Term
| Lower motor neuron injury |
|
Definition
Decreased reflexes
Decreased tone
Muscle atrophy |
|
|
Term
| Upper motor neuron injury |
|
Definition
Spasticity
Increased tone
Increased reflexes |
|
|
Term
|
Definition
| Ipsilateral paresis, loss of vibration and proprioception; contralateral loss of pain and temp |
|
|
Term
|
Definition
From peripheral nerve injury
motor/sensory loss LE
bowel and bladder dysfunction
saddle anesthesia |
|
|
Term
|
Definition
| only for moving patients, not letting them stay on for long periods of time (very uncomfortable and not good for injury) |
|
|
Term
| NEXUS criteria for clearing C-spine after trauma |
|
Definition
No bony tenderness
No neuro deficits
No intox (EtOH)
No altered level of consciousness
No distracting injuries |
|
|
Term
|
Definition
| Very common with calcaneal fractures |
|
|
Term
|
Definition
Horizontal fx through spinous process, lamina, pedicle and vertebral body
50% have organ involvement
Moving vehicle collisions (seatbelt) and falls
Mostly seen in kids |
|
|
Term
|
Definition
10% have associated lumbar fracture
26% have other injury
Check urine analysis (look for blood) if suspicous
Simultaneous injuries can mask pain of fracture |
|
|
Term
| Long term issues - Podiatric |
|
Definition
Increased fractures...how to teat?
Hypertrophic skin changes - higher lesion/longer injury
Hypertrophic nail changes - higher lesion/longer injury
Pressure ulcers
DVT |
|
|
Term
| Spinal cord injury without radiographic abnormality |
|
Definition
25-50% of pediatric spinal injuries
Vertebral bodies are displaced, then return into place so not visible on x-ray
weak, burning, paresthesia |
|
|
Term
|
Definition
80% of strokes
Thrombosis (clot in brain)
Embolic (clot thrown to brain)
Hypoperfusion |
|
|
Term
|
Definition
20% of strokes
lots of types |
|
|
Term
| TIA - transient ischemic attack |
|
Definition
| Stroke-like symptoms that resolve in 24 hours.....most in 3 hours |
|
|
Term
| Risk factors for a thrombolic stroke |
|
Definition
HTN
CAD
Diabetes
Vascular disease
sickle cell
smoking
age |
|
|
Term
| Risk factors for a embolic stroke |
|
Definition
A-fib (most common)
Valve replacement
MI
age |
|
|
Term
|
Definition
Seizure
Hypoglycemia
Metabolic issues (low K, Low Na)
Encephalopathy
Brain lesion
Sepsis
Medication |
|
|
Term
|
Definition
Only widely used treatment for ischemic stroke
Want to see a normal CT before administration
6% of patients get a brain bleed - not as good of a recovery as recovery from a stroke
Not many patients qualify for it |
|
|
Term
| Contraindications for tPA |
|
Definition
Bleed, tumor, huge stroke on CT with mass effect, brain swelling
More than 3 hours from onset of symptoms (have to be precise)
Resolving symptoms or minor symptoms
INR greater than 1.7 |
|
|
Term
| 4 Cardinal signs of Parkinson's Disease |
|
Definition
Resting tremor
Cogwheel Rigidity
Bradykinesia
Postural instability |
|
|
Term
| Secondary (sympomatic) causes of Parkinson's |
|
Definition
Infectious (postviral encephalitis)
Atherosclerotic
Drug-induced
Toxic agents: carbon mononxide, manganese, carbon disulfide
Miscellaneous: tumors, head trauma, Parkinson-Plus syndromes |
|
|
Term
| Genetic component of Parkinson's |
|
Definition
Nine genes and several additional loci have been identified to date
Genetic factors account for 10-15% of cases |
|
|
Term
Environmental influences on PD causation
Causative association |
|
Definition
Rural living
Well-water drinking
Manganese, cyanide
Pesticides
Wood mills
Tetrahydreaisoquinolines
Carbon monoxide
MPTP |
|
|
Term
Environmental influences on PD causation
Protective association |
|
Definition
|
|
Term
|
Definition
Each patient is assessed and treated individually
Initiate symptomatic treatment when pt begins to experience functional disability
