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214 Cards in this Set
- Front
- Back
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what are the 4 main myopathies discussed?
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inflammatory
dystrophic metabolic corticosteroid |
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what are the two neuromuscular junction (NMJ) diseases discussed?
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Myasthenias Gravis
Botulism |
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What Neuropathies were discussed?
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median, ulnar, radial, peroneal nerve entrapment
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what two forms of headaches were discussed?
(besides the one you get from class) |
cluster
subaracnoid hemorrhage |
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what are the two inflammatory myopathies we covered?
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dermatomyositis
polymyositis |
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name the myopathy:
*presents ages 5-14yo *malar or heliotrope rash *edema of periorbital skin |
dermatomyositis- an inflammatory myopathy
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pseudohypertrophic
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Duchenne MD
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Rubbery Calves - disease and cause of
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Duchenne MD
from fat replacing CT |
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subsarcolemmal cytoskeletal protein
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Dystrophin
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what disease does this pertain to:
LABS sed rate, CPK-MM,Aldolase all increased TX: Steroids and inmmunosuppressants |
dermatomyositis and polymyositis inflammatory myopathies
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most common dystrophy- especially kids and more common in bosy
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Duchenne Muscular dystrophy
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Stabbing, penetrating, burning, explosive pain
ONLY on one side of head Starts at eyes and spread to same side of head |
cluster headache
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secondary symptoms of cluster headache
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stuffy or runny nose
redness or watering eyes droopy eyelid constrx of pupil facial swelling |
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what disease?
presents age 50-60 yo can be viral, bacterial, idiopathic |
polymyositis
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what disease?
*axial muscle wkness *phonation and deglutination affected*dysphonia & dysphagia |
polymyositis
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in what disease is abscence or abnormal levels of Dystrophin an issue?
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Duchenne MD, dystrophinopathies
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T/F? dystrophin protein is absent in all types of dystrophies?
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FALSE, the "muscular dystrophies" have abnormalities with the muscle, not the protein
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innervates skin of hand
flexor carpi digitorum hypothenar muscles |
ulnar nerve
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results to Gower's Maneuver
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Duchenne MD, when unable to walk
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innervates flexor abductor digitiminimi
3rd and 4th lumbricals interroseous muscles |
ulnar nerve -
also innervates flexor carpi ulnaris |
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combined the lumbricals and interosseus help to
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flex the MCP joint
extend the IP joints |
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compression of nerve and transverse carpal ligament
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median nerve entrapment and carpal tunnel
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foot drop
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peroneal nerve entrapment
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difficulty grabbing and opening a jar
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symptom of carpal tunnel syndrome - median nerve injry
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ape hand
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median nerve entrapment
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innervates skin of hand and most flexor muscles that flex fingers and wrist
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median nerve
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Claw hand
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injury of ulnar nerve
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Labs:
CPK-MM increased to 50x Nl fibrosis necrosis and Fat infiltration seen on biopsy |
Duchenne MD
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abscence of this protein causes wkness of sarcolemma and permits rupturing of muscle
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Dystrophin - sarcolemmal cytoskeletal protein
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walks on toes, contracture of achiles tendon, waddling gait
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Duchenne MD
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onset around age 4
ambulatory loss by age 8-12, death in teens or 20's |
Duchenne MD
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signs/symptoms of carpal tunnel
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pain and paresthesia in wrist and hand
pain may radiate to forearm, elbow, shoulder increased by flexion and/or extension of wrist wkness of grip weak thumb abduction and opposition |
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restrictive pulmonary deficit from progressive kyphoscoliosis ----disease?
