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Neuro II > 39 Radiculopathy, Neuropathy > Flashcards

39 Radiculopathy, Neuropathy Flashcards

1
Q

Roots that do not contain sensory nerve fibers
?

A

C1, Co1

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2
Q

Cervical herniations MC affect:

A

C7&raquo_space; C6

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3
Q

Cervical spondylosis MC affects:

A

C5, C6

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4
Q

Cervical spondylosis:

Epidemiology?

A

60+ y/o, M>F (slight)

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5
Q

Lumbosacral radiculopathies MC affect:

A

L5, S1

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6
Q

Signs/symptoms associated with radiculopathies?

A
  1. sharp, electric, radiating pain; worsened by movements that stretch the nerve root
  2. Weakness/Atrophy: motor nerve fibers w/in myotome lost (1 root affected = one myotome lost)
  3. Paresthesias (sensory nerve fibers for dermatome are lost)
  4. Muscle Stretch Reflexes: ↓ ~ classic LMN disease finding
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7
Q

Cervical Maneuvers associated with cervical radiculopathy?

A

neck extension (best), neck rotation, Spurling’s Maneuver

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8
Q

Epidemiology of disc herniations?

Epidemiology of spondylosis?

A

50 yo

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9
Q

MC cause of cervical spondylosis?

A

myeloradiculopathy (Spinal Canal Stenosis)

**can present ~ALS from compression of CST

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10
Q

MC causes of lumbosacral spondylosis?

A
  1. neurogenic claudication (ambulation –> lower extremity pain/weakness)
  2. Cauda Equina Syndrome
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11
Q

What bone conditions/injuries contribute to radiculopathy? How?

A
  1. Trauma (younger patients ): causes spinal column instability = ↑risk of radiculopathy
  2. Bone Disease:
    - osteoporosis/malacia
    - Paget’s Disease
    - AVN from pro-longed steroids (SLE)
  3. Neoplastic
    - constitutional symptoms (weight loss)
    - Cauda Equina Syndrome
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12
Q

Imaging for dx of radiculopathy?

A

MRI

greater contrast sensitivity + Gadolinium Contrast allows det scar tissue vs. disk protrusion

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13
Q

Function of EDX?

A

confirms clinical diagnosis from History and Physical

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14
Q

EDX assesses:

A
  • sensory/motor nerves
  • muscle fibers
  • demyelination + axon loss
  • location of d/o
  • severity/prognosis
  • diagnosis
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15
Q

Conservative trx for radiculopathy?

A
  • *most improve w/in 6 weeks
  • AVOID Bed Rest: be as routine as possible
  • PT
  • Rx: pain, steroids, nerve blockers
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16
Q

Features of polyneuropathy?

A

symmetric/distal weakness in glove/stocking pattern

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17
Q

Features of Mononeuritis?

A

weakness + sensory loss in nerve’s distribution pattern (myotome/dermatome)

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18
Q

Features of Mononeuritis complex?

A

multiple myotomes/dermatomes involved

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19
Q

Findings of plexopathies (LMN Disease)?

A
  • ↓reflex
  • ↓conduction velocity
  • denervation/↓# motor units on EMG
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20
Q

Muscle biopsy in plexopathies (LMN Disease)?

A

atrophic fibers + fiber type grouping

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21
Q

Lesion of Median nerve?

A

Carpal Tunnel = numbness in Lateral 3.5 Digits + Atrophy of Thenar Compartment
(weakness in wrist flexion)

22
Q

Lesion of Ulnar nerve?

A

medial elbow entrapment =

  • Numbness in 5th and 1/2 of 4th Digits
  • Atrophy of Hypothenar/Interosseous
23
Q

Lesion of radial nerve?

A

axillary entrapment = wrist drop

24
Q

Lesion of peroneal nerve?

A

compr at fibular head or knee = foot drop

25
Q

Demyelinating Neuropathy:

Nerves Affected?

A

large myelinated axons =

  • fibers joining muscles
  • fibers for reflexes
  • position/vibratory sense
26
Q

Demyelinating Neuropathy:

Path?

A

patchy segmental demyelination with preservation of axon

27
Q

Demyelinating Neuropathy:

Symptoms?

A

weakness (proximal + distal), ↓reflexes, ↓epicritic + intact protopathic

28
Q

Demyelinating Neuropathy:

Diseases?

