diff dx neuro- pathologies Flashcards
diabetic sensory neuropathy presentation type of neuropathy onset early signs (2) clinical features
presentation: symmetrical, mainly sensory stocking and glove presentation
starts as isolated mononeuropahy and progresses to polyneuropathy
insidious onset
earl signs; loss of ankle reflex & decreased vibratory sense in foot
clinical signs tell us type of fiber involvement; small fibers (myelinated & unmyelinated) => distal pain and parasthesia
neuropathic diabetic ulceration presentation
beefy red, because good vascularity
diabetic autonomic neuropathy (5)
- loss of sexual response & impotence
- hypotonic bladder => incontinence or infection
- disturbance of BP & HR control
- GI dysfunction ( bloating, nausea, diarrhea)
- diffuse or absent sweat response
diabetic focal neuropathy (2)
- appears sudden
2. improves in weeks or months w/o chronic damage
alcoholic neuropathy
cause
presentation
common complaint
- caused by vi-B deficiency (only seen with alcoholics)
- typically mixed; primarily or solely lower limbs, pain, weakness & paraesthesia
- c/o intense burning paraesthesia in soles of feet
pathophysiology of alcoholic neuropathy
relatively mild reduction of motor and sensory conduction velocities => deceased amplitue of sensory action potentials
Guillain-Barre syndrome (3)
- ascending weakness
- acute, progressive, symmetrical ridiculopathy
- presents as inflammatory cell attack on the myelin sheaths with myelin breakdown and often axonal degeneration
3 types of GBS
- acute inflammatory demylinating polyridiculoneuropathy
most common, affects motor & sensory - acute motor axonal neuropathy
sensory intact
not demylinating => destroys axon = destroys AHC - acute motor & sensory neuropathy
rarest, with poor prognosis for recovery
GBS recovery
can take from 2-3 months to 5 years
acute motor & sensory neuropathy has the worst prognosis
GBS pt intervention
acute (4)
subacute (4)
chronic (5)
acute:
1. prevent contractures
2. manage pain
3. respiratory management
4. blood gas levels
subacute:
- ROM
- ADL
- muscle strengthening** don’t over fatigue PNS when healing*
- respiratory management continued
chronic:
- strengthening
- ROM
- increased endurance & aerobic conditioning
- ** always avoid undue fatigue
- pain management
charcot-marie-tooth disease
a.k.a.
dx (6)
a.k.a. hereditary motor & sensory neuropathy (HMSN)
dx
- pt hx (atrophy and weakness)
- family hx (genetic)
- physical exam
- nerve conduction studies
- nerve biopsy
- genetic testing
CMT/HMSN type I
what type
pathophys
cause
demyelination
repeated cycles o demyelination & remyslination which thicken around axons (can be palpated) “onion bulbing”
mutation of peripheral myelin protein (PMP)
CMT/HMSN type II
axonal
direct axonal death
clinical presentation of CMT type I characterized by... cause clinical presentation (5) sensory
- characterized by slow progressive weakness & atrophy beginning in distal limb muscles
- histologically => onion bulbing
caused by autosomal dominant gene
clinical presentation:
- high steppage gait due to foot drop
- inverted “champange bottles” appearance of the limbs = significant distal atrophy*
- bilateral pes cavus due to intrinsic foot muscle weakness and wasting
- areflexia
- gait ataxia, positive rhomberg test
sensory affected but pt doesnt complain because they never had normal sensory to being with
thoracic outlet syndrome
def
compression neuropathy and vascular involvement of brachial plexus or subclavian vessels
neurogenic TOS
characteristic sign
rarest/ least common
characteristic sign called Gilliatt-Summer hand = severe wasting in the fleshy base of the thumb. there may be numbness along the underside of the hand and forearm or dull aching pain in the neck, shoulder and armpit
vascular TOS
presentation (5)
symptoms (4)
pallor, weak or absent pulse in affected arm.
may be cool to the touch and paler than affected limb.
symptoms
- numbness
- tingling
- aching
- heaviness
4 locations/ types of T.O.S.
- cervical rib (very rare)
- anterior scalene syndrome
- pec minor syndrome (usually postural)
btwn muscle & rib with elevation/abduction above head - costoclavicular syndrome
btwn clavice & 1st rib w/ depression and retraction
adson test
testing for anterior scalene syndrome
turn head to involved side, extend head & neck, abduct arm & deeply inhale. check radial pulse and or replication of symptoms
2 most common causes of TOS
- acute trauma + anatomic predisposition
2. repetitive stress + poor posture
pronator teres syndrome
symptoms
compression syndrome
- more common in females
- anterior proximal pain
- point tenderness over pronator teres
- positive tinels signe
- resisted pronation => increased symptoms
ulnar at the elbow / tardy ulnar palsy/cubita tunnel (3)
and who is at risk
- comes on 15-20 years after fx of med epicondyle
- pain in medial forearm
- occurs with prolonged elbow flexion &/ or subluxation of nerve from ulnar groove
SCI pts are at high risk because of all the mat exercises, need elbow pads
5 causes of compartmental syndromes
- edema
- tendon hypertrophy
- repetitive motion
- metabolic conditions = diabetes
- anatomical changes (arthritic)
5 pt interventions for carpal tunnel (CTS) and all compression injuries
- 24 hr splinting
- pulsed US (to increase blood flow)
- nerve gliding - neural tension testing
- tendon gliding
- hand strengthening- intrinsics * not long finger flexors that are inn by medial nerve*
bells palsy
lesion
presentation
cause
LMN lesion, on CN 7
asymmetrical facial paralysis, frontalis affected
caused by herpes zoster up to 50% of the time
myasthenia gravis what is it initial presentation bulbar manifestation triggers pt intervention
autoimmune disorder linked to thymus gland that decreases ACH packets and receptors at NMJ
initial presentation is ptosis and/or diplopia & weakness with abnormal fatigue in PROXIMAL muscles
can have bulbar &/or respiratory weakness -> medical emergency
bulbar manifestation => dysphagia, dysphonia
triggers include pregnancy, stress & infection
pt intervention = energy conservation, low impact aerobics
botulism
blocks the release of ACH
descending paralysis w/ dyspnea w/i 12 hrs
muscles commonly affected by myasthenia gravis
PROXIMAL!
- eye lid/ ptosis is first affected usually
- UEs
- neck
- trunk
- hip flexors
what is double crush syndrome?
two distinct, local lesions on 1 nerve
Seen with CTS and a lot of diabetics
