Clinical Neuro Flashcards
(59 cards)
1
Q
C5 Motor control
A
deltoid, biceps
2
Q
C6 Motor control
A
wrist extension
3
Q
C7 Motor control
A
triceps
4
Q
C8 Motor control
A
finger flexors
5
Q
T1 Motor control
A
hand intrinsics
6
Q
L1, 2, 3 Motor control
A
iliopsoas
7
Q
L2, 3, 4 Motor control
A
quads
8
Q
L4, 5 Motor control
A
tibialis anterior
9
Q
L5-S1 Motor control
A
peroneus longus and brevis
10
Q
S1 Motor control
A
gastroc/soleus
11
Q
biceps reflex nerve root
A
C5-6
12
Q
brachioradialis reflex nerve root
A
C5-6
13
Q
Triceps reflex nerve root
A
C7-8
14
Q
knee jerk nerve root
A
L2-4
15
Q
achilles/gastroc reflex nerve root
A
S1
16
Q
DTR grade changes with CNS involvement
A
goes up–>hyperactive
17
Q
DTR grade changes with peripheral nerve involvement
A
goes down–>diminished or absent
18
Q
peripheral nerve sensations
A
light touch, pain and temp, proprioception, vibration
19
Q
cortical sensations
A
2 point descrimination, stereognosis, graphesthesia, bilateral simultaneous localization
20
Q
DTR grading scale
A
0=absent, 1+=diminished, 2+=normal, 3+=increased, 4+=hyperactive
21
Q
CLASSIFICATIONS of acute traumatic peripheral nerve injuries
A
neuropraxia, axonotmesis, neurotmesis
22
Q
neuropraxia
A
reversible conduction block from ischemia. if due to mechanical compression, recovery begins 1 minute after removal of pressure
23
Q
axonotmesis
A
axonal interruption but basal lamina remains intact; wallerian degeneration; 6+ hours of mechanical compression; good prognosis but several months for nerve to regenerate.
24
Q
neurotmesis
A
nerve fiber and basal lamina interruption-COMPLETE severance of nerve. poor prognosis for recovery.
25
Wallerian degeneration
process of axon separating from the neuron's cell body when nerve is cut or crushed, and degenerating distal to the injury.
26
CATEGORIES of peripheral nerve lesions
mononeuropathy, mononeuropathy multiplex, polyneuropathy, plexopathy, radiculopathy
27
mononeuropathy
compression, traction or vascular in origin. ex: carpal tunnel, thoracic outlet syndrome
28
mononeuropathy multiplex
discrete lesion of multiple individual peripheral nerves. often caused by vascular disorders affecting blood supply to peripheral nerves. appears random. causes: multiple compression, necrotizing vasculitis, diabetes, inflammation, malignant infiltration
29
polyneurophathy
can be motor, sensory, sensorimotor or autonomic. more likely bilateral/symmetrical. usually LE before UE symptoms. causes: Charcot-Marie_Tooth, diabetes, renal diseases, Guillan-Barre, AIDS meds, chemo, SLE, Vit B deficiency, multiple myelopathy
30
plexopathy
damage to plexus (brachial, lumbar) by tumor or trauma
31
Radiculopathy
damage to NERVE ROOT. usually caused by disc bulge or herniation, tumor, or herpes zoster causing damage to the dorsal root
32
Diabetic neuropathies
sensory polyneuropathy, autonomic neuropathy, diabetic focal neuropathy
33
sensory polyneuropathy
most common form of diabetic neuropathy. insidious onset, loss of achilles tendon reflex, and decreased vibratory sense in the feet. may present with distal pain and paresthesia. loss of protective pain sense-->foot ulceration, fxs, neuropathic joints. sensory loss happens first, bilaterally in stocking/glove fashion. may progress to motor and motor loss happens second, proximal to distal, asymmetrical.
34
autonomic neuropathy
will affet internal organs/heart. sx: loss of sexual response, hypotonic bladder w/ recurrent infection or incontinence, BP and HR disturbance, GI dysfunction,, diffuse or absent sweat
35
diabetic focal neuropathy
appears suddenly, affecting specific nerves, tends to improve in weeks or months without chronic damage. may present as femoral or pelvic pain, chest or abdominal pain, pain behind eyes or blurred vision, other CNS sx. This population more susceptible to nerve compression syndromes.
36
Tx for diabetic neuropathies
control blood glucose level, relieve discomfort, special care, and shoes, meds for pain, no heat, BP regulation, white socks.
