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36 Cards in this Set

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What chemical is is in the neurochemical junction for transmission of the motor unit?
ACh
What is an example of an inherited myopathy?
Muscular Dystrophy
Whats an example of an acquired myopathy?
Polymyositis
How does one come up with the majority of the neurological diagnosis?
History and PE
Describe the reflex arc.
Synapse b/w dorsal root ganglia & anterior horn cell, maybe w/ interneurons.
Thus, receptor-->primary sensory neuron-->spinal cord-->spinal cord motor neuron-->muscle
What's the difference b/w a lesion at the dorsal root and a lesion distal to the dorsal root ganglia (ex. plexus)?
-Lesion of dorsal root (intact DRG): intact sensory N but w/ sensory sx's.
-Lesion distal to DRG (e.g. plexus): abnl sensory nerve.
Where do the dorsal root and ventral roots start and go to?
Dorsal root: b/w DRG & cord
Ventral root: b/w AHC & foramen
What three occurs in neuropathy if the parasympathetic system is affected more?
Inc HR, dec gastric motility, erectile dysfunction. Also w/ lack of vasoconstriction & lack of HR/BP response postiion change--orthostatic response.
On History & Exam, fatigability would indicate a problem where?
NMJ
What would difficulty getting out of chairs or climbing stairs indicate?
Proximal Lower extremity weakness
Where would weakness be if patient said they have difficulty when shampooing?
Proximal Upper extremity weakness
Hyperreflexia & Babinski sign are an indication of what?
UMN lesion
What are three characteristics of an acute peripheral neuropathy--"spinal shock"?
Ascending weakness, hypotonia, hyporeflexia or arreflexia (babinski sign not reliable)
What is the treatment for an acute myelopathy?
hi dose steroids IV, emergent neurosurgical consultation, radiation therapy if due to spine mets
Is a lumbar puncture indicate in acute myelopathy?
Do not do lumbar puncture until absence of compressive cord lesion is proven b/c may convert partial to complete block.
In which condition should there be emergent neuroimaging of spinal cord from cervical and thoracic down to conus?
Acute myelopathy
What is the most common cause of peripheral neuropathy?
Diambetes
What lab exams should be done for a patient w/ peripheral neuropathy?
fasting blood sugar (for DM), CPK (muscle), ESR (inflammation), ANA (CT d/o--Lupus, Sjogrens), Other antibodies, liver & renal fxn tests, thyroid fxn tests, serum + urine protein electrophoresis (looking for M protein)
What would you see in albuminocytologic dissocation of CSF?
nl CSF WBC, Elevated CSF protein.
Which condition should you think of when you get elevated CSF WBC cot in demyelinating polyneuropathy?
HIV
Distinguish b/w myopathy & neuropathy on Needle EMG examination?
Examination activation of motor units (MUP).
-Large MUP: Neuropathy, Small MUP: myopathy;
-Polyphasic: usually Neuropathy due to reinnervation
-Reduced recruitment: neuropathy, increased recruitment: myopathy.
What can you use an EMG to see?
Lesions of peripheral nervous system: anterior horn cell, N roots & plexus, individual peripheral Nervies or general, NMJ, muscle, includes N injury, CAN'T test small unmyelinated nerves.
What can you NOT test w/ electromyography?
CNS lesions & small fiber neuropathy
How long does it takes for a nerve to degenerate post injury?
7-10 days.
Describe the motor/sensory pathway for the nervous system beginning w/ the muscle & ending in the brain.
Muscle-->NMJ-->Nerve-->Plexus--->Nerve root-->(Anterior Horn Cell)-->Spinal cord-->Brain.
Describe myopathy including muscle pain, motor, sensory, reflexes.
Muscle pain w/ mvmt, palpation. Sensory-nl
Reflexes: nl or reduced, proportional to degree of wkness.
Motor: nl, hypertonicity, or atrophy, nl or reduced muscle tone, dysphagia possible, eye mvmts nl, face normal.
What lab value should be considered in myopathy?
CPK--may be elevated or nl-->& elevated sed rate if inflammatory.
What will be the results of an EMG in myopathy?
NL sensory nerves & NL or reduced amplitude motor nerves.
What will be the results of a Needle EMG in myopathy?
increased spontaneous activity, small MUP, increased recruitment.
What are the results of nerve condution, repetitive nerve conduction, and needle EMG exam w/ neuromusclear junction dis.?
-Nerve conduction-NL
-Repetitive N conduction: decremental response;
-Needle EMG examination: NL
How does Neuromuscular Junction Dis. affect muscle tone, reflexes, & sensory?
Sensory-nl, reflexes-nl or reduced, muscle tone-nl or reduced.
How does NJD affect the bulbar musculature?
dysphagia, dysarthria--Neuro emergency!
What does NJD do to the eyes?
variable diplopia & ptosis (test for prolonged-2 minute upgaze or arm elevation)
A nerve lesion of which cranial nerve will give you upper & lower face weakness?
CN VII
How does a nerve lesion (axonal & demyelinating)appear on EMG?
Axonal: nl latency, reduced amplitude, nl conduction velocity,
Demyelinating (ex. GBS): prolonged latency, slowed conduction velocity, blocks.
How does a Nerve lesion appear on needle EMG?
Increased insertional activity,positive waves & fibrillation potentials, reduced recruitment, large polyphasic MUPs