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214 Cards in this Set
- Front
- Back
what are the 4 main myopathies discussed?
|
inflammatory
dystrophic metabolic corticosteroid |
|
what are the two neuromuscular junction (NMJ) diseases discussed?
|
Myasthenias Gravis
Botulism |
|
What Neuropathies were discussed?
|
median, ulnar, radial, peroneal nerve entrapment
|
|
what two forms of headaches were discussed?
(besides the one you get from class) |
cluster
subaracnoid hemorrhage |
|
what are the two inflammatory myopathies we covered?
|
dermatomyositis
polymyositis |
|
name the myopathy:
*presents ages 5-14yo *malar or heliotrope rash *edema of periorbital skin |
dermatomyositis- an inflammatory myopathy
|
|
pseudohypertrophic
|
Duchenne MD
|
|
Rubbery Calves - disease and cause of
|
Duchenne MD
from fat replacing CT |
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subsarcolemmal cytoskeletal protein
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Dystrophin
|
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what disease does this pertain to:
LABS sed rate, CPK-MM,Aldolase all increased TX: Steroids and inmmunosuppressants |
dermatomyositis and polymyositis inflammatory myopathies
|
|
most common dystrophy- especially kids and more common in bosy
|
Duchenne Muscular dystrophy
|
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Stabbing, penetrating, burning, explosive pain
ONLY on one side of head Starts at eyes and spread to same side of head |
cluster headache
|
|
secondary symptoms of cluster headache
|
stuffy or runny nose
redness or watering eyes droopy eyelid constrx of pupil facial swelling |
|
what disease?
presents age 50-60 yo can be viral, bacterial, idiopathic |
polymyositis
|
|
what disease?
*axial muscle wkness *phonation and deglutination affected*dysphonia & dysphagia |
polymyositis
|
|
in what disease is abscence or abnormal levels of Dystrophin an issue?
|
Duchenne MD, dystrophinopathies
|
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T/F? dystrophin protein is absent in all types of dystrophies?
|
FALSE, the "muscular dystrophies" have abnormalities with the muscle, not the protein
|
|
innervates skin of hand
flexor carpi digitorum hypothenar muscles |
ulnar nerve
|
|
results to Gower's Maneuver
|
Duchenne MD, when unable to walk
|
|
innervates flexor abductor digitiminimi
3rd and 4th lumbricals interroseous muscles |
ulnar nerve -
also innervates flexor carpi ulnaris |
|
combined the lumbricals and interosseus help to
|
flex the MCP joint
extend the IP joints |
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compression of nerve and transverse carpal ligament
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median nerve entrapment and carpal tunnel
|
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foot drop
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peroneal nerve entrapment
|
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difficulty grabbing and opening a jar
|
symptom of carpal tunnel syndrome - median nerve injry
|
|
ape hand
|
median nerve entrapment
|
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innervates skin of hand and most flexor muscles that flex fingers and wrist
|
median nerve
|
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Claw hand
|
injury of ulnar nerve
|
|
Labs:
CPK-MM increased to 50x Nl fibrosis necrosis and Fat infiltration seen on biopsy |
Duchenne MD
|
|
abscence of this protein causes wkness of sarcolemma and permits rupturing of muscle
|
Dystrophin - sarcolemmal cytoskeletal protein
|
|
walks on toes, contracture of achiles tendon, waddling gait
|
Duchenne MD
|
|
onset around age 4
ambulatory loss by age 8-12, death in teens or 20's |
Duchenne MD
|
|
signs/symptoms of carpal tunnel
|
pain and paresthesia in wrist and hand
pain may radiate to forearm, elbow, shoulder increased by flexion and/or extension of wrist wkness of grip weak thumb abduction and opposition |
|
restrictive pulmonary deficit from progressive kyphoscoliosis ----disease?
