B&B Exam 1 Small Group Cases Flashcards
What DDx for proximal muscle weakness?
NMJ disease, inflammation, or DMD
Case 1 = Dermatomyositis
immune-mediated inflammatory disorder of muscle that is pathologically characterized by cellular infiltration/perifascicular atrophy
Rash and DMD like symptoms
-associated with cancer
Case 2 = GBS
GBS is an autoimmune reaction to PNS tissue
GBS is precipitated by a viral infection…
viruses could include West Nile, Lyme
Explains why patient had fever (acute symptoms), which after a few months were followed by GBS symptoms
There is protein in CSF because an acute inflammatory polyneuropathy is characteristic of the disease
polyneuropathy = roots inside the dura
What is CIDP (chronic inflammatory demylinating polyneuropathy)?
The chronic form of GBS
Case 3: an extramedullary mass that impinged on the dorsal nerve roots and spinal cord at C5 and C6 on the left side
Symptoms:
Both legs had Flexor weeakness and UMN signs (because mass was compression the ventral surface of spinal cord)
-left biceps reflex was absent but left triceps reflex was there
-ipsilateral dorsal column deficit
-conralateral temp and proprio loss
Examples of extramedullary mass: meningiomas, neurofibromas
What is the purpose of motor innervation to muscle (aside from moving them lol)?
Apparently, LMNs provide trophic factor maintaining or stimulating muscle growth
What is the purpose of motor innervation to muscle (aside from moving them lol)?
Apparently, LMNs provide trophic factor maintaining or stimulating muscle growth
Case 4: Degeneration of anterior horn cells
Symptoms:
Patient had weakness and atrophy in all different kinds of muscles (tongue, right biceps, left triceps, etc.)
Too diffuse spread of muscle problems to localize to one area
BOTH upper and lower motor neuron signs
How does EMG demonstrate denervation?
- Fibrillations (random AP’s fired by resting muscle) indicate recently denervated muscle cells
- Enlargement of motor unit seen in sprouting (as in the electrical signal given for one motor unit is much bigger than baseline)
Case 5: Subarachnoid Hemorrhage as a result of Aneurysm from PCOMM
- Worst headache of Life
- Initial CT scan showed no blood but this case wanted to remind us 10% of Subarachnoid bleeds can only be diagnosed with lumbar puncture
- congenital polycystic kidney (connective tissue dysfunction) disease put this patient more at risk for SAH
- a dangerous sequelae to SAH is vasospasm of arteries…so you give patient Calcium blockers to prevent that
If old man came in with ocular muscle weakness but a normal pupil, what would DDx be?
Lack of parasympathetic involvement = potential infarct of nerve or muscle
Case 6: Parkinson’s Disease
loss of dopiminergic neurons in basal ganglia
When a patient presents with truncal ataxia, why is it important that rapid alternation and finger-to-nose test are normal?
Eliminates the cerebellar hemispheres so you know it’s a vermis/paravermis problem rather thn an appendicular ataxia
Case 7: Wallenburg’s Syndrome
Lateral Medullary Syndrome
Localized to PICA
Patient had hiccups, ataxia, all this other shit because at the level of the medulla, you have a ton of nuclei there
Horner’s syndrome present as well
Case 8: Epidural hematoma leading to uncal herniation
The “lucid interval” refers to a situation in which patient loses consciousness for 10 minutes but recovers completely without deficit…although symptoms come back. The normal time in between is apparently pretty characteristic of epidural hematoma
