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Medicine Podiatric > wk 2- neuro > Flashcards

wk 2- neuro Flashcards

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1
Q

issues of neuropathy (sensory/motor)

A

loss of sensation
- repetitive trauma
-unaware of injuries
- loss of proprioceptive feedback - impacting muscle tone and posture, gait and foot structure

motor deficits
- reduce muscle tone, strength
- gait changes / loading issues

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2
Q

diagnostic approach

A
  1. locate lesion
  2. find pathophysiology causing lesion
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3
Q

nervous system made up of what systems

A
  1. CNS: brain and spinal cord
  2. PNS: Afferent (sensory), efferent (motor)
  3. somatic: voluntary nervous system
  4. autonomic nervous system: involuntary (regulates bodies organs
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4
Q

what controls movements and what makes up the motor pathway

A

motor cortex which involves upper and lower motor neurons when descending down the body

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5
Q

what controls regulatory actions

A

basal ganglia and cerebellum

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6
Q

the motor cortex controls what?

A

the contralateral side of the body

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7
Q

Upper motor neuron tracts where

A

cerebral cortex to anterior/ventral horn (spinal cord)

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8
Q

lower motor neuron tracts where

A

anterior/ventral horn (spinal cord) to peripheral nerve that synapses at neuromuscular junction

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9
Q

symptoms of an UMN lesion

A
  • increased tone
  • hyper reflexia
  • babinski sign present
  • no muscle twitching/spasicity

occurs when theres a lesion above anterior/ventral horn

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10
Q

examples of UMN lesion pathology

A

stroke
cerebral palsy
multiple sclerosis

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11
Q

symptoms of LMN lesion

A

-decreased tone
-hypo reflexia / absent
- no babinski sign
- muscle twitching/spasicity

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12
Q

exmaples of LMN lesion pathology

A

poliomyelitis
nerve entrapment

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13
Q

sensory pathways

A

3 main pathways

  1. Dorsal column-medial leminscal pathway: fine touch and vibration, crosses over in the
    brainstem
  2. Spinothalamic pathway: coarse touch & pressure,
    pain and temperature; cross over in spinal cord 2-3
    levels above entry
  3. Spinocerebellar pathways: convey information re
    muscle stretch to ipsilateral cerebellum
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13
Q

autonomic system is made up of

A
  1. parasympathic system- rest and digest
  2. sympathetic system- fight or flight
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13
Q

dermatomes/myotomes in the lower leg

A

L3- knee extensors
L4- ankle dorsiflexors
L5- long toe dorsiflexors
S1- ankle plantarflexors
S2- knee flexors

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14
Q

imaging/investigations for nerves

A

CT and MRI
nerve conduction tests
serum and CSF testing

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15
Q

seizure is

A

sudden, abnormal electrical discharge in the brain

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16
Q

epilepsy is

A

tendency to experience recurrent seziures

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17
Q

seizure classification

A
  1. simple partial/focal- no LOC
  2. complex partial/focal- Reduced consciousness
  3. generalised- LOC
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18
Q

stroke and clinical features

A

block of blood flow to the brain

F- face or mouth drooped?
A- can they lift arms up?
S- slurred speech? can they undertsand you
T- time is critical call 000 if any signs

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19
Q

cerebral palsy

A

impaired voluntary movement due to brain prenatal development malformations or peri/postnatal brain injury

manifests by age 2
non progressive

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20
Q

different presentations of CP

A
  • spastic syndromes- causes weakness/stiffness in legs, resistance to passive movement. (70%)

-athetoid / dyskinetic syndromes- slow, writhing, worm like movements

  • ataxic syndromes- weak, tremor, wide base
  • combination of these is also common
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21
Q

other clinical features of CP

A

-misalignment of eyes
-normal intelligence in hemiplagia/paraplegia
-foot deformities: equinas, planovalgus, equinovarus