37
alcoholic neuropathy
caused by vitamin B deficiency, pathology is axonal degeneration (NOT demyelination), resulting in severely decreased amplitudes of sensory action potentials and relatively mild reduction of motor and sensory conduction velocities. presents as a mixed neuropathy with a combo of weakness, parathesia and pain, affecting principally or solely the lower limbs.
38
Guillain-Barre syndrome
acute onset, inflammatory attack resulting in myelin breakdown and often axonal degeneration. progressive, symmetrical polyradiculopathy affecting moror and sensory w/ ANS symptoms.
39
Charcot-Marie-Tooth Disease (CMT)(HMSN)
aka Hereditary Motor and Sensory Neuropathy-common inherited neurological disorder (1/2500). loss of muscle tissue and sensation across various parts of the body. 70% autosomal dominant mutation of chromosome 17. also can be autosomal recessive or x-linked.
40
neuropraxias
compartmental compression syndromes: thoracic outlet syndromes, carpal tunnel syndrome, Pronator teres syndrome, ulnar nerve compression syndrome, brachial compression at axilla, saturday night palsy (mid-humeral radial nerve compression)
41
Bell's Palsy
facial paralysis resulting from dysfunction of CN 7. acute onset (72 hours). 70% recover within one year. 50% idiopathic, 15% infectious, 14%neurologic, 14% neoplastic, 8% trauma.
42
myasthenia gravis
affecting the neuromuscular junction, circulating antibodies block Ach receptors at the post synaptic NMJ. PT intervention: energy conservation, low impact aerobics.
43
peripheral nueropathy motor symptoms
weakness, DTR absent, Atrophy, Fibrillations, Fascicultions
44
Peripheral neuropathy sensory symptoms
sensory symptoms lead to motor symptoms. numbness, decreased sensation, paresthesia (pins and needles), dysesthesia (burning), hyperesthesia (increased sensitivity), decreased joint position sense
45
peripheral neuropathy sympathetic symptoms
altered sweating, blood flow, temperature, texture/color/smoothness change, hair loss, edema, hyperesthesia, cardiac/GI/GU symptoms
46
three types of Guillain-Barre syndrome
GBS=Acute inflammatory demyelinating immune-mediated polyneuropathy, acute motor axonal neuropathy, acute motor and sensory neuropathy
47
GBS Acute inflammatory demyelinating immune-mediated polyneuropathy
most common form of Guillain-Barre demyelinating polyneuropathy. good prognosis, normal function within a year for most
48
Acute motor axonal neuropathy (GBS)
variant of GBS that only affects motor axons. Severe with slow recovery.
49
Acute motor and sensory neuropathy (GBS)
less common form of GBS with worse prognosis. some consider it a distinct type of peripheral neuropathy.
50
PT Intervention for GBS
respiratory monitoring, prevent contracture, manage pain and skin breakdown. sub-acute: ROM, ADLs, strengthening w/o fatigue,. same but more for long term mgmt.
51
2 forms of CMT/HMSN
demyelinating neuropathies, axonal neuropathies
52
demyelinating neuropathy CMT
mutation of peripheral myelin protein gene. thickened/abnormal myelin axons or demyelination depending on the type.
53
axonal neuropathy CMT
results from abnormalities of the nerve axon rather than the myelin sheath
54
PT intervention for CMT
orthotics, high toe box shoes, UE ADL assistive devices, stretch plantar fascia, maintain ROM of foot and hand arches
55
clinical presentation of demyelinating CMT
family hx, symptoms by 20, slow progression weakness & atrophy beginning in distally, foot drop-->high-steppage gait, inverted champagne bottle limbs, pes cavus, AREFLEXIA, diminished vibration and proprioception, gait ataxia, spinal deformity, essential tremor, enlarged palpable peripheral nerves, cardiac conduction abnormalities, phrenic nerve involvement w/ diaphragm weakness
56
HMSN
Hereditary Motor and Sensory Neuropathy
57
compartmental compression syndromes
neuropraxias: TOS, CTS, Pronator Teres Syndrome, Ulnar nerve compression at elbow and wrist, brachial compression at axilla, saturday night palsy
58
LE compartmental compression syndromes
peroneal nerve at head of fibula, tarsal tunnel syndrome
59
shingles
herpes zoster-peripheral neuropathy. most common neurotrophic viral infections. affects the posterior root ganglia-->pain and vesicular skin eruption in sensory distribution of the affected nerve. occasionally affects AHC (5%). severe burning pain.
