Nerve damage

Question 1

where is an UMN

what does it do

Answer 1

brain/brain stem/ventral cord of spinal cord

supplies input to LMN

Question 2

where is an LMN

what does it do

Answer 2

outside spinal cord

commands muscle contraction, supplied by UMNs

Question 3

aetiology of LMN lesion (3)

Answer 3

MND
nerve compression
diabetic neuropathy

Question 4

aetiology of UMN lesion

Answer 4

stroke
brain tumour
spinal cord problem

Question 5

do UMNs supply the face bilaterally or unilaterally

Answer 5

bilaterally

Question 6

do LMNs supply the face bilaterally or unilaterally

Answer 6

unilaterally

Question 7

how does UMN lesion present in face

Answer 7

bilaterally with forehead sparing (bc forehead has bilateral supply)

Question 8

how does LMN lesion present in face

Answer 8

unilaterally (incl forehead)

Question 9

what is the nerve supply to the forehead(where do the UMNs come from)

Answer 9

bilateral - has UMNs from both sides

Question 10

tone in UMN lesion

Answer 10

increased

Question 11

tone in LMN lesion

Answer 11

decreased

Question 12

atrophy in LMN lesion

Answer 12

increased (presents as wasted muscles and weakness)

Question 13

atrophy in UMN lesion

Answer 13

no

Question 14

reflexes in UMn lesion

Answer 14

hyperreflexia eg babinskis sign

Question 15

reflexes in LMN lesion

Answer 15

diminished (problem at the last part of reflex)

Question 16

is ‘fingers feel like a bunch of bananas’ an UMn or LMN lesion sign

Answer 16

UMN - increased tone in fingers (LMN would have wasting)

Question 17

what do the toes do in babinskis

what is the normal plantar response

Answer 17

fanning - up and down

usually curl down

Question 18

is bells palsy UMn or LMN

hence how does it present in face

Answer 18

LMN

unilateral motor and sensory loss including forehead (drooping of face)

Question 19

which nerve is damaged in bells palsy

Answer 19

CN VII (facial)

Question 20

radiculopathy definition

Answer 20

damage to anterior and posterior rami of one spinal nerve

= probs sensory and motor dysfunction in that myotome/dermatome

Question 21

cervical disc prolapse causes problems where

Answer 21

arms

Question 22

lumbar disc prolapse causes problems where

Answer 22

legs

Question 23

what do you want to find out once you’ve figure out its a radiculopathy (nerve problem)

Answer 23

use dermatomes/myotomes to figure our which nerves

if several ?named nerve problem

Question 24

treatment of lateral disc prolapse

treatment of central disc prolapse

Answer 24

lateral - nothing, just symptomatic, more hassle than its worth
central - surgery bc irreversible, patients choice (risks of surgery)

Question 25

aetiology of brown sequard syndrome (2)

Answer 25

trauma - knife injury | demyelination

Question 26

how does brown sequard syndrome present

Answer 26

ipsilateral paralysis ipsilateral loss of vibration and fine touch contralateral loss of pain and temp

Question 27

why is paralysis and loss of vibration and fine touch ipsilateral in brownsequard syndrome

Answer 27

corticospinal tract and dorsal column cross fibres at the medulla (above the lesion)

Question 28

what part of the spine is affected in brown sequard syndrome

Answer 28

half of it (spinal cord hemisection) L or R

Question 29

why is pain and temp loss contralateral in brown sequards syndrome

Answer 29

spinothalamic tract crosses fibres below the lesion (as the enter the spinal cord)

Question 30

aetiology of central cord syndrome

Answer 30

syringomyelia | trauma - old person with fall and hit head

Question 31

pathophysiology of central cord syndrome

Answer 31

reduced blood supply to centre of spinal cord

Question 32

which spinal tract is completely fine in central cord syndrome

Answer 32

dorsal column

Question 33

how is the corticospinal tract affected in central cord syndrome

Answer 33

``` lateral fibres (leg) are fine medial fibres (arm) are affected ```

Question 34

is fine touch normal or affected in central cord syndrome

Answer 34

normal

Question 35

what motor supply is affected in central cord syndrome

Answer 35

arms - bc they are more medial than legs

Question 36

how is the spinothalamic tract affected in central cord syndrome

Answer 36

it is lateral so not affected BUT fibres that enter at that level cross over in the spinal cord here so they are affected eg if central cord syndrome at C5-6 = loss of pain and temp sensation to badge patch and thumb

Question 37

what type of weakness occurs in central cord syndrome

Answer 37

upper limb weakness

Question 38

presentation of central cord syndrome (2)

Answer 38

upper limb weakness (from medial corticospinal tract) pain and temp loss at nerves that enter spine at level of damage (cape like ST loss) NO loss of fine touch (dorsal column fine) lower limbs fine

Question 39

treatment of bone mets to spine

Answer 39

dexamethasone high dose | radiotherapy

Question 40

treatment of primary bone cancer

Answer 40

surgical excision

Question 41

where does osteomyelitis (infection) usually occur in the spin

Answer 41

epidural abscess

Question 42

what type of spine problem gets worse walking up hills

Answer 42

spinal claudication

Question 43

loss of bladder/bowel control saddle anaesthesia erectile dysfunction loss of motor function in legs (paralysis)

Answer 43

cauda equina SURGICAL EMERGENCY

Question 44

treatment of cauda equina

Answer 44

emergency surgical decompression

Question 45

plexopathy definition

Answer 45

nerve damage to a plexus

Question 46

peripheral neuropathy definition

Answer 46

damage to a peripheral nerve

Question 47

what is mononeuritis multiplex

Answer 47

damage to more than one peripheral nerve

Question 48

what is guillain barre syndrome

Answer 48

acutee motor demyelinating neuropathy | usually post infectious

Question 49

presentation of guillian barre syndrome

Answer 49

pain progressive paraplegia (lower limbs) diarrhea (from infectious cause)

Question 50

treatment of guillian barre syndrome

Answer 50

IVIg or plasma exchange

Question 51

what is a rare genetic neuropathy

Answer 51

hereditary sensory motor neuropathy - range of presentations

Question 52

is bells UMN or LMN who does this present

Answer 52

LMN = unilateral face drooping INCLUDING forehead

Question 53

is hyperreflexia UMN or LMN

Answer 53

UMN