|
Duchenne MD
|
|
the most common nerve entrapment injury
|
carpal tunnel syndrome
|
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causes of carpal tunnel
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repetitive stress
excessive use of wrist CT thickening of the ligament **arthritic tenosysnovitis |
|
symptoms include generalized muscle cramps and early fatigue from exercise - lack of energy
|
McArdles metabolic myopathy- due to inability to break down glycogen to glucose for energy
|
|
pain and paresthesia in wrist and hand and first 3 1/2 fingers
|
carpal tunnel syndrome - median nerve entrapment
|
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corticosteroid myopathy
|
complications of high dose steroids
Cushing's Syndrome |
|
what treatments are available for carpal syndrome
|
splint wrist in neutral position
-steroid injection -surgical decompression division of carpal ligament |
|
subsarcolemmal glycogen vacuoles seen histologically
|
McArdles-metabolic myopathy
|
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treatment is limited to physical therapy and bracing
|
Duchenne MD
|
|
Tinsels test is diagnostic for
|
carpal tunnel syndrome
|
|
thenar atrophy is a late sign
|
carpal tunnel
|
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caused by myophosphorylase deficiency
|
McArdles disease
|
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what is Phalen's test?
|
carpal tunnel compression test -
|
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an endocrine disorder in which the adrenal gland overproduces corticosteroids
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Cushing's syndrome
|
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causes muscle catabolism, atrophy of fibers, wkness in shoulder, hip and other areas
|
Cushing's Disease - a metabolic myopathy
|
|
symptoms can include:
dysphagia, dyspnea, nasal speech, smile degeneration to snarl |
myasthenias gravis
|
|
what gland is a major player in Myasthenias Gravis?
|
Thymus gland - it produces the Ab that kill the Nm receptors causing rapid fatigability, and motor deficits
|
|
describe in order the affects of Myasthenias gravis on the body
|
1. eyelid-ptosis
2. extraocular - diplopia 3. bulbar muscles -nasal speech - jaw hangs open 4. dysphagia mimetic muscle inactivity smile degenerates to snarl intercostal musclse and diaphragm depressed |
|
death can be caused from respiratory muscle depression - cant take another breath in
|
botulism poisoning
|
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rapid fatigability
ptosis diplopia bulbar muscles affected |
Myasthenias Gravis
|
|
bacteria that cx foamy frothy food
|
Clostridium botulinum - an anerobic bacteria implicated in Botulism poisoning
|
|
deep tendon reflexes or sensory fx not affected but muscles of facial expression are
|
myasthenias gravis - a NMJ disorder
|
|
treatment includes discontinuation of steroids
|
Cushing's syndrome
|
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treatment includes pyridostigmine, plasmaphoreses, IV gamma globulin and immunosuppressants
|
Myasthenias gravis - NMJ disease
|
|
some symptoms of this disorder include:
acute progressive wkness w/in 72 hours -alpha motor neuron and parasympathetic terminals affected -dilated pupils -dry mouth |
botulilsm toxin poisoning - a NMJ disorder
|
|
'index muscle' is used for diagnosis of this
|
ulnar nerve lesion
|
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arthritis tenosysnovitis
|
implicated with carpal tunnel syndrome
|
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bilateral damage, may be an issue related to systemic conditions, diabetes, alcoholism
|
polyneuropathy
|
|
this causes loss of deep tendon reflexes (DTR's)
|
botulism
|
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unilateral affects
|
mononeuropathies
|
|
risus sardonicus is a rsult of ....
|
tetanus- Clostridium tetani
|
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T/F, Tetanus is not a NMJ disease?
|
True, it is a result of bacillus bacteria invasion of the brain and spinal cord
|
|
destruction of cholinergic axon terminals causing a decreased release of Ach is a sign of
|
Botulism poisoning
|
|
what is the treatment for Botulism toxin?
