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151 Cards in this Set
- Front
- Back
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What are the three types of Peripheral Nerve Disorders? |
1) Neuropathies 2) Motor Neuron Disorders 3) Spinal Cord Disorders |
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A neuropathy can be contrasted to a _______ |
Myopathy |
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In a myopathy, what is the cause of muscle weakness? |
a defect within the muscle |
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In a myophathy, is weakness symmetric or asymmetric? |
symetric |
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In a myophathy, is weakness proximal or distal? |
proximal > distal |
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In a myopathy, which is lost first DTR's or muscle strength? |
In a myopathy, DTR's and muscle strength are lost at the same time. |
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In a myopathy, how is sensation effected? |
In a myopathy, sensation is normal? |
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In a myopathy, how is bladder function effected? |
In a myopathy, bladder function is normal? |
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In a myopathy, what labs are abnormal? |
elevated muscle enzymes like - CPK - aldolase - SGPT - SGOT are often observed |
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In a neuropathy, what is the cause of muscle weakness? |
Primary defect within the nerves |
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In a neuropathy, is weakness symmetric or asymmetric? |
asymmetric |
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In a neuropathy, is weakness proximal or distal? |
distal > proximal |
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In a neuropathy, which is lost first DTR's or muscle strength? |
DTR is lost early |
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In a neuropathy, how is sensation effected? |
Sensation is lost |
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In a neuropathy, how is bladder function effected? |
autonomic nervous system (e.g. bladder function) is often abnormal |
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In a neuropathy, what labs are abnormal? |
none lab aberrations are associated with neuropathy |
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Again: What are the three types of Peripheral Nerve Disorders? |
1) Neuropathies 2) Motor Neuron Disorders 3) Spinal Cord Disorders |
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The three types of Peripheral Nerve Disorders may occur as Upper Motor Neuron Diseases or Lower Motor Neuron Diseases. How does an Upper Motor Neuron Disease present? |
- Spastic paralysis - Slowness due to decreased control of active movement - Brisk DTRs - Babinski sign |
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The three types of Peripheral Nerve Disorders may occur as Upper Motor Neuron Diseases or Lower Motor Neuron Diseases. How does an Lower Motor Neuron Disease present? |
–Flaccid paralysis –Fibrillations –Fasciculations –Absent or reduced DTRs |
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How do Fibrillations and Fasciculations compare? |
– Fibrillations: invisible rapid and unsynchronized contraction of muscle fibers – Fasciculations: involuntary contraction of muscles |
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Which, Fibrillations or Fasciculations can only be detected by EMG? |
Fibrillations |
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Which, Fibrillations or Fasciculations are visible? |
Fasciculations |
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Again: What are the three types of Peripheral Nerve Disorders? |
1) Neuropathies 2) Motor Neuron Disorders 3) Spinal Cord Disorders |
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What are the two types of Neuropathies? |
1) Mononeuropathies 2) Polyneuropathies |
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Are Mono-neuropathies sensory, motor or sensory-motor? |
sensory-motor |
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Are Mono-neuropathies symmetrical or asymmetrical? |
asymmetrical |
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What are the symptoms of Mono-neuropathies? |
- flaccid paralysis - loss of DTRs - reduced or absent sensation - hypo-algesia - analgesia - Paresthesias (spontaneously occurring sensation) including sensations of pain - dysesthesias - Allodynia: conversion of non-painful stimuli (e.g. temperature or touch) into pain - Hyperalgesia: exaggerated pain in response to mild pain stimuli - Hyperpathia: exaggerated and prolonged pain from mild pain stimuli |
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What is hypo-algesia? |
hypo-algesia |
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What is analgesia? |
analgesia |
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What are paresthesias? |
Par-esthesias are spontaneously occurring sensation |
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What is dysesthesias? |
dys-esthesias are spontaneously occurring sensations of pain |
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What is allodynia? |
Allodynia is the conversion of non-painful stimuli (e.g. temperature or touch) into pain |
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What is hyper-algesia? |
Hyper-algesia is exaggerated pain in response to mild pain stimuli |
