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Neuro > Foot Drop > Flashcards

Foot Drop Flashcards

1
Q

Foot drop = weakness in…

A

dorsiflexion and eversion of foot

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2
Q

Charcot Marie Tooth:

diagnosis?

A

DNA analysis

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3
Q

Charcot Marie Tooth type 1 p/w:

A
  1. slowly progressive distal wasting
  2. weakness of anterolateral muscle compartment
  3. pes cavus
  4. absent tendon reflexes
  5. mild sensory loss
  6. thick (sometimes palpable) peripheral nerves
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4
Q

How is Charcot Marie Tooth type 2 different than type 1?

A
  • later onset

- preserved nerve conduction velocity

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5
Q

How is Charcot Marie Tooth type 2 diagnosed?

A
  • Slowing of nerve conduction
  • histo of segmented demyelination
  • hypertrophy
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6
Q

Types of chronic bilateral foot drop?

A
  • Polyneuropathy
  • Motor neuron disease (ALS)
  • Distal myopathies (RARE)
  • Charcot marie tooth
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7
Q

How can Peroneal Mononeuropathy be differentiated from L5 Radiculopathy?

A

Ankle Jerk preserved

rarely preserved in L5 Radiculopathy b/c usually loss of S1 root = loss of AJ

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8
Q

What is left intact in Peroneal Mononeuropathy?

A

Ankle inversion + toe and plantar flexion (b/c tibial nerve innervates post. calf muscles)

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9
Q

Where does sciatic nerve divide?

A

as high as trochanter or above popliteal fossa

*divides into common peroneal and tibial

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10
Q

Common Peroneal Nerve travels with ___ in the thigh. It separates in…

A

tibial division in the thigh

Separates in the popliteal fossa (and travels around the fibular head)

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11
Q

Common Peroneal Nerve:
Motor branch innervates…
Sensation from…

A

Motor branch to the short head of biceps femoris

Sensation branch from lateral knee

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12
Q

Where does the common peroneal nerve divide into the superficial & deep peroneal nerves?

A

fibular tunnel formed by a fibrous arch and the aponeurosis of the soleus

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13
Q

Compression of the common peroneal nerve at the fibular head causes loss of (motor and sensory) :

A
  • loss of dorsiflexion and ankle eversion
  • loss of Sensation anterolateral leg and dorsum of foot

(so ankle inverts and foot plantar flexes)

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14
Q

Predisposing factors in compression peroneal mononeuropathy at fibular head:

A
  • Recent anesthesia and surgery
  • Prolonged hospitalization
  • THA (??)
  • braces, plaster casts, habitual leg crossing
  • DM
  • polyneuropathy
  • baker’s cysts
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15
Q

How will common peroneal nerve damage present?

A
  1. Foot drop w/ tendency to invert foot [unopposed tibialis posterior]
  2. high stepping gait
  3. sensory loss over the lateral aspect of the leg/knee & dorsum of foot
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16
Q

Deep peroneal nerve innervates:

A
  1. Tibialis anterior
  2. Extensor hallucis longus
    3/4. Extensor digitorum longus & brevis [after crossing thru the anterior tarsal tunnel]
  3. Peroneus tertius
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17
Q

Entrapment of deep peroneal nerve occurs in:

A

in anterior tarsal tunnel at ankle

18
Q

How will deep peroneal nerve entrapment present?

A
  1. Weakness of toe dorsiflexion (foot drop)
  2. Sensory loss in first dorsal web space (medial 2 toes)
  3. High stepping gait
  4. Weakness of ant compartment of leg

*eversion spared

19
Q

Superficial Peroneal Nerve:
Innervates?
Sensory from?

A

peroneus longus & brevis

dorsolateral foot & leg

20
Q

Superficial Peroneal Nerve entrapment occurs at:

A

fascial exit on anterolateral leg

21
Q

How will Superficial Peroneal Nerve entrapment present?

