Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
86 Cards in this Set
- Front
- Back
|
What are the different layers in a nerve cell?
|
Epinerium
Perineurium Endoneurium Mesonerium |
|
|
What are the cells that surround the nerves in the CNS?
|
Oligodendrocytes
|
|
|
What are the cells that surround the nerves in the PNS?
|
Schwann cells
|
|
|
What is the definition of neuropraxia?
|
A neurologic injury in which the neuron is in continuity, but there is a place of focal demylenation resulting in focal counduction block
Basically, Schwann cells are gone and they take a couple of weeks to come back. |
|
|
How long does it take someone to recover from neuropraxia? What's the recovery like?
|
2-3 weeks
Complete recovery! |
|
|
What is the definition of axonotmesis?
|
Axon is damaged, but the endoneurium is intact
|
|
|
What is the definition of Wallerian degeneration? When is it present?
|
When the more distal neuron to the lesion dies off
Axonotmesis Neurotmesis |
|
|
What is the determining factor in whether a neuron will grow back?
|
Whether or not there is an endoneurial tube along which the neuron can grow.
|
|
|
What is the rate of growth down an endoneurial tube?
|
1 mm/day
|
|
|
What is the prognosis of axonotmesis?
|
Good, but variable recovery
Often the new innervation isn't perfect |
|
|
What is the definition of neurotmesis?
|
Severed or damaged nerve
|
|
|
What is the prognosis for neurotmesis?
|
Very poor
Recovery is impeded by discontinuity/scar and doesn't happen spontaneously |
|
|
What is the treatment for neurotmesis?
|
Recreate a tube of endoneurium for the new nerve to grow along
Do a nerve graft |
|
|
What should you do if there's a sharp injury that results in neuronotmesis?
|
Repair it immediately with a direct, end-on-end anastamosis
|
|
|
What should you do if there's a blunt injury that results in neuronotmesis?
|
Identify the lesions, record them
Delay the repair until after the extent of the injury is certain: you don't want to graft a nerve onto one that's dead. |
|
|
What should you do in which there's a trauma with no early evidence of neurnotmesis?
|
Document what problems are present
Wait and see what happens. |
|
|
What are common causes of radial nerve damage?
|
Crutches/axillary compression
Humerus fractures/spiral groove |
|
|
What are common causes of ulnar nerve damage?
|
Repeated elbow trauma
|
|
|
What are common causes of median nerve damage?
|
Distal radius fractures
|
|
|
What are common causes of sciatic nerve damage?
|
Buttock injections
|
|
|
What are common causes of peroneal nerve damage? Why is this a concern?
|
Fibular fractures
People just cast the leg without testing for function. When they take the cast off, they find that the peroneal nerve is just damaged horridly |
|
|
What type of an injury causes Erb's palsy?
|
When the head is leaned away from the shoulder
|
|
|
What parts of the brachial plexus are damaged in Erb's palsy?
|
C5/C5 - upper trunk
|
|
|
What does someone who has Erb's palsy look like?
|
Waiter's tip hand
"Useful hand at the end of a useless arm |
|
|
What type of an injury causes Klumpke's palsy?
|
Reaching the arm up too far
Can be caused by a difficult birthing |
|
|
What are the nerve roots damaged in Klumpke's palsy?
|
C8, T1, sometimes C7
|
|
|
What does someone look like when they've got Klumpke's palsy?
|
Claw hand
|
|
|
What is the definition of carpal tunnel syndrome?
|
Entrapment of the median nerve just distal to the wrist, within the carpal tunnel
|
|
|
What conditions predisposes someone to carpal tunnel syndrome?
|
Repetitive motion
Obesity, pregnancy Mucopolysacccaridosis V Acromegaly |
|
|
What is the clinical presentation of someone with carpal tunnel syndrome?
|
Nocturnal dysesthsia
Daytime pain with activity Weak grip: opponens atrophies Phallen's sign Tinel's sign |
|
|
What is phallens sign?
|
Symptoms with held wrist flexion
|
|
|
What is tinel's sign?
