Palsy

Question 1

what is a palsy

Answer 1

paralysis usually accompanied weakness, loss of feeling and with involuntary tremors or movements

Question 2

what is cerebral pasly

Answer 2

non-progressive disorder of tone and posture from an acquired pre- or post-natal insult (up to 30 days of life)
not usually apparent at birth, may be noted as early as 4 months, definitely by 2 years

Question 3

what are the risk factors of CP

Answer 3

include permaturity, perinatal deprivation of blood or oxygen to the brain via:
PVL(periventricular leukomalacia), IVH (Intraventricular hemorrhage) or Hypoxic-ischemic encephalopathy (HIE), maternal infection, trauma, and other processes involving ischemia, inflammation, infection, genetic predisposition

Question 4

what maternal infections increase the risk of CP

Answer 4

Zika
TORCH -
Toxoplasmosis
Other
Rubella
CMV
HSV

Question 5

what are the classifications of CP

Answer 5

Hypotonic
Hypertonic or Spastic
Dystonic
Cerbellar ataxia

Question 6

what are the types of Hypotonic CP

Answer 6

quadriparesis or tetrapaesis
diaparesis or diplegia
hypotonia with choreoathetosis

Question 7

what are types of Hypertonic or spastic CP

Answer 7

quadriparesis
hemiparesis
diparesis or diplegia

Question 8

what is dystonic CP

Answer 8

facial rictus, stimultaneous contaction of agnoist and antagonist muscles, opsithotonus

Question 9

what is cerebellar ataxia CP

Answer 9

unsteady wide - based gate, gross motor delay, coordination and balance problems (~3%)

Question 10

how is CP diagnosed

Answer 10

labs - look for congenital infection in mothers and kids
imaging - mri for brain changes or normal

Question 11

what are differential diagnoses for CP

Answer 11

some neurodegenerative and neurometabolic disorders can mimic, genetic testing is helpful in differentiating

Question 12

what is the prognosis of CP

Answer 12

spasticity tends to worsen with time vs hypotonia can improve with age

Question 13

what is the intelligence level in CP patients

Answer 13

cognitive impairment does not always match physical deficits. can have normal intelligence with more severe hyper- or hypotonicity

Question 14

what is the treatment of CP

Answer 14

multidisciplinary approach:
PT/OT
Bracing
Pharmacologic treatment of spasticity

Question 15

what are generalized medications treatments for CP

Answer 15

oral antispasmodics (baclofen, tizanidine, benzodiazepeine)

Question 16

what are localized treatments for CP

Answer 16

botulinum toxin (botox), bracing, orthopedic surgery, neurosurgery

Question 17

what is a selective dorsal rhizotomy

Answer 17

effective in young children with spastic dispraises who can walk - involved cutting abnormal nerve in lower spinal cord to relax muscles

Question 18

what is radial nerve palsy

Answer 18

paralysis of radial nerve due to compression of nerve against humerus

Question 19

what is the common cause of radial nerve palsies

Answer 19

fracture of the humerus - during fracture or repair
sedated with ETOH, falling asleep with chair over arm
during sleep with a parner resting on your arm

Question 20

when are radial nerves more likely to be severed and need repair

Answer 20

open fractures, high energy traumas, open wounds

Question 21

what are the symptoms of radial nerve palsy

Answer 21

pain, weakness, loss of function in wrist, hand and fingers
numbness over the lateral dorsum of hand
wrist drop or finger drop

Question 22

what is the cause of axillary radial nerve compression

Answer 22

crutches and the triceps muscle is affected and interferes with elbow extension

Question 23

how is radial nerve palsy diagnosed

Answer 23

ultrasound can be used to distinguish between nerve ruptures, swelling around nerve, neuroma formation

Question 24

what is the initial treatment for radial nerve palsy

Answer 24

brace or spline and PT plus NSAIDs - 90% will improve with observation alone and can take 3-6 months

Question 25

what is bells palsy

Answer 25

weakness or paralysis of facial muscles caused by damage to CN7, facial nerve (mononeuropathy)

Idiopathic

Question 26

what are known conditions associated with Bells palsy

Answer 26

associated with viral infections (HSV, EBC, VZV)
associated with lyme disease
if caused by stroke, trauma it is NOT bells palsy

Question 27

what neurons are responsible for saliva production as well as lacrimal glands and nasal oral mucous membranes

Answer 27

neurons from the motor complex

Question 28

what carries info from anterior 2/3 of the tongue

Answer 28

neurons from the motor complex

Question 29

are patients with Bells Palsy able to lift their eyebrow

Answer 29

NO

Question 30

what must be excluded for bells palsy diagnosis

Answer 30

stroke, tumor or trauma

Question 31

what are risk factors for Bells Palsy

Answer 31

PREGNANCY, DIABETES, OLD AGE , immune compromise - can also be caused by HIV, Sarcoidosis, lyme, meningitis

Question 32

what is the presentation of Bells Plasy

Answer 32

sudden onset, muscle weakness maximal at 48 hours after onset
onset can be preceded or accompanied by retro-aural pain which lasts a few days

Question 33

what labs and studies are done for the diagnosis of Bells Palsy

Answer 33

CBC, BMP, magnesium, and calcium, HgbA1c, ESR, Lyme titer, ANA,RF, HIV, +/- MRI if clinical exam suggests lesion

Question 34

what is the treatment of bells palsy

Answer 34

usually resolves within 6 months - but can be permanent
treatment is not usually required but if severe - can use corticosteroid to reduce inflammation of the nerve (high dose pred)

Question 35

where does the facial nerve originate

Answer 35

in the brainstem

Question 36

what neurons travel along with the facial nerve

Answer 36

motor and sensory neurons