Strohm content Flashcards
(100 cards)
1
Q
Encephalopathy: [definition]
A
Encephalopathy: dysfunction of cerebrum
2
Q
Myelopathy: [definition]
A
Myelopathy: dysfunction of spinal cord
3
Q
Radiculopathy: [definition]
A
Radiculopathy: dysfunction of nerve root
4
Q
Plexopathy: [defintion]
A
Plexopathy: dysfunction of plexus
5
Q
Polyneuropathy: [defintion]
A
Polyneuropathy: dysfunction of more than one nerve
6
Q
Mononeuropathy: [definition]
A
Mononeuropathy: dysfunction of one nerve
* Ex: median mononeuropathy = carpal tunnel syndrome
7
Q
Myopathy: [definition]
A
Myopathy: dysfunction of muscle
8
Q
Examples of bulbar weakness:
A
Bulbar weakness involves a bilateral LMN lesion of CN IX, X, XI, XII
* Dysarthria: speech poorly articulated
* Dysphagia: difficulty swallowing
* Dysphonia: voice weak
9
Q
Biceps and brachioradialis reflex involves [spinal level]
A
Biceps and brachioradialis reflex involves C5, C6
* C5, C6 pick up sticks
10
Q
Triceps reflex involves [spinal level]
A
Triceps reflex involves C6,C7
* C7 not 8 lay them straight
11
Q
Cremasteric reflex involves [spinal levels]
A
Cremasteric reflex involves L1, L2
12
Q
Patellar reflex involves [spinal levels]
A
Patellar reflex involves L2-L4
* L2-L4 kick the door
13
Q
Achilles reflex involves [spinal levels]
A
Achilles reflex involves S1, S2
* S1, S2 buckle my shoe
14
Q
Anal wink reflex involves [spinal levels]
A
Anal wink reflex involves S3, S4
15
Q
Increased muscle stretch is detected by muscle spindle receptors via [type axons]
A
Increased muscle stretch is detected by muscle spindle receptors via type Ia and II sensory axons
16
Q
Muscle spindle afferent fibers travel to the spinal cord via _ and synapse with _ and _
A
Muscle spindle afferent fibers travel to the spinal cord via DRG and synapse with alpha motor neuron and inhibitory interneuron
17
Q
Increased muscle stretch will send signals to the spinal cord that result in simultaneous _ and _
A
Increased muscle stretch will send signals to the spinal cord that result in simultaneous inhibition of antagonist muscle (prevent overstretching) and activation of agonist muscle (contraction)
18
Q
Increased muscle force is detected by golgi tendon organ via [type axons]
A
Increased muscle force is detected by golgi tendon organ via type Ib sensory axons
19
Q
Explain the golgi tendon pathway:
A
- Type Ib fibers sense increased muscle tension
- Fiber travel to spinal cord via DRG
- Activation of inhibitory interneuron
- Inhibition of agonist muscle (to reduce tension)
20
Q
_ is an immune-mediated or inflammatory PNS demyelinating disease
A
Guillain-Barre syndrome is an immune-mediated or inflammatory PNS demyelinating disease
21
Q
_ is a hereditary PNS demyelinating disease
A
Charcot Marie Tooth disease is a hereditary PNS demyelinating disease
22
Q
Most cases of Guillain-Barre are _ , meaning they are monophasic and acute; cases that are > 8 weeks are called _
A
Most cases of Guillain-Barre are acute inflammatory demyelinating polyneuropathy (AIDP) , meaning they are monophasic and acute; cases that are > 8 weeks are called CIDP
23
Q
Miller-fisher syndrome is a type of Guillain-Barre in which we see _ deficits due to antibodies against _
A
Miller-fisher syndrome is a type of Guillain-Barre in which we see oculomotor deficits due to antibodies against GQ1B
24
Q
The most common pattern of multiple sclerosis is _
A
The most common pattern of multiple sclerosis is relapsing remitting
25
_ is a common presentation of multiple sclerosis that involves *painful unilateral vision loss* and Marcus Gunn pupil
**Acute optic neuritis** is a common presentation of multiple sclerosis that involves *painful unilateral vision loss* and Marcus Gunn pupil
26
Pyramidal tract demyelination in M.S. may present as [symptoms]
Pyramidal tract demyelination in M.S. may present as **weakness, spasticity**
27
M.S. patients may experience spinal cord syndromes such as _
M.S. patients may experience spinal cord syndromes such as **electric shock-like sensation along cervical spine on neck flexion**
* Also neurogenic bladder, paraparesis, etc
28
M.S. symptoms may be aggrevated by _ temperatures