|
Paresthesias with percussion
|
|
|
What are some diagnostic tests that you should do for carpal tunnel syndrome?
|
EMG/nerve conduction studies
-Assess C6 radiculopathy -look for conduction block |
|
|
When is treatment indicated for carpal tunnel syndrome?
|
When you have EMG proven dysfunction concurrent with motor loss
This is more effective as shown by RCT |
|
|
What different things should you think of when someone comes in with a mononeuropathy?
|
Vascular-diabetes
Infectious Neoplastic Toxic/Metabolic Inflammatory Inherites |
|
|
What are some degenerative spine diseases?
|
Back pain
Disk herniation Degenerative pondylosis |
|
|
What are some red flags in someone with back pain?
|
Trauma:
-Steroid use -Osteopororis ->70 YO Infection: -Pain worse when supine/at night Tumor: -Age >50 or <20 Other: -Bowerl/Bladder changes |
|
|
What are some treatment options for back pain?
|
Don't give them narcotics.
NSAIDS Activity modification Treat a specific cause |
|
|
What are the properties of disk disease?
|
Bulge/herniation of the intervertebral disk
Typically affects one nerve root Injury by compression and inflamation |
|
|
What are the properties of spondylosis?
|
Bony overgrowth affecting both the bone and disk
Narrowing of the neural foramen, entire spinal canal, or both Affects multiple roots Just injury by compression |
|
|
Why does inflammation occur with disk diesase?
|
The nucleus propulsus is a remnant of the notocord, which came before self vs. nonself. It elicits an immune reaction
|
|
|
What is the definition of radiculopathy?
|
Dysfunction of a nerve root
|
|
|
What are the signs/symptoms of radiculopathy?
|
Pain in the distribution of that nerve root
Dermatomal sensory disturbances Weakness of the muscle innervated by that nerve root Hypoactive muscle stretch reflexes of the muscle innervated by that root Lower motor neuron pattern |
|
|
What is sciatica?
|
Radiculopahy in a nerve root contributing to the sciatic nerve
|
|
|
What is the definition of myelopathy?
|
Dysfunction (usually focal) of the spinal cord
|
|
|
What does the dysfunction from myelopathy look like?
|
All levels of function at and below the insult
-Multiple dermatomes -Lower motor neuron pattern at the level of the lesion -Upper motor neuron pattern blow |
|
|
What is the definition of spinal stenosis?
|
A narrowing of the spinal canal
|
|
|
What are the symptoms of neurogenic claudication?
|
Pain is better when bending or sitting
Nerve root distribution Resolves slowly with rest |
|
|
What are the symptoms of vascular claudicaion?
|
Pain is better with rest
Muscles are served by a vessel Resolves quickly with rest |
|
|
How do you differentiate between neurogenic and vascular claudication?
|
Neurogenic:
Better when bending/sitting Resolves slowly Nerve root distribution Vascular: Pain is quickly better with rest Muscle is served by a vessel |
|
|
What patients are at high risk for lumbar spinal stenosis?
|
Patients with congenital stenosis: achondroplasia
Elderly |
|
|
What is the treatment for lumbar spinal stenosis?
|
Surgical decompresion
|
|
|
What are diagnostic tests for degenerative disk disease?
|
Radicular pain/motor/sensory dysfunction
Sensitive to stretch Sensitive to cough/pressure: cough/sneezing Worse with sitting |
|
|
How do you differentiate between degenerative disk disease and spinal stenosis?
|
If it gets better with sitting, spinal stenosis
|
|
|
What are the different ways that discs can herniate?
|
Central/paramedian: effecting the tranisiting root (the root from the vertebrae below!)