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Duchenne MD
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the most common nerve entrapment injury
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carpal tunnel syndrome
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causes of carpal tunnel
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repetitive stress
excessive use of wrist CT thickening of the ligament **arthritic tenosysnovitis |
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symptoms include generalized muscle cramps and early fatigue from exercise - lack of energy
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McArdles metabolic myopathy- due to inability to break down glycogen to glucose for energy
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pain and paresthesia in wrist and hand and first 3 1/2 fingers
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carpal tunnel syndrome - median nerve entrapment
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corticosteroid myopathy
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complications of high dose steroids
Cushing's Syndrome |
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what treatments are available for carpal syndrome
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splint wrist in neutral position
-steroid injection -surgical decompression division of carpal ligament |
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subsarcolemmal glycogen vacuoles seen histologically
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McArdles-metabolic myopathy
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treatment is limited to physical therapy and bracing
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Duchenne MD
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Tinsels test is diagnostic for
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carpal tunnel syndrome
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thenar atrophy is a late sign
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carpal tunnel
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caused by myophosphorylase deficiency
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McArdles disease
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what is Phalen's test?
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carpal tunnel compression test -
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an endocrine disorder in which the adrenal gland overproduces corticosteroids
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Cushing's syndrome
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causes muscle catabolism, atrophy of fibers, wkness in shoulder, hip and other areas
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Cushing's Disease - a metabolic myopathy
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symptoms can include:
dysphagia, dyspnea, nasal speech, smile degeneration to snarl |
myasthenias gravis
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what gland is a major player in Myasthenias Gravis?
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Thymus gland - it produces the Ab that kill the Nm receptors causing rapid fatigability, and motor deficits
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describe in order the affects of Myasthenias gravis on the body
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1. eyelid-ptosis
2. extraocular - diplopia 3. bulbar muscles -nasal speech - jaw hangs open 4. dysphagia mimetic muscle inactivity smile degenerates to snarl intercostal musclse and diaphragm depressed |
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death can be caused from respiratory muscle depression - cant take another breath in
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botulism poisoning
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rapid fatigability
ptosis diplopia bulbar muscles affected |
Myasthenias Gravis
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bacteria that cx foamy frothy food
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Clostridium botulinum - an anerobic bacteria implicated in Botulism poisoning
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deep tendon reflexes or sensory fx not affected but muscles of facial expression are
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myasthenias gravis - a NMJ disorder
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treatment includes discontinuation of steroids
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Cushing's syndrome
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treatment includes pyridostigmine, plasmaphoreses, IV gamma globulin and immunosuppressants
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Myasthenias gravis - NMJ disease
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some symptoms of this disorder include:
acute progressive wkness w/in 72 hours -alpha motor neuron and parasympathetic terminals affected -dilated pupils -dry mouth |
botulilsm toxin poisoning - a NMJ disorder
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'index muscle' is used for diagnosis of this
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ulnar nerve lesion
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arthritis tenosysnovitis
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implicated with carpal tunnel syndrome
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bilateral damage, may be an issue related to systemic conditions, diabetes, alcoholism
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polyneuropathy
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this causes loss of deep tendon reflexes (DTR's)
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botulism
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unilateral affects
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mononeuropathies
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risus sardonicus is a rsult of ....
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tetanus- Clostridium tetani
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T/F, Tetanus is not a NMJ disease?
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True, it is a result of bacillus bacteria invasion of the brain and spinal cord
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destruction of cholinergic axon terminals causing a decreased release of Ach is a sign of
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Botulism poisoning
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what is the treatment for Botulism toxin?
