Neuro Differential Diagnosis Flashcards
(76 cards)
1
Q
common UMN diseases:
A
MS
ALS
stroke
SCI
TBI
2
Q
UMN
Structures Involved -
A
Cortex, brainstem, spinal cord
3
Q
UMN
Tone -
Reflexes -
A
tone: Increased SPASTICITY - Velocity dependent
reflexes: Hyperreflexia and abnormal reflexes - Clonus, Babinski
4
Q
UMN
Sensation -
A
Decreased
5
Q
UMN
Involuntary Movements -
Voluntary Movements -
A
Involuntary Movements - Muscle spasms
Voluntary Movements -Movements in synergic patterns
6
Q
common LMN diseases:
A
ALS
GBS
polio
peripheral neuropathy
7
Q
LMN
Structures Involved -
A
Peripheral nerves, nerve roots, cranial nerves
8
Q
LMN
Tone -
Reflexes -
A
tone: Decreased - hypotonia
reflexes: Hyporeflexia or absent
9
Q
LMN
Sensation -
A
Decreased
10
Q
LMN
Involuntary Movements -
Voluntary Movements -
A
Involuntary Movements - Denervationf asciculations
Voluntary Movements - Weak or absent
11
Q
common Basal Ganglia diseases:
A
Parkinson’s
Huntington’s
Dystonia
12
Q
Basal Ganglia
Structures Involved -
A
Basal ganglia
13
Q
Basal Ganglia
Tone -
Reflexes -
A
Tone: IncreasedRigidity NOT Velocity dependent
Reflexes: Decreased or normal
14
Q
Basal Ganglia
Sensation -
A
Normal
15
Q
Basal Ganglia
Involuntary Movements -
Voluntary Movements -
A
Involuntary Movements - Resting tremors
Voluntary Movements - Bradykinesia, akinesia
16
Q
Cerebellum
Structures Involved -
A
Cerebellum
17
Q
Cerebellum
Tone -
Reflexes -
A
Tone: Decreased or normal
Reflexes : Decreased or normal
18
Q
Cerebellum
Sensation -
A
Normal
19
Q
Basal Ganglia
Involuntary Movements -
Voluntary Movements -
A
Involuntary Movements - None
Voluntary Movements - Ataxia, Intention tremor, Dysdiadochokinesia, Dysmetria, Nystagmus
20
Q
Presence of which of the following signs is MOST INDICATIVE of a
lesion distal to the anterior horn cell?
A. Positive Babinski, presence of spasticity and foot drop
B. Negative Babinski, decrease in muscle tone and sensations
C. Increase in muscle tone and no change in sensation, presence of
resting tremor
D. Presence of intentional tremors and nystagmus
A
B. Negative Babinski, decrease in muscle tone and sensations
21
Q
Parkinson’s Disease (PD)
A
Progressive neurological disorder caused by the depletion of dopamine in substantia nigra
- Older adults
- Males > Females
22
Q
PD Symptoms
A
Cardinal signs:
* Tremor (Resting)
* Rigidity
* Akinesia
* Postural instability
23
Q
PD Tremor
A
- Resting tremors
- “Pill rolling”
- Usually U/L
24
Q
PD Rigidity
A
- Involuntary increase in muscle tone present throughout the ROM
- Cogwheel or lead pipe
- Initially asymmetrical
- Proximal
25
cogwheel vs lead-pipe rigidity
cogwheel = ratchet-like
lead-pipe = smooth & consistent
26
PD Akinesia
- Cannot initiate movement or
“freezing”
- Bradykinesia vs hypokinesia vs akinesia
27
PD Postural Instability
Thoracic kyphosis and forward head
"phantom" pillow
28
PD early symptoms:
* Loss of smell
* Constipation
* Sleep disorders
29
PD motor symptoms:
Hypophonia, mask-like face, micrographia
30
PD cardio symptoms:
Orthostatic hypotension, fatigue, weakness
31
PD respiratory symptoms:
Restrictive lung disease due to decreased chest expansion
32
PD cognition/behavior symptoms:
Difficulty with dual tasking, depression, dementia
33
Gait in PD
Freezing of Gait
Festinating Gait
* Decreased step width and step length
* Decreased trunk rotation and arm swing
* En bloc turning
34
Freezing of Gait:
Sudden inability to initiate movement
̶
Visual Targets: Drop a tissue, music, wide doorways/modify
environment
35
Festinating Gait:
Short stride, shuffling, increasing speed, anteropulsive
̶Add toe wedge or declined heel to move COM posteriorly
36
Hoehn and Yahr
Stage I
Minimal or absent; unilateral if present
37
Hoehn and Yahr
Stage II
Minimal bilateral or midline involvement.
Balance not impaired
38
Hoehn and Yahr
Stage III
Impaired righting reflexes.
Unsteadiness when turning or rising from chair.
