Terms in this set (102)

Seizure—a transient disturbance of cerebral function due to an abnormal neuronal discharge in the brain
Prodrome—mood or behavioral changes, myoclonic jerking, HA, lethargy, palpitations, epigastric sensations that may precede an attack
Aura—movement or odd sensation immediately before the before the attack, signals the beginning of the seizure
Ictus—the attack or seizure
Postictal period—period immediately following the attack
Todd's paralysis—transient hemiparesis occurring during the postictal period that may last minutes to hours
Etiology—congenital abnormalities, perinatal injuries, metabolic disorders, trauma, tumors and other space-occupying lesions, vascular disease, degenerative disease, infectious disease
Triggers—flashing lights, loud noises, fever, physical exhaustion, malnutrition, menses, injury, drugs, stress
Path—alteration in membrane potential that makes certain neurons abnormally hyperactive/hypersensitive to changes in their environment
DX—define the type of seizure, determine triggers, look for residual brain disease or dysfunction, perform general physical and neuro exam, UA, Blood work, TDM, EEG, CT scan of head, MRI of brain
TX during a seizure—maintain airway, protect from injury, record the attack
Medication TX—anticonvulsants, can discontinue gradually if seizure-free for 2 years
Surgical TX—anterior callosotomy (palliative), lobectomy/lesionectomy (curative), vagal nerve stimulation (partial-onset)
Solitary seizure—EEG within 24 hours, prophylactic drug TX not necessary
Alcohol withdrawal—generalized tonic-clonic within 48 hours, hospitalize for observation, treat with benzodiazepines
Progressive/fatal brain disease
Most common form of dementia
Women > 80 years of age
Unknown etiology, may have familial link (chromosome 14, 19, 21)
Hippocampus, temporal cortex, nucleus basalis of Meynert
Plaques, tangles, amyloid protein, decreased Ach & NE, choline acetyltransferase deficiency
Risk factors—old age, smoking, low folate levels, family history, twins, obesity, depression, lower education level, genetics (chromosome 14, autosomal dominant inheritence)
Presentation—subtle onset of memory loss followed by slowly progressive dementia, impaired language, visuospatial deficits, aimless wandering, delusions, loss of inhibition and aggression, disturbed sleep, rigidity, mutism, incontinence
Capgras syndrome—believing that a caregiver has been replaced by an imposter
Death usually occurs in 3 to 15 years due to malnutrition, secondary infections, pulmonary emboli, heart disease
Atrophy of cerebral cortex
Frontal release signs—palmomental reflex (twitching of ipsilateral chin upon stroking of thenar eminence), glabellar reflex (blinking with tapping on glabella), snout reflex (similar to primitive sucking reflex), grasp reflex
Lab/imaging—CT (diffuse cortical atrophy), MRI (hippocampus atrophy), PET (hypoperfusion in posterior temporal-parietal cortex), normal EEG
DX—insidious onset and progressive worsening of multiple cognitive deficits including: memory impairment, aphasia, apraxia, agnosia, disturbance in executive functioning
TX—no cure, symptomatic management, cholinesterase inhibitors (increase levels of Ach; Donepezil, Galantamine, Rivastemine), antioxidants (vitamin E, selegiline), Memantine, Gingko Biloba, Surgery
Autoimmune inflammatory demyelinating disease
Females of Northern European descent between age 20-45
Path—areas of demyelination in basal ganglia, medulla, cerebellum, optic nerves, spinal cord
Acute lesions—inflammatory mononuclear cells, presence of macrophages containing lipids
Relapsing remitting—most common type of MS, clearly defined exacerbations followed by periods of partial or complete recovery and remissions
Secondary progressive—second phase of relapsing remitting followed by steady decline in neurological function
Primary progressive—rare, slow but almost continuous decline in neurological function
Progressive relapsing—rare, progressive from onset but with clear exacerbations
Risk factors—genetics, optic neuritis
Presentation—numbness, tingling impairment of vibration and joint position sense, decreased pain and light touch perception, trigeminal neuralgia, back pain, muscle cramping due to spasticity, muscle weakness, bowel/bladder incontinence, dysarthria, ataxia, tremor, fatigue, dizziness, vertigo, depression, diplopia, optic neuritis, heat sensitivity, action tremor, positive Babinski's sign, impaired coordination/balance, impaired visual acuity, nystagmus
DX—LP with CSF analysis, WBC count slightly elevated, normal glucose, protein slightly elevated or normal, electrophoresis (oligoclonal bands), IgG elevated, MRI (diagnostic tool of choice)
ESR, ANA, RF titer to help identify the presence of a vasculitic disorder that may be mimicking MS
MRI—Ovoid appearing lesions in the periventricular region, corpus callosum, deep white matter structures, basal ganglia
Evoked potential testing—detecting clinically silent lesions, documenting an organic basis for vague complaints
Complications—increased risk of infection, sexual dysfunction, pressure ulcer, spasticity, depression
Average life expectancy is 5-7 years
TX—self-catheterization/fiber (urinary/bowel incontinence), SSRIs for depression, Corticosteroids (RRMS/PRMS), IV glucocorticoid + cyclophosphamide (SPMS), IV glucocorticoid (PPMS)
Disease modifying therapies—Avonex, Copaxone, Rebif, Betaseron