Treat the most bothersome symptoms
Levodopa-sparing strategies should be considered to limit long term motor complications, especially in younger patients |
|
|
Term
| Pharmacological options in PD |
|
Definition
Dopaminergic agents - Dopamine agonists, Levodopa/carbidopa, MAO-B inhibitors, Anticholinergic agents
Antiviral agents - amantadine
COMT-inhibitors |
|
|
Term
| Carbidopa/Levodopa (Sinemet) |
|
Definition
Most efficacious symptomatic PD med
Virtually all PD patients respond
Symptomatic improvement with preserved capacity to maintain activities of daily living and employment
May decrease mortality |
|
|
Term
| Disadvantages of Levodopa |
|
Definition
Majority of patients develop motor complications
Neuropsychiatric problems: confusion, psychosis
Does not treat all features of PD such as freezing, postural instability, autonomic dysfunction, speech abnormalities, dementia
Does not stop disease progression |
|
|
Term
| First generation Dopamine agonist |
|
Definition
|
|
Term
| Second generation Dopamine agonists |
|
Definition
Ropinirole
Pramipexole
Rotigotine |
|
|
Term
| Advantages of Dopamine agonist treatment in PD |
|
Definition
Directly stimulates dopamine receptors
Effective as monotherapy in early PD
Dietary amino acids do not interfere with dopamine absorption and transport across the BBB
Longer duration of action than standard levopdopa
No metabolic conversion; bypass degenerating nigrostriatal neurons
Reduce incidence of levodopa related motor complications
possible neuroprotection |
|
|
Term
| Disadvantages of Dopamine agonist treatment in PD |
|
Definition
Will need additional dopaminergic therapy as disease progresses
Specific side effects
Does not completely prevent development of levodopa related motor complications
does not treat all features of PD (freezing, postural instability, autonomic dysfunction, dementia)
Does not stop disease progression |
|
|
Term
| Apomorphine hydrochloride |
|
Definition
Non-ergoline dopamine agonist
Used in advanced PD patients
Indications for use - acute intermittent treatment of hypomobility, "off" episodes, unpredictable "on/off" episodes |
|
|
Term
| Apomorphine hydrochloride dosing |
|
Definition
| Subcutaneous injection only |
|
|
Term
| Apomorphine hydrochloride side effects |
|
Definition
Orthostatic hypotension
Nausea/vomiting
Sleep attacks
Dyskinesias
QT prolongation |
|
|
Term
|
Definition
|
|
Term
|
Definition
COMT-inhibitor
Liver function monitoring is required because of the potential for hepatotoxicity |
|
|
Term
| COMT-inhibitors - rationale |
|
Definition
Prolongs levodopa action by inhibiting COMT, involved in levodopa metabolism
Extends duration of levodopa effect
Indicated as adjuct to carbidopa/levodopa for patients experiencing "wearing off"
No role as monotherapy - used only in combination with levodopa |
|
|
Term
|
Definition
Selective MAO-B inhibitor
Clinically active by inhibiting dopamine metabolism in the brain
May be neuroprotective
Often used as initial treatment in patients without significant functional disability
dosage: 5 mg at breakfast and lunch |
|
|
Term
|
Definition
Potent, selective 2nd generation irreversible MAO-B inhibitor
Administered once daily
No amphetamine metabolites
pre-clinical studies demonstrate potential neuroprotective properties |
|
|
Term
|
Definition
Orally disintegrating selegiline
Primarily avoids first pass liver metabolism
Greater bioavailability of active drug
More consistent absorption
Once-daily dosing without water
No dietary or medication restrictions related to tyramine
Decreases "off" time (2.2 hours)
Increase in dyskinesia-free "on" time (1.8 hours)
Not an inhibitor of CYP450 enzymes
Contraindicate with meperidine, tramadol, methadone and propoxyphene, dextromethorphan
