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year 2 > diff dx neuro- pathologies > Flashcards

diff dx neuro- pathologies Flashcards

1
Q 
diabetic sensory neuropathy
 presentation
 type of neuropathy
 onset
 early signs (2)
 clinical features
A

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

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2
Q

neuropathic diabetic ulceration presentation

A

beefy red, because good vascularity

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3
Q

diabetic autonomic neuropathy (5)

A
  1. loss of sexual response & impotence
  2. hypotonic bladder => incontinence or infection
  3. disturbance of BP & HR control
  4. GI dysfunction ( bloating, nausea, diarrhea)
  5. diffuse or absent sweat response
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4
Q

diabetic focal neuropathy (2)

A
  1. appears sudden

2. improves in weeks or months w/o chronic damage

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5
Q

alcoholic neuropathy
cause
presentation
common complaint

A
  1. caused by vi-B deficiency (only seen with alcoholics)
  2. typically mixed; primarily or solely lower limbs, pain, weakness & paraesthesia
  3. c/o intense burning paraesthesia in soles of feet
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6
Q

pathophysiology of alcoholic neuropathy

A

relatively mild reduction of motor and sensory conduction velocities => deceased amplitue of sensory action potentials

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7
Q

Guillain-Barre syndrome (3)

A
  1. ascending weakness
  2. acute, progressive, symmetrical ridiculopathy
  3. presents as inflammatory cell attack on the myelin sheaths with myelin breakdown and often axonal degeneration
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8
Q

3 types of GBS

A
  1. acute inflammatory demylinating polyridiculoneuropathy
    most common, affects motor & sensory
  2. acute motor axonal neuropathy
    sensory intact
    not demylinating => destroys axon = destroys AHC
  3. acute motor & sensory neuropathy
    rarest, with poor prognosis for recovery
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9
Q

GBS recovery

A

can take from 2-3 months to 5 years

acute motor & sensory neuropathy has the worst prognosis

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10
Q

GBS pt intervention
acute (4)
subacute (4)
chronic (5)

A

acute:
1. prevent contractures
2. manage pain
3. respiratory management
4. blood gas levels

subacute:

  1. ROM
  2. ADL
  3. muscle strengthening** don’t over fatigue PNS when healing*
  4. respiratory management continued

chronic:

  1. strengthening
  2. ROM
  3. increased endurance & aerobic conditioning
  4. ** always avoid undue fatigue
  5. pain management
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11
Q

charcot-marie-tooth disease
a.k.a.
dx (6)

A

a.k.a. hereditary motor & sensory neuropathy (HMSN)

dx

  1. pt hx (atrophy and weakness)
  2. family hx (genetic)
  3. physical exam
  4. nerve conduction studies
  5. nerve biopsy
  6. genetic testing
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12
Q

CMT/HMSN type I
what type
pathophys
cause

A

demyelination

repeated cycles o demyelination & remyslination which thicken around axons (can be palpated) “onion bulbing”

mutation of peripheral myelin protein (PMP)

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13
Q

CMT/HMSN type II

A

axonal

direct axonal death

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14
Q 
clinical presentation of CMT type I
 characterized by...
 cause
 clinical presentation (5)
 sensory
A
  1. characterized by slow progressive weakness & atrophy beginning in distal limb muscles
  2. histologically => onion bulbing

caused by autosomal dominant gene

clinical presentation:

  1. high steppage gait due to foot drop
  2. inverted “champange bottles” appearance of the limbs = significant distal atrophy*
  3. bilateral pes cavus due to intrinsic foot muscle weakness and wasting
  4. areflexia
  5. gait ataxia, positive rhomberg test

sensory affected but pt doesnt complain because they never had normal sensory to being with

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15
Q

thoracic outlet syndrome

def

A

compression neuropathy and vascular involvement of brachial plexus or subclavian vessels

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16
Q

neurogenic TOS

characteristic sign

A

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

17
Q

vascular TOS
presentation (5)
symptoms (4)

A

pallor, weak or absent pulse in affected arm.
may be cool to the touch and paler than affected limb.

symptoms

  1. numbness
  2. tingling
  3. aching
  4. heaviness
18
Q

4 locations/ types of T.O.S.

A
  1. cervical rib (very rare)
  2. anterior scalene syndrome
  3. pec minor syndrome (usually postural)
    btwn muscle & rib with elevation/abduction above head
  4. costoclavicular syndrome
    btwn clavice & 1st rib w/ depression and retraction
19
Q

adson test

A

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

20
Q

2 most common causes of TOS

A
  1. acute trauma + anatomic predisposition

2. repetitive stress + poor posture

21
Q

pronator teres syndrome

symptoms

A

compression syndrome

  1. more common in females
  2. anterior proximal pain
  3. point tenderness over pronator teres
  4. positive tinels signe
  5. resisted pronation => increased symptoms
22
Q

ulnar at the elbow / tardy ulnar palsy/cubita tunnel (3)

and who is at risk

A
  1. comes on 15-20 years after fx of med epicondyle
  2. pain in medial forearm
  3. 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

23
Q

5 causes of compartmental syndromes

A
  1. edema
  2. tendon hypertrophy
  3. repetitive motion
  4. metabolic conditions = diabetes
  5. anatomical changes (arthritic)
24
Q

5 pt interventions for carpal tunnel (CTS) and all compression injuries

A
  1. 24 hr splinting
  2. pulsed US (to increase blood flow)
  3. nerve gliding - neural tension testing
  4. tendon gliding
  5. hand strengthening- intrinsics * not long finger flexors that are inn by medial nerve*
25
Q

bells palsy
lesion
presentation
cause

A

LMN lesion, on CN 7

asymmetrical facial paralysis, frontalis affected

caused by herpes zoster up to 50% of the time

26
Q 
myasthenia gravis
 what is it
 initial presentation
 bulbar manifestation
 triggers
 pt intervention
A

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

27
Q

botulism

A

blocks the release of ACH

descending paralysis w/ dyspnea w/i 12 hrs

28
Q

muscles commonly affected by myasthenia gravis

A

PROXIMAL!

  1. eye lid/ ptosis is first affected usually
  2. UEs
  3. neck
  4. trunk
  5. hip flexors
29
Q

what is double crush syndrome?

A

two distinct, local lesions on 1 nerve

Seen with CTS and a lot of diabetics

year 2 (24 decks)

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