Some activities are restricted, but patient can live independently and continue some forms of employment.
39
Hoehn and Yahr
Stage IV
All symptoms present and severe.
Standing and walking possible only with assistance.
40
Hoehn and Yahr
Stage V
Confined to bed or wheelchair.
41
PD Interventions
* Caregiver education
* Gait training: Metronomes, music, visual cues, one step
commands when freezing/frozen
* Posture: Rotation exercises and crossing midline, Prone lying
* Hypokinesia: BIG movements, Stretching/ROM/chest mobility
* Balance training
* Tai chi, yoga, cycling, dance therapy
42
According to the Hoehn and Yahr classification of disability, which of
the following character of disability is the MOST APPROPRIATE about
Stage III?
A. Inability to walk without rollator
B. Confined to wheelchair
C. May be able to live independently and continue employment
D. Balance not impaired
C. May be able to live independently and continue employment
43
PD Pharmacological Treatment
Levodopa/Carbidopa: (sinemet combo)
* Gold Standard
* Higher level levodopa delivered to brain
* On/off phenomenon: Random fluctuations in motor performance and responses
̶Dyskinesia: On phase
̶Dystonia: Off phase
* Schedule PT one hour after dose
*High-protein diet can block the effectiveness of levodopa
44
DYSKINESIA
Involuntary, repetitive, smooth,
muscle movements
* e.g., snake-like twisting of arm
* Affects large muscle groups
(arms, head, trunk, legs)
* Not usually painful
* ON phase
45
DYSTONIA
Prolonged, involuntary muscle
contractions; muscle spasm
* e.g., toe curling
* Affects a specific muscle or group of muscles
* Causes pain (sometimes debilitating)
* OFF phase
46
During the physical therapy session, the clinician notices that the
patient with Parkinson’s disease suddenly begins twitching their lips
and performs involuntary snake-like motions with their arms. What
could be the cause of present symptoms?
A. Patient has skipped his levodopa dose
B. Patient is at peak levodopa dose
C. Patient is in honeymoon period
D. Patient is in the off state of levodopa
B. Patient is at peak levodopa dose
47
Multiple Sclerosis (MS)
* AUTOIMMUNE disease
* Progressive demyelination of the neurons in CNS
immune system attacks brain and spinal cord nerve coverings (myelin) = disrupts their ability to send signals to the rest of the body
48
MS Signs and Symptoms
* Motor: Spasticity
* Sensory: Numbness and paresthesia
* Gait: Scissoring, extensor spasticity in LE, ataxia, uneven steps
* Bladder: Spastic, flaccid
* Speech and Swallowing: Dysphagia (difficulty swallowing), dysphonia (difficulty with voice production)
* Cognition: Diminished attention, concentration
* FATIGUE
49
MS MS Signs and Symptoms
other systems:
* Optic Neuritis, Trigeminal Neuralgia
* Cerebellum: Nystagmus, coordination, balance, ataxia, intention tremor
* Emotion: Pseudobulbar affect (inappropriate laughing or crying)
50
MS - Unique Signs and Symptoms
1. Lhermitte’s Sign
2. Uhthoff's Phenomenon
3. Charcot’s Triad
4. Cranial Nerve- II
51
Lhermitte’s Sign
An electric shock-like sensation that radiates down the spine and into the limbs when the neck is flexed
Due to demyelination or lesion in the dorsal columns of the cervical spine
52
Uhthoff’s Phenomenon
Temporary worsening of neurological symptoms with increased body temperature (e.g. from heat, fever, or exercise)
Heat slows or blocks conduction in demyelinated nerves
53
Charcot’s Triad
SIN
Scanning (staccato) speech
Intention tremor
Nystagmus
54
Cranial Nerve II – Optic Nerve
Vision – carries sensory information from the retina to the brain
Exam findings if damaged:
Visual field deficits (e.g. monocular blindness, bitemporal hemianopia)
Loss of visual acuity
Afferent pupillary defect (Marcus Gunn pupil)
Tested with: Snellen chart, visual fields, fundoscopic exam, swinging flashlight test.
55
A physical therapist is performing gait analysis on a patient. The physical
therapist notes that the patient has impaired trunk control, increased tone
in the right plantarflexors and ataxic gait. This gait pattern is MOST OFTEN
observed in patients with diagnosis of which condition?