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What is Hyper-pathia? |
Hyperpathia is exaggerated and prolonged pain from mild pain stimuli |
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What populations are at risk of developing mono-neuropathies? |
- diabetics - certain workers - people remaining in disjointed positions for prolonged periods |
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Name the six Major Mono-neuropathies |
1) median 2) ulnar 3) radial 4) femoral 5) sciatic 6) fibular |
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What is the median-nerve-associated: 1) Motor paresis 2) DTR lost 3) pain/sensory loss 4) examples |
The median-nerve-associated 1) Motor paresis of thumb abduction with thenar atrophy 2) DTR lost is none 3) pain/sensory loss is pain in thumb, second, third fingers and lateral ½ of 4th finger 4) example is Carpal Tunnel |
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What causes carpal tunnel syndrome? |
median nerve injury due to - repetitive movements - inflammation (e.g. RA) - fluid retention (e.g. pregnancy) |
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What are the findings in people with Carpal Tunnel Syndrom |
- motor paresis of thumb abduction - thenar atrophy - pain/sensory loss is pain in thumb, second, third fingers and lateral ½ of 4th finger - worse at night - awakens people |
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How do we test for Carpal Tunnel Syndrome? |
Tinnel sign by percussing wrist |
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What is the treatment for Carpal Tunnel syndrome? |
– Rest – Splint – Diuretics – Anti-inflammatory – Steroid injections – Surgery |
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What is the ulnar-nerve-associated: 1) Motor paresis 2) DTR lost 3) pain/sensory loss 4) examples |
What is the ulnar-nerve-associated: 1) Motor paresis is of - finger adduction - thumb adduction - 5th finger adduction and extension - 4th finger adduction and extension 2) DTR lost is none 3) pain/sensory loss in - fifth finger - medial ½ of 4th finger 4) examples are - Claw hands (**look up position**) |
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***Look up benediction sign*** |
***Look up benediction sign*** |
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What is the radial-nerve-associated: 1) Motor paresis 2) DTR lost 3) pain/sensory loss 4) examples |
What is the radial-nerve-associated: 1) Motor paresis of wrist, thumb and finger extensors (i.e. wrist drop) 2) DTR lost is Brachioradialis 3) pain/sensory loss in dorsum of the hand 4) examples are- Saturday night palsy |
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What is the femoral-nerve-associated: 1) Motor paresis 2) DTR lost 3) pain/sensory loss 4) examples |
What is the femoral-nerve-associated: 1) Motor paresis of knee extensors 2) DTR lost is quadriceps 3) pain/sensory loss in anterior, thigh, medial calf 4) there are no nick-names for femoral nerve neuropathy |
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What is the sciatic-nerve-associated: 1) Motor paresis 2) DTR lost 3) pain/sensory loss 4) examples |
What is the sciatic-nerve-associated: 1) Motor paresis of ankle dorsiflexors and plantar flexors (flail ankle) 2) DTR lost is Achilles 3) pain/sensory loss in buttock, lateral calf and most of the foot 4) example is sciatica from herniated disc |
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What is the peroneal-nerve-associated: 1) Motor paresis 2) DTR lost 3) pain/sensory loss 4) examples |
What is the peroneal-nerve-associated: 1) Motor paresis of ankle dorsiflexors and evertors (foot drop) 2) DTR lost is None 3) pain/sensory loss in dorsum of foot and lateral calf 4) example is foot drop that occurs after prolonged leg crossing |
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What is another name for peroneal nerve? |
peroneal nerve = fibular nerve |
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Again: What are the three types of Peripheral Nerve Disorders? |
1) Neuropathies 2) Motor Neuron Disorders 3) Spinal Cord Disorders |
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What are the two types of Neuropathies? |
1) Mononeuropathies 2) Polyneuropathies |
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Are Poly-neuropathies sensory, motor or sensory-motor? |
- sensory - motor - or sensory-motor |
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Are Poly-neuropathies symmetrical or asymmetrical? |
symmetrical (generalized; involving all peripheral nerves) |
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What are the symptoms of Poly-neuropathies? |
It depends on whether poly-neuropathy is sensory, motor, or sensory-motor |
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What are the symptoms of sensory Poly-neuropathies? |
numbness and paresthesias in fingers and hands (stocking gloves hypalgesia |
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What are the symptoms of motor Poly-neuropathies? |
distal limbs weakness, atrophy and flaccidity |
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What are the two types of pathophysiologies that can cause polyneuropathy? |
1) damage to myelin (demyelinating neuropathies) 2) damage to axons (axonopathies) |
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What is the etiology of demyelinating neuropathies? |
inflammatory illnesses |
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What is the etiology of axonopathies? |