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IV antiserum
cardiorespiratory support may be needed |
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Bilateral damage
distal sensory nerves Distal motor nerves Bottoms of feet are 1st, Dorsum and ankles Calves and/or hands |
polyneuropathy
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affects of this include blocking of inhibitory neurons, hyperreflexia, and muscle spasms
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Clostridium tetani, Tetanus
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this affects the cubital tunnel
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ulnar nerve
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this includes entrapment of compound nerves: ulnar, median, radial, peroneal and tibial
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mononeuropathies - where nerve entrapment is the key issue
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this nerve is implicated in 'saturday night palsey'
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Radial nerve entrapment
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this can be seen and palpated on the thumb side of the 2nd metacarpal
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index muscle - diagnostic for ulnar nerve lesion
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symptoms include difficulty spreading fingers, 1st dorsal interooseus atrophy, wk or atrophied
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ulnar nerve, cubital tunnel syndrome
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prominent 1st dorsal interosseus atrophy is a sign of this
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index muscle - early diagnosis of ulnar nerve paralysis
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wrist drop
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radial nerve entrapment
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worst headache of my life
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subarachnoid hemorrhage from ruptured cerebral aneurysm
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innervates triceps, supinator, brachioradialis and skin of dorsum of hand
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radial nerve
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atrophy of lumbricals,interosseus and hypothenar eminence
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ulnar nerve (mainly)
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the MC cx of subaracnoid hemorrhage
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rupture of a cerebral aneurysm
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restlessness, agitation and nausea area result of this
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cluster headache
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signs are pain & paresthesia of dorsum of hand,fingers but not weak triceps, supination
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injury at mid-humerus, from a blunt trauma
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foot drop
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entrapment of peroneal nerve from wearing too tight boots
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denervation causing muscle atrophy and tophic changes of the skin
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atrophy of severe chronic denervation
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this nerve innervates wrist and finger extensors and helps flex elbow and aids supination
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Radial nerve
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Lavisnky sign
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take reflex hammer, stroked across ball of foot, and if upper motor neuron lesion in brain, the big toe flexes upward =
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MC peripheral mononueropathy
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proximal, middle,
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which cranial nerves are ONLY sensory
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CN I, II, VIII,
olfactory, optic, vestibulochoclear |
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smell, vision, parasympa to eyes
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CN I, II, III
olfactory, optic, occulomotor |
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in a cranial neuropathy that affects CN 3, what is a deficit?
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medial rectus muscle - ocular convergence
levator palpebral - troubel opening the upper eyelid = hanging eyelid |
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what causes hanging eyelid?
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damage to CN 3, affecting the levator palpebral muscle
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superior oblique muscle, action and innervation
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CN 4,trochlear N. moves eye down and medially
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olfactory N
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CN 1
smell |
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Vision
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CN 2, optic
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parasympathetic to eye muscles
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occulomotor CN 3
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miosis
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pupillary constrictor muscle CN 3
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lens focus
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CN 3, occulomotor
ciliary body |
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ocular convergence
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medial rectus
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opens upper eyelid
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levator palpebral mucsle
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superior oblique muscle
action/nerv |
occulomotor
moves eye down and medially |
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oronasal mucus membranes and teeth
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sensory action from CN 5, trigeminal
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corneal reflex
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cornea - sensory of CN 5, trigeminal
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facial nerve actions
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para to lacrimal gland - tears
submaxillary and |
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lateral movement of eye
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lateral rectus , CN VI
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submaxillary and sublingal glands - innervation
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CN , facial
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motor to jaw muscles, masseter temporal and pterygoid muscles
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CN 5, trigeminal
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anterior 2/3 tongue, taste, pinna of the ear
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CN 7, facial - sensory fx
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obicularis orus closes eye in response to
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CN 7, facial nerve motor function
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facial expression
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facial mumetic muscles
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this .....muscle elevates the pharynx and larynx and is innervated by.....nerve
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stylopharyngeus muscle - CN 9 glossopharyngeal
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sensory from semicircular canals, saccule and utricle for dynamic and static balance
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innervated by vestibulocochlear n
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mydriasis/asnisocoria
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pupillary constrictor, CN 3
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ptosis
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CN 3, levator palpebrae
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what two cranial nerves fx in salivation
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CN 7, facial = submaxillary and sublingual
CN 9, glossopharyngeal - acts at parotid gland - salivation |
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glossylpharyngeal
? sensory from |
S from: posterior 1/3 tongue=taste
*orpharynx - swallowing eustachian tube - middle ear pain carotid sinus & body |
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CN 9, motor to
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stylopharyngeal muscles-elevates pharynx and larynx
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CN 10 - Vagus
*para motor? * sympa motor to |
para motor to abd & thoracic organs
*sympa motor - solft palate, pharynx, larynx |
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CN 10 is sensory from ?
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aortic bodies and arch
posterior 1/3 tongue pharynx, larynx, ear cancal |
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anosmia
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rare
CN 1 olfactory - cant smell |
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what innervates the tongue?