Should avoid use with TCAs and SSRIs |
|
|
Term
|
Definition
Antiviral agent discovered by chance to have antiparkinson activity
May be useful in early PD, especially for bradykinesia and/or tremor
Also an adjunct to levodopa, may decrease dyskinesias
Side-effects - leg edema, livedo reticularis, hallucinations, confusion
dosage - 200-300 mg/day |
|
|
Term
|
Definition
Dopaminergic depletion leads to cholinergic overactivity
Effective mainly for tremor
Common agents are trihexyphenidyl and benztropine
Limited by side effects - dry mouth, confusion, constipation, blurred vision, urinary retention |
|
|
Term
|
Definition
Ablative procedures - thalamootomy, pallidotomy
Deep brain stimulation of the Vm nucleus of the thalamus, Globus pallidus pars interna and subthalamic nucleus
Restorative procedures - fetal human nigral transplantation, fetal porcine nigral transplantation, trophic factors |
|
|
Term
| Deep brain thalamic stimulation |
|
Definition
Lead tip implanted via cannula
Lead wire biried subcutaneously under scalp and neck
Pulse generator implanted subcutaneous subclavicualr area
Pulse settings adjusted externally
Localization using CT or MRI stereotactic parameters and clinical response
generator turned on and off with a magnet |
|
|
Term
|
Definition
an involuntary, rhythmic oscillatory movement of part(s) of the body
Produced by alternating or synchronous contractions of antagonist muscles |
|
|
Term
|
Definition
| Tremor in absence of voluntary movement and with body pat fully supported |
|
|
Term
|
Definition
| Tremor while voluntarily maintaining body part against gravity |
|
|
Term
|
Definition
| Tremor during voluntary movement |
|
|
Term
|
Definition
| Kinetic tremor during specific, skilled movement |
|
|
Term
|
Definition
| Tremor of lower extremities or trunk while standing in place |
|
|
Term
|
Definition
Postural and/or kinetic tremor
Frequency of 4-12 Hz
Anatomic distribution
Hands and forearm affected
Typically bilateral
Sporadic or inherited
Alcohol responsive |
|
|
Term
| Diagnostic criteria for Essential tremor |
|
Definition
Persistent and visible tremor
Bilateral, postural or kinetic tremor of hands and forearms or isolated head tremor in absence of abnormal head posture
Long duration (> 3 yrs), family history, beneficial response to alcohol |
|
|
Term
| Functional disability of Essential tremor |
|
Definition
Impact on handwriting
Difficulty with eating or drinking
Problems with fine motor skills
Effect on intelligibility of speech
Social embarrassment |
|
|
Term
| Differential Diagnosis of Essential tremor |
|
Definition
Enhanced physiologic tremor
Drug-induced tremor
Tremor due to metabolic abnormalities
Parkinson's disease
Wilson's disease
Cerebellar/Rubral tremor
Neuropathic tremor
Dystonic tremor |
|
|
Term
| Rationale for NO treatment of ET |
|
Definition
Side effects may be more severe than symptoms or disability from tremor
No agents are known to effect the rate of disease progression
Disability may be minimal in some patients |
|
|
Term
|
Definition
Beta blockers
Primidone
Combination primidone/propranolol therapy
Calcium channel blockers - nimodipine, nicardipine
Carbonic anhydrase inhibitors - acetazolamide, methazolamide
Clonazepam, Diazepam, Alprazolam
Topiramate
Clozapine |
|
|
Term
| First line treatment of ET |
|
Definition
Propranolol
Primidone
Combination of Propranolol and Primidone |
|
|
Term
|
Definition
approximately 40-70% of patients benefit
Rarely eliminates tremor completely
Reduction in amplitude by 50-60% with no effect on frequency
most effective against hand tremor
some effect on head, voice and tongue tremor
standard and long-acting formulations available |
|
|
Term
|
Definition
66% reduction in tremor severity
Complete suppression of tremor can be achieved
