(39) Radiculopathies, Plexopathies, and Neuropathies

Question 1

what level is the most common cervical disk herniations

Answer 1

C7&raquo_space;> C6

Question 2

what level is the most common cervical spondylosis

Answer 2

C5 and C6

Question 3

95% of lumbar herniations are at what levels

Answer 3

L5 or S1

Question 4

what part of the nerve lies on top of the disk

Answer 4

nerve root

Question 5

describe the pain typical in radiculopathies

Answer 5

paracentral and radiating

Question 6

what are 3 features (other than pain) of radiculopathies

Answer 6

1. weakness/atrophy
2. parasthesias/sensory loss
3. diminished/absent stretch reflexes

Question 7

what is the freq cause of radiculopathy in persons > 50 and <50

Answer 7

> 50 = spondylosis

<50 = disc herniation

Question 8

CT or MRi for radiculopathies

Answer 8

MRI

Question 9

what testing is most helpful for assessing nerve function?

Answer 9

EDX

Question 10

T or F: EDX testing asses muscle fibers

Answer 10

true

Question 11

T or F: EDX identifies demyelination and axon loss

Answer 11

true

Question 12

muscle fiber biopsy seen with neuropathies

Answer 12

atrophic fibers and fiber type grouping

Question 13

findings in carpel tunnel syndrome

Answer 13

numbness in first 3.5 fingers with pain (*thenar muscles only, not hypothenar)
prolonged conduction time

Question 14

findings in ulnar N compression

Answer 14

weakness and atrophy in hypothenar mulces (digits 4 and 5)

Question 15

nerve affected in saturday night palsy (compressing the radial nerve at the spiral groove)

Answer 15

radial N

Question 16

What nerve is affected to cause wrist drop

Answer 16

radial

Question 17

what nerve is affected to cause foot drop? where is is compressed?

Answer 17

peroneal at the fibular head of the knee

Question 18

is diabetic neuropathy demyelinating

Answer 18

yes

Question 19

What are the findings in a demyelinating neuropathy

Answer 19

weakness (distal and proximal)
areflexia
decreased vibrational and positional sense with intact pain and temp sensations
slow NCV

Question 20

T or F: typically is the axon is destroyed in demyelinating neuropathy

Answer 20

False– it is preserved

Question 21

distal weakness with distal areflexia + glove and stocking sensory loss + nml CNV with reduced AP amplitude and denervation on EMG

Answer 21

axonal neuropathy

Question 22

etiology if axonal neuropathy

Answer 22

toxins, uremia

Question 23

vasculitis and trauma cause damage ti myelin and axons and is known as

Answer 23

Wallerian degeneration

Question 24

myelin ovoids are characteristic of

Answer 24

axonal neuropathy

Question 25

higher arched feet + hammer toes + demyelinating disease

Answer 25

charcot-marie-tooth disease

Question 26

mutation and pattern of inheritance in CMT disease

Answer 26

deletions in genes that express myelin basic protein (PMP 22(1A) or (1B))

AD

Question 27

pathogenesis of diabetic neuropathy

Answer 27

accumulation of sorbitol –> Inc ROS

deficiency of myoinositol

Question 28

diabetic opthalmoplegia affect CN ____

Answer 28

III

*infarcts in the N

Question 29

What neoplasm can cause a neuropathy

Answer 29

lymphoma (invades nerves)

Question 30

are reflexes present in Guillain Barre?

Answer 30

no

Question 31

are sensory nerves affected in guillian barrre

Answer 31

no

Question 32

What is characteristcaly found in the spinal fluid of patients with Guillian Barre?

Answer 32

elevated spinal fluid protein

Question 33

how is the H reflex and F response affected in GBS? why?

Answer 33

prolonged, due to demyelination

Question 34

How is GBS treated?

Answer 34

gamma globulin infusions + respiratory assistance

Corticosteroids do NOT work!!

Question 35

presentation of chronic inflammatory neuropathy

Answer 35

areflexia
symmetrical prox and distal weakness
loss of position and vibratory sense 
nml pain and temp sensation 
slow NCV (= there is a block due to de-meylination)
may be relapsing 
elevated spinal fluid protein

Question 36

treatment for chronic inflammatory neuropathy

Answer 36

GCS, immunosuppressant, gamma globulins