M.S. symptoms may be aggrevated by **hot temperatures**
* *Ex: exercise, hot bath*
29
The classic demographic for MS is _
The classic demographic for MS is **20-30 yo female**
30
[Imaging] showing _ is diagnostic for MS
**MRI** showing **multiple lesions, separated by time and space** is diagnostic for MS
31
Multiple sclerosis
32
Osmotic demyelination syndrome
33
Progressive multifocal leukoencephalopathy (PML)
34
_ is a disorder of beta-oxidation due to a mutation in ABCD1 gene that causes buildup of VLCFA in the adrenal glands and white matter of the brain
**Adrenoleukodystrophy** is a disorder of *beta-oxidation* due to a mutation in ABCD1 gene that causes buildup of VLCFA in the adrenal glands and white matter of the brain
* *X-linked recessive*
* *Progressive disease that leads to adrenal gland crisis, coma, death*
35
Another name for osmotic demyelination syndrome is _
Another name for osmotic demyelination syndrome is **central pontine myelinolysis**
36
Osmotic demyelination syndrome is massive axonal demyelination in the _ secondary to rapid osmotic change
**Osmotic demyelination syndrome** is massive axonal demyelination in the **pontine white matter** secondary to *rapid osmotic change*
37
The most common cause of osmotic demyelination syndrome is _
The most common cause of osmotic demyelination syndrome is **iatrogenic- correction of hyponatremia**
38
Signs of osmotic demyelination syndrome include _
Signs of osmotic demyelination syndrome include **acute paralysis, dysarthria, dysphagia, diplopia, loss of consciousness**
* *Can cause "locked in syndrome"*
39
"Locked in syndrome" can be caused by _
"Locked in syndrome" can be caused by **osmotic demyelination syndrome**
40
Correcting sodium too fast:
"From high to low, _ "
"From low to high _ "
Correcting sodium too fast:
"From high to low, **your brains will blow** " - *cerebral edema/ herniation*
"From low to high **your pons will die** " - *osmotic demyelination syndrome*
41
_ is the most common subtype of Guillain-Barre syndrome
**Acute inflammatory demyelinating polyradiculopathy** is the most common subtype of Guillain-Barre syndrome
42
AIDP is an autoimmune condition (subtype of Guillain-Barre) that destroys _
AIDP is an autoimmune condition (subtype of Guillain-Barre) that destroys **Schwann cells**
* *Damage occurs via inflammation*
* *Demyelination of motor fibers, sensory fibers, peripheral nerves*
43
Guillain Barre does not have known definitive causal link to any pathogen though assocition with _ is most common
Guillain Barre does not have known definitive causal link to any pathogen though assocition with ***Campylobacter jejuni*** is most common
* Damage is mediated by inflammation
* Likely facilitated by molecular mimicry and triggered by stress
44
Guillain-Barre results in [symmetric/ asymmetric] and [ascending/ descending] paralysis
Guillain-Barre results in **symmetric** and **ascending** paralysis
45
Gullain-Barre will often present with _ DTR
Gullain-Barre will often present with **depressed or absent** DTR
* *Starting in the lower extremities*
* *Can progress to facial paralysis and respiratory failure*
46
Guillain-Barre is associated with _ , an increase in CSF protein with normal cell count
Guillain-Barre is associated with **albuminocytologic dissociation** , an *increase in CSF protein* with *normal cell count*
47
Guillain Barre is treated via:
Guillain Barre is treated via:
* Respiratory support
* **Plasmapheresis or IVIG**
48
Acute disseminated encephalomyelitis is _
Acute disseminated encephalomyelitis is **multifocal inflammation and demyelination after infection**
* *Can also occur after vaccination*
* *Presents with rapidly progressive multifocal neurologic symptoms, altered mental status*
49
Charcot-Marie-Tooth disease is also called _
Charcot-Marie-Tooth disease is also called **hereditary motor and sensory neuropathy**
50
Charcot-Marie-Tooth is a "dysmyelinating" disease, meaning _
Charcot-Marie-Tooth is a "dysmyelinating" disease, meaning **there is defective production of proteins involved in structure and function of peripheral nerves/ myelin sheath**
