Module 15: Neurological Disorders

Module Authors

Nancy Nielsen-Brown PA-C
Assistant Professor, Department of Physician Assistant Education
Western University of Health Sciences, Pomona, CA
Physician Assistant, Department of Neurology
Rancho Los Amigos Medical Center, Downey, CA

Tina M. Meyer, PA-C
Clinical Consultant and Adjunct Professor
Western University of Health Sciences, Pomona, CA

Review Concepts

By the end of this Review Concept you should be able to:

• List the structures of the head that are sensitive and insensitive to pain
• Differentiate the etiology and clinical presentation of inorganic and organic headaches
• Describe diagnostic protocols for headaches, including patient history, physical and neurologic examination, and relevant laboratory studies
• Classify the different types of headaches
• Describe the epidemiology, clinical manifestations, diagnostic workup, and clinical management of the following types of headaches:
  • Muscle tension
  • Migraine
  • Cluster
  • Hypertensive
• Classify the different types of migraine headaches
• Describe the epidemiology, clinical manifestations, diagnostic workup, and clinical management of headaches associated with the following conditions:
  • Temporal arteritis
  • Subarachnoid hemorrhage Meningitis.
  • Intracranial mass lesions
  • Low CSF pressure
  • Trigeminal neuralgia

By the end of this Review Concept you should be able to:

• State the overall incidence of cerebrovascular disease, and the incidence of various types of stroke.
• List possible etiologies for hemorrhagic stroke and ischemic stroke.
• List medical conditions and lifestyle factors that increase the risk of stroke.
• Describe the signs and symptoms of stroke.
• Describe diagnostic and treatment protocols for patients diagnosed with stroke.

By the end of this Review Concept you should be able to:

• Describe the signs, symptoms, and diagnostic workup of transient ischemic attacks.
• Identify therapies for transient ischemic attack and determine when to use each therapy.
• Compare and contrast therapeutic regimens recommended for patients with acute ischemic stroke and embolic stroke.
• Describe the signs, symptoms, and diagnostic workup of intercerebral hemorrhage.
• Describe the signs, symptoms and diagnostic workup of subarachnoid hemorrhage.
• Describe therapeutic recommendations for the prevention of cerebral vasospasm and seizures secondary to subarachnoid hemorrhage.
• Differentiate between factors that lead to a good prognosis versus factors that lead to a poor prognosis.

By the end of this Review Concept you should be able to:

• List the types of central nervous system infections.
• Describe the incidence and pathogens associated with central nervous system infections.
• Describe the diagnostic procedures for working up central nervous system infections.
• Describe the etiology and pathogenesis of brain abscesses.
• List the signs and symptoms of brain abscesses.
• Outline diagnostic procedures, treatment, and possible complications associated with brain abscesses.
• Describe the incidence and pathogenesis of herpes simplex encephalitis.
• List the signs and symptoms of herpes simplex encephalitis.
• Outline the diagnostic procedures and clinical management of herpes simplex encephalitis.
• Describe the incidence, signs and symptoms, diagnostic work-up, and treatment of toxoplasmosis.
• Describe the epidemiology, signs and symptoms, diagnostic work-up, and treatment of cysticercosis.

By the end of this Review Concept you should be able to:

• State the definition of meningitis.
• Classify the different types of meningitis.
• Describe the epidemiology and clinical manifestations of bacterial meningitis.
• Outline procedures for the diagnostic workup and clinical management of bacterial meningitis.
• List possible complications of bacterial meningitis.
• Describe the epidemiology and clinical manifestations of aseptic meningitis.
• Outline procedures for the diagnostic workup and clinical management of aseptic meningitis.
• Describe the epidemiology and clinical manifestations of tuberculous meningitis.
• Differentiate among initial, progressive, and advanced symptoms of tuberculous meningitis.
• Describe procedures for the diagnostic workup and clinical management of tuberculous meningitis.
• Describe the epidemiology, causative agents, and clinical manifestations of fungal meningitis.
• Differentiate among early, progressive, and late signs of fungal meningitis.
• Describe the diagnostic protocols, treatment, and possible complications of fungal meningitis.

By the end of this Review Concept you should be able to:

• Describe the epidemiology of tremors.
• Differentiate between types of tremors based on clinical presentation.
• List drugs used to treat tremors.
• Describe the prognosis for tremors.
• Describe the incidence and provoking factors of dystonias.
• Differentiate types of dystonias based on their clinical presentation.
• Outline management priorities and interventions for dystonias.
• Differentiate between chorea and athetosis.
• List drugs used to treat chorea and athetosis.
• Describe epidemiology of tics.
• Differentiate various types of tics based on their clinical presentation.
• Outline management priorities and interventions for tics.
• Describe the epidemiology and treatment of myoclonus.
• Describe the pathogenesis and etiology of dyskinesias and akathesias.
• Outline management priorities and interventions for dyskinesias and akathesias.

