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NEUROLOGY (path) > CNS lesions (spinal cord), neuropathies... > Flashcards

CNS lesions (spinal cord), neuropathies... Flashcards

1
Q

Central cord lesion

A

Pathophysiology:

  • syringomyelia
  • cord trauma

Clinical:

  • loss of pain and temperature appreciation with sparing of other modalities
  • bilateral, may be asymmetric

Dx/Rx:

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2
Q

Anterolateral cord lesion

A

Pathophysiology:

  • intrinsic lesions tend to spare sacral fibers
  • extramedullary lesions tend to compress the cord and involve sacral fibers

Clinical:
- contralateral impairment of pain and temperature appreciation

Dx/Rx:

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3
Q

Anterior cord lesion

A

Pathophysiology:
- ischemic myelopathies

Clinical:

  • pain and temperature appreciation are impaired below the level of the lesion
  • weakness results from paralysis of muscles supplied by motor neurons in anterior horn

Dx/Rx:

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4
Q

Posterior column lesion

A

Pathophysiology:

Clinical:

  • tight, band-like sensation in regions corresponding to level of spinal involvement
  • Lhermitte’s sign
  • loss of vibration and joint position below lesion

Dx/Rx:

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5
Q

Brown-Sequard syndrome

A

Pathophysiology:
- lateral hemisection of cord

Clinical:

  • ipsilateral pyramidal deficit below the lesion
  • ipsilateral impaired vibration, position sense
  • contralateral loss of pain and temperature appreciation that begins 2 segments below lesion

Dx/Rx:

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6
Q

Guillain-Barre syndrome (type of AIPD)

A

Pathophysiology:

  • acute or subacute polyneuropathy that follows minor infectious illness
  • Campylobacter jejuni
  • anti-GM1 antibodies
  • self-limiting: 70-75% recover completely
  • Miller-Fisher variant: ataxia, areflexia, ophthalmoplegia; (+) anti-GQ1b

Clinical:

  • patients present with weakness that is symmetric and begins in legs proximally > distally
  • DTRs often absent
  • +/- autonomic dysfunction with tachycardia, labile BP, etc.
  • CSF: increased protein

Dx/Rx:

  • plasmapheresis vs. IV IG
  • corticosteroids are NOT indicated!!!!
  • monitor forced vital capacity? (FVC)
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7
Q

CIPD

A

Pathophysiology:

  • similar to guillain-barre but with a chronic and progressive course
  • unknown cause
  • adults 40-60

Clinical:

  • weakness, hyporeflexia vs. areflexia
  • loss of vibratory sense (large fiber)
  • paresthesia, pain
  • +/- dysarthria, dysphagia, impotence, incontinence

Dx/Rx: corticosteroids

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8
Q

Diabetic neuropathy

A

Pathophysiology:

  • polyneuropathy (mixed sensory, motor) occurs in 70% of cases
  • usually develops after 5-10 years of dz

Clinical:

  • numbness, pain, paresthesias in legs>arms
  • diabetic autonomia: postural hypotension, cardiac rhythm disturbance, etc.
  • +/- autonomic neuropathy
  • CSF: increased protein

Dx/Rx: glucose control!

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9
Q

Hypothyroidism

A

Pathophysiology:

  • a rare cause of polyneuropathy
  • usually a/w entrapment neuropathy (carpel tunnel)

Clinical:

  • polyneuropathy
  • +/- acute confusional state, dementia, cerebellar degeneration

Dx/Rx: replenish thyroid

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10
Q

Uremia

A

Pathophysiology:
-severity of nerve dysfunction relates to severity of impaired renal function

Clinical:

  • symmetric sensorimotor polyneuropathy in legs >arms, distal>proximal
  • +/- carpel tunnel syndrome

Dx/Rx:

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11
Q

Sensorimotor polyneuropathy

AIDS

A

Pathophysiology:
- most common neuropathy a/w HIV

Clinical:

  • pain, paresthesias in feet
  • weakness
  • AJ, patellar reflexes absent

Dx/Rx:

  • progressive course
  • no treatment
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12
Q

Inflammatory demyelinating polyneuropathy

AIDS

A

Pathophysiology:
- immune-mediated vs. direct secondary viral infection (CMV, etc.)