|
IV antiserum
cardiorespiratory support may be needed |
|
Bilateral damage
distal sensory nerves Distal motor nerves Bottoms of feet are 1st, Dorsum and ankles Calves and/or hands |
polyneuropathy
|
|
affects of this include blocking of inhibitory neurons, hyperreflexia, and muscle spasms
|
Clostridium tetani, Tetanus
|
|
this affects the cubital tunnel
|
ulnar nerve
|
|
this includes entrapment of compound nerves: ulnar, median, radial, peroneal and tibial
|
mononeuropathies - where nerve entrapment is the key issue
|
|
this nerve is implicated in 'saturday night palsey'
|
Radial nerve entrapment
|
|
this can be seen and palpated on the thumb side of the 2nd metacarpal
|
index muscle - diagnostic for ulnar nerve lesion
|
|
symptoms include difficulty spreading fingers, 1st dorsal interooseus atrophy, wk or atrophied
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ulnar nerve, cubital tunnel syndrome
|
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prominent 1st dorsal interosseus atrophy is a sign of this
|
index muscle - early diagnosis of ulnar nerve paralysis
|
|
wrist drop
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radial nerve entrapment
|
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worst headache of my life
|
subarachnoid hemorrhage from ruptured cerebral aneurysm
|
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innervates triceps, supinator, brachioradialis and skin of dorsum of hand
|
radial nerve
|
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atrophy of lumbricals,interosseus and hypothenar eminence
|
ulnar nerve (mainly)
|
|
the MC cx of subaracnoid hemorrhage
|
rupture of a cerebral aneurysm
|
|
restlessness, agitation and nausea area result of this
|
cluster headache
|
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signs are pain & paresthesia of dorsum of hand,fingers but not weak triceps, supination
|
injury at mid-humerus, from a blunt trauma
|
|
foot drop
|
entrapment of peroneal nerve from wearing too tight boots
|
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denervation causing muscle atrophy and tophic changes of the skin
|
atrophy of severe chronic denervation
|
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this nerve innervates wrist and finger extensors and helps flex elbow and aids supination
|
Radial nerve
|
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Lavisnky sign
|
take reflex hammer, stroked across ball of foot, and if upper motor neuron lesion in brain, the big toe flexes upward =
|
|
MC peripheral mononueropathy
|
proximal, middle,
|
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which cranial nerves are ONLY sensory
|
CN I, II, VIII,
olfactory, optic, vestibulochoclear |
|
smell, vision, parasympa to eyes
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CN I, II, III
olfactory, optic, occulomotor |
|
in a cranial neuropathy that affects CN 3, what is a deficit?
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medial rectus muscle - ocular convergence
levator palpebral - troubel opening the upper eyelid = hanging eyelid |
|
what causes hanging eyelid?
|
damage to CN 3, affecting the levator palpebral muscle
|
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superior oblique muscle, action and innervation
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CN 4,trochlear N. moves eye down and medially
|
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olfactory N
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CN 1
smell |
|
Vision
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CN 2, optic
|
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parasympathetic to eye muscles
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occulomotor CN 3
|
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miosis
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pupillary constrictor muscle CN 3
|
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lens focus
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CN 3, occulomotor
ciliary body |
|
ocular convergence
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medial rectus
|
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opens upper eyelid
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levator palpebral mucsle
|
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superior oblique muscle
action/nerv |
occulomotor
moves eye down and medially |
|
oronasal mucus membranes and teeth
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sensory action from CN 5, trigeminal
|
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corneal reflex
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cornea - sensory of CN 5, trigeminal
|
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facial nerve actions
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para to lacrimal gland - tears
submaxillary and |
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lateral movement of eye
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lateral rectus , CN VI
|
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submaxillary and sublingal glands - innervation
|
CN , facial
|
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motor to jaw muscles, masseter temporal and pterygoid muscles
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CN 5, trigeminal
|
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anterior 2/3 tongue, taste, pinna of the ear
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CN 7, facial - sensory fx
|
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obicularis orus closes eye in response to
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CN 7, facial nerve motor function
|
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facial expression
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facial mumetic muscles
|
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this .....muscle elevates the pharynx and larynx and is innervated by.....nerve
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stylopharyngeus muscle - CN 9 glossopharyngeal
|
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sensory from semicircular canals, saccule and utricle for dynamic and static balance
|
innervated by vestibulocochlear n
|
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mydriasis/asnisocoria
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pupillary constrictor, CN 3
|
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ptosis
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CN 3, levator palpebrae
|
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what two cranial nerves fx in salivation
|
CN 7, facial = submaxillary and sublingual
CN 9, glossopharyngeal - acts at parotid gland - salivation |
|
glossylpharyngeal
? sensory from |
S from: posterior 1/3 tongue=taste
*orpharynx - swallowing eustachian tube - middle ear pain carotid sinus & body |
|
CN 9, motor to
|
stylopharyngeal muscles-elevates pharynx and larynx
|
|
CN 10 - Vagus
*para motor? * sympa motor to |
para motor to abd & thoracic organs
*sympa motor - solft palate, pharynx, larynx |
|
CN 10 is sensory from ?
|
aortic bodies and arch
posterior 1/3 tongue pharynx, larynx, ear cancal |
|
anosmia
|
rare
CN 1 olfactory - cant smell |
|
what innervates the tongue?
