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33 Cards in this Set
- Front
- Back
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3 connective tissue coverings |
Epineurium Perineurium Endoneurium |
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Changes in the PNS with age |
Ventral roots are affected more than dorsal roots Blood vessels become atherosclerotic Myelin deterioration ANS dysfunction common in elderly Changes in dermal vascular control leads to decrease in wound repair |
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Neurapraxia |
segmental demyelination which slows action potential |
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Axonotmesis |
axon is damaged but connective coverings remain intact |
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Neurotmesis |
complete severance of axon and disruption of connective coverings |
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Mononeuropathy |
single peripheral nerve is invovled |
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Radiculoneuropathy |
involvement of the nerve root |
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Polyradiculitis |
involvement of several peripheral nerves |
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Myopathy
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involvement of muscle (muscle degenerates)
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Sensory nerve injury presentation |
follow peripheral nerve distribution or dermatomal pattern |
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Motor nerve injury presentation |
paresis or paralysis distal to lesion |
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Spinal motor nerve injury presentation |
weakness in all muscles receiving axons from that spinal level |
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Neuropathies with sensory involvement symptoms |
Tingling, burning Dysesthesia and paresthesias in feet Involvement of more than one nerve results in sensory loss in stocking-glove distribution |
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Neuropathies with motor involvement symptoms |
Distal weakness
Tonal abnormalities DTR are diminished or absent |
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Axonal degeneration |
Rapid muscle atrophy Electrophysiologic changes |
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Segmental demyelination of preganglionic fibers of the ANS |
Changes in vascular control and sweating |
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Idiopathic facial paralysis or Bell's Palsy |
Incidence - 20/100,000 a year Etiology and pathogenesis - Uncertain, latent herpes virus reactivation Risk - Diabetes Mellitus, Pregnant women Clinical Manifestations - Unilateral facial paralysis, facial expressions different Treatment - corticosteroids, antiviral medication |
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Tardy Ulnar Palsy/Retroepicondylar Palsy |
Etiology - Complication of elbow fracture, associated with callus formation or valgus deformity Risk - Repeated trauma, shallow ulnar groove, entrapment of nerve at elbow |
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Tardy Ulnar Palsy Pathogenesis |
Compression of the nerve secondary to repeated microtrauma associated with fractures Fibrous bands or recurrent cubital subluxations Entrapment at the entrance or exit of the cubital fossa |
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Tardy Ulnar Palsy Clinical Manifestations |
Clawhand deformity Flattening of hypothenar eminence Atrophy of dorsal interossei with guttering between extensor tendons Paralysis of FCU Sensory loss is variable |
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Tardy Ulnar Palsy Medical Management |
Nerve conduction velocity studies Treatment: -Mild cases treated conservatively -Severe requires decompression or transportation surgery |
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Saturday Night Palsy/ Sleep Palsy Etiology |
Radial nerve compression caused from direct pressure against a firm object Typically follows deep sleep after intoxication |
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Saturday Night Palsy Pathogenesis Clinical Manifestations |
P: Segmental demyelination of radial nerve
CM: Level of the lesion determines the extent of paralysis Paralysis of wrist and finger extensors and diminishing grip strength |
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Saturday Night Palsy Medical Management Prognosis |
MM: Diagnose by considering history, clinical exam and electrophysiologic exam Treatment is focused on asymptomatic management P: Normal conduction can be expected in a few months |
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Morton's Neuroma Etiology Pathogenesis |
E: Neuropathy in forefoot
Common in people 45-60 Women affected more than men P: Mechanical irritation from intrinsic or extrinsic factors Inflammatory conditions |
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Morton's Neuroma Clinical Manifestations Medical Management |
CM: Burning, Tingling, Sharp pain in interspaces of foot MM: Diagnose by considering history and clinical exam Mulder's sign Laseque's sign |
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Morton's Neuroma Treatment Prognosis |
T: Pressure relief, Soft orthosis, Metatarsal pad, Corticosteroid injection, Surgical intervention P: 50% have pain relief after conservative treatment, 65-100% following surgical intervention |
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Alcoholic Neuropathy Etiology |
Typical after years of alcohol abuse Possible nerve injury from toxic effect of alcohol or nutritional deficiencies New research: alcohol-related neuropathies are a result of a total lifetime accumulation of ethanol |
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Alcoholic Neuropathy Pathogenesis Clinical Manifestations |
P: Segmental demyelination Axonal degeneration changes begin distally and move proximally CM: Minor loss of muscle bulk Decreased ankle reflexes Impaired sensation in feet Aching calves |
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Alcoholic Neuropathy Medical management |
Diagnosis is made by considering history, clinical exam and electrodiagnostics Diet to improve nutritional status and abstinence from alcohol is treatment of choice Symptoms may be treated by use of orthotic devices and medication |
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Post-Polio Syndrome Define Risk |
Post-Polio is new neuromuscular symptoms that occur decades after recovery from initial incident of polio Risk: One-fourth to one-half of the 1.63 mil polio survivors will develop post-polio syndrome Initial degree of motor weakness is a factor in the development of post-polio syndrome |
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Post-Polio Syndrome Etiology Pathogenesis Clinical Manifestations |
E: Post-polio syndrome is related to the initial involvement of motor neuron cell bodies affected Essentially, surviving axons increase the size of innervation ratio P: Ongoing muscle denervation PPS - surviving neurons can no longer maintain muscle innervation CM: Muscle strength declines Pain, atrophy, respiratory and swallowing problems are common |
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Post-Polio Syndrome Medical Management Treatment Prognosis |
MM: EMG, Muscle biopsies T: Symptomatic treatment and lifestyle modifications P: Slow progressive disorder |