A. Multiple sclerosis
B. Parkinson’s disease
C. Duchenne muscular dystrophy
D. Guillain-Barré syndrome
A. Multiple sclerosis
56
MS Types: 1996 Classification
Relapse-Remitting RR
Primary Progressive
Secondary Progressive
Progressive Relapsing
57
Relapse-Remitting RR
Short duration attacks with full or partial recovery, may or may not leave lasting symptoms/deficits
̶Most common form (about 80%)
58
Primary Progressive
Steady increase in disability without attacks/exacerbations
59
Secondary Progressive
Initially RR, then symptoms increase without periods of
remission
60
Progressive Relapsing
Steady increase in disability with superimposed attacks
*Eliminated from usage in 2013
> Added Clinically Isolated Syndrome
61
Clinically Isolated Syndrome (CIS)
First episode of inflammatory demyelination in the CNS
Could become MS if additional activity occurs
TWO types:
1. Not active – No additional MRI activity
2. Active – With additional MRI activity >>> Relapse- remitting
62
MS Interventions
* Do not overfatigue
* Manage Overheating/ Temperature
* Energy conservation
* Exercise is best in the morning
* Include coordination and balance training
63
MS Interventions
frequency -
intensity -
time -
type -
frequency - 3-5x/week (alternating days, mornings if possible)
intensity - Low intensity (3-5 METS) 50-70% VO2 (SUBMAX)
time - 30 minutes per session
type - Cycle, walk, swim, Circuit training may be best
64
Amyotrophic Lateral Sclerosis (ALS)
Progressive neurological
disorder that damages
nerve cells and causes
disability
* Death of motor neuron
65
ALS Signs and Symptoms
UMN & LMN presentation without sensory loss
̶Muscle atrophy, fasciculations (LMN)
̶Spasticity, hyperreflexia (UMN)
̶Dysphagia, dysarthria (Bulbar)
* ONLY motor neurons will be affected
* Cognition: Dementia, attention deficits
66
ALS -
emotion & other symptoms
Emotion: Pseudobulbar affect- emotional lability
* Muscles: Cervical spine extensors weakness is
common
* Respiratory muscle weakness ----> DEATH!
67
A patient with amyotrophic lateral sclerosis has weakness of all extremities and gets fatigued very easily while doing ADLs. Which of the following will be CONTRAINDICATED for this patient to maintain mobility and function as much as possible?
A. Recommending soft foam collar for neck
B. Taking frequent breaks during activities
C. Recommend HKAFO and walker for ambulation
D. Slow, prolonged stretches and ROM exercises for upper and lower
extremities
C. Recommend HKAFO and walker for ambulation
68
ALS Medical Management
* No effective treatment for disease
69
ALS PT Management
* Focus on functional activities/ADLs and energy conservation initially and end
stages
* Recommend soft foam collar for neck if weakness is present
* Maintain respiratory function, breathing exercises
* Avoid over fatiguing
̶> Take frequent breaks during activities, energy conservation techniques
* ROM, positioning if needed
70
Guillain-Barré Syndrome (GBS)
* AUTOIMMUNE
* AFTER an infection
* Acute inflammatory DEMYELINATING
POLYRADICULONEUROPATHY
* Rapid loss of myelin in nerve roots, peripheral nerves and cranial nerves
71
GBS Signs and Symptoms
* Motor loss/paralysis: DISTAL TO PROXIMAL, Rapid and progressive
* Sensory loss: Glove and stocking, Burning, tingling, numbness
* Decreased reflexes/Areflexia
* Respiratory and cranial involvement: VII, IX, X, XI, XII
* Fatigue
72
GBS first symptoms to appear =
weakness and tingling in extremities
- limb weakness
- difficulty swallowing
- shortness of breath
- flaccid paralysis
73
GBS Intervention
* Respiratory care
* Teach energy conservation techniques
* Avoid overuse and fatigue (can prolong recovery)
* Recovery: 6-12 months, may recover fully
74
A patient with Guillain-Barré Syndrome is in rehab and is beginning to regain
some muscle strength. Which of the following is the MOST APPROPRIATE
initial intervention to address muscle weakness and functional recovery?
A. High-intensity interval training to rapidly increase muscle strength and
endurance
B. Progressive resistance exercises with a focus on low to moderate intensity
and high repetitions
C. Functional task-specific training with a focus on activities like running and
jumping
D. Continuous passive motion exercises to maintain joint range of motion
without muscle engagement
B. Progressive resistance exercises with a focus on low to moderate intensity
and high repetitions
75
Marcus Gunn pupil =
Relative Afferent Pupillary Defect (RAPD)
It’s a sign of optic nerve (CN II) damage, not CN III.
During the swinging flashlight test, the affected eye shows less constriction (or paradoxical dilation) when light is shined into it compared to the normal eye.
It's a problem with afferent input (CN II), not the efferent pupillary response (CN III).
76
cataract =
lens of the eye becomes cloudy or opaque, leading to blurred or dim vision
The lens is normally clear and helps focus light on the retina.
In a cataract, proteins in the lens break down and clump together, clouding part of the lens.
As it worsens, vision becomes hazy, colors look faded, and night vision may decline.
Common causes:
Aging (most common)
Diabetes
Long-term UV exposure
Smoking
Eye injury
Steroid use
Genetic disorders