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posterior 1/3 = CN 10
anterior 2/3 taste-CN 7 CN 12 - motor to tongue |
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motor action of sternocleidomastoid and upper traps
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Cn 11, accessory
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gag reflex
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CN 10. cagus - via pharynx and layrnx
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the difference b/t diplopia and blurred vision
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diplopia is seeing two images from non fx EOM's and blurred vision is from failur of lens to accommodate - both CN 3
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herperacusis (loudness)
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stapedius muscle neuropathy - CN 7
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unilatery palsy of front of neck when frowning, unilateral facial wkness
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platysma muscle - and facial muscles from motor fibers of CN 7
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sluggish or absent light reflex of eye
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deficit to pupillary constrictor muscle of CN 3
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jaw deviates to one side
"sidedness" |
CN 5 neuropathy of masticator muscles casuing wk or malaligned jaw
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Tic douloureux
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trigeminal neuralgia
short bouts of exruciating pain in any of the CN 5 facial divisions |
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what can cause Diplopia ?
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EOM not fx due to
1. palysy of CN 2. entrapment of eye muscle 3. orbital fracture from either CN 3, or CN 4 affecting medial rectus or superior oblique Cn 6 - lacteral rectus |
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bilateral loss of corneal reflex , with numbness or pain
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neuropathy of the facial dvision of trigeminal nerve
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dry eyes, dry mouth
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deficits of CN 7, facila nerve -
para to lacrimal gland, submaxillary, sublingual glands |
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vertigo and nystygmus
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sensory fibers of CN 8 vestibular
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severe pain in the ear for 2 days, vesicular rash in and external to ear
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herpes zoster oticus
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greatest cause of grey hair, hair loss, palsy of buttocks
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this class - just checking to see if you were paying attention :-)
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Bell's palsey
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facial paralysis of cN 7
(w/assoc.drooling) cx by viral infx, entrapment of nerve (acoustic neuroma) lyme disease (bilateral palsy) |
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Meniere's Disease
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recurrent episodes of low-freq hearing loss, tinnitus, vertigo, and nystygmus
cx by overproduction of endolymph in cochlear duct (CN 8) |
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sensoneural hearing loss
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sensory from Cn 8, cochlear
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causes of conductive hearing loss
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-excessive cerumen
-otitis media -congenital ankylosis of ossicles -otosclerosis (older adults) |
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causes of sensorineural hearing loss
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dying hair cells -neuronal fx abnormal from
1.presbycusis 2. ototoxic drugs 3. acoustic neuroma 4.Meniere's disease |
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what is Presbycusis
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gradual dying off of cochlear hair cells with age
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what are the ototoxic drugs?
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aminoglycosides and diuretic
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What is an acoustic neuroma?
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slow-growing tumor (benign) of the Schwan cells (sometims schwannoma) surrounding CN 8, vestiublar portion
-unilateral deafness and nystagmus |
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what is nystagmus?
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involuntary cyclic movement of the eyes
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what is Meniere's Disease and how is it caused?
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recurrent episodes of low-frequency hearing loss, tinnitus, vertigo and nystagmus
Cx: overproduction of endolymp in the cochlear duct |
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differentiate between true vertigo and vasovagal syncope
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True vertigo- pt feels she is moving or her surroundings are moving, ALWAYS cx some nystagmus, vertical, rotary, or horizontal. Vasov. does not present with that
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peripheral vertigo- cause
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cx by abnl fx within the cochlea, semcircular canals or vestibular fibers of CN 8
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peripheral vertigo - signs/symptoms
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severe= pt falls; N/V, tinnitus or hearing loss and horizontal or rotary nystagmus
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what are the 3 forms of peripheral vertigo?
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Meniere's disease
Acoustic Neuroma Vestibular neuronitis |
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Vestibular neuronitis:
(labrynthitis) |
viral,bacterial or idiopathic
(labrynthitis)acute onset vertigo, postural imbalance, N/V and persistent horizontal or rotary nystagmus. NO hearing loss |
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CENTRAL VERTIGO
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abnl fx in the vestibular nuclei- brainstem, cerebellum or cerebral hemispheres
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Benign Positional Vertigo
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common in the elderly
acute change of head position getting into or out of bed -due to carbonate crystals breaking off the otoliths in the utricle and clogging the posterior semicircular canal. |
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symptoms of central vertigo
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mild, no N/V tinnitus or hearing loss;
-nystagmus can be rotary or vertical |
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in what diseases is central vertigo present?
