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75 Cards in this Set

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Destructive or compressive CNS lesions often cause what kind of sensory symptoms?
negative (sensory loss)
Name two reasons for a cold feeling in the legs
neurologic, peripheral vascular disease
Complaint of "tightness" n a band around the chest is characteristic of what kind of lesion?
spinal cord
Name three neurologic reasons for gait difficulty?
weakness, sensory ataxia, cerebellar ataxia
Diminished perianal and genital sensation indicates what kind of lesion (2)?
spinal cord, sacral nerve root lesion
Where can you localize urinary incontinence to?
upper motor neuron dysfunction (brain,spinal cord), or lower motor neuro dysfunction (peripheral nerves)
If upper extremities are not involved in a lesion, it is most likely below where?
brachial plexus, C5-T1
What is the difference between a relative sensory level and an absolute sensory level?
relative-sensation partially diminished below the level
absolute- sensation completely absent below the level
What is a "hung" sensory level?
The sensory level can be below the actual location of the lesion
Name some exam findings consistent with spinal cord disease
paraparesis (weaknessof both legs), hyperreflexia, bilateral Babinski signs, sensory level, urinary incontinence
What is syringomyelia?
cystica cavitation of spinal cord; typically associated with congenital brainstem anomatlies, remote spinal cord trauma, or tumors in the spinal cord
loss of pain and temperature in cape-distribution,atrophy and weakness, and spastic para or quadriparesis describes?
cervical syringomyelia
Sensory level- loss of vibration and proprioection describes?
neurosyphilis- affecting posterior columns
Spastic paraparesis with sensory level to vibration & proprioception describes?
Vitamin B12 deficiency, involving posterior and lateral columns (HIV can present similarly)
Spastic paraparesis and sensory level to pain/temperature describes what?
anterior spinal artery infarction
What happens to reflexes in anterior spinal artery infarction?
reflexes and tone can be decreased at first, but you would expect them to be increased- bc it's an upper motor neuron problem
Weakness and sensory level to vibration/proprioception ipsilateralto lesion; sensory level to pinprick contralaterally below lesion describes?
brown sequard syndrome; caused by lateral hemisection of the cord
What does HTLV-1 do to the CNS?
infection of the spinal cord, which leads to a myelopathy primarily affecting the corticospinal tracts of the thoracic cord
Bilateral lower extremity weakness and spasticity describes?
HTLV-1 associated myelopathy
Which tract crosses over in the spinal cord rather than in the brainstem?
spinothalamic (pain & temp)
What is the best imaging test to check for spinal cord compression?
MRI
What do you do for management of severe spinal cord compression?
consider iv methylprednisone, consider radiation if known cancer, emergent neurosurgery consult for resection and decompression
How long does it take spinal cord to get serious damage?
can occur within 24 hours
What is autonomic hyperreflexia and when does it occur?
when normal stimuli lead to excess sympathetic nerve activation, occurs with cervical and thoracic cord lesions
What is neurogenic bladder?
occurs due to dysynergy between the detrusor and sphincter muscles; resulting in flaccid bladder
What do patients complain of who have distal weakness?
impaired fine motor skills
What do patients complain of with proximal weakness?
heaviness of the limbs
Symmetric onset of paresthesias with distal weakness most likely localizes to?
peripheral nerves or nerve roots
Is a spinal cord lesion usually symmetric or asymmetric in onset?
asymmetric
Is a spinal cord lesion associated with bowel/bladder dysfunction?
yes
Do neuromuscular junction and muscle disorders normally present with proximal > distal or vice versa weakness?
proximal > distal weakness
Distal weakness symmetric in all four extremities is most consistent with what type of nerve disorder?
peripheral nerve disorder
What would you expect of a sensory exam in a peripheral nerve disorder?
normal, but you can have paresthesias and pain
Decreased reflexes mean dysfunction of?
lower motor neurons
What would you expect of coordination testing in a lower motor neuron problem?
slow, but not ataxic
why do pts. with distal le weakness have high stepping gait?
inability to dorsiflex foot at the ankle
What studies are ordered when peripheral nerve, NMJ,or muscle disorder is suspected?
EMG and nerve conduction study (NCS)
What does abnormal EMG tell you?
there is a problem with the axons
What does abnormal NCS tell you>
Abnormal myelin
What is lumbar puncture finding in GBS?
increased protein
Why do you get increased protein in GBS?
myelin breakdown in subarachnoid space as the root exits the cord
What type of cell mediates demyelination in GBS?
macrophages
Which nerve roots does GBS affect more than the other?
ventral > dorsal
When is peak of GBS symptoms?
2-4 weeks
What should be measured to monitor respiratory status in GBS?
FVCs and NIFs
What is FVC?
FVC is the maximal amount of air that can be exhaled after a maximal inhalation.
Normal FVC is 3-6 liters, depending on age, gender & height.
If image gets better if you close one eye, what does that mean?
disconjugate gaze, rather than monocular diplopia which means structural abnormalities within the eye
What does shortness of breath, better when sitting mean?
gravity helps the diaphragm work when you are sitting down
Where are you likely to note weakness in someone with nmj problem?
proximal muscles, vs. distal
In NMJ or nerve problem (vs. central), is weakness likely to be symmetric or asymmetric
symmetric
What would you expect of sensory exam in myopathy or NMJ disorder?
normal
What would you expect of reflexes in myopathy or nmj disorder?
normal, in severe cases they can be depressed
Fatigability of weakness indicates likelines of which type of problem?
NMJ
Muscle atrophy, fasiculations, and hyperreflexia with asymmetric pattern indicates?
ALS
What is the mechanism of MG?
ACh receptor antibodies prevent depolarization, act a postsynaptic receptor
What is the mechanism of LEMS?
voltage gated ca channel antibodies block calcium influx needed for Ach release at pre-synaptic terminal
What is the mechanism of action of aminoglycosides at nerve terminal? rela
block voltage gated calcium channels
What is the MOA of botulinum toxinat presynaptic membrane?
prevents veiscles from anchoring at presynaptic membrane to release AcH
What would you expect of EMG/NCS in NMJ disease?
normal
What additional testing could you get if you suspected NMF problem?
repetitive nerve stimulation (will show decrement), single fiber EMG, esp. in face, will show "jitter"
What is the most sensitive test for myasthenia gravis?
SFEMG (95% sensitive)
What antibodies can you look for in someone with MG?
acetylcholine receptor antibodies or anti-MuSK antibodies
What defines myasthenic crisis?
presence of respiratory distress requiring ventilatory assistance
What is severe MG treated with?
IVIG or plasmapheresis, same dose as GBS, except give IVIG for 6-8 days
What else should you do to evaluate patient with MG?
Get chest Xray to evaluate for thymoma
How many patients with MG also have thymoma?
10-15%
What drug to you use to treat MG?
pyridostigmine- cholinesterase inhibitor
Long term treatment of MG?
thymectomy (even if no thymoma, avoid aminoglycoside antibiotics, continue pyridostigmine
Why take out thymus of someone without thymoma?
because more than half of patients with MG have thymic hyperplasia; lots of ppl improve with thymectomy
What other therapies can you use if MG isn't controlled with cholinesterase inhibitors?
corticosteroids, myophenolate mofetil, azathioprine, cyclosporine, cyclophosphamide
What nerve is messed up in foot drop?
peroneal nerve?
Patients with foot drop due to peroneal nerve palsy have what kind of inversion?
strong
Patients with foot drop due to l5 radiculopathy have what kind of inversion?
weak
What parts of the leg does L5 dermatome involve?
lateral shin, medial foot, big toe
What tract dysfunction is clonus a sign of?
corticospinal tract