(39) Radiculopathies, Plexopathies, and Neuropathies Flashcards
what level is the most common cervical disk herniations
C7»_space;> C6
what level is the most common cervical spondylosis
C5 and C6
95% of lumbar herniations are at what levels
L5 or S1
what part of the nerve lies on top of the disk
nerve root
describe the pain typical in radiculopathies
paracentral and radiating
what are 3 features (other than pain) of radiculopathies
- weakness/atrophy
- parasthesias/sensory loss
- diminished/absent stretch reflexes
what is the freq cause of radiculopathy in persons > 50 and <50
> 50 = spondylosis
<50 = disc herniation
CT or MRi for radiculopathies
MRI
what testing is most helpful for assessing nerve function?
EDX
T or F: EDX testing asses muscle fibers
true
T or F: EDX identifies demyelination and axon loss
true
muscle fiber biopsy seen with neuropathies
atrophic fibers and fiber type grouping
findings in carpel tunnel syndrome
numbness in first 3.5 fingers with pain (*thenar muscles only, not hypothenar)
prolonged conduction time
findings in ulnar N compression
weakness and atrophy in hypothenar mulces (digits 4 and 5)
nerve affected in saturday night palsy (compressing the radial nerve at the spiral groove)
radial N
What nerve is affected to cause wrist drop
radial
what nerve is affected to cause foot drop? where is is compressed?
peroneal at the fibular head of the knee
is diabetic neuropathy demyelinating
yes
What are the findings in a demyelinating neuropathy
weakness (distal and proximal)
areflexia
decreased vibrational and positional sense with intact pain and temp sensations
slow NCV
T or F: typically is the axon is destroyed in demyelinating neuropathy
False– it is preserved
distal weakness with distal areflexia + glove and stocking sensory loss + nml CNV with reduced AP amplitude and denervation on EMG
axonal neuropathy
etiology if axonal neuropathy
toxins, uremia
vasculitis and trauma cause damage ti myelin and axons and is known as
Wallerian degeneration
myelin ovoids are characteristic of
axonal neuropathy
higher arched feet + hammer toes + demyelinating disease
charcot-marie-tooth disease
mutation and pattern of inheritance in CMT disease
deletions in genes that express myelin basic protein (PMP 22(1A) or (1B))
AD
pathogenesis of diabetic neuropathy
accumulation of sorbitol –> Inc ROS
deficiency of myoinositol
diabetic opthalmoplegia affect CN ____
III
*infarcts in the N
What neoplasm can cause a neuropathy
lymphoma (invades nerves)
are reflexes present in Guillain Barre?
no
are sensory nerves affected in guillian barrre
no
What is characteristcaly found in the spinal fluid of patients with Guillian Barre?
elevated spinal fluid protein
how is the H reflex and F response affected in GBS? why?
prolonged, due to demyelination
How is GBS treated?
gamma globulin infusions + respiratory assistance
Corticosteroids do NOT work!!
presentation of chronic inflammatory neuropathy
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
treatment for chronic inflammatory neuropathy
GCS, immunosuppressant, gamma globulins
