CIDP, Thoracolumbar Injuries, Cauda Equina Syndr, -Myelitis Flashcards
Lambert-Eaton Myasthenic Syndrome:
Symptoms?
Reflexes??
fatigue, weakness, myalgia, musc tenderness, stiffness metallic taste and dry mouth orthostasis constipation impotence
DTR absent or decr
Lambert-Eaton Myasthenic Syndrome:
Treatment?
- evaluate for malignancy
2. Guanidine hydrochloride: inhibits mitochondrial Ca uptake -> Ach release (causes BM suppression)
Lambert-Eaton Myasthenic Syndrome gets (better/worse) with exercise
better
Myasthenia gravis vs Lambert-Eaton?
- MG has worse oculomotor symptoms + autonomic symptoms + weakness
- MG tx = antiAchAse + immunosuppressive drugs
- Electrodiagnostic abnormalities are more prominent in LEMS
Best marker for disease severity in Lambert-Eaton Myasthenic Syndrome?
Compound muscle action potential at rest
CAUDA EQUINA SYNDROME affects…
nerve roots below T10
CAUDA EQUINA SYNDROME signs/symptoms?
- Multiple root involvement
- Patchy/asymmetric LMN signs and sensory loss
(saddle anesthesia, sexual dysf, loss of bladder or fecal control) - Bil loss of ankle reflexes
How does CAUDA EQUINA SYNDROME occur?
traction and pelvic fractures following gunshot injuries, MVA, and falls from height
Disc prolapse symptoms?
LBP + weakness
When should you MRI spine?
weakness + changed eflexes + radiculopathy signs
Red Flags of myelopathy indicating MRI of spine (4):
loss of weight + night sweats + endemic areas + TTP on spine
If no red flags associated with back pain?
give muscle relaxer/NSAID and see them in clinic (if come back w/ new Sx, order imaging)
Acute Myelopathy: signs/symptoms?
- weakness
- sensory loss below level of lesion
- ANS dysfunction (urinary retention)
- Anal sphincter tone + cremaster reflex + anal wink + bulbocavernosus response are lost or diminished
- Urinary retention and bowel dysfunction
Acute Myelopathy: CSF?
- Mild to moderate lymphocytic pleocytosis
- incr protein
- Normal or mildly decr glucose
Transverse Myelitis involves…
MC cause?
complete axial plane of cord = loss of all sensory/motor below lesion
viruses
Partial Myelitis results in…
Brown-Sequard Syndrome
- Ispilateral UMN signs below lesion (CS tract)
- Ipsilateral loss of tactile, vibration, proprioception sense (dorsal column) below lesion
- C/L pain and T loss (ST tract) below lesion
- LMN signs at level of lesion (flaccid paralysis)
If above T1, Partial Myelitis results in…
Horner’s
Partial Myelitis:
acute phase?
chronic phase?
Acute Phase: tone and reflexes of affected limb
Chronic Phase: spasticity w/ pathologic reflexes in the affected limbs
In Partial Myelitis, sensory loss is usually…(in relation to lesion)
1-2 levels below actual cord lesion
Viruses causing LMN weakness
polio
west nile
enterovirus
Symptoms of Poliomyelitis?
- acute, asymm weakness in legs > thoracic/abd/bulbar musc
- decr tone
- lost reflexes
- bladder dysf in acute phase
**sensory is spared
CSF in Poliomyelitis?
- mild-mod lymphocytic pleocytosis (10-1000cells/mm3)
- incr prot (100-500 mg/dL)
- nl/mild decr glc
Dx of Poliomyelitis?
- viral PCR + ab titer
- incr IgG
- CSF
- MRI (affected areas swollen and enhanced w gadolinium on T1; high signal on T2)
Tx of Poliomyelitis?
- Acyclovir for (3): EBV, VZV, HSV
- Ganciclovir/foscarnetforCMV
- Tx chronic spasticity = baclofen +/- BZDs +/- tizanidine
