Neurology Potpourri - 2 Flashcards
(75 cards)
1
Q
T/F: Carpal tunnel is MC in women.
A
TRUE
2
Q
What are the risk factors of carpal tunnel?
A
Obesity
Pregnancy
3
Q
What disease involves the following structures:
- flexor retinaculum (transverse carpal ligament)
- carpal bones
- 9 flexor tendons
- Median nerve
A
Carpal Tunnel Syndrome
4
Q
What sensory and motor deficits would a patient with Carpal Tunnel Syndrome present with?
A
Motor:
- ABductor pollicis brevis
- Flexor pollicis brevis (SF head)
- Opponens pollicis
- 1st & 2nd lumbricals
5
Q
What disease does this describe?
Median nerve compression –> inflammation –> ischemia –> nerve damage
A
CTS (carpal tunnel syndrome)
6
Q
What disease?
Extrinsic:
Compression is work related (typing on a keyboard)
Recreation related (cycling)
Positional (sleeping)
Intrinsic:
small anatomical space
fluid retention during pregnancy
tendon inflammation due to overuse or connective tissue disorder
A
CTS
7
Q
Clinical presentation of what disease?
- aching radiating to the thenar area
- pain + numbness
- dropping objects, cannot open jars or twist off lids
- pain worsened by repetitive motion/ remaining stationary
A
CTS
8
Q
Clinical Px of what dz?
- sx worse @ night
- pt awakens at night with pain or numbness & needs to “shake out” involved hand/wrist (flick sign)
A
CTS
9
Q
What dz is this?
Physical Exam:
- Inspect for thenar atrophy
- thumb opposition against resistance
- sensation over median nerve (Phalens & Tinnels)
A
CTS
10
Q
What is the Dx & Tx of CTS
A
Clinical Dx
+/- nerve conduction testing
Treatment:
1. NSAIDS
2. PT
3. Wrist Splint @ night
+/- ergonomic modifications
11
Q
How do you treat CTS if initial treatments didnt work?
A
Ortho surgery consultation
steroid injection
carpal tunnel release
12
Q
Describe anatomy of ulnar nerve
A
passes through condylar groove b/w medial epicondyle & olecrenan
13
Q
Clinical Px for which disease?
- Paresthesias, tingling, numbness in medial hand, 1/2 of 4th finger, entire 5th finger.
- pain @ elbow/forearm
- Dec. sensation in ulnar distribution
- Tinel’s sign @ elbow.
A
Ulnar neuropathy (cubital tunnel syndrome)
14
Q
Tx for ulnar neuropathy
A
- elbow pads
- surgical tx performed IF:
1. no improvement after 6-12 wks conservative tx
2. progressive palsy or paralysis
3. muscle wasting, clawing
15
Q
Clinical Px of what?
- wrist drop
- cannot extend finger or abduct thumb
- sensory loss in dorsal web b/w thumb and index finger
- normal tricepts & brachioradialis strength
- triceps reflex intact
- spontaneously recovers in 6-8 weeks
A
Radial neuropathy
16
Q
Tx of radial neuropathy
A
cock-up wrist & finger splints
PT
17
Q
Clinical Px of what?
- paresthesias, numbness, occasionally pain in lateral thigh
- Sx increased with standing/walking
- sx relieved by sitting
- knee reflexes intact
A
Lateral cutaneous femoral neuropathy
“Meralgia paresthetica”
18
Q
What is another name of lateral cutaneous femoral neuropathy?
A
meralgia paresthetica
19
Q
T/F: meralgia paresthetica (lateral cutaneous femoral neuropathy) resolves spontaneously over wks-mos but CANNOT have permanent numbness
A
False: you CAN have permanent numbness
20
Q
Tx of lateral cutaneous femoral neuropathy (meralgia paresthetica)
A
weight loss
avoid tight belts
analgesics (lidocaine patch)
NSAIDS
neuropathic pain meds
21
Q
What is another name of Lateral cutaneous femoral neuropathy?
