Common Clinical Presentations Flashcards
(13 cards)
SC injury sparing posterior columns
ASA (anterior spinal artery) stroke
Ascending paralysis, hyporeflexia, autonomic instability
GBS
Give IVIG not steroids
Lucid interval followed by rapid decline in level of consciousness
epidural hematoma (DOES NOT CROSS SUTURES)
Bilat cape-like loss of pain and temp sensation
Central SC lesion (syringomyelia)
Because preferentially affects spinothalamic and multiple cervical levels
Fatigable muscles
MG - esp after exercise (decremental response w/ repetitive stimulation)
- more bulbar and eye findings
Lambert eaton - better w/ short bursts of exercise, worse sustained activity (decremental response w/ slow repetitive stimulation BUT incremental response w/ fast or tetanic repetitive nerve stimulation)
- rarely bulbar/ocular, autonomic dysfunction
Weakness of shoulders and hips with sparing of ocular, pharyngeal and facial muscles
Limb-Gurdle Muscular Dystrophies
Boys & girls equally affected
Weak and stiff distal muscles + myotonia
Myotonic Dystrophy
tx = phenytoin and carbamazepine for tone
joint contractures + weakness/atrophy of biceps, triceps, ant tibialis and peroneal muscles
Emery-Dreifuss Muscular Dystrophy
Immuno-staining for emerin
No specific tx, ROM for dec contractures
May also have cardiomyopathy
Periodic paralyses (episodic muscle weakness)
Channelopathies
Fever, depressed arousal, muscle rigidity, autonomic dysfunction
neuroleptic malignant syndrome
From dopamine blockade (haloperidol, risperidone, chlorpromazine, clozapine, sudden dec L dopa)
Tx - stop offending drug, fluid resuscitation, support in ICU
Proximal muscle weakness, heliotrope rash, Gottren patches on knuckles
Dermatomyositis
Polymyositis if no skin manifestations
Tx = steroids
Asymmetric, proximal and distal muscle weakness, elevated CK, not responsive to steroids
Inclusion body myositis
basophilic rimmed vacuoles on biopsy
Hypothyroid v hyperthyroid muscle problems
Both present w/ proximal muscle weakness and resolve with treatment of underlying disease
Hypo = high CK and slow relaxation of reflexes (may take longer to resolve even once euthyroid)
Hyper = normal CK, may have brisk reflexes
