In Guillian Barre Syndrome, 30% experience respiratory failure, requiring intubation….
What test should you do to follow respiratory function?
Frequent monitoring of:
Vital Capacity and Negative Inspiratory Force.
- What is the natural course of Guillian Barre Syndrome?
- How does trx effect recovery time?
- What are the two indications for TRX?
- What is the TRX?
- Worsens over 2 weeks, plateaus 2-4 weeks, spontaneous recovery over months.
- TRX decreased recovery time by 50%
- TRX if 1) non ambulatory and < 4 weeks of symptom onset.
- TRX = IVIG or Plasmapheresis (not both); NO STEROIDS.
What physical exam findings in evaluating paralysis +/- paresthesia, prompts immediate MRI of spine?
What three broad categories of diseases can cause this picture?
- Sensory Level
- Bowel/Bladder dysf.
- Compressive neuropathy (abscess, herniation, ext)
- Inflammatory myelopathy (Transverse Myelitis)
- Non-Inflammatory Myelopathy
What is the immediate management of compressive neuropathy (spinal cord impingement) ?
- Immobilization
- STEROIDS
- Surgical consult ASAP
What is the classic presentation of Transverse Myelitis?
How does presentation changed from early disease vs later disease?
What does MRI show?
CSF show?
Progressive LE muscle weakness following URI.
Accompanied by sensory loss and Bowel/bladder dsf.
EARLY = Flaccid Paralysis + Decreased DTR LATE = Spastic Paralysis + Increased DTR (UMN signs)
MRI = Gladolineum enhancement in cord
CSF shows = Increased IgG and WBC
After acute management of stroke, what 3 tests do you want to perform to work up etiology?
- EKG –> r/o MI/arrhythmia
- Carotid duplex +/- MRA/CTA
- Echocardiogram –> thromboembolic disease
What are the two mechanisms in which you can get HYPOcalcemia AFTER parathyroidectomy?
- Relative hypoparathyroidism
- -> TRANSIENT Suppression of left over parathyroid gland, due to increased Ca levels (while patient was hyperPTH, before surgery)
- -> Recovery in days. - Hungry Bone syndrome.
- -> Sudden decrease in PTH hormone (in prior hyperPTH patient) causes influx of Ca into bone.
- ->Develops 2-4 days post surgery.
What are the two physical exam maneuvers to test for hypocalcemia?
Chevostek sign –> tap jaw causing contractions
Trousseaus sign –> Carpopedal spasm when blood supply is cut off with tourniquet.
What are the 4 hallmark symptoms of HYPOca?
Perioral numbness, paresthesias
Muscle cramps
INCREASED DTR
AMS/Seizure (if severe)
What are the symptoms of HYPER Ca?
“stones, bones, groans, moans and psych overtones”
Stones --> Kidney stones Bones --> bone pain Groans --> lethargy/fatigue Moans --> Abd pain Psych overtones --> Depression, confusion
In order to meet criteria for brain death you need to have a CNS catastrophe of know etiology AND you cannot have confounding effects of what 4 things?
- HYPOthermia
- Electrolyte
- Endocrine
- Drug intoxication
What are the 5 reflexes you look for (that looks at cortical and brainstem function) for initial evaluation of BRAIN DEATH?
- Fexor/Extensor posturing (brain originating motor response)
- -ve caloric testing (occulorvestibular response)
- No gag
- No corneal or pupillary response
- No rooting or sucking reflex.
In patient who do not have cortical and brainstem functioning bc they exhibit:
- COMA
- Fexor/Extensor posturing (brain originating motor response)
- -ve caloric testing (occulorvestibular response)
- No gag
- No corneal or pupillary response
- No rooting or sucking reflex.
After meeting above criteria…What is the test that CONFIRMS brain death?
APNEA test.
- -> pre-oxygenate and disconnect ventilator
- -> Brain death confirmed if no respiratory response in 8-10 min.
What tests can you do if initial testing for cortical and brain stem activity is Equivocal?
EEG –> electrocerebral silence
MRA/CTA –> no cerebral perfusion
Pineal Gland tumor can cause Parinaud’s Syndrome…
What are the 4 defending S/S of Parinaud’s Syndrome?
Besides Parinaud’s Syndrome what is another common symptoms of Pineal Gland tumor?
- Loss of pupillary response to light
- Vertical gaze palsy
- Loss of optokinetic reflex (rapid saccades when tracking)
- Ataxia.
HA –> obstructive hydrocephalus