toxins or nutritional changes or metabolic etiologies |
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How many poly-neuropathies are there? |
six |
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Name the six poly-neuropathies: |
1) Guillan-Barre 2) Diabetic Neuropathy 3) Heavy metal neuropathy 4) nutritional neuropathy 5) infectious neuropathy 6) metabolic neuropathy |
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What is the pathophysiology of Guillan Barre Syndrome? |
demyelinating polyneuropathy |
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What causes Guillan Barre Syndrome? |
Guillan Barre is triggered by an acute infection |
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What infections trigger Guillan Barre? |
- Campylobacter jejuni - preceding GI infection - preceding respiratory infection - HIV - Lyme Disease - hepatitis - CMV Symptom |
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Describe the progression of Guillan Barre: |
- Symmetrical numbness/paresthesias of fingers and toes - flaccid paralysis (with absent knee/ankle DTRs) in lower limbs ascends - lower CNs are affected - weakness of facial muscles - difficulty speaking, - difficulty maintaining open airway - quadriplegia - respiratory paralysis - areflexia - locked-in syndrome (in severe cases) |
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What are the metabolic features associated with Guillan Barre? |
- hypoxia (is common) - hyponatremia (is common) - May be associated with SIADH |
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What is the mental status of patients with Guillan Barre? |
normal |
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What is the prognosis of patient's with Guillan Barre syndrome? |
- 80% have complete recovery within a few months to a year - 20% have mild to severe residual symptoms - 5-10% recover with severe disability - 5% have 1 or more relapses (chronic relapsing variety) |
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How long after the onset of Guillan Barre does recovery begin? |
4 weeks |
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How do we diagnose Guillan Barre? |
Lumbar Puncture CSF has elevated protein without cellular increase (albumin-cytologic dissociation) |
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What is the key word for the CSF finding in patients with Guillan Barre? |
albumin-cytologic dissociation = elevated protein without cellular increase |
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What is the treatment of Guillan Barre? |
- Plasmapheresis - IV immunoglobulins - Supportive care |
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How does Diabetic Neuropathy present? |
- loss of sensation in stocking glove distribution - loss of DTRs in ankles then knees - impaired sensation in fingertips - sudden pain (often at night, preventing sleep) |
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What is the treatment of Diabetic Neuropathy? |
- Opioids - Antiepileptics (gabapentin, pregabalin) - TCAs - Duloxetine - Cream containing capsaicin (depletes substance P) |
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What heavy metals can cause poly-neuropathy? |
- lead - arsenic - mercury - thallium |
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What are the two main categories of symptoms in patient's with lead poisoning? |
1) CNS symptoms 2) motor polyneuropathy |
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What population is more likely to present with CNS symptoms when they have lead poisoning? |
children |
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What population is more likely to present with motor poly-neuropathy symptoms when they have lead poisoning? |
adults |
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What CNS symptoms do children with lead poisoning present with? |
- learning disabilities - inattention - poor school performance - seizures (in severe cases) - mental retardation (in severe cases) |
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What motor poly-neuropathy symptoms do children with lead poisoning present with? |
foot drop and wrist drop (symmetrical) |
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What are the symptoms of Arsenic poisoning? |
- Guillain-Barre like syndrome - mee lines on fingernails - hyperpigmentation - hyperkeratosis |
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What are the symptoms of Mercury poisoning? |
- Neuropathy - cognitive impairment - ataxia - visual field changes - Gums have dark line below teeth |
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What are the symptoms of Thallium poisoning? |
- neuropathy - alopecia |
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Which metal poisoning is also associated with pica? |
lead poisoning |
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What nutritional deficiencies that can cause poly-neuropathies? |
- B1 (thiamine) - B3 (niacin) - B12 (cobalamin) |
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What are the symptoms of B1 deficiency? |
sensorimotor neuropathy, weight loss, edema |
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What is another name for B1 deficiency? |
Beriberi |
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What are the symptoms of B3 deficiency? |
dementia, dermatitis, diarrhea |
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What is another name for B3 deficiency? |
