DSA 21 Disturbances of Sensation Flashcards
diminished pinprick, touch or vibration
hypesthesia
increased or exaggerated painful sensation to a painful stimulus
allodynia
affects a SINGLE muscle group
mononeuropathy
What disorders are associated with mononeuropathies?
Diabetes, thyroid disease, RA, SLE (these are METABOLIC disease)
lateral femoral cutaneous nerve neuropathy
Meralgia Paresthetica
sensory disturbance in the distribution of >1 peripheral nerve; may have saturday night palsy and carpal tunnel syndrome
mononeuropathy multiplex
sensory disturbance in the distribution of a nerve root or dermatome
radiculopathy
What is a common physical finding of a person with radiculopathy?
pain at the site of the nerve root
subacute/chronic radiculopathy
suggests degenerative or possibly inflammatory spine disease
acute radiculopathy
traumatic, infectious, or vascular etiology
weakness in the distribution of a single nerve root
myotome; present in radiculopathy
positive straight leg raising
radiculopathy
positive spurling sign
radiculopathy
What if someone has negative imaging but they have symptoms of radiculopathy?
ischemic etiology; nerve root infarction
acute polyneuropathy
GBS
What is the onset of most polyneuropathies?
gradual or subacute
Why does someone with a polyneuropathy have orthostatic hypotension?
polyneuropathy affects all types of peripheral nerves including AUTONOMIC and orthostatic hypotension is an autonomic dysfunction
What are some causes of peripheral polyneuropathy?
diabetes, alcoholism, thyroid disease, rheumatologic diseases
What conditions have pain at the level of the lesion?
radiculopathy, spinal cord lesion; so dn’t be tricked!
sphincter dysfunction impairing bowel and or bladder dysfunction
spinal cord lesion
spinal ataxia
inherited spinal cord disease that will be negative on imaging
A patient is diagnosed with B12 deficiency spinal cord lesion. Is imaging a diagnostic factor?
will be negative on imaging
what are some inflammatory spinal cord lesions
transverse myelitis, combined degeneration of the cord or MS; will either be negative or positive on imaging
Brown-sequard syndrome
ipsilateral loss of proprioception, contralateral loss of pain and temp, ipsilateral UMN weakness
onset of syringomyelia?
gradual
identify: shawl-like distribution of decreased pain and sensory loss
syringomyelia
what sensory loss is unaffected in syringomyelia?
light touch and proprioception
LMN-type hand weakness and atrophy of the hands
syringomyelia
etiology of syringomyelia
enlargement of the central canal of the spial cord
subacute combined degeneration of the cord
B12 deficiency
B12 deficiency symptoms
decreased vibration and position sense in the feet, positive Romberg, UMN weakness, gait disturbed
What is frequently associated with a B_12 deficiency
macrocytic hyperchromic anemia
What if there is a low normal of B_12?
check methylmalonic acid
Crossed signs in which there is sensory loss on one side and cranial nerve findings on the other side
brainstem lesion
acute brainstem lesion
vascular disease
gradual brainstem lesion
neoplastic
acute or subacute brainstem
demyelinating like MS
Large vs small thalamic lesions
large will include corticospinal tract (UMN weakness)
small thalamic lesion symptoms
contralateral numbness and tingling and contralateral pain
diminished sensation on the entire left or right half of the body
thalamic lesion
thalamic syndrome
contralateral numbness and pain
What condition doesn’t cause a thalamic lesion?
MS
dominant hemisphere affected in a parietal lobe lesion
language disturbance along with sensory disturbance to any/all modalities
asteriognosis
lack of the the mental perception of depth or three_dimensionality by the senses, usually in reference to the ability to perceive the form of solid objects by touch.
associated with a parietal lesion
Agraphesthesia
associated with a parietal lesion
difficulty recognizing a written number or letter traced on the skin after parietal damage
extinction with bilateral simultaneous stimulation
parietal lesion
diminished 2 point discrimination
parietal lesion
what if a parietal lesion doesn’t involve the dominant hemisphere
may be spatial disturbance and DENIAL of illness
non_dominant parietal lobe
important in visuo_spatial perceptions
What condition does not affect the cerebral cortex?
MS
patient presents with infarct of the nerve root. what do you expect to see on MRI?
nothing, MRI is frequently negative for infarct of the nerve root
in radiculopathy of thoracic spine, more likely to result from ______ than _________.
nerve root infarction, disc herniation
what is myelopathy?
disorder affecting the spinal cord. sensory/motor deficit will be below the level of the lesion
what are complications of B12 deficiency?
combined degeneration of the spinal cord, dementia, and polyneuropathy
what is the clinical manifestation of Wallenberg’s syndrome (lower medulla)?
ipsilateral facial numbness, hoarseness and dysarthria, ipsilateral Horner’s syndrome, ipsilateral arm and leg ataxia, diminished sensation in contralateral arm, leg, and torso
what sensory disturbance is seen in thalamic lesions?
contralateral loss/decrease of all sensation, contralateral pain
what sensory disturbance is seen in parietal lobe lesions?
decreased discriminative function on opposite side of the body.
abnormal 2 point discrimination, graphesthesia, stereognosis, bilateral simultaneous stimulation
