Dif Dx - NMS Flashcards
Amyotrophic Lateral Sclerosis
(ALS, Lou Gehrig’s Disease)
A degenerative dx that involves both UMN and LMN. Cranial nerves can be affected as well
- Ms weakness is progressive and can affect muscles of respiration
- Weakness may appear hands first
- Dysarthria & dysphagia
- LMN: Muscle atrophy, cramping, and fasciuclations
- UMN: spasticity and hyperreflexia
- Often no sensory changes
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Alzheimer’s Disease
Progressive neurological disorder that results in deterioration and irreversible damage within the cerebral cortex and subcortical areas of the brain
- dx is intially noted by change in higher cortical functions characterized by subtle changes in memory, impaired concentration, and difficulty with new learning
- typical course of disease avg 7-11 years with death resulting from infection or dehydration
Bell’s Palsy
An inflammatory response affecting the facial nerve (CN VII), results in paralysis of the ms of facial expression. Branch affected determines sx
- Difficulty wrinkling forehead, closing eye tightly, and smiling
- Loss of control salvation
- One sided facial muscle weakness/paralysis
- Normal sensation
- Mouth droops
- Decreased taste sensation on the anterior 2/3 tongue
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Guilain Barre Syndrome (GBS)
A polyneuropathy of probable immune-mediate viral origin, resulting in symmetric motor paralysis and progressive muscular weakness that develops quickly
- LMN dx affecting cranial and peripheral nerves
- Sensory loss (stocking/glove)
- Parasthesias (ting/burn)
- Ms weakness progresses LE to UE and distal to proximal
- May produce tetraplegia with respiratory failure
- Tachycardia, cardiac rhythm changes, blood pressure changes
- Recovery is slow, up to a year with 3% mortality
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Multiple Sclerosis
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A demylenating disease more prevelant in colder climates. Dx may be relatively mild, have bouts of remission/exacerbation or get progressively worse.
- Sensory disturbances including tingling, numbness, pain
- Coordination problems and spasticity
- Fatigue
- Diplopia
- Bowelbladder problems
- Communication disorders
- Psychosocial problems including euphoria and/or depression
- Adverse reactions to heat
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Parkinson’s Disease
A progressive disease affecting the basal ganglia with a decrease in dopamine production and/or receptors in the brain
- Tremor, rigidity, fatigue
- Difficulty initiating or slowness or movements (bradykinesia)
- Abnormal gait (festinating or slow shuffling)
- Flexed posture
- Mask-like face
- Decreased postural reflexes
- Behavioral changes including memory loss/apathy
- Leading to 2ndary: decubitus ulcers, muscle atrophy, contractures, decreased vital capacity and falls
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Post Polio Sydrome
A new form of Muscular Dystrophy that may occur decades after the initial episode of polio. New denervation occurs with assymetrical muscular weakness<!--StartFragment-->
- Myalgia
- Joint pain
- Variable assymetrical muscular atrophy with decreased strength.
- Excessive fatigue and decreased endurance contribue to LOF
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Muscular Dystrophy
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Genetic disease that affects males and causes destruction of muscle cells. <!--StartFragment-->
- Progressive weakness from proximal to distal presenting in boys from 3-7 y/o
- Waddling gait pattern, toe walking, lordosis, frequent falls, difficulty standing up (gower’s sign) and problems climbing stairs (weak gluts and quads)
- Contractures and deformities as the result of muscle imbalances especially of heel cords and tensor facia latae
- As disorder progresses, the child will develop kyphoscoliosis (after 11)
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Charcot-Marie-Tooth Disease
A hereditary disorder of the peroneal and distal leg muscles
- <!--StartFragment-->Foot drop and “stork leg deformity”<!--EndFragment-->
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Upper Brachial Plexus Injury (Erb’s Palsy)
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C5/C6 nerve roots are stretched during birthing <!--EndFragment--><!--StartFragment-->
- weakness in GH ABD, ER, elbow flex, supination
- Classically shoulder is ADD and IR and presents w/ “waiter’s tip” deformity
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Lower Brachial Plexus Injury (Klumpke’s Paralysis)
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C8/T1 are stretched during birth
- Weakness of hand and wrist flexors
“claw hand” appearance is common
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Cerebral Palsy
-General, and causation-
A group of non-progressive disorders resulting from gestational, perinatal, or postnatal CNS damage, characterized by voluntary movement impairments caused by:<!--StartFragment-->
- Hemorrhage below lining of ventricles
- Hypoxic encephalopathy
- Malformations
- Trauma of CN
Most often spastic and athetoid and less often ataxia and athetoid. Spastic paraplegia fairly common at birth
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Spastic Cerebral Palsy
- Most common
- UMN affected w/ the spasticity affecting both limbs on one side (hemiplegia), both legs (paraplegia), all four (tetraplegia)or an intermediate form between para/tetra that affects mostly the legs (diplegia)
- Affected limbs have increased DTRs, muscle tone and abnormal postures/mvmnt w/ mass patterns of flexion or extension, weakness and tendancy for contractures
- Scissor gait and toe walking**
- Visual, auditory, cognitive, and oral motor deficits may be present.
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Athetoid CP
- <!--StartFragment-->Results from basal ganglia involvement
- Slow, writhing involuntary movements may affect extremities
- Decreased muscle tone, poor functional stability in proximal joints, poor visual tracking, speech delay, oral motor problems
- Tonic reflexes ATNR, STNR, tonic lab may persist and block functional positions and movement
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Ataxic CP
- Uncommon
- Results from cerebellar involvement
- Weakness, poor coordination, intention tremor, wide based gait, difficulty w. rapid or fine movement
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