A

Guillain Barre, Diphtheria, Diabetes

29
Q

Axonal Neuropathy:

Etiology?

A

Uremia + Toxins

30
Q

Axonal Neuropathy:

Symptoms?

A
  • distal areflexia
  • stocking-glove sensory deficit
  • trophic changes
31
Q

Axonal Neuropathy:

Pathology?

A

myelin ovoids characteristic of axonal degradation

32
Q

Axonal Neuropathy:

Nerve conduction?

A

normal w/↓amplitude of APs

33
Q

Wallerian Neuropathy:

Etiiology?

A

trauma + Vasculitis

34
Q

Wallerian Neuropathy:

Path?

A

Toluidine blue stain demonstrates pale fascicle area without myelinated fibers

35
Q

Charcot Marie Tooth Disease:

Etiology?

A

hereditary (AD) disease, periph demyelinating:

  • Type 1A: del of myelin protein PMP Ch. 17
  • Type 1B: def of protein 0 Ch. 1

**PMP 22: peripheral myelin protein is involved in compaction of myelin on peripheral nerves

36
Q

Charcot Marie Tooth Disease:

Symptoms?

A

Signs Below Knee:

  1. distal muscle weakness
  2. atrophy of leg below knee
  3. orthopedic foot problems (hammer toe/↑arch feet)
37
Q

DM Neuropathy:

Pathogenesis of diffuse sensory motor neuropathy?

A

↑Sorbitol + ↓Myoinositol In Nerves

38
Q

DM Neuropathy:

Types of neuropathies?

A
  1. Mononeuropathy
  2. Mononeuritis Complex
  3. Dif Polyneuropathy (sensory, motor, ANS, mixed)
  4. Truncal (truncal sensory deficit)
  5. Diabetic Amyotrophy (LS Plexus ischemia)
39
Q

DM Neuropathy:

Presentation of diffuse sensory motor neuropathy?

A

burning of feet –> numbness, weakness

40
Q

DM Neuropathy:

Prognosis of diffuse sensory motor neuropathy?

A

improves w/ good control of DM

41
Q

What causes the excess sorbitol in DN?

A

excess glu converted to sorbitol via aldose reductase

*Sorbitol Dehydrogenase: enzyme required to convert sorbitol —> fructose; lacking in Schwann Cells, Retina, Lens, Kidneys

42
Q

What are the consequences of excess sorbitol in DN?

A

Osmotic damage –> ↑osmotically active particle in Schawnn Cells, which causes: Vasculopathy and Entrapment Neuropathies

43
Q

DM Neuropathy:

Pathogenesis of mononeuritis, mononeuritis multiplex, and diabetic ophthalmoplegia?

A

caused by infarct to nerves or plexus

44
Q

Guillain Barre Syndrome:

etiology?

A

AI, 2-weeks post-infection with Campy, EBV, CMV, Mycoplasma

45
Q

Guillain Barre Syndrome:

Clinical findings?

A
  1. Paralysis
  2. Radiculoneuropathy: acute + inflammatory
  3. Mild paresthesia (no sensory defect)
  4. Areflexia
46
Q

Guillain Barre Syndrome:

Description of paralysis?

A
  • ascending –> respiratory/facial DZ
  • progressive prox demyelination (occurs over 2-3 weeks post-infection)
  • symmetrical
47
Q

Guillain Barre Syndrome:

Trx?

A
  1. Symptoms: respiratory assistance

2. ɣ Globulin Infusion: get rid of antibodies

48
Q

Chronic Inflammatory Neuropathy:

Etiology?

A

AI inflammatory neuropathy affecting the myelin sheath

49
Q

Chronic Inflammatory Neuropathy:

Clinical findings?

A
  1. Paralysis (sym w/distal + prox features)
  2. Severe loss of epicritic system (intact pain/temperature)
  3. Conduction Block
  4. Areflexia

*no cranial nerve deficits or central demyelination

50
Q

Chronic Inflammatory Neuropathy:

Path?

A

segmental demyelination with signs of de/re-myelination

51
Q

Chronic Inflammatory Neuropathy:

Trx?

A

Steroids, Immunosuppressant, ɣGlobulin

52
Q

Chronic Inflammatory Neuropathy:

Labs/Imaging/Biopsy?

A
  • EMG shows ↓denervation
  • incr CSF protein
  • biopsy = segmental demyelination

Neuro II (18 decks)

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