51
Charcot-Marie-Tooth disease has [inheritance pattern]
Charcot-Marie-Tooth disease has **autosomal dominant** inheritance
52
Presenting symptoms of Charcot-Marie Tooth disease include:
Presenting symptoms of Charcot-Marie Tooth disease include:
* **Foot deformities** (pes cavus, hammer toe)
* **Lower extremity weakness** (foot drop)
* **Sensory deficits**
53
The most common type of Charcot marie tooth, CMT1A is caused by [mutation]
The most common type of Charcot marie tooth, CMT1A is caused by **PMP22 gene duplication**
54
Progressive multifocal leukoencephalopathy is a demylination disease of the (CNS/PNS)
**Progressive multifocal leukoencephalopathy** is a demylination disease of the **CNS**
* Involves destruction of oligodendrocytes
55
PML occurs secondary to _
PML occurs secondary to **reactivation of a latent JC virus infection**
* Occurs primarily in AIDS patients
* Rapidly progressive, often fatal
56
_ motor neuron produces muscle movement on contraction
**Alpha motor neuron** produces muscle movement on contraction
57
_ motor neuron regulates the sensitivity to stretch and contributes to fine motor control
**Gamma motor neuron** regulates the sensitivity to stretch and contributes to fine motor control
58
Name some chronic, *axonal* polyneuropathies
Chronic, *axonal* polyneuropathies:
* **Diabetic neuropathy**
* **B12 deficiency**
* Critical illness myopathy/neuropathy
59
Arsenic and lead poisoning cause acute (axonal/demyelinating) polyneuropathy
Arsenic and lead poisoning cause acute **axonal** polyneuropathy
60
Delayed (blocked) conduction velocity on nerve conduction study may be an indication of [type pathology]
Delayed (blocked) conduction velocity on nerve conduction study may be an indication of **demyelinating neuropathy**
* E.g. Guillain Barre
61
Reduced signal amplitude on nerve conduction study may be an indication of underlying [type pathology]
Reduced signal amplitude on nerve conduction study may be an indication of underlying **axonal neuropathy**
* E.g diabetic neuropathy
62
What disease is seen in navy?
63
UMN lesion will cause _ bladder
UMN lesion will cause **spastic** bladder
* *Urgency, incontinence, increased bladder tone*
* *E.g. stroke, MS, spinal cord lesion*
64
LMN lesion will cause _ bladder
LMN lesion will cause **flaccid** bladder
* *Incontinence, retention, no anal reflex, decreased bladder tone*
* *E.g. cauda equina*
65
Spinal muscular atrophy is a congenital degeneration of _ that results in _
Spinal muscular atrophy is a congenital degeneration of **anterior horns of spinal cord** that results in **LMN symptoms, hypotonia**
66
A "floppy baby" with marked hypotonia and tongue fasiculations is suggestive of _
A "floppy baby" with marked hypotonia and tongue fasiculations is suggestive of **spinal muscular atrophy**
* aka *Werdnig-Hoffmann disease*
67
Werdnig-Hoffmann disease is a [inheritance pattern] mutation in _ gene
Werdnig-Hoffmann disease is an **autosomal recessive** mutation in **SMN1**
* *Causes defective snRNP*
68
ALS is associated with _ bladder deficits
ALS is associated with **no bladder deficits**
69
Amyotrophic lateral sclerosis involves _ type degeneration
Amyotrophic lateral sclerosis involves **combined UMN and LMN** degeneration
* UMN: corticobulbar/corticospinal
* LMN: medullary and spinal cord degeneration
70
ALS can be caused by a defect in _
ALS can be caused by a defect in **superoxide dismutase 1**
71
Complete occlusion of the anterior spinal artery spares the _ and _
Complete occlusion of the anterior spinal artery spares the **dorsal column** and **Lissauer tract**
72
The _ regions of the anterior spinal artery is a watershed area
The **mid-thoracic (T3-T8)** regions of the anterior spinal artery is a watershed area
* *Below T8 the artery of Adamkiewicz supplies ASA*
73
Complete occlusion of the ASA presents with _ deficit *below the lesion*
Complete occlusion of the ASA presents with **UMN** deficit *below the lesion*
* *Corticospinal tract*
74
Complete occlusion of the ASA presents with _ deficit *at the level of the lesion*
Complete occlusion of the ASA presents with **LMN** deficit *at the level of the lesion*