A
  1. Weakness of eversion (proximal damage only)
  2. Sensory loss of anterolateral leg and dorsum of foot

*Dorsiflexion spared + tendency to invert on dorsiflexion

22
Q

Location of L5 root sensory loss:

A

mostly BIG TOE, more medial

*HIGH yield for test

23
Q

Lumbosacral cord arises from:

A

L4 and L5

24
Q

MCC of L5 radiculopathy?

A

prolapsed disk that impinges on root as the pass laterally to the intervertebral foramina

**usually lower roots

25
Q

Clinical features of L5 radiculopathy?

A
  • low BP with ttp
  • Pain radiating down back of the leg from butt to ankle (sciatica)
    - Weakness (extensor hallucis longus)
26
Q

How do you induce passive traction of lumbosacral roots?

A

straight leg raise with patient supine

*limited by pain and muscle spasm

27
Q

Loss of S1 causes:

A

weak gastrosnemius and soleus + no ankle jerk

28
Q

Symptoms of L5 radiculopathy?

A
  • Ankle inversion and toe flexion weak w/ footdrop (weakness at extensor hallicus, ankle dorsiflexors, and peroneal muscles)
  • Sensory loss and paresthesias mainly = big toe (poorly demarcated) and medial foot
29
Q

If L5 radiculopathy is NOT accompanied by S1 radiculopathy…

A

Plantar flexion + AJ WNL

30
Q

Gluteus medius & maximus innervated by…

Tensor fascia lata innervated by…

A

L5-S1

L5

31
Q

Diagnosis?

Pushing something heavy w/ shooting, electric pain; Subsequent foot drop.

A

L5 radiculopathies

i.e. spinal cord stenosis

32
Q

Diagnosis?

Pelvic surg + SQH (epidural) in mother s/p birth who can’t move leg

A

retroperitoneal hematoma of lumbosacral plexus

33
Q

Diagnosis?

Tight Cast causing foot drop

A

common peroneal nerve entrapment/injury

34
Q

Diagnosis?

Pt. w/ weakness in dorsiflexion, inversion, eversion, toe flexion

A

Sciatic involvement can be suspect w/ THA or osteophytes in sciatic foramen

  • This lesion is probably root!
35
Q

What muscle is innervated by lateral cord of sciatic nerve prior to dividing to common peroneal & medial popliteal (post tibial)?

A

Muscular Branches of sciatic Nerve = Short head of biceps muscle

36
Q

What are the muscles innervated by TIBIAL NERVE L5 (NOT via the common peroneal nerve)?

A 
o Paraspinals (lumbar & high sacral)
o Gluteus medius
o TFL
o Flexor digitorum longus
o Tibialis posterior
37
Q

Why send person for EMG with foot drop if you can Dx w/ MRI (3 reasons)?

A
  1. You can have asymptomatic discs that have been protruding for years
  2. MRI can miss very lateral disc herniation (must do CT myelogram to ID those)
  3. Pts. that don’t fit in MRI (or have pacemaker, aneuyrism clip)

*THEREFORE sometimes must do EMG to ID L5 vs. common peroneal etiology

38
Q

Diagnosis?

Sensory Nerve Action Potential is slow or absent across fibular head w/o other problems

A

common peroneal head entrapment

39
Q

Diagnosis?

Sural nerve –saphenous nerve (from common peroneal) Sensory Nerve Action Potential absent

A

probably sciatic (higher lesion)

40
Q

Lesion with a normal Sensory Nerve Action Potential?

A

lesion is ROOT only: DRG is pseudounipolar, and it leaves the cell body intact

41
Q

Lesion with absent Sensory Nerve Action Potential?

A

lesion is PLEXUS or PERIPHERAL nerve due to disconnection from cell body in DRG

42
Q

When should you do something about a foot drop?

A

in forst 12-24h..you can save function o flimb and prevent problems with urinary leakage

*admit, consult neurosrx, STAT imaging, steroids (if time)

Neuro (7 decks)

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