Hon Review Flashcards
What’s the most common anterior horn cell disease?
ALS
What do you expect to see or hear in the patient or in their history if they have ALS?
weakness, gait disturbance, clumsiness
what are you going to see on examination of a patient with ALS?
fasciculations (usually later in disease), objective muscle weakness, increased reflexes, babinski response, muscle atrophy
do you expect to see numbness or tingling or loss of sensation with ALS? Pain?
no and no
primary lateral sclerosis- is this upper or lower motor neuron?
upper
spinal muscular atrophy, is this primarily upper or lower motor neuron?
lower
what are the 2 basic areas of the spinal cord that are involved in motor neuron diseases-especially ALS?
anterior horn cell and the corticospinal tracts
2 important diseases of the NMJ?
myasthenia gravis and LEMS
is myasthenia gravis pre-synaptic or post-synaptic?
post synaptic
is LEMS pre or post synaptic?
pre synaptic
what is the typical presentation of a patient with myasthenia gravis?
ptosis and diplopia, fatigable weakness
if you do a nerve conduction on patients with MG what are you expecting?
~10% decrement
what is the blood test to look for MG?
AChR antibodies
what is the age distribution for MG?
bimodal: younger women and older men
What would the nerve conduction studies show in a patient with LEMS?
incremental response to exercise (big time increment)
How would a patient with LEMS present?
proximal muscle weakness, complains of getting out of chair, difficulty climbing stairs; they also have muscle pain; worst complaint: dry mouth; diminished DTRs
LEMS tends to be classified as what?
a paraneoplastic syndrome
what is the antibody that we look for if we are looking for LEMS?
VGCC antibodies
LEMS is often discovered when patients are taking exogenous what?
magnesium
what does magnesium act as?
a false neurotransmitter
what kinds of cancer do we typically see with LEMS?
small cell lung carcinoma or breast cancer
what is the classic presentation of a diabetic with peripheral neuropathy?
predominantly sensory: burning, stinging, tingling feeling that usually starts in the toes or the soles/pads of the feet
late, late, late in peripheral neuropathy of any kind you can get dysautonomia. What is this?
hypotension, urinary retention, or urinary urgency/frequency
remember that generalized sensory motor peripheral neuropathy has the so-called what distribution?
stocking and glove distribution- usually starts in the feet
what is the definition of peripheral neuropathy?
weakness, sensory loss, and impairment of reflexes caused by diffuse lesion of peripheral nerves
when you have B12 deficiency it can cause what?
subacute combined degeneration
what is subacute combined degeneration?
both upper and lower motor neuron issue
what is typically affected in B12 deficiency?
the posterior columns
what might you see on the exam of a patient with a B12 deficiency? aka how do we check the posterior columns?
an abnormal romberg test -poor balance
what is the most common radiculopathy in the upper extremity and at what level?
C7 nerve root; C6-7 is the level
what is the most common mononeuropathy in the UE?
carpal tunnel
