuro 2 > Additional CNS Disorders > Flashcards

Additional CNS Disorders Flashcards

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1
Q

List CNS disorders to be covered

A
  1. Myasthenia Gravis
  2. Hydrocephalus
  3. Infections
  4. Seizures
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2
Q

What is Myasthenia Gravis?

A
  • a neuromuscular junction disorder characterized by progressive muscular weakness and fatiguability on exertion
  • autoimmune disease
    • antibody-mediated attack on acetylcholine receptors at neuromuscular junction
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3
Q

Etiology and risk factors for Myasthenia Gravis

A
  1. Etiology
    • cause → unknown
    • possible thymus dysfunction
  2. Risk Factors
    • average age of onset → 59
    • Female:Male (2:1)
    • Prior autoimmune disorder
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4
Q

S/S of Myasthenia Gravis

A
  1. LMN disorder
  2. Weakness
    • worsens with continous contraction, improves with rest
    • muscles of face and throat particularly
    • generalized weakness throughout body
      • extremities
      • intercostal muscles
  3. Diplopia and ptosis
  4. Laryngeal irritation
    • cause voice impairments, dysphonia
    • increased risk for choking/aspriation
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5
Q

what is the first symptom in 50% of Myasthenia Gravis pts?

A

ocular related symptoms like diplopia and ptosis

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6
Q

what is the most pronounced symptom in Myasthenia Gravis?

A

Weakness

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7
Q

how may the course of Myasthenia gravis appear?

A

course varies - may progress from mild to severe

progression typically seen within 18 months of symptom onset

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8
Q

Exacerbating factors of Myasthenia gravis

A
  1. Fatigue
  2. Illlness
  3. Stress
  4. Extreme heat
  5. Some meds
    • beta-blockers
    • calcium-channel blockers
    • some antibiotics
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9
Q

List the subtypes of Myasthenia gravis

A
  1. Ocular myasthenia
  2. Mild generalized myasthenia
  3. Severe generalized myasthenia
  4. Myasthenia crisis*
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10
Q

describe ocular myasthenia

A
  1. only affects the muscles that move the eyes and eyelids
  2. double vision
  3. blurry vision
  4. ptosis
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11
Q

what is myasthenia crisis?

A

not really a subtype

myasthenia gravis + respiratory failure

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12
Q

T/F: the vast majority of Myasthenia Gravis pts are impacted by myasthenia crisis?

A

FALSE

  • 15-20% of myasthenia pts are affected by a myasthenia crisis at least once in their lives
  • median time to first myasthenic crisis from onset of MG ranges from 8-12 months
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13
Q

Structures involved in myasthenia crisis

A
  1. upper airway muscles
  2. respiratory muscles
    • both inspiratory and expiratory muscles can be affected resulting in dyspnea
  3. combo of upper and respiratory muscles
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14
Q

Precipitating factors to myasthenia crisis

A
  1. physical stressors
  2. environmental stressors
  3. aspiration pneumonia
  4. infection
  5. perimenstrual state
  6. pregnancy
  7. sleep deprivation
  8. surgery
  9. pain
  10. temp extremes
  11. tapering of immune-modulating meds
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15
Q

potential complications and treatments for myasthenia crisis

A
  1. Complications
    • fever
    • infection
    • DVT
    • cardiac complications
  2. Treatments
    • IVIg
    • Plasmaphoresis
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16
Q

Diagnostic Testing for Myasthenia Gravis

A
  1. Edrophonium test
  2. Blood analysis
  3. Ice Pack Test
  4. Electrodiagnostic Testing
    • NCV → repetitive nerve stimulation
  5. Pulmonary Function Tests
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17
Q

Medical management of Myasthenia Gravis

A
  1. IVIg
  2. Plasmapheresis
  3. Cholinesterase inhibitors
  4. Corticosteroids
  5. Immunosuppressants
  6. Surgical management (secondary sequale)
    • videothorascope
    • Tracheostomy
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18
Q

T/F: dietary changes can be beneficial for MG pts?

