Procedures 3

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Procedures 3
2013-01-16 00:27:44
Neuro Peds

Multiple sclerosis
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  1. MS def
    Chronic, demyelinating disease of the CNS
  2. Disease typically affects
    • 20-40
    • females
    • whites
  3. Exacerbation
    • relapse
    • period of acute symptoms worsening
    • increased with fatigue and hot temps
  4. Remission
    • a period free of evolving (new) symptoms
    • unpredictable and variable
    • each baseline of remisson can be worse & worse
    • *can be caused by oligodendrocytes to recover and remyelinate never fibers
  5. Sclerotic plaques
    means scar tissue
  6. Charcot's Triad
    • intention tremor
    • scanning spech
    • nystagmus
  7. Nystagmus
    rapid eye movements
  8. Scanning Speech
    • low volume with slurred speech, long pauses and disrupted melody of speech
    • occurs because of incoordination of tongue and oral muscles
  9. MS Etiology
    • Currently believed to be an auto-immune disease attacking the CNS
    • some researchers believe it could be slow exposure virus and genetic
    • different areas have higher incidences of MS
  10. Damage is to the Oligodendrocytes
    • cells that make myelin
    • this slows nerve transmission
    • eventually can lead to transmission block
    • axon damamge can also occur
  11. MS Pathophysiology
    local inflammation, edema, and infiltrates surroundingĀ acute lesionsĀ can cause disruption of nerve function
  12. Diplopia
    double vision
  13. Scotoma
    dark spot in the middle of the eye
  14. MS Clinical Features
    • Paresthesias or numbness
    • Dysesthesia
    • Trigeminal Neuralgia
    • Lhermitte's ssign
  15. Paresthesias
    pins and needles
  16. Dysesthesia
    • Burning or achin pain
    • can also be called paroxysmal limb pain
  17. Trigeminal Neuralgia
    • Also known as tic douloureux
    • attacks of stabbing pain in the face
    • results from demyelination of sensory fibers of the trigeminal nerve (cranial nerve 5)
  18. Lhermitte's Sign
    • indicates dorsal column damage
    • pts feel "electric shock" down spine into legs with cervical flexion
  19. Signs of damage to corticospinal tract of Motor cortex
    • Falling or dragging of foot, LE weakness
    • Spacitiy 80%
    • LE usually more involved than UE
    • Mild paresis can increase to total paralysis
    • brisk tendon reflexes, involuntary spasms
    • movements are slow, stiff, and weak with abnormal timing
    • disturbed agonist and antagonist relationships
  20. Dysdiadochokinesia
    • rapid alternating movements
    • self feeding, bringing spoon to mouth and back to bowl
  21. Motor Impairments Associated with Cerebellar Damage
    • Ataxia, Dysmetria, and dysdiadochokinesia
    • ataxic gait-WBOS, staggerings slow uncoordinated advancement of LE
    • poor balance
    • postural tremors
    • intention tremors with voluntary actions
  22. Involvement of brain stem can lead to
    • Dysphagia
    • Dizziness and vertigo
  23. Fatigue in MS
    • 75%-90% say it is the worst symptom
    • correlation with depression
    • usually in pm
    • heat and humidity exacerbate faituge
  24. Depression
    up to 50% of pts
  25. Euphoria with Emotional Dysregulation
    • exaggerated sense of well-being incongruent with actual status and incidents of uncontrollable laughter and crying
    • this occurs more frequently with MS than any other neurological diseases
  26. Lability
    occurs as some pts fluctuate between euphoria and uncontrollable crying