A
skinny jeans syndrome
22
Q
Causes of skinny jean syndrome (lateral cutaneous femoral neuropathy OR meralgia paresthetica)
A
obesity
belts w/stuff hanging off
skinny jeans & heels
23
Q
Clinical Px for what dz?
- Foot drop
- sensory loss
- onset upon wakening
- NO pain
A
Peroneal neuropathy
24
Q
Which dz must you differentiate from L5 radiculopathy?
A
Peroneal neuropathy
25
What dz is this?
acute idiopathic **facial nerve (CN VII) mononeuropathy**
**Lower motor neuron "lesion"**
**weakness --\> paralysis**
**caused by HSV**
Bell Palsy
26
What are **risk factors** of Bell Palsy?
**DM**
**pregnancy in 3rd trimester**
27
Clinical px of what dz?
* _sudden_ onset, **peaks by 3 days**
* forehead unfurrows
* **facial creases & nasolabial fold** disappear
* corner of the **mouth droops**
* **sagging of the lower eyelid**
* **tearing from the eye**
* **loss of corneal reflex**
Bell Palsy
28
What is the main difference between **Bell Palsy vs. Stroke**?
Stroke spares the forehead
Bell Palsy does not
29
Bell's palsy is a _______ lesion.
Stroke is a _______ lesion.
Peripheral
Central
30
How do you **dx Bell Palsy (main dx)**?
Dx based on **history & physical exam**
31
What other **diagnostic tests (+/-)** can you do for Bell Palsy?
**electrodiagnostic testing** for complete paralysis
**High resolution CT/ Gadolinium enhanced MRI** : slow progression beyond 3wks, no improvement after 4 mos or when **hx/physical exam suggest an alternate diagnosis**
**Serologic testing:** Borrelia Burgdorferi
**Audiometry:** if hx/PE suggest an alternate diagnosis
32
What is **1st line of treatment** of **Bell Palsy**?
**Prednisone:** start within 3 days of sx onset
33
When would you use Valacyclovir in Bell Palsy?
reserved for **pts with severe nerve palsy** or **HZV presentation**
34
Additional therapeutic interventions for Bell Palsy
Eye protection
Acupuncture
PT
35
What is CRPS (complex regional pain syndrome) AKA **"reflex sympathetic dystrophy"**?
**rare** disorder of extremities characterized by _autonomic & vasomotor instability_
36
What dz?
* Burning pain
* autonomic dysfunction
* vasomotor instability
Preceded by surgery or trauma
Complex Regional Pain Syndrome (CRPS)
OR
"reflex sympathetic dystrophy"
37
**inflammation, neurogenic inflammation, maladaptive changes in pain perception @ CNS**
What dz?
**CRPS**
38
Clinical Px for what dz?
* Most commonly involves findings **localized to the hand** (not a single peripheral nerve)
* **burning/aching**, **allodynia** that is aggravated by changes in **environment** or **emotional stress**
* **color & temp** changes
* **physical changes in skin & nails**
* Limited **ROM**
CRPS (complex regional pain syndrome)
"reflex sympathetic dystrophy"
39
Clinical Px for what dz?
* cutaneous vasomotor changes (vasodilation & vasoconstriction)
* **red, mottled ashen** color
* **inc or dec temp**
* **dry or hyperhidrotic skin** (excessive sweating)
* **edema**
* **Motor abnormalities**
* **Psychological distress**
CRPS
## Footnote
**"Reflex sympathetic dystrophy"**
40
_Affected limb px within weeks of injury:_
* **swollen, red, burning**
* **diaphoresis**
* sx **near site of injury**
**What stage of CRPS Type 1?**
**_Acute_** Stage
41
Affected limb sx within **mos** of injury:
* skin **cool & diaphoretic**
* **sudek's atrophy** of bone on x-ray
* pain occurs **throughout entire limb**
**What stage of CRPS Type 1?**
**_dystrophic_** stage
42
affected limb sx **yrs** after injury:
* skin **pale & shiny**
* **atrophy of muscle & bone**
* pain **constant w/tx**
What stage of CRPS Type 1 is this?
**_Atrophic_** Stage
43
Dx of CRPS?