|
posterior 1/3 = CN 10
anterior 2/3 taste-CN 7 CN 12 - motor to tongue |
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motor action of sternocleidomastoid and upper traps
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Cn 11, accessory
|
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gag reflex
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CN 10. cagus - via pharynx and layrnx
|
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the difference b/t diplopia and blurred vision
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diplopia is seeing two images from non fx EOM's and blurred vision is from failur of lens to accommodate - both CN 3
|
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herperacusis (loudness)
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stapedius muscle neuropathy - CN 7
|
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unilatery palsy of front of neck when frowning, unilateral facial wkness
|
platysma muscle - and facial muscles from motor fibers of CN 7
|
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sluggish or absent light reflex of eye
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deficit to pupillary constrictor muscle of CN 3
|
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jaw deviates to one side
"sidedness" |
CN 5 neuropathy of masticator muscles casuing wk or malaligned jaw
|
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Tic douloureux
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trigeminal neuralgia
short bouts of exruciating pain in any of the CN 5 facial divisions |
|
what can cause Diplopia ?
|
EOM not fx due to
1. palysy of CN 2. entrapment of eye muscle 3. orbital fracture from either CN 3, or CN 4 affecting medial rectus or superior oblique Cn 6 - lacteral rectus |
|
bilateral loss of corneal reflex , with numbness or pain
|
neuropathy of the facial dvision of trigeminal nerve
|
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dry eyes, dry mouth
|
deficits of CN 7, facila nerve -
para to lacrimal gland, submaxillary, sublingual glands |
|
vertigo and nystygmus
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sensory fibers of CN 8 vestibular
|
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severe pain in the ear for 2 days, vesicular rash in and external to ear
|
herpes zoster oticus
|
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greatest cause of grey hair, hair loss, palsy of buttocks
|
this class - just checking to see if you were paying attention :-)
|
|
Bell's palsey
|
facial paralysis of cN 7
(w/assoc.drooling) cx by viral infx, entrapment of nerve (acoustic neuroma) lyme disease (bilateral palsy) |
|
Meniere's Disease
|
recurrent episodes of low-freq hearing loss, tinnitus, vertigo, and nystygmus
cx by overproduction of endolymph in cochlear duct (CN 8) |
|
sensoneural hearing loss
|
sensory from Cn 8, cochlear
|
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causes of conductive hearing loss
|
-excessive cerumen
-otitis media -congenital ankylosis of ossicles -otosclerosis (older adults) |
|
causes of sensorineural hearing loss
|
dying hair cells -neuronal fx abnormal from
1.presbycusis 2. ototoxic drugs 3. acoustic neuroma 4.Meniere's disease |
|
what is Presbycusis
|
gradual dying off of cochlear hair cells with age
|
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what are the ototoxic drugs?
|
aminoglycosides and diuretic
|
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What is an acoustic neuroma?
|
slow-growing tumor (benign) of the Schwan cells (sometims schwannoma) surrounding CN 8, vestiublar portion
-unilateral deafness and nystagmus |
|
what is nystagmus?
|
involuntary cyclic movement of the eyes
|
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what is Meniere's Disease and how is it caused?
|
recurrent episodes of low-frequency hearing loss, tinnitus, vertigo and nystagmus
Cx: overproduction of endolymp in the cochlear duct |
|
differentiate between true vertigo and vasovagal syncope
|
True vertigo- pt feels she is moving or her surroundings are moving, ALWAYS cx some nystagmus, vertical, rotary, or horizontal. Vasov. does not present with that
|
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peripheral vertigo- cause
|
cx by abnl fx within the cochlea, semcircular canals or vestibular fibers of CN 8
|
|
peripheral vertigo - signs/symptoms
|
severe= pt falls; N/V, tinnitus or hearing loss and horizontal or rotary nystagmus
|
|
what are the 3 forms of peripheral vertigo?
|
Meniere's disease
Acoustic Neuroma Vestibular neuronitis |
|
Vestibular neuronitis:
(labrynthitis) |
viral,bacterial or idiopathic
(labrynthitis)acute onset vertigo, postural imbalance, N/V and persistent horizontal or rotary nystagmus. NO hearing loss |
|
CENTRAL VERTIGO
|
abnl fx in the vestibular nuclei- brainstem, cerebellum or cerebral hemispheres
|
|
Benign Positional Vertigo
|
common in the elderly
acute change of head position getting into or out of bed -due to carbonate crystals breaking off the otoliths in the utricle and clogging the posterior semicircular canal. |
|
symptoms of central vertigo
|
mild, no N/V tinnitus or hearing loss;
-nystagmus can be rotary or vertical |
|
in what diseases is central vertigo present?