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*multiple sclerosis
*TIA, brainstem stroke *cerebellar hemorrhage |
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what signs/symptoms often accompany central vertigo?
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dysfunction of CN other than CN 8:
diplopia, dysarthria, dysphagia, facial wkness or numbness |
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VESTIBULAR NEURITIS
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– SIGNIF N/V, AND LATERAL NYSTAGMUS,
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pt's vertigo is due to stx such as cerebellum, brainstem, etc , this is .....
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central vertigo
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vestibular apparatus is composed of
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3 semicircular canals
utricle saccule |
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if pt's vertigo is due to a problem anywhere from the root of CN 8 - toward and into the labyrinth, it is..
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peripheral vertigo
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deficient or absent gag reflex stems from what neuropathy?
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dificit in CN 9, or 10
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severe pain in throat, tongue, and ear on swallowing
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glossopharyngeal neuralgia
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constant pain in one ear, severe pain in throat and tongue
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possibly cancer of the pharynx
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paralysis of soft palate, nasal speech, deviation of uvula toward normal side onn phonation - due to what nerve issue?
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CN 10 vagus
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hoarseness of voice results from
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paralysis of larynx
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weakness turning head to the right
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paralysis of LEFT sternocleidomastoid muscle of CN 11 accessory nerve
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weakness shrugging left shoulder
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paralysis of left trapezius- CN 11, accessory
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deviation of protruded tongue toward weak side, & may possibly see fasciculations and atrophy of paralyzed side of tongue
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CN 12 neuropathy
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mononeuropathies
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unilateral, asymmetric
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-distal axons are sick
-starts in feet -symmetric,larger, fast-conducting, sensory fibers affected -affects DC-ML and DTR |
peripheral neuropathies
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prototype for all peripheral neuropathies
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diabetic neuropathy
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2 phenomena of diabetic neuropathy
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1. microangiopathy
2. direct axonal damage |
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microangiopathy
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happens to caps supplying distal nerves
-non-enzymatic glycosylation (caramellization) -advanced glycosylation endproducts -LDL trapped - atherosclerosis os small vessels |
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what tissues do not require insulin in order to take up glucose from the blood?
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nerves, kdiney, vessel walls, lens of the eye
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what happens when plasma glucose is too high for too long?
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and increased amount of glucose diffuses into nerve, kidney, vessal walls and lens of eye (tissues)
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negative effects of increased intracellular sorbitol and fructose?
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sorbitol cx degeneration of schwann cells - demyelination
both: inc'd intracellular osmolarity>osmosis>CELL LYSIS & SCWANN CELL INJURY |
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signs and symptoms of diabetic neuropathy
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large fiber neuropathy :
DC-ML fibers sensory>bottoms of feet>lower leg>hand> |
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stocking and glove presentation
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sensory:painles paresthesias, numbness, dec'd proprioception & vibration sense
motor:dec'd or absent ankle flexion, wk plantar/dorsiflexion |
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amyloidosis
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presents with small fiber neuropathy
A-delta, C-fibers== dysesthesias distal pain and temp loss proprioception/vibration preserved Nl reflexes |
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dysesthesias
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unpleasant abnoarmal sensation produced by normal stimuli to skin
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focal neuropathies
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acute onset of neuropathies -
acute vascular occlusion-ischemia-pain and neuro deficient |
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diabetic opthalmoplegia
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CN 3 cranial neuropathy
unilateral eye pain -diplopia -ptosis |
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neurological issue associated with diabetes
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stocking and glove
amyloidosis focal neuropathies cranial neuropathies risk of carpal tunnel autonomic neuropathies hyperglycemic unawareness neuroglycopenia |
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hyperglycemic unawareness
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unaware of early signs of low glucose:
-wkness,tremor, nervousness,tachycardia sudden neuroglycopenia: -visual disturbances -confusion, bizarre behavior -amnesia,seizures,coma |
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T/F beta blockers are a recommended treatment?
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FALSE!!!
