Clinical knowledge - movement and control Flashcards
Signs of cerebellar problems
nystagmus dysarthria finger-nose ataxia intention tremor dysdiadokokinesis heel-knee-shin ataxia gait ataxia falls signs are ipsilateral lesions don't produce paralysis, paresis or deficits in termination or initiation of movement
scoliosis
sideways curvature of spine
compresses lungs and abdominal organs
reduces total capacity of lungs
treating scoliosis
can be realigned with surgical rods with flexibility
spinal implant works for adults but children are still growing so treating them is difficult as repetitive surgery is required
what is a laminectomy
remove lamina to expose spinal cord or repair herniated disc
replaced by wires
spina bifida occulta
tuft of hair at point of missing spinous process
degeneration of intervertebral discs
occurs over time
causes loss of height
herniated intervertebral disc
nucleus pulposus seeps out of annulus fibrosis
how to test for scoliosis?
ask patient to bend over
one side will go lower than the other
caudal epidural injections
commonly used during birth process
commonly used imaging for spine
x-rays CT MRI myelography isotype studies ultrasound
checking x-ray of cervical spine
A = alignment and adequacy - fractures, disruption of lines, margins between bones/ intervertebral discs B = bone C = cartilage S = soft tissues
when to use CT scan
if there is a suspicion of spinal injury
axial, sagittal or coronal can be used to look for prevertebral soft tissue swelling and cartilage or bony abnormalities
when to use x-ray
look for alignment
vertebral height
intervertebral spaces
presence of osteophytes
degenerative changes on x-rays
hypertrophy of ligaments cannot be seen but can cause more problems than osteophytes
intervertebral discs cannot be seen
kyphosis
is normal but exaggerated curvature of thoracic spine is pathological
can get kyphosis and scoliosis = kyphoscoliosis
spondylolistesis
normally affects lumbar spine
can be degenerative as ligaments become lax
can be caused by abnormality in pars interarticularis
pars defect can predispose to this
vertebra slipping backwards or forwards on 1 below
MRI use
best for visualising spinal cord and nerve roots
important for looking at cauda equina
disc degeneration
loss of height
loss of hydration
disc prolapse
loss of disc water loss of height degeneration of annulus fibrosis protrusion or extrusion can impinge on nerves tension reduced in outer disc
myelography
less commonly used due to MRI used for those who cannot undergo MRI injection of contrast into vertebral canal to view nerve roots and check for compression invasive more risks than MRI contrast injected into subdural space Used to diagnose disc prolapse
ultrasound
can be used to see spinal canal contents in neonates
used for spina bifida occulta, cord tethering or masses - congenital abnormalities
when can ultrasound of a baby’s spine be done?
up to 3 months of age as posterior elements haven’t been matured so the ultrasound beams can get through
bone scan
injection of radioactive tracer
osteoblastic abnormalities uptake the radioactive tracers
looks for cancers
multiple bony metastases
what are the most likely causes of multiple bony metastases
prostate or breast cancer
Jefferson/ burst fracture
fracture of C1
perched facets
misalignment of facet joints
displacement anteriorly or posteriorly
associated with ligament injury and sometimes bony injury
teardrop fracture
caused by severe flexion and compression forces
associated with severe ligamentous injury
bony injury
usually unstable
epidural space abscess
non-traumatic
can be infective
contrast required to see on imaging
discitis
seen on MRI
causes oedema
can cause epidural abscesses
cauda equina syndrome
caused by compression of nerve roots below level of spinal cord
diagnostic and surgical emergency
diagnosis of cauda equina syndrome
MRI
what causes cauda equina syndrome?
degenerative disease of spinal column or disc prolapses
risk of cauda equina syndrome
paralysis
what are the red flags suggesting cauda equina syndrome?
altered perineal sensation
bilateral lower limb pain
change in bladder habit
spinal metastases
from prostate primary
dark on MRI
can compress spinal cord - medical emergency
mitochondrial dysfunction
can lead to neurodegeneration because mitochondrial energy metabolism provides a line of defence against excess glutamate
what are the types of neurontransmitters?
amino acids
monoamines
peptides
other
amino acid neurotransmitters
GABA
glutamate
glycine
monoamine neurotransmitters
catecholamines
peptide neurotransmitters
opioids
other neurotransmitters
acetylcholine
what are monoamines used in?
attention
cognition
emotion
opioids
involved in perception of pain
what is a treatment for alzheimer’s disease?
galantamine
how does galantamine work?
Acetylcholinesterase inhibitor so prevents the breakdwon of acetylcholine so the neurotransmitter is present for longer in the synaptic cleft
what does nicotine do?
acts directly on all nicotinic acetylcholine receptors in the brain
treatments for depression
monoamine oxidase inhibitors
SSRIs
what do monoamine oxidase inhibitors do?
prevent breakdwon of monoamine neurotransmitters
increasing their concentration
how do SSRIs work?
block serotonin reuptake channels