Response of head and vocal tremor less constant |
|
|
Term
| Second line treatment of ET |
|
Definition
Benzodiazepines
Topiramate
Clozapine
Gabapentin |
|
|
Term
|
Definition
Medication-resistant tremor
Used for intramuscular injections
useful in treating head and vocal tremors |
|
|
Term
|
Definition
| A neurological movement disorder characterized by an irresistible urge to move the legs accompanied by uncomfortable sensations that often occur in the evening or when at rest, which may be temporarily relieved with movement |
|
|
Term
| Epidemiology of Restless Leg Syndrome |
|
Definition
Affects approximately 10% of US adults
age of onset varies widely
greater prevalence in women |
|
|
Term
|
Definition
Urge to move the legs, accompanied or caused by uncomfortable leg sensations
Temporary relief with movement, partial or total relief from discomfort by walking or stretching
Onset or worsening of symptoms at rest or inactivity
Worsening or onset of symptoms in the evening or at night |
|
|
Term
| Differential diagnosis of RLS |
|
Definition
Peripheral neuropathy
Nocturnal leg cramps
Akathisia
Vascular disease
Sleep disorders |
|
|
Term
|
Definition
Pregnancy
Renal failure
Low serum ferritin or iron deficiency
Neuropathy, including diabetic neuropathy |
|
|
Term
| Pharmacologic treatment of RLS |
|
Definition
Dopaminergic agents
Benzodiazepines
Anticonvulsants
Opioids |
|
|
Term
| Nonpharmacologic treatment of RLS |
|
Definition
Mental alerting activities
Abstinence from caffeine, nicotine and alcohol
Iron replacement |
|
|
Term
| Purpose of electrodiagnostic studies |
|
Definition
| To determine if there is a problem in the peripheral nervous system and if so, where the problem is occuring |
|
|
Term
| Components of electrodiagnostic studies |
|
Definition
NCS (Nerve conduction studies)
EMG (Electromyography) |
|
|
Term
|
Definition
Represent a physiologic piece of the diagnostic puzzle
Real time information about what is happening physiologically with respect to the nerve and muscle |
|
|
Term
|
Definition
Establish the correct diagnosis
Localize the lesion
Determine treatment if diagnosis is already known
Provide information about prognosis |
|
|
Term
|
Definition
| EMG or NCS should not be performed prior to 21 days after the injury or onset of symptoms |
|
|
Term
|
Definition
Failure of nerve conduction across the affected nerve segment combined with normal nerve conduction above and below the segment
No Wallerian degeneration involved
Carries a good prognosis |
|
|
Term
|
Definition
| Disruption of axon continuity with Wallerian degeneration, but perineurium and/or endoneurium are still intact |
|
|
Term
|
Definition
| Severance of nerve; carries poor prognosis and surgical repair is needed for functional recovery |
|
|
Term
|
Definition
| Degenerative changes which ocur in the distal axonal segments and their myelin sheath secondary to proximal axonal injury or death of the cell body |
|
|
Term
|
Definition
Severe bleeding disorder
Automated implanted cardiac defibrillator
active skin/soft tissue infection (cellulitis) |
|
|
Term
|
Definition
| Interval between the onset of a stimulus and the onset of a response |
|
|
Term
|
Definition
The maximum voltage difference between two points
It is proportional to the number and size of nerve fibers that are depolarized
Provides an estimate of the amount of nerve tissue that is electronically active |
|
|
Term
| NCS - conduction velocity |
|
Definition
The speed at which the nerve fibers are carrying the electrical stimulus between two sites
Comparison of conduction between two segments of the same nerve can localize a lesion |
|
|
Term
| NCS - factors affecting conduction velocity |
|
Definition
Infant CV is 1/2 that of an adult