No specific test\*\*
starts after limb trauma **4-6 wks**
not explained by initial trauma
affects **distal limb**, goes beyond region involved in trauma
44
"pain out of proportion"
what dz?
CRPS
45
What is the **budapest consensus criteria** for clinical dx of **CRPS**?
_**Continuing pain, disproportional to inciting event. \*\***_
1 or more **sx/sign** in **3** of the following 4 categories:
**sensory** (hyperesthesia, allodynia)
**vasomotor** (temp, asymmetry, skin color changes)
sudomotor/edema
**motor/trophic** (dec. ROM, weakness, tremor, dystonia, changes of hair/skin/nails)
46
What dx tools would you utilize for **CRPS** to determine whether there are **bone changes/demineralization** present?
**Bone scan:** diffuse increased uptake in affected extremity (early phase)
**X-ray:** generalixed osteopenia (later stages)
47
Tx for mild cases of CRPS?
NSAIDS
48
Tx for severe cases w/edema of CRPS?
Prednisone
49
Neuropathic medications for CRPS?
tricyclic antidepressants: **nortriptyline**
anticonvulsatnts: **gabapentin + pregabalin**
SNRI's: **duloxetine, venlafaxine**
50
what meds would you use for **bone changes (demineralization)** present in **CRPS**?
**biphosphonates, calcitonin**
51
What dz would you use the following as last line meds?
## Footnote
**Topical lidocaine**
**tramadol, opioids**
CRPS
52
You can use neuromodulation as a tx for CRPS
## Footnote
**T/F?**
True:
implanted **spinal cord stimulators**
transcutaneous nerve stimulation **(TENS)**
**brisk rubbing of affected part** (counter irritation) & **acupuncture**
53
You can use PT/OT for CRPS.
T/F?
True
54
How can you attempt to prevent CRPS?
early mobilization after injury or surgery
55
What disorder?
Neurodevelopmental d/o manifested by **motor & phonic tics**
**M\>F**
Accompanied by OCD & ADHD.
affects kids aged 6-17 **(adolescents)**
Tourette Syndrome
56
T/F: Fam hx of Tourette syndrome or OC is common
**True**
57
What is the onset age of tics typically?
2-15 yrs w/ avg age of onset 6 yrs.
58
Give examples of
Simple & Complex motor tics
Simple: blinking, facial grimacing, shoulder shrugging, head jerking
Complex: bizarre gait, kicking, jumping, body gyrations, scrathcing and seductive gestures
59
What is echopraxia and what disorder is this part of?
mimicking gestures
TS
60
What is copropraxia and what disorder is this part of?
obscene gestures
TS
61
Give examples of **simple** vocal/phonic tics
sniffing, coughing, throat clearing, grunting
62
Define coprolalia
obscene words
63
define echolalia
repitition of words
64
Define **palilalia**
**repeating a phrase/word** with **inc rapidity**
65
Do tics often improve when focused on other tasks in Tourette's Syndrome?
Yes, they do
66
T/F: tics worsen with stress, anxiety or excitement
TRUE
67
What are the clinical manifestations of Tourette?
motor/vocal/phonic tics
ritualistic behavior--\> repeating behavior
PE normal except for presence of tics
68
Dx of Tourettes Syndrome
**Brain MRI:** order only when abnormality detected on neurological exam.
**EEG:** IF need to evaluate seizure activity
69
Diagnostic criteria for Tourette Syndrome
**multiple motor** + **one or more phonic tics** must be present (_do not need to be concurrent_)
tics must occur **multiple times a day, nearly everyday**
OR
**intermittently** throughout a _period of more than one year_
_Onset before 18 y/old_
_tics must be witnessed_
70
Tx of Tourette Syndrome
Tx psychiatric disorder 1st if present
CIBT (comprehensive behavioral intervention)
71
1st line Mod-severe tics TX
clonidine/guanfacine
72
Which tx of TS is favored by specialists?
antidopaminergic (tetrabenazine)
73
Tx for severe tics unresponsive to other meds
Haloperidol (antipsychotic)
74
Tx for focal motor tics
Botox
75
