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Neuro 9 Degen D/O 2
Degenerative Disorders Part 2
Question | Answer |
---|---|
A 66yo woman with forgetfulness and decreased B/L parietal lobe activity on PET scan has what form of dementia? | Alzheimer's Disease |
What 2 classes of medications are used in the tx of Alzheimer's Disease? | 1. AChE-i like donepezil and rivastigmine 2. NMDA-receptor blocker like memantadine |
How does one differentiate between vascular dementia and Alzheimer disease? | MRI brain will show evidence of multiple infarcts in case of vascular dementia. |
What are 2 sx that should clue you in to the diagnosis of MS? | 1. Unilateral optic neuritis with pain in one eye that is worse w/movement and central vision loss 2. Internuclear ophthalmoplegia |
What is the most sensitive test for MS? | MRI brain: look for assymetrical white matter lesions of different ages |
What medication decreases the frequency of relapses in pts with MS? | IFN-beta |
What important neuronal tract is the first to be compressed and compromised in the case of a syringomyelia? | Spinothalamic tract (carries pain and temp) |
What are the differing presentations of Alzheimer disease, Pick disease, and Lewy body dementia? | *Alz: regular dementia *Pick: dementia + personality changes + progressive aphasia *Lewy body: dementia + Parkinsonian sx + visual hallucinations (may also have syncope and frequent falls) |
What 2 SE should a physician be aware of when using atypical antipsychotics? | Weight gain and DM (rare, but can progress to DKA!) |
What are the s/s of a TCA overdose? How is it managed? | Anticholinergic, cardiotox, and CNS tox. Tx is sodium bicarb (esp if QRS >100ms) and benzos (seizures) |
A pt is brought to ER with HA, vomiting, neck pain, and fever. There is progressive m weakness, but sensation is intact. CSF analysis shows normal glucose and protein, but the CSF lymphocyte ct ishigh. What is the dx? | Polio |
How is dementia diagnosed in general? | With the MMSE (<24/30=dementia) |
What are the unique features of dementia cuased by Pick disease? | dementia + behavioral/personality changes + progressive aphasia |
What are the unique features of Lewy body dementia? | Dementia + Parkinsonian sx (bradykinesia, shuffling gait, cogwheel rigidity) + visual hallucinations + repeat syncopal episodes (falls) |
What are the components of a dementia workup? | MMSE, CBC (megaloblastic anemia), UA (UTI), Chem 8 (hypercalcemia), RPR, HIV, TSH (hypo), Vit B12, CT or MRI head (MRI superior) |
What anticholinergic drug can be used to treat the early tremors of Parkinson's disease? | Trihexylphenidyl |
Pt presents with rapidly progressive dementia, myoclonus, and shart triphasic synchronous discharges on EEG. What is the diagnosis and the prognosis? | Creutzfeld-Jacob dz, spongiform encephalopathy caused by prions. Die in 1yr or less from dx. |
What is the most specific symptom for dementia? | Impairment in functioning. |
What CT findings might you see in an Alzheimer pt? Are these findings specific for the disease? | Cortical atrophy that is more prominent in temporal and parietal lobes. Not a specific finding. AD is a dx of exclusion. |
What is the 2nd MCC of dementia? | Vascular (differentiate from AD with MRI looking for multiple infarcts) |
What is the tx for AD? | Cholinesterase inhibitors: donepezil, rivastigmine, galantamine. NMDA receptor blocker: memantine |
Pt presents with pain in her R eye that is exacerbated by movement. She also complains of weakness in her lower extremities and problems with "dizziness." On PE, when she tries to her L, her R eye barely moves and her L eye has L-beating nystagmus. Dx? | MS. Her PE finding is internuclear opthalmoplegia caused by lesion of the R medial longitudinal fasciculous |
What are the CSF findings in MS? | Increased protein, mildly elev Wt ct, oligoclonal banding, and increased IgG |
What are the MRI findings in MS? | Multiple asymmetric white matter lesions |
What is the tx for MS? | Corticosteriods: methylprednisone |
What drugs can be used to reduce the frequency and length of MS exacerbations? | IFN-beta and glatiramer acetate |