Lateral |
|
|
What type of herniation is more common?
|
Central/paramedian
|
|
|
What is the natural history of degenerative disk disease?
|
It's variably symptomatic
Most spontaneously resolve within 6-12 months |
|
|
What's the treatment of degenerative disk disease?
|
Supportive care:
-Activity modification -Analgesics -Steroids SURGICAL DECOMPRESSION! |
|
|
What are the different types of nerve root/sheath tumors?
|
Schwannomas
Neurofibromas Tumor-like masses: synovial cyst |
|
|
How can you differentiate between osteomyelitis and a tumor?
|
An infection is in the entire disc space
Tumors are just in the bone |
|
|
What are the risk factors for a spinal epidural abscess?
|
Substance abuse
Immunocompromised |
|
|
What is the main mechanism of spread that casues spinal epidural abscess?
|
Hematogenous spread
|
|
|
What are the main types of organisms causing spinal epidural abscesses?
|
Staph aureus: 50%
Streptococcus, Mycobacterium |
|
|
What is the mechanism of injury in a spinal epidural abscess?
|
Compression, vascular insult
|
|
|
What is the most common location for a spinal epidural abscess?
|
Thoracic>Lumbar>Cervical
|
|
|
What are some primary extradural bony spinal tumors?
|
Chordoma
Sarcoma Aneurysmal Bone cyst Ostoid Osteoma |
|
|
What are some common mets that go to the spine?
|
Lung
Lymphoma Prostate Breast Myeloma |
|
|
Are Mets of Primary tumors more common in the spine?
|
Mets.
|
|
|
What predisposes a kid to have a myelomeningocele?
|
A lack of folate in the mother
|
|
|
What kinds of drugs can cause folate deficiencies in mothers?
|
Anticonvulsants
|
|
|
What is the best prevention of myelomeningocele?
|
Folate for the moms!
|
|
|
What is a lipomyelomeningocele?
|
Caudal spinal cord becomes attached to a fatty mass and doesn't end at L4.
|
|
|
What is syringomyelia?
|
An accumulation of the spinal cord with fluid
|
|
|
What conditions is syringomyelia associated with?
|
Chiari malformation
Post-traumatic Cord neoplasm |
|
|
What is a chiari malformation?
|
Herniation of the cerebellar tonsils through the foramen magnum with concurrent hydrocephalus
|
|
|
What are indications for imaging of the spine?
|
Pain?
Somnolent? Distracted? Intoxicated? Neurologic deficit? |
|
|
What symptoms are seen in an anterior cord syndrome?
|
Loss of motor function (corticospinal tracts)
Loss of pain/temperature sensation (spinothalamic tracts) Preservation of position, two-point discrimination (dorsal columns) Poor prognosis for motor recovery |
|
|
What are the symptoms seen in brown-sequard syndrome?
|
Ipsilateral and inferior to the lesion:
-Loss of motor control (corticospinal tract) -Loss of position, two point sensation Contralateral: -Dissociated sensory loss - loss of pain, temp/light touch 1-2 levels below the lesion -Preservation of crude light touch |
|
|
What is the prognosis for Brown Sequard syndrome?
|
Recovery of some motor function
|
|
|
What are some symptoms of a central cord syndrome?
|
Motor:
-More upper vs. lower extremities -Early improvement in leg function Sensory: -Cape-like loss of pain/temperature -Burning hands common |
|
|
What are the symptoms of conus medullaris syndrome?
|
Rarely painful
Saddle anesthesia with sensory dissociation Symmetric motor loss Bladder symptoms in early clinical course Reflex: only sacral affected |
|
|
What are the symptoms of cauda equina syndrome?
|
Radicular - usually painful
Saddle, often asymmetric, no dissociation Motor assymetry Bladder symptoms late in course Reflexes: Lumbar and sacral roots affected |
|
|
What is the management of people with a spinal cord injury?
|
ABCs
Protect the cord Full trauma assessment Neurological assessment |
|
|
What are some things that you can give someone with a spinal cord injury?
|
Corticosteroids (methylprednisolone)
Aggressive rehab |
|
|
What is the clinical presentation of someone with a spinal tumor?
|
Pain
-Nocturnal back pain -Radiculopathy -Dysthesia if intramedullary Weakness -Radicular pattern @ level of the lesion -Cord syndromes - lateral compression from extramedullary tumor -Progressive long tract involvement |
|
|
What are the most common types of spinal tumors?
|
Extradural: 55%
Intradural-extramedullary: 40% |