Pellagra |
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What are the symptoms of B12 deficiency? |
Reversible dementia (CNS) and neuropathy/sensory loss (PNS) |
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How does B12 deficiency cause reversible dementia and sensory loss? |
demyelination of the central and peripheral nervous systems |
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What vitamin is associated with alcohol-induced neuropathy? |
B1 (thiamine) |
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What are the infectious causes of poly-neuropathy? |
- Herpes zoster - Erythema migrans - Lyme Diseas - Bell’s palsy - HIV |
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What are the poly-neuropathy manifestations of Herpes Zoster? |
typically affects the root of Cranial Nerve 5 |
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What are the symptoms of Lyme Disease? |
- Erythema migrans - arthritis - low grade fever - Bell's Palsy like syndrome - mild neuropathy --> GB like symptoms |
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What are the poly-neuropathy manifestations of HIV? |
- peripheral neuropathies (distal pain) - dementia |
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What are two Metabolic Neuropathies? |
1) Acute intermittent porphyria 2) Metachromatic Leukodystrophy |
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What are the symptoms of Acute intermittent porphyria? |
- dramatic attacks of quadriperesis and severe abdominal pain - Agitation - delirium - depression - psychosis - Red urine |
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What is the cause of Metachromatic Leukodystrophy? |
genetic |
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What is the mode of inheritance of Metachromatic Leukodystrophy? |
Autosomal recessive |
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What is the pathophysiology of the poly-neuropathy aspect of Metachromatic Leukodystrophy? |
Demyelination of CNS (white matter) and PNS |
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What is the presentation of Metachromatic Leukodystrophy? |
young adult with frontal cognitive impairment (personality/behavior change) progresses to dementia progresses to spasticity (from PNS demyelination) and ataxia (from CNS demyelination) |
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Again: What are the three types of Peripheral Nerve Disorders? |
1) Neuropathies 2) Motor Neuron Disorders 3) Spinal Cord Disorders |
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Name the three Motor Neuron Disorders: |
1) Amyotropic Lateral Sclerosis 2) Werdnig-Hoffman disease (in infants) and Kugelberg-Welander (in children) 3) Poliomyelitis |
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What is the cause of ALS? |
- excessive free radicals - Most cases are sporadic - 5-10% of cases are genetic |
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What is the mode of inheritance of genetic type of ALS? |
autosomal dominant |
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Does ALS affect upper or lower motor neurons? |
both |
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What are the symptoms of ALS? |
Earliest symptoms: lower motor neurons - weakness followed by - twitching in one leg - fasciculations in one leg - cramping in one leg - atrophy in one arm or leg These lower motor symptoms then spread to other limbs Upper motor neurons symptoms include - muscle spasticity (tight stiff muscles) - exaggerated DTRs - Babinski sign Bulbar and pseudobulbar (crying, laughter) palsy leading to difficulty talking and swallowing |
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List all the things that are normal in patients with ALS: |
- mental status - ocular motility - sensation - bladder/bowel functions |
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What is the prognosis of patient's with ALS? |
- death usually occurs within one year - mental status is usually normal - fronto-temporal dementia develops in 10% - associated with high risk of suicide |
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What is the treatment of ALS? |
riluzole |
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What is the mechanism of action of riluzole? |
- NMDA antagonist - inhibits glutamate neurotransmission |
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How does riluzole effect the prognosis of ALS? |
may slow progression |
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Does ALS affect upper or lower motor neurons? |
Lower motor neuron |
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What are the motor neuron symptoms of Werdnig-Hoffman disease? |
- Progressive flaccid quadriperesis - Muscle atrophy, fasciculations and loss of DTRs |
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start on slide 19 (Poliomyelitis section) |
*** |
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What is the cause of Poliomyelitis? |
Results from poliovirus infection of motor neurons of anterior horn of spine and brainstem |
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What population is affected by Poliomyelitis? |
Affects mostly children |
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What is the very first symptoms of Poliomyelitis? |
acute febrile illness |
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Does Polio affect Upper Motor Neuron or Lower Motor Neuron? |
Lower Motor Neuron |