|
*multiple sclerosis
*TIA, brainstem stroke *cerebellar hemorrhage |
|
what signs/symptoms often accompany central vertigo?
|
dysfunction of CN other than CN 8:
diplopia, dysarthria, dysphagia, facial wkness or numbness |
|
VESTIBULAR NEURITIS
|
– SIGNIF N/V, AND LATERAL NYSTAGMUS,
|
|
pt's vertigo is due to stx such as cerebellum, brainstem, etc , this is .....
|
central vertigo
|
|
vestibular apparatus is composed of
|
3 semicircular canals
utricle saccule |
|
if pt's vertigo is due to a problem anywhere from the root of CN 8 - toward and into the labyrinth, it is..
|
peripheral vertigo
|
|
deficient or absent gag reflex stems from what neuropathy?
|
dificit in CN 9, or 10
|
|
severe pain in throat, tongue, and ear on swallowing
|
glossopharyngeal neuralgia
|
|
constant pain in one ear, severe pain in throat and tongue
|
possibly cancer of the pharynx
|
|
paralysis of soft palate, nasal speech, deviation of uvula toward normal side onn phonation - due to what nerve issue?
|
CN 10 vagus
|
|
hoarseness of voice results from
|
paralysis of larynx
|
|
weakness turning head to the right
|
paralysis of LEFT sternocleidomastoid muscle of CN 11 accessory nerve
|
|
weakness shrugging left shoulder
|
paralysis of left trapezius- CN 11, accessory
|
|
deviation of protruded tongue toward weak side, & may possibly see fasciculations and atrophy of paralyzed side of tongue
|
CN 12 neuropathy
|
|
mononeuropathies
|
unilateral, asymmetric
|
|
-distal axons are sick
-starts in feet -symmetric,larger, fast-conducting, sensory fibers affected -affects DC-ML and DTR |
peripheral neuropathies
|
|
prototype for all peripheral neuropathies
|
diabetic neuropathy
|
|
2 phenomena of diabetic neuropathy
|
1. microangiopathy
2. direct axonal damage |
|
microangiopathy
|
happens to caps supplying distal nerves
-non-enzymatic glycosylation (caramellization) -advanced glycosylation endproducts -LDL trapped - atherosclerosis os small vessels |
|
what tissues do not require insulin in order to take up glucose from the blood?
|
nerves, kdiney, vessel walls, lens of the eye
|
|
what happens when plasma glucose is too high for too long?
|
and increased amount of glucose diffuses into nerve, kidney, vessal walls and lens of eye (tissues)
|
|
negative effects of increased intracellular sorbitol and fructose?
|
sorbitol cx degeneration of schwann cells - demyelination
both: inc'd intracellular osmolarity>osmosis>CELL LYSIS & SCWANN CELL INJURY |
|
signs and symptoms of diabetic neuropathy
|
large fiber neuropathy :
DC-ML fibers sensory>bottoms of feet>lower leg>hand> |
|
stocking and glove presentation
|
sensory:painles paresthesias, numbness, dec'd proprioception & vibration sense
motor:dec'd or absent ankle flexion, wk plantar/dorsiflexion |
|
amyloidosis
|
presents with small fiber neuropathy
A-delta, C-fibers== dysesthesias distal pain and temp loss proprioception/vibration preserved Nl reflexes |
|
dysesthesias
|
unpleasant abnoarmal sensation produced by normal stimuli to skin
|
|
focal neuropathies
|
acute onset of neuropathies -
acute vascular occlusion-ischemia-pain and neuro deficient |
|
diabetic opthalmoplegia
|
CN 3 cranial neuropathy
unilateral eye pain -diplopia -ptosis |
|
neurological issue associated with diabetes
|
stocking and glove
amyloidosis focal neuropathies cranial neuropathies risk of carpal tunnel autonomic neuropathies hyperglycemic unawareness neuroglycopenia |
|
hyperglycemic unawareness
|
unaware of early signs of low glucose:
-wkness,tremor, nervousness,tachycardia sudden neuroglycopenia: -visual disturbances -confusion, bizarre behavior -amnesia,seizures,coma |
|
T/F beta blockers are a recommended treatment?
|
FALSE!!!