Adult CV reached by 5 years of age
At 60 CV drops by 10%
Decreased limb temperature affects latency (prolonged), amplitude (increased) and CV (decreased) |
|
|
Term
| NCS - late responses (F wave and H reflex) |
|
Definition
| Most useful for detecting proximal nerve pathologies, especially early in disease |
|
|
Term
|
Definition
Due to a monosynaptic spinal reflex
Primary value is in distinguishing S1 from L5 radiculopathies (H reflex will be abnormal in S1 radiculopathy) |
|
|
Term
| Lumbosacral radiculopathies |
|
Definition
Most likely due to disc herniation
Majority involve the L5 or S1 nerve roots |
|
|
Term
| Most common cause of Dementia |
|
Definition
| Alzheimer's disease (70-80% of cases) |
|
|
Term
| Diffuse Lewy Body Disease |
|
Definition
| Only form of dementia that presents with waxing and waning of cognition |
|
|
Term
|
Definition
Behavioral/personality changes
Aphasia (language difficulties) |
|
|
Term
| Tx of Alzheimer's disease |
|
Definition
AChase inhibitors
Memantine - stabilizes neurotransmitter glutamate activity
Non-pharmacologic interventions |
|
|
Term
| Major risk factor for dementia in later years |
|
Definition
|
|
Term
|
Definition
Always serious
Always needs attention
Sudden change in mental status over hours or days - patient described as "not quite themselves"
Hallmark is fluctuation (waxing and waning) |
|
|
Term
| Major risk factor for delerium |
|
Definition
|
|
Term
| Most common causes of dementia in the hospital |
|
Definition
| Ischemia and infection + CNS stressors |
|
|
Term
|
Definition
Benzodiazapenes
Anti-psychotics
Cholinergic enhancers |
|
|
Term
| Motor activity in normal gait |
|
Definition
| Dependent upon intact reflex arc - not dependent upon higher levels of motor function in brain and spinal cord, but these higher levels may affect reflex |
|
|
Term
|
Definition
hemiparetic/hemiplegic or stroke gait
Unilateral UMNL
CVA, brain injury, brain abscess |
|
|
Term
|
Definition
Cerebral hemisphere - hemiplegia
Brain stem - quadriplegia
Spinal cord (cervical) - quadriplegia
Spinal cord (below cervical) - paraplegia |
|
|
Term
|
Definition
| dorsiflexor/evertor insufficiency or strong activity of their antagonists |
|
|
Term
|
Definition
| Spasticity of tibialis anterior |
|
|
Term
|
Definition
| worsened pre-CVA flatfoot caused by spastic achilles |
|
|
Term
|
Definition
| spasticity of long flexors |
|
|
Term
|
Definition
Paraperetic/spastic diplegic or CP gait
Bilateral UMNL
CP, CVA, MS, spinal cord disease |
|
|
Term
|
Definition
"drunk" gait
Cerebellar lesion
Broad-based, speed and length of stride varies irregularly from step to step
Posture is erect, feet are separated
Difficulty walking tandem
Negative Romberg |
|
|
Term
|
Definition
Resembles drunk gait
problem with proprioceptors or peripheral nerves
CAN maintain balance with eyes open, but lose balance with eyes closed (positive Romberg test)
Commonly seen in diabetics with loss of position sense who need to look at the floor to tell them where their foot is located in space |
|
|
Term
|
Definition
Pathology located in inner ear
Falling to one side whether standing or walking
Asymmetric nystagmus
Normal proprioception and muscle strength exclude sensory ataxia and hemiparesis |
|
|
Term
|
Definition
"dropfoot" or neuropathic gait
If unilateral - L5 radiculopathy, sciatic neuropathy, peroneal neuropathy
If bilateral - distal polyneuropathy (diabetes), lumbosacral polyradiculopathy |
|
|
Term
|
Definition
Trendelenberg, "gluteus medius limp", "duck walk" or myopathic gait
proximal lower limb weakness due to myopathy, NMJ disease or proximal symmetric spinal muscle atrophy |
|
|
Term
|
Definition
Form of extrapyramidal disease
Lesion of substantia nigra causing decreased dopamine levels
Hypokinetic gait |
|
|