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What are the neurological signs of Polio? |
Lower Motor Neuron Signs - asymmetric paresis - fasciculations - absent DTRs |
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In patients with Polio, what is one of the worst neuro symptoms? |
throat and chest muscle paralysis necessitating respiratory support |
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What neuro symptoms are normal in patients with poliomyelitis? |
- normal mentation - normal eye movement - normal bladder/bowel control |
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Again: What are the three types of Peripheral Nerve Disorders? |
1) Neuropathies 2) Motor Neuron Disorders 3) Spinal Cord Disorders |
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List the high yield spinal cord disorders |
1) Spino-cerebellar ataxia 2) Brown Sequard Syndrome 3) Spinal Cord Transection 4) Disk herniation 5) Subacute combined degeneration 6) Anterior Spinal Artery (ASA) Infarction 7) Syringomyelia |
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*** See slide 21 for spinal cord anatomy *** |
*** See slide 21 for spinal cord anatomy *** |
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List the spino-cerebellar ataxias: |
Friedreich ataxia, ataxia-telangiectasia, olivopontocerebellar atrophy, and Charcot-Marie-Tooth disease |
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What is the cause of spin-cerebellar ataxias? |
Genetic mutations cause loss of myelin and degeneration of spinocerebellar tracts and cerebellum |
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What is the genetic profile of patients with spina-cerebellar ataxia? |
- autosomal recessive or - autosomal dominant - excessive trinucleotide repeats on different chromosomes |
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What are the symptoms that all types of spin-cerebellar ataxia present with? |
- ataxia - loss of vibration and position sense |
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What is the cause of Brown-Sequard Syndrome? |
lateral hemisection of spinal cord |
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What are the symptoms of Brown-Sequard Syndrome? |
1) cortico-spinal tract signs 2) dorsal column signs 3) spino-thalamic tract signs |
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What are cortico-spinal tract signs? |
ipsilateral paresis, hyperactive DTRs and Babinski sign |
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What are dorsal column signs? |
ipsilateral fine touch position and vibration sensory loss |
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What are spino-thalamic tract signs? |
contralateral pain and temperature loss |
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What are the signs of transecting the spine at C3 vertebrae and above? |
quadriplegia and loss of diaphragm function, necessitating the use of a ventilator for breathing |
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What are the signs of transecting the spine at C4 through C7? |
sensory loss, partial quadriplegia, apnea, bladder/bowel/sexual impairment |
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What are the signs of transecting the spine at the thoracic vertebrae level? |
sensory loss, paraplegia, bladder/bowel/sexual impairment |
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What are the signs of transecting the spine at the lumbosacral verterbrae level? |
sensory loss, lower extremities weakness, bladder/bowel/sexual impairment |
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Where do the majority of disk herniations occur? |
L4 through L5 or L5 through S1 |
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Weakness of the ankle may be due to injury at what spinal cord level? |
S1 or S2 |
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What level of the spinal cord is injured in Cauda Equine syndrome? |
L1 through S5 |
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What are some of the causes of Cauda Equina Syndrome? |
- trauma - tumors - disks - spinal stenosis |
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What are the symptoms of Cauda Equine syndrome? |
- Pain in legs and low back (saddle-like distribution) - Lower extremities weakness (sometimes paraplegia) - Loss of DTRs - Incontinence - Sexual dysfunction |
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How do we diagnose Cauda Equine Syndrome? |
CT or MRI |
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What is the cause of Subacute combined degeneration? |
B12 deficiency |
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Which spinal columns does Subacute combined degeneration affect? |
lateral column and dorsal column |
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What are the symptoms of Subacute combined degeneration? |
combined upper and lower motor neurons symptoms |
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Which spinal columns does Anterior Spinal Artery (ASA) Infarction affect? |
entire cord except dorsal columns |
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What are the symptoms of Anterior Spinal Artery (ASA) Infarction? |
- quadriplegia - a-reflexia |
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Which spinal columns does Syringomyelia affect? |
spino-thalamic tract |
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What are the symptoms of Syringomyelia? |
loss of pain and temperature senses |
