B7.008 Prework 1: Peripheral Nerve Clinical Concepts Flashcards
1
Q
radiculopathy
A
damage at the root
2
Q
plexopathy
A
damage at the plexus
3
Q
neuropathy
A
damage at the nerve / peripheral nerve
4
Q
myelopathy
A
damage at the spinal cord
5
Q
encephalopathy
A
damage at the brain
6
Q
diagnosis of neuro conditions
A
syndrome lesion -identify system -identify likely localization based on pattern -confirm and refine localization etiology
7
Q
focal lesion
A
unilateral, asymmetric pattern
structural etiology
anatomic
8
Q
diffuse lesion
A
bilateral, symmetric pattern
toxic or metabolic etiology
physiologic
9
Q
midline lesion
A
bilateral, symmetric pattern in LOWER LIMBS
no arm symptoms
structural etiology
anatomic
10
Q
multifocal lesion
A
bilateral, asymmetric pattern
inflammatory or infiltrative etiology
anatomic or physiologic
11
Q
examples of system involvement
A
- motor
- sensory
- spinothalamic = pain/temp
- dorsal column = fine touch/ proprioception - autonomic
12
Q
pathologies associated with neuropathies
A
myelinopathies
axonopathies
13
Q
small fibers
A
spinothalamic
pain
temp
14
Q
large fiber
A
dorsal column
vibration
touch
proprioception
15
Q
temporal evolution of neuropathy
A
acute (days to 4 wks)
subacute (4-8 wks)
chronic (>8 wks)
16
Q
most common cervical radiculopathies
A
C7 = 46% C6 = 18% C5 = 7%
17
Q
T4
A
nipple level
18
Q
T10
A
umbilicus
19
Q
C5 weakness
A
deltoid
infraspinatus
biceps
20
Q
C5 reflex decrease
A
biceps
pectoralis
21
Q
C5 region of sensory abnormality
A
shoulder
upper lateral arms
22
Q
C6 weakness
A
wrist extensors
biceps
23
Q
C6 reflex decrease
A
biceps
brachioradialis
24
Q
C6 region of sensory abnormality
A
1st and 2nd fingers
lateral forearms
25
C7 muscle weakness
triceps
26
C7 reflex decrease
triceps
27
C7 region of sensory abnormality
third finger
28
most common lumbar radiculopathies
```
S1 = 45-50%
L5 = 40-45%
L4 = 3-10%
```
29
L4 weakness
iliopsoas
| quads
30
L4 reflex decrease
patellar tendon (knee jerk)
31
L4 region of sensory abnormality
knee
| medial lower leg
32
L5 weakness
foot dorsiflexion
bio toe extension
foot eversion, inversion
33
L5 reflex decrease
none
34
L5 region of sensory abnormality
dorsum of foot
| big toe
35
S1 weakness
foot plantar flexion
36
S1 reflex decrease
Achilles tendon
37
S1 region of sensory abnormality
lateral foot
small toe
sole
38
radial nerve
extension at all arm, wrist, and proximal finger joints below the shoulder
forearm supination
thumb abduction in plane of palm
39
median nerve
thumb flexion and opposition
flexion of digits 2 and 3
wrist flexion and abduction
forearm pronation
40
ulnar nerve
finger adduction and abduction other than the thumb
thumb adduction
flexion of digits 4 and 5
wrist flexion and adduction
41
axillary nerve
abduction of arm at shoulder beyond first 15 deg
42
musculocutaneous nerve
flexion of arm at elbow
| supination of forearm
43
femoral nerve
leg flexion at hip
| leg extension at knee
44
obturator nerve
adduction of the thigh
45
sciatic nerve
leg flexion at the knee
46
tibial nerve
foot plantar flexion and inversion
| toe flexion
47
superficial peroneal nerve
foot eversion
48
deep peroneal nerve
foot dorsiflexion
| toe extension
49
common causes of focal neuropathies
acute: trauma
chronic: entrapment
50
traumatic neuropathy
```
acute mechanical compression of nerve
duration and magnitude of forces determines severity of injury
-neuropraxic
-axonotmetic
-neurotmetic
```
51
neuropraxia
focal demyelination
axon and connective tissue intact
recovery 1-8 weeks
52
axonotmesis
axon injury
connective tissue intact
recovery length dependent, 1 mm/day
53
neurotmesis
axon transected
connective tissue disrupted
no recovery without surgical intervention
(penetrating injury)
54
entrapment neuropathy
```
mechanical compression of a nerve in a narrowed anatomic compartment
dysfunction related to a combination of:
-nerve ischemia
-focal demyelination
-axon crush injury
```
55
describe in detail the pattern associated with distal symmetric peripheral neuropathy
```
bilateral, symmetric, sensory, distal
length dependent: longest nerves most susceptible bc they work the hardest (often due to a toxin)
-stocking and glove sensory loss
absent ankle reflexes
with or without motor involvement
```
56
causes of distal symmetric peripheral neuropathy
most common : diabetic
cryptogenic
less common: hereditary (charcot marie tooth, toxins)
57
describe the pattern associated with a distal symmetric small fiber neuropathy
```
bilateral, symmetric, sensory, distal
diffuse & length dependent
pain and temp loss ONLY
preserved posterior column (fine touch, proprioception, vibration)
preserved reflexes
no weakness
```
58
describe the pattern seen in AIDP and CIDP
```
bilateral, symmetric, motor, proximal and distal
diffuse, NON length dependent
symmetric sensory loss
generalized hyporeflexia
proximal and distal weakness
```
59
describe the injury associated with AIDP and CIDP
myelinopathies
| immune-mediated
60
AIDP
Guillain Barre
acute, inflammatory, demyelinating polyneuropathy
immune mediated attack against peripheral nerve myelin
may occur after infection
61
ttx for AIDP
IVIg
| plasmapheresis
62
CIDP
chronic, inflammatory, demyelinating polyneuropathy
autoimmune polyneuropathy
responsive to chronic immunosuppression
63
types of lesions to consider with multifocal pattern
```
multiple roots (polyradiculitis) : look at meninges (CSF bathes all roots)
multiple nerves: monneuropathy multiplex, vasculitis
```
64
acute to subacute etiologies of polyradiculopathy mononeuropathy multiplex
neoplastic
autoimmune
infectious (lyme)
65
chronic etiologies of polyradiculopathy mononeuropathy multiplex
hereditary predisposition to pressure palsies
66
acute
| focal
trauma
67
acute
| diffuse, distal
acute toxin (drugs) exposure
68
acute
| diffuse, distal and proximal
AIDP
69
acute
| midline
cauda equina
trauma
hematoma
70
acute
| multifocal
inflammatory
neoplastic
infectious
71
chronic
| focal
entrapment
72
chronic
| diffuse, distal
```
diabetes
cryptogenic
hereditary
chronic toxin
organ failure
```
73
chronic
| diffuse, distal and proximal
CIDP
74
chronic
| midline
cauda equina entrapment
spinal stenosis
tumor
75
chronic
| multifocal
predisposition to pressure palses