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22
Q

diagnosis of CP

A

neuro imaging (MRI)
blood tests- screen for metabolic disease

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23
CP management
1. stretching for ROM, strengthening muscles and facilitating correct movement patterns 2. braces and orthoses 3. spasticity medication - baclofen 4. botulinum injections - prevent uneven muscle pulls/fixed contractures 5. surgery tendon release/transfer to improve joint range/alignment
24
parkinsons
progressive, degenerative neurological disorder causing parkinsonism (tremors, rigidity, postural instability, slow movement)
25
patho of parkinsons
degeneration or injury to dopaminergic circuits in the basal ganglia, impacting direct and indirect pathways of motor function
26
risk factors for parkinsons
family history male head injury pesticides exposure rural living
27
clinical features of parkinsons
- resting tremor - rigidty - slow movement - postural instability - can be with dementia, autonomic or neuropsychiatric symptoms
28
friedreich's ataxia
progressive loss of voluntary muscle coordination, obstructive cardiac hypertrophy, and development of DM
29
friedrecichs ataxia clinical features
-delayed motor milestones -tendency to stagger / fall -distal muscle weakness greatest in peroneal -cavus foot type with contracture of digits -wide base gait
30
difference between incomplete and complete injuries to the spinal cord
incomplete- partial preserving of function below level and bowel and bladder complete- complete loss below including bowel and bladder dysfunction
31
spinal cord ASiA classification
grade A- complete loss of sensory and motor below level of injury Grade B- incomplete sensory loss, complete motor loss below level Grade C- incomplete motor, muscle strength less than 3/5 Grade D- incomplete motor, muscle strength 3/5 or more Grade E- normal sensory and motor
32
Spina bifida
Congenital brith defect that occurs when the neural tube that forms the spinal cord does not close properly during foetal development
33
Types of Spina bifida
1. Occulta 2. Meningocele 3. Myelomeningocele
34
Cauda equina
Acute onset of lower limb neurological symptoms (radicular pain, weakness, sensory changes) and urinary and bowel dysfunction Emergency can lead to permanent changes
35
Radiculopathy
Nerve root compression
36
Symptoms of Radiculopathy
Pain Numbness Flaccid motor weakness- emergency if this symptom occurs to avoid permanent disability
37
MS affects what nerve fibres
Central nerve fibres
38
GBS affects what nerve fibres
Peripheral nerve fibres
39
MS
Thought to be linked to an immunological process Disseminated patches of demyelination in the brain and spinal cord -common in women around 20-40y
40
Clinical features of MS
- paraesthesia -weakness -clumsiness -visual disturbances
41
MS diagnosis
MRI of brain and spinal cord CSF analysis
42
MS management
Medicine 1. immunotherapy early during onset 2. cortciosteroids for relapses 3. neurpathic pain medicines for symptoms (antidepressants/anticonvulsants)
43
GBS
rapidly progressive but self limiting inflammatory polyneuropathy involves the demyleination of peripheral nerves resulting in weakness and sensory loss in LMN
44
GBS clinical features
ascending, symmetrical weakness and paralysis (starts with lumbs then goes to arms) with associated parasthesia
45
GBS management
1. hospital -IV fluids -respiratory support -physical therapy IV immunoglobin can shorten hospital stay
46
chronic peripheral polyneuropathy
symmetrical, bilateral parathesia in glove and stocking dsitrubition with feet affected first burning sensation in feet, often at night
47
diagnosis of chronic peripherl polyneuropathy
loss of sensation distally reduced vibration and propriception
48
hereditary peripheral neuropathy
CMT
49
CMT
autosomal dominant condition, that is slowly progressive sensory and motor peripheral neuropathy doesnt affect lifespan
50
clinical features of CMT
-pas cavus -hammer toes -gait disturbances, foot drop -equinovarus deformity -muscle weakness -stork leg appearance- due to distal wasting -glove and stocking -loss of reflexes
51
management of CMT
1. braces/orthoses for foot drop
52
Peroneal nerve palsy
compression of the nerve against lateral fibula neck common in thin patients who cross legs
53
clinical featues of peronela nerve palsy
weakness in dorsiflexion and eversion causing foot drop sensory changes in lower limb that it innervates
54
myasthenia gravis
acquired autoimmune disorder chronic, progressive weakness of of voluntary skeletal muscles
55
Motor neuron disease
incurable neurodegenerative disease of motor neurons (UMN, LMN) death usually within 3 years of diagnosis
56
clinical features of MND
limb weakness progresses to trips falls
57
muscular dystrophy
two types duchenne muscular dystrophy and becker muscular dystrophy X-linked recessive disorders progressive proximal muscle weakness caused by muscle fibre degeneration DMD is worse
58
MD management
1. active/passive exercises 2. braces/orthoses 3. daily prednisone, extends period of mobilisaiton, improves lungs and heart function, improves survival with DMD
59

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