A

TRUE

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19
Q

Examination for MG

A
  1. Cranial Nerves
  2. Respiratory function
  3. Muscle strength
  4. Functional mobility
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20
Q

cranial nerve findings in MG pts during examination

A
  1. examine for:
    • diplopia
    • ptosis
    • progressive dysarthria or nasal speech
    • difficulty in chewing and swallowing
    • difficulties in facial expression
    • drooping facial muscles
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21
Q

muscle strength findings during exam in MG pts

A
  1. proximal more involved than distal
  2. fatigability
  3. repeated muscle use results in rapid weakness
  4. endurance typically poor
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22
Q

what types of functional mobility deficits are expected in MG?

A

difficulty climbing stairs, rising from a chair or lifting

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23
Q

MG prognosis

A
  • 25-50% of pts require inpatient rehab after myasthenic crisis
  • even with moderately severe cases, with appropriate treatment, ppl can continue to work and live independently between exacerbations
  • life expectancy = normal
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24
Q

PT goals for MG

A
  1. functional strengthening
  2. energy conservation techniques
  3. breathing exercises and strategies
  4. monitor changes in pt’s condition for complications, VS, respiration and swallowing
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25
what is hydrocephalus?
abnormal buildup of CSF in the ventricles * leads to ventricular enlargement → places excessive pressure on surrounding brain tissue * most commonly seen in infants and older adults * can be congenital or acquired
26
what are the 3 subtypes of hydrocephalus?
1. Communicating hydrocephalus 2. Non-communicating hydrocephalus 3. Normal pressure hydrocephalus
27
what is communicating hydrocephalus?
CSF flow blocked after leaving ventricles
28
what is non-communicating hydrocephalus?
CSF flow blocked along one or more of the narrow passages connecting the ventricles
29
what is normal pressure hydrocephalus?
idiopathic or result of bleeding in the brain's CSF, head trauma, infection, tumor, or a complication of surgery characterized by normal ICP
30
NPH S/S
1. Clinical Triad of Symptoms * Altered mental status * Gait Disturbances * Urinary incontinence
31
how might altered mental status appear in NPH?
1. mild dementia 2. disorientation 3. confusion 4. apathy 5. personality changes 6. decreased attention span 7. reduced processing speeds 8. motor slowing most affected
32
what do gait disturbances look like in NPH?
shuffling "magnetic" gait
33
when does urinary incontinence appear in the disease process in NPH?
much later than gait disturbances and altered mental status
34
how is hydrocephalus diagnosed?
1. Neuro exam 2. MRI/CT 3. Lumbar Puncture 4. ICP-monitoring (when applicable)
35
describe medical management for hydrocephalus
1. monitoring 2. surgical intervention * shunt placement * endoscopic third ventriculostomy * not used in NPH * only if shunt fails
36
T/F: a shunt failure in hydrocephalus is no need for concern
FALSE it can be a medical emergency
37
S/S of shunt dysfunction
1. HA 2. diplopia 3. Photosensitivity 4. N/V 5. Neck/shoulder soreness 6. seizures 7. redness or tenderness along shunt tract 8. low-grade fever 9. excessive sleepiness or exhaustion 10. reoccurence of hydrocephalus symptoms
38
Hydrocephalus prognosis
1. if left untreated can be fatal 2. early diagnosis and successful treatment greatly increases chance of good recovery * life expectancy = normal 3. many pts make close to or full recovery from shunt placements * lingering symptoms possible * increased chance of lingering symptoms with: * increased age * time progresses with disease
39
NPH prognostic factor
when gait disturbances precede mental disturbances = more favorable outcome
40
T/F: multiple surgeries may be needed for shunts?
TRUE to repair or replace
41
list several CNS infections
1. Brain abcess 2. Encephalitis 3. Meningitis
42
what is a brain abcess and what may cause it?