Term
|
Definition
Propulsive gait or frontal gait disorder
"slipping clutch" gait
results from bilateral frontal lobe disease
Impaired ability to plan and execute sequential movements |
|
|
Term
|
Definition
Extrapyramidal process - "worm-like" gait
Wildly ataxic/hyperkinetic gait - inerrupted by abrupt large amplitude involuntary movements
Balance NOT affected |
|
|
Term
|
Definition
| Patient favors painful extremity which results in limited knee flexion and less prominent heel strike and toe off |
|
|
Term
|
Definition
Hysterical gait
Normal coordination of movement in bed or while sitting but can't walk without assistance |
|
|
Term
|
Definition
Pronounced toe-walking gait
Usually secondary to congenitally tight gastroc-soleus or sudden growth spurt
Always consider neurological disorder like CP, myelomeningocele or spastic hemiplegia |
|
|
Term
|
Definition
"Stress"
90% in US, more common in women
Usually has a trigger
Usually constant, bilateral, not associated with nausea or photphobia |
|
|
Term
|
Definition
Avoid triggers
Ibuprofen (or other OTC NSAIDS)
Tylenol
Caffeine as adjunct
Biofeedback/relaxing |
|
|
Term
|
Definition
| Triptans (serotonin receptor agonist) - Expensive, 80% effective, increased risk of CV event, don't use in uncontrolled HTN or CV disease |
|
|
Term
|
Definition
Beta blockers
Birth control pills
antidepressants
Antiseizure meds (neurontin) |
|
|
Term
|
Definition
Clusters of headaches that can last from 3 minutes to hours
Pain so intense person can consider suicide
much more common in males
eye/nose on one side often affected |
|
|
Term
|
Definition
> 50 years old
new onset
ESR (sed rate) > 50
Pain at site or decreased pulse
Bx of temporal artery
Tx is Prednisone prior to Bx (to prevent permanent visual loss) |
|
|
Term
|
Definition
Raccoon eyes
Battle signs
CSF/blood in ear canal
Skull depression
Penetrating object
Confusion/memory loss
Neuro changes
Vital signs
Mechanism
Persistent vomiting |
|
|
Term
|
Definition
Dead person has a score of 3
Normal is 15
8 = intubate |
|
|
Term
|
Definition
Anything that makes you suspect brain injury
Any abnormal neuro exam
Anticoagulants and any hit to the head
too much EtOH on board to eval |
|
|
Term
|
Definition
shear injury, bleed, stroke, tumor
Won't show a concussion |
|
|
Term
|
Definition
Low pressure venous bleeding of bridging veins - pulls arachnoid away from dura
Blood can cause increase ICP, direct pressure or ischemia
May cross suture lines
Crescent shapes
Usually not associated with skull Fx |
|
|
Term
| Subdural hematoma - risk factors |
|
Definition
Trauma, especially with LOC
Antioagulants (fall + anticoags = CT)
Hemophiliacs
EtOH abuse |
|
|
Term
|
Definition
Bleeding between skull and dural layer - most have skull fractures
20% have "lucid interval"
Lesion more localized, elliptical shaped |
|
|
Term
|
Definition
| associated with Epidural Hematoma |
|
|
Term
| Subarachnoid hemmorhage S/Sx |
|
Definition
Worst headache of their life
Sudden "thunderclap" - but most have a prodromal headache about 2 weeks prior
Nausea/vomiting/photofobia
LOC
Neuro changes in 25%
Seizure |
|
|
Term
| Tumors that metastasize to the brain |
|
Definition
Melanoma
Lung
Breast Colon
Kidney |
|
|
Term
|
Definition
| Cancerous tumors are invasive and aggressive while benign tumors lack those qualities, they can also be life threatening due to limited space in the brain. both can lead to bleed stroke or seizures |
|
|
Term
|
Definition
Originates in the astrocytes (brain glue)
Number one type of brain cancer in kids
Can become undifferentiated in the adult and is called Glioblastoma Multiform (most common type in adults) |
|
|
Term
|
Definition
3rd most common type in adults
Most common resulting problem is hormone distruption
Tx is surgery |
|
|