* *Ventral horn*
75
_ is an infectious cause of progressive sensory ataxia (impaired proprioception and coordination)
**Tabes dorsalis** is an infectious cause of *progressive sensory ataxia* (impaired proprioception and coordination)
* *Associated with charcot joints, argyll robertson pupils, paroxysmal shooting pain*
76
In syringomyelia, the syrinx expands and damages the _ of the spinothalamic tract
In syringomyelia, the syrinx expands and damages the **anterior white commissure** of the spinothalamic tract
77
Subacute combined degeneration involves demyelination of (3) tracts:
Subacute combined degeneration involves demyelination of (3) tracts: **SCD**
* **Spinocerebellar tracts**
* **Lateral corticospinal tracts**
* **Dorsal columns**
78
Subacute combined degeneration will present with _ signs
Subacute combined degeneration will present with **ataxic gait, parethesia, impaired position/vibration sense, UMN symptoms**
79
Cauda equina syndrome is associated with radicular pain, absent _ reflexes, loss of bladder and anal sphincter control, and _ anesthesia
Cauda equina syndrome is associated with radicular pain, absent **knee and ankle** reflexes, loss of bladder and anal sphincter control, and **saddle** anesthesia
80
Tabes dorsalis
81
ALS
82
Syringomyelia
83
SCD: vitamin B12 deficiency
84
Non-infectious cause
Spinal muscular atrophy
85
Complete occlusion ASA
86
Syringomyelia most commonly occurs at [spinal levels]
Syringomyelia most commonly occurs at **C8-T1**
* *Caused by trauma, tumor, chiari malformation*
87
Anterior spinal cord syndrome is associated with loss of pain and temperature _ level
Anterior spinal cord syndrome is associated with loss of pain and temperature **below the lesion**
88
Hemisection of the spinal cord causes a contralateral loss of _ two levels below the lesion
Hemisection of the spinal cord causes a contralateral loss of **pain and temperature** two levels below the lesion
* *Spinothalamic tract*
89
Hemisection of the spinal cord causes ipsilateral _ signs below the level of the lesion
Hemisection of the spinal cord causes ipsilateral **UMN signs** *below the level of the lesion*
90
Hemisection of the spinal cord causes ipsilateral _ signs at the level of the lesion
Hemisection of the spinal cord causes ipsilateral **LMN signs** *at the level of the lesion*
91
Hemisection of the spinal cord causes _ lateral loss of fine discrimination, vibration, proprioception below the level of lesion
Hemisection of the spinal cord causes **ipsilateral** loss of fine discrimination, vibration, proprioception below the level of lesion
92
If brown-sequard syndrome occurs above _ level, ipsilateral Horner syndrome (ptosis, miosis, anhidrosis) is possible
If brown-sequard syndrome occurs above **T1** level, ipsilateral Horner syndrome (ptosis, miosis, anhidrosis) is possible
93
Friedreich ataxia is an autosomal recessive trinucleotide repeat GAA, involving [chromosome] and a gene that encodes _
Friedreich ataxia is an autosomal recessive trinucleotide repeat GAA, involving **chromosome 9** and a gene that encodes **frataxin** (iron-binding protein)
94
Friedreich ataxia involves degeneration of [tracts]
Friedreich ataxia involves degeneration of **lateral corticospinal tract, spinocerebellar tract, dorsal columns**
95
The primary pathology in Friedreich ataxia is a loss of _ cells
The primary pathology in Friedreich ataxia is a loss of **sensory ganglion cells**
96
Poliovirus is an RNA picornavirus that causes destruction of cells in the [spinal cord region]
Poliovirus is an RNA picornavirus that causes destruction of cells in the **anterior horn**
* Affects LMNs
* *Asymmetric weakness*
97
Conus medullaris syndrome involves [spinal levels]
Conus medullaris syndrome involves **T12-L2**
98
Conus medullaris syndrome presents with _ reflexic DTR
Conus medullaris syndrome presents with **hyperreflexic DTR**
99
Sudden and symmetrical describes the deficits of (conus medullaris/cauda equina)
Sudden and symmetrical describes the deficits of **conus medullaris**
* *Cauda equina is gradual and asymmetrical*
100