By the end of this Review Concept you should be able to:

• Describe the epidemiology of cerebral palsy.
• Differentiate spastic, extrapyramidal, and atonic cerebral palsy in terms of clinical presentation.
• Describe the epidemiology of Wilson's disease.
• Differentiate between acute classic and chronic pseudosclerotic Wilson's disease.
• Outline diagnostic and treatment protocols for Wilson's disease.
• Describe the epidemiology, clinical presentation, and clinical management of Huntington's disease.
• Differentiate between Parkinson's disease and Parkinsonian symptoms.
• Describe the etiology and pathophysiology of Parkinson's disease.
• List primary and secondary manifestations of Parkinson's disease.
• List disorders that are commonly misdiagnosed as Parkinson's disease.
• Outline treatment protocols for Parkinson's disease.
• List pharmacotherapeutic agents that can prevent secondary medical problems in patients with Parkinson's disease.
• Describe potential psychosocial problems in patients with Parkinson's disease and resources for addressing such problems.

By the end of this Review Concept you should be able to:

• Describe the epidemiology of seizure disorders in the general population.
• Differentiate among the following kinds of seizures based on clinical presentation:
  • partial seizures
  • generalized seizures
  • status epilepticus
  • acute repetitive seizures
• Describe the clinical presentation of the following seizure disorders:
  • Grand mal
  • Petit mal
  • Simple partial
  • Complex partial
  • Febrile convulsions
• Describe medical conditions that can induce seizure disorders.
• Describe procedures for evaluating and diagnosing patients with seizure disorders.
• Describe in general terms the advantages, limitations, side effects, and administration of drugs used to treat seizure disorders.
• List agents recommended as initial and adjunct therapy for specific types of seizure disorders.
• Describe surgical options for the clinical management of seizure disorders.

By the end of this Review Concept you should be able to:

• nerve fibers.
• Describe the epidemiology of multiple sclerosis (MS) .
• Classify and describe the different forms of MS.
• Describe visual disturbances related to MS.
• List primary, secondary, and tertiary symptoms of MS.
• List clinical indicators that are diagnostic for MS.
• Outline procedures and protocols in the diagnostic workup and clinical management of MS.
• Describe interventions for the treatment of secondary complications of MS.
• Describe the epidemiology of Guillain-Barre syndrome.
• Describe the clinical presentation of Guillain-Barre syndrome.
• List diagnostic indicators of Guillain-Barre syndrome.
• Outline procedures and protocols in the diagnostic work-up and clinical management of Guillain-Barre syndrome.

By the end of this Review Concept you should be able to:

• State the definition, incidence, and prognosis of myasthenia gravis.
• Describe the etiology and pathophysiology of myasthenia gravis.
• List common signs or symptoms of myasthenia gravis.
• Describe the epidemiology and clinical presentation of neonatal and penicillamine-induced myasthenia gravis.
• Outline diagnostic and treatment protocols for myasthenia gravis.
• State the definition and incidence of Lambert-Eaton myasthenic syndrome.
• List the signs and symptoms of Lambert-Eaton myasthenic syndrome.
• Outline diagnostic and treatment protocols for Lambert-Eaton syndrome.

By the end of this Review Concept you should be able to:

• Define the following clinical conditions
  • Amyotropic Lateral Sclerosis/Lou Gehrig Disease
  • Douchenne dystrophy
  • Becker's dystrophy
  • Limb/Girdle (Erb's) dystrophy
  • Landouzy-Dejerne dystrophy
  • Emery-Dreifuss dystrophy
  • Charcot-Marie Tooth dystrophy
• List the primary signs and symptomsassociated with each of the above conditions
• Identify at least one recommended intervention strategy for each of the above conditions.

By the end of this Review Concept you should be able to:

• roots.
• Describe common signs or symptoms of peripheral nerve injury.
• State common etiologies for mononeuropathies, polyneuropathies, and plexopathies.
• Describe the epidemiology, clinical presentation, and clinical management of Bell's palsy.
• Describe the epidemiology, clinical presentation, and clinical management of distal radial nerve and peroneal nerve compression neuropathy.
• Describe the epidemiology, clinical presentation, and clinical management of carpal tunnel syndrome.
• Describe the epidemiology, clinical presentation, and clinical management of herpes zoster neuropathy.
• Describe the epidemiology, clinical presentation, and clinical management of the following polyneuropathies:
  • Diabetic
  • Alcoholic
  • Nutritional
  • Toxic

By the end of this Review Concept you should be able to:

• Describe the four levels of altered consciousness.
• Describe the etiology and signs and symptoms of altered level of consciousness.
• Describe emergency management procedures for coma.
• Outline diagnostic procedures for coma, including patient history and physical examinations.
• Describe the etiology and clinical presentation of locked-in syndrome, persistent vegetative state, and brain death.

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