|
|
Guillian-Barre' Syndrome
|
peripheral neuropathy
acute inflammatory demyelinating polyneuropathy aka postinfectious polyneuropathy |
|
affects of Guillian-Barre' syndrome
|
rapidly progressive, ascending motor wkness of:
legs,arms,resp myo, = paralysis early & general HYPO- or areflexia early paresthesias NO true sensory loss |
|
causes may include:
viral URI or GI infx, campylobacter jejuni infx, and may occur w/ SLE, or Lymphoma |
Guillian-Barre' Syndrome
|
|
signs and symptoms of GB syndrome
|
symmetri or asymmetric ascending weakness
-legs,arms,resp. myo -paralysis in 50%~1wk,90%1mo. -early & genera. hypreflexia or areflexia, and paresthesias 1/3 on vent. support, most 2-4 wk, paralysis all 4 limbs 5% die no true sensory loss, |
|
definitive signs and labs of GBS
|
inc'd CSF protein w/out pleocytosis
-ALWAYS present w/early and gen. hyporeflexia or areflexia- if wk patient has NL reflexes its NOT GBS |
|
prognosis and treatment for GBS
|
tx: leave it to the neuro team
prog: most recover completely w/in 3-6mo, some have residual weakness |
|
Lou Gerhrigs disease - Amyotrophic lateral sclerosis(ALS)
|
cx relentless progressive deterioration upper and lower motor neuron
|
|
CN with parasympathetic motor fibers
|
Cn 3, occulomotor
CN 7, facial n CN 9 glossophyrngeal CN 10 Vagus - |
|
primary headache
|
benign, no organic pathology
tention, cluster,migraine, rebound,caffeine withdrawl |
|
secondary headache
|
underlying disease or pathology
-glaucoma, temporal artiritis, meningitis, intracranial hemorrage |
|
sinusitis, influenza,severe HTN, lyme disease are what?
|
other secondary headaches
|
|
what are the majority of h/a classified as?
|
benign, primary
|
|
features of the h/p exam that indicate the h/a is secondary to serious pathology
|
marked change in h/a pattern
rapidly incrs. freq of h/a sudden onset of severe new onset after age 50 persistent h/a after trauma |
|
what combination of other symptoms makes you suspect secondary?
|
h/a + fever, nuchal rigity, pailledema, clumsy, seazures, impaired mental status, focal neuro signs
|
|
T/F pain from the h/a stems from neuronal structures of brain parenchyma
|
FALSE, there are no pain receptors there
instead it comes from cranial structures |
|
what cranial structures are implicated in the cause of pain of a headache?
|
1. head and neck muscles
2. scalp and vessels 3. meningeal & cerebral arteries 4. venous sinuses 5. pain AFFERENTS of CN 5,9,10 6 parts of dura matter at base of brain |
|
cause of tension h/a
|
stress, anxiety, depression,poor posture, alcohol, various meds, osteorathritis
|
|
signs and symptoms of tension headache
|
from none to moderate throbbing
dull, pressing or band-like pain bilateral |
|
treatment for tension h/a
|
self treat with aspirin, acetaminophen or ibuprophan
Rx: anaprox (naproxen) |
|
antipyretic, analgesic, anti-inflammatory
|
NSAIDS, aspirin, but NOT acetamenophin - not anti-inflammatory
|
|
butalbital
|
barbiturate that has potential for addiction
|
|
what happens if you use butalbital more than 2x week?
|
risk of progression to chronic daily h/a
= rebound h/a |
|
define chronic daily h/a
|
presence of tension h/a at least 6 days/week
|
|
what Rx treatments for tension h/a?
|
NSAIDS, muscle relaxant
|
|
pericranial muscles
|
cause of tension h/a
they include the : 1. frontalis 2.temporalis 3/ sternocleidomastoid r. trapezius |
|
T/F tension and cronic daily h/a's are avascular?
|
true
|
|
migraine - where
|
vascular h/a
cerebral cortex is hyperexcited, unilartery |
|
cephalgia
|
head pain aka cephalalgia
|
|
mood change, blurred vision, flashing lights, photophobia, tingling, numbness
|
migrain headache
|
|
vasocontrictive phase
|
causes pts auras
|
|
vasodilatory phase
|
causes the headache itself
|
|
signs and symptoms of migrained
|
throbbing, unilateral,photophobia +/or phonophobia
wavy lines-teichopsia weakness, clumsy |