Clinical:

  • proximal weakness with less pronounced sensory disturbances
  • areflexia, hyporeflexia
  • CSF: increased protein, lymphocytic pleocytosis

Dx/Rx:

  • corticosteroids
  • plasmapheresis
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13
Q

Lumbosacral polyneuropathy

AIDS

A

Pathophysiology:

  • occurs late in disease course
  • in patients with prior opportunistic infections

Clinical:

  • diffuse, progressive leg weakness
  • back pain
  • paresthesias of feet, perineum
  • areflexia
  • urinary retention
  • CSF: increased protein, pleocytosis, decreased glucose

Dx/Rx: treat secondary infection

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14
Q

Leprosy

A

Pathophysiology:

  • most common cause of peripheral neuropathy worldwide
  • mycobacterium leprae
  • nerve hypertrophy can be palpated

Clinical:

  • tuberculoid leprosy: infection confined to small patch of skin and associated nerves
  • hypopigmented papule over which sensation (pain, temp) is impaired
  • lepromatous leprosy: symmetric sensory polyneuropathy that affects pain, temperature in exposed areas of body
  • tendon reflexes spared!!!

Dx/Rx:

  • dapson
  • rifampin
  • clofazimine
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15
Q

Multiple myeloma

A

Pathophysiology:
- polyneuropathy is a common complication of multiple myeloma

Clinical:

  • distal symmetric polyneuropathy with all sensorimotor modalities affected
  • (+) pain
  • depressed reflexes

Dx/Rx: treat MM

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16
Q

Dapsone

A

a drug used to treat leprosy that can produce reversible polyneuropathy

17
Q

Hydralazine

A
  • antihypertensive a/w sensory polyneuropathy

- resolves after drug is d/c

18
Q

Isoniazid

A
  • anti-tuberculosis agent produces a reversible sensory polyneuropathy
19
Q

Vitamin B6 (pyridoxine)

A
  • toxicity produces a sensory neuropathy that impairs vibration and position sense
  • sensory ataxia
  • Lhermitte sign
  • ankle areflexia
20
Q

Vincristine

A
  • sensory symptoms + loss of reflexes

- improves with d/c

21
Q

Charcot marie tooth

A

Pathophysiology:

  • hereditary motor and sensory neuropathies
  • AD inheritance

Clinical:

  • weakness and distal wasting of muscles in limbs +/- sensory loss
  • pes cavus
  • absent DTRs
  • nerves palpably thickened in 50%
  • nerve conduction veolicites reduced

Dx/Rx:

22
Q

Median nerve compression

A

Pathophysiology:

  • carpel tunnel syndrome
  • common in pregnancy
  • trauma, arthritis, tenosynovitis, myxedema, acromegaly

Clinical:

  • pain and paresthesias confined to the median nerve distribution in the hand
  • awaken patient from sleep
  • weakness and atrophy as it advances
  • (+) Tinel sign, (+) Phalen maneuver

Dx/Rx:

  • corticosteroids
  • conservative measure
  • surgical decompression
23
Q

Tabes Dorsalis

A

Pathophysiology:

  • neurosyphilis
  • degeneration of posterior columns of spinal cord

Clinical:

  • unsteadiness
  • lancinating pains
  • urinary incontinence
  • impaired position, vibrational sense in the legs
  • ataxic gait (+) Romberg
  • +/- Argyll Roberts pupil

Dx/Rx: treat underlying infection

24
Q

Syringomyelia

A

Pathophysiology:

  • cavitation of spinal cord
  • communicating –> communication b/w central canal and cavity
  • -a/w developmental abnormalities
  • noncommunication –> cystic dilation of the cord not in communication with CSF
  • -2/2 trauma, tumors, etc.

Clinical:

  • clinical disturbance depends on site of cavitation
  • sensory loss at level of lesion
  • impaired pain, temperature sensation
  • light touch preserved
  • a/w scoliosis

Dx/Rx: decompression

25
Q

Subacute combined degeneration

A

Pathophysiology:
- vitamin B12 deficiency 2/2 pernicious anemia, D.latum, infection, surgery, etc.

Clinical:

  • onset of distal paresthesias and weakness
  • followed by spastic paraparesis and ataxia
  • vibration, position, pyramidal loss in legs
  • +/- macrocytic anemia

Dx/Rx: vit B12

26
Q

Dejerine Roussy syndrome

A

Pathophysiology:
- thalamic lesion

Clinical:

  • sensory loss
  • spontaneous pain
  • perverted cutaneous sensation (abnormally unpleasant?)

Dx/Rx:

  • analgesic
  • anticonvulsant
  • antidepressant
27
Q

Herpes Zoster

A

Pathophysiology:

  • increasingly common with advanced age
  • inflammatory rxn in 1+ dorsal root ganglion
  • spontaneous reactivation of varicella virus

Clinical:

  • burning, shooting pain in involved dermatome
  • vesicular erythematous rash 2-5 days later
  • may lead to postherpetic neuralgia
  • Ramsay Hunt Syndrome: CN VII nerve palsy a/w herpetic eruption that involves the ear, palate, pharynx or neck

Dx/Rx:

  • analgesics
  • corticosteroids

NEUROLOGY (path) (8 decks)

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