1. pus-filled swelling in brain 2. Cause → bacteria or fungi * typically preceded by infection or severe TBI
43
Symptoms of a brain abscess
1. location dependent * HA * AMS * focal weakness * seizures * visual disturbances * fever and chills with coinciding neck stiffness
44
Treatment and complications of brain abscesses
1. Treatment * antibiotics/antifungals * drainage 2. Complications * recurrence * brain damage * seizures * meningitis
45
what is encephalitis?
inflammation of brain tissue caused by viral infection * exam will look for sores around lips or genitals, mosquito bites, ticks * complete neuro exam, blood tests, CT scan or MRI, spinal tap, brain biopsy
46
acute-subacute symptoms of Encephalitis
Flu-like S/S * lasts 2-3 weeks 1. fever 2. fatigue 3. sore throat 4. vomiting 5. HA 6. confusion 7. irritability 8. unsteady gait 9. drowsiness 10. visual sensitivity
47
More severe symptoms of Encephalitis
1. seizures 2. muscle weakness 3. paralysis 4. memory loss 5. sudden impaired judgement 6. poor responsiveness 7. vary from mild to life threatening
48
T/F: mild cases often result in full recovery while severe cases do not
TRUE severe can result in damage to nervous system despite mild symptoms they can still be life threatening
49
what is meningitis
inflammation of meninges in brain or spinal cord 1. caused by bacterial or viral infection (also fungal, parasitic, and amebic) 2. may also be caused by injuries, CA, and cerain drugs
50
Symptoms of Meningitis
1. Hallmark signs: * sudden awful HA, fever, neck stiffness 2. Other signs: * N/V * confusion or difficulty concentrating * seizures * sleepiness or difficulty waking up * sensitivity to light * lack of interest in drinking or eating * skin rash in some cases
51
Prevention and treatment of Meningitis
1. Prevention * childhood vaccines * hygeine 2. Treatment * antibiotics * antifungals * steroids
52
physical exam signs for Meningitis
1. Kernig's Sign 2. Brudzinski's Sign
53
General treatment guidelines for CNS infections
1. depending on severity of disease and how long it takes to get diagnosed and managed, pts may full recover w/o need for PT or will be left with neuro damage 2. symptom management 3. initiate PT once medical POC has been established
54
what is a seizure?
sudden, uncontrolled electrical disturbance in the brain * may or may not have a preceding aura (more common with epilepsy) * often followed by "postictal state"
55
Primary and secondary causes of seizures
1. Primary → epilepsy 2. Secondary * 2/2 trauma * infection * inflammation * certain meds
56
result of seizures
motor, cognitive and autonomic manifestations can lead to alterations in consciousness
57
what is a postical state?
1. transient state * lasts 5-30 minutes (but can last longer with more severe seizure episodes) 2. characterized by drowsiness, confusion, nausea, HA, HTN
58
types of seizures
1. Focal → can occur with or w/o LOC 2. Generalized → 6 subtypes
59
list the 6 subtypes of generalized seizures
1. Absence (Petit mal seizures) * children * staring off into space, subtle body movements 2. Tonic * muscle stiffening 3. Atonic (drop seizures) * sudden loss of muscle tone/control, drops to ground 4. Clonic * repeated/rhythmic, jerking movements 5. Myoclonic * sudden, brief jerks/twitches of arms and legs 6. Tonic-clonic (grand-mal seizure) * body stiffens, shaking, abrupt LOC * bladder incontinence and/or biting of tongue
60
medical management of seizures
1. Meds → anticonvulsants 2. Surgery 3. Monitoring * continous EEG
61
what should you do if you witness a seizure
1. Stay calm and as soon as you are able, call for help 2. ensure pt is in a safe position * away from anything they might injure themselves on during a dramatic seizure event * supine or sidelying 3. ensure pt has adequate ventilation 4. DO NOT put your hand in their mouth 5. Evalutate for any postictal S/S
62
general treatment guidelines for Seizures
1. no PT for 24 hours after a seizure or until MD clearance 2. pts often asymptomatic between seizures 3. more severe seizure disorder may have lingering S/S (often largely cognitive), treat symptoms as they appear 4. Pt edu * auras, postical state * triggering factors
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