Assorted points about cases

Question 1

A radiculopathy presents with ____ when compared with a peripheral nerve lesion, which presents with _____

Answer 1

Paresis and sensory symptoms (i.e. numbness) over 1 dermatome
Paralysis distal to the lesion

Question 2

A spinal cord lesion involves ______ symptoms

Answer 2

Both sensory and motor

Question 3

Why might a pt with a spinal cord injury present initially with hyporeflexia but later develop hyperreflexia? What does it mean if a pt has flaccid paralysis with hyperreflexia later?

Answer 3

Spinal shock/edema masks true response initially
There is damage to both the ventral horn (cell bodies, LMN-> flaccid paralysis) and to the lateral white matter (UMN axons -> hyperreflexia) of the cord

Question 4

A pt that presents with mostly sensory symptoms may have _____. A pt with diffuse motor symptoms may have_______.

Answer 4

Dorsal root disease

ALS

Question 5

What can be used to localize a SCI?

Answer 5

Anesthesia over 1 dermatome (b/c no input there)

Question 6

A inability to urinate or defecate indicates involvement of _____ which also receives sensory input from the _____

Answer 6

Sacral spine

Peri-anal/anal area

Question 7

A patient in decerebrate posture has a lesion _____ whereas a patient with a decorticate posture has a lesion ____

Answer 7

Below the red nucleus (i.e. in the pons)

Above the red nucleus (i.e. in the midbrain)

Question 8

A lesion that affects a nucleus or a cranial nerve will cause _____ signs. A lesion that affects descending cortical control of the Cr (i.e. ___ tract) will cause _____ signs.

Answer 8

LMN
Corticobulbar tract
UMN

Question 9

Cerebellar signs include (midline ) _____ which indicate damage to the _____ and (lateral) ________ which indicate damage to the _____

Answer 9

Ataxia, gaze-induced nystagmus, broad-based gait, hypotonia
Vermis, paravermal areas and flocculus
Dysmetria, intention tremor, trouble with rapidly alternating movements
Cerebellar hemispheres

Question 10

finger-to-nose and heel-to-shin tests assess integrity of the ….

Answer 10

cerebellar hemispheres (lateral cerebellum)

Question 11

If a tremor goes away when a patient makes a movement, you could call it a ___ which is characteristic of…..

Answer 11

resting tremor
Parkinson’s disease
(compare to an intention tremor with lateral cerebellar problems)

Question 12

Parkinson’s is a disease of ____ causing _____kinesia. Hemiballism and Huntington’s also affect the ___, causing ____kinesia

Answer 12

Both affect the basal ganglia
Hypo
Hyper

Question 13

Symptoms such as ____ make you consider a lesion to the basal ganglia

Answer 13

involuntary (flinging) movements
writhing, jerky movements
These are specific for hemiballism

Question 14

Cognitive deficits over a period of time and of a progressive nature should make you think ____ as an etiology

Answer 14

Dementia/disease process

Question 15

Meningitis presents with ____. The inflammation of the meninges causes ____ which causes the symptoms.

Answer 15

A stiff neck and (if infectious) a high WBC in the CSF

Communicating/non-obstructive hydrocephalus

Question 16

If a pt’s symptoms are all over the neuraxis and cannot be localized with 1 focal lesion, you should consider ____ as an etiology

Answer 16

A disease process (i.e. MS, ALS, thiamine deficiency)

Question 17

MS involves _____. ALS involves ______.

Answer 17

Several separate lesions (i.e. brain stem, spinal cord, cortex)
Motor neuron degeneration (mostly LMN signs with some UMN signs) at no one segmental level

Question 18

An aneurysm of the posterior communicating artery is in close proximity to ___ so it may cause ____

Answer 18

Cr 3
problems with parasympathetic innervation of the eye (accommodation, pupillary light reflex/pupil is dilated) and if it progresses further, trouble with eye movements