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Guillian-Barre' Syndrome
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peripheral neuropathy
acute inflammatory demyelinating polyneuropathy aka postinfectious polyneuropathy |
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affects of Guillian-Barre' syndrome
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rapidly progressive, ascending motor wkness of:
legs,arms,resp myo, = paralysis early & general HYPO- or areflexia early paresthesias NO true sensory loss |
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causes may include:
viral URI or GI infx, campylobacter jejuni infx, and may occur w/ SLE, or Lymphoma |
Guillian-Barre' Syndrome
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signs and symptoms of GB syndrome
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symmetri or asymmetric ascending weakness
-legs,arms,resp. myo -paralysis in 50%~1wk,90%1mo. -early & genera. hypreflexia or areflexia, and paresthesias 1/3 on vent. support, most 2-4 wk, paralysis all 4 limbs 5% die no true sensory loss, |
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definitive signs and labs of GBS
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inc'd CSF protein w/out pleocytosis
-ALWAYS present w/early and gen. hyporeflexia or areflexia- if wk patient has NL reflexes its NOT GBS |
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prognosis and treatment for GBS
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tx: leave it to the neuro team
prog: most recover completely w/in 3-6mo, some have residual weakness |
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Lou Gerhrigs disease - Amyotrophic lateral sclerosis(ALS)
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cx relentless progressive deterioration upper and lower motor neuron
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CN with parasympathetic motor fibers
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Cn 3, occulomotor
CN 7, facial n CN 9 glossophyrngeal CN 10 Vagus - |
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primary headache
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benign, no organic pathology
tention, cluster,migraine, rebound,caffeine withdrawl |
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secondary headache
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underlying disease or pathology
-glaucoma, temporal artiritis, meningitis, intracranial hemorrage |
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sinusitis, influenza,severe HTN, lyme disease are what?
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other secondary headaches
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what are the majority of h/a classified as?
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benign, primary
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features of the h/p exam that indicate the h/a is secondary to serious pathology
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marked change in h/a pattern
rapidly incrs. freq of h/a sudden onset of severe new onset after age 50 persistent h/a after trauma |
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what combination of other symptoms makes you suspect secondary?
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h/a + fever, nuchal rigity, pailledema, clumsy, seazures, impaired mental status, focal neuro signs
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T/F pain from the h/a stems from neuronal structures of brain parenchyma
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FALSE, there are no pain receptors there
instead it comes from cranial structures |
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what cranial structures are implicated in the cause of pain of a headache?
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1. head and neck muscles
2. scalp and vessels 3. meningeal & cerebral arteries 4. venous sinuses 5. pain AFFERENTS of CN 5,9,10 6 parts of dura matter at base of brain |
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cause of tension h/a
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stress, anxiety, depression,poor posture, alcohol, various meds, osteorathritis
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signs and symptoms of tension headache
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from none to moderate throbbing
dull, pressing or band-like pain bilateral |
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treatment for tension h/a
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self treat with aspirin, acetaminophen or ibuprophan
Rx: anaprox (naproxen) |
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antipyretic, analgesic, anti-inflammatory
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NSAIDS, aspirin, but NOT acetamenophin - not anti-inflammatory
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butalbital
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barbiturate that has potential for addiction
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what happens if you use butalbital more than 2x week?
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risk of progression to chronic daily h/a
= rebound h/a |
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define chronic daily h/a
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presence of tension h/a at least 6 days/week
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what Rx treatments for tension h/a?
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NSAIDS, muscle relaxant
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pericranial muscles
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cause of tension h/a
they include the : 1. frontalis 2.temporalis 3/ sternocleidomastoid r. trapezius |
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T/F tension and cronic daily h/a's are avascular?
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true
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migraine - where
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vascular h/a
cerebral cortex is hyperexcited, unilartery |
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cephalgia
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head pain aka cephalalgia
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mood change, blurred vision, flashing lights, photophobia, tingling, numbness
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migrain headache
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vasocontrictive phase
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causes pts auras
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vasodilatory phase
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causes the headache itself
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signs and symptoms of migrained
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throbbing, unilateral,photophobia +/or phonophobia
wavy lines-teichopsia weakness, clumsy |
