Lecture 1: Introduction To Neurologic Differential Diagnosis Flashcards
Define
Structure of nervous system with emphasis on centers (nuclei) and pathways
Neuroanatomy
Define
Combination of many factors coming together to cause an illness
Etiology
Mechanism by which a disease is caused
Pathogenesis
What are the steps to Neurological Differential Diagnosis? (5)
- Observation, Medical Record, Subjective
- Interpret
- Hypothesize
- Neuro Exam, Special Tests
- Diagnosis
A patient states they have fasciculations and atrophy, what do you suspect?
LMN disorder
A patients states they have hypermetria, dysdiadochokinesia, and ataxia, what do you suspect?
Cerebellum involvement
Patient states they have hypokinesia and bradykinesia, what do you suspect?
Basal Ganglia Involvement
A patient presents with Spasticity and (+) Babinskis, what do you suspect?
UMN Involvement
Patient presents with poor stereognosis and graphesthesia, what do you suspect?
Cortex Involvement
Patient has complete unilateral hearing loss and facial weakness, what do you suspect?
Cranial Nerve Involvement
How do you localize if the patient is suffered get from a central or peripheral nervous issue?
Test the Following
- Motor Patterns
- Sensory Panthers
- Cognition
- Basal Ganglia
- Cerebellum
Are cranial nerves central or peripheral nerves?
Peripheral nerves
The Upper Motor Neurons come from the ____________
Cortex
The Upper Motor Neurons come from the cortex to the … (2)
- Motor Nuclei in Brainstem
2. Alpha Motor neuron in Spinal Cord
Lower motor neurons originate in the … (2)
- Motor Nuclei in Brainstem
2. Alpha Motor Neuron
Lower motor neurons that originate from the motor nuclei in the brain stem go where next?
- > Motor Nuclei in the brainstem
- –>Cranial Nerves
- —–>Muscles in Face/Head
Lower motor neurons that originate in the alpha motor neuron go where next?
- > Alpha Motor Neuron
- –>Spinal Nerve Root
- —–>Peripheral Nerve
- ———>Muscles in the body
What do Upper motor neurons originate?
Cortex
Where do Lower Motor Neurons Originate?
- Motor Nuclei in brain stem
2. Alpha motor neurons in spinal cord
Termination of Upper motor neurons for the head and face occur where?
Motor Nuclei in the brainstem
Termination for lower motor neurons in the head/face occur where/how?
Through cranial nerves to muscles of head and face.
Termination of Upper motor neurons to the body occur where?
Alpha motor neurons in the spinal cord
Termination of lower motor neurons for the body occur where?
Through spinal nerve roots then peripheral nerves to the body.
When diagnosing UMN and LMN involvement, what is true for both in regards to Weakness?
Both UMN and LMN present with weakness
When diagnosing UMN and LMN involvement, what is true for both in regards to Atrophy?
UMN lesions do not resent with Atrophy
LMN lesions present with Atrophy
When diagnosing UMN and LMN involvement, what is true for both in regards to Fasiculations?
UMN lesions do NOT present with Fasciculations
LMN Lesions present with Fasciculations
When diagnosing UMN and LMN involvement, what is true for both in regards to Reflexes?
UMN lesions lead to Hyperreflexia
LMN Lesions lead to Hyporeflexia
When diagnosing UMN and LMN involvement, what is true for both in regards to Tone?
UMN lesions have INCREASED Tone
LMN lesions have DECREASED Tone
With acute UMN lesions, what is true of reflexes and tone?
With acute UMN lesions, reflexes and tone may be decreased.
Although UMN lesions do not lead to Atrophy, how does one still develop atrophy?
Mild atrophy may develop due to disuse
Lesions in the Cortex present with weakness where in the body?
Contralateral Face and Body
=>Right Cortex Lesion
==>Left Sided weakness in face and body
Lesions in the Brainstem present with weakness where in the body?
Ipsilateral Face, Contralateral Body
=>Brainstem Lesion on the Right
==>Right Facial Weakness
===>Left Sided Body Weakness
Lesions in the Spinal Cord (injury) present with weakness where in the body?
At and below the level of lesion
Patients with polyneuropathy present with what general pattern of weakness?
Distal > Proximal
-Hands and Feet First
Patients with Neuromuscular junction abnormalities present with what general pattern of weakness?
Patchy
-Face is commonly affected.
Patients who present with myopathy show signs of what general pattern of weakness?
Proximal > Distal
Hips and shoulders > Hands and Feet
What are the grades for Reflexes?
0 Absent
1+ Diminished
2+ Average
3+ Brisker than average, but not indicative of disease
4+ Very Brisk, Hyperactive, may have clonus
What grades for reflexes should be we concerned about?
0 and 4
1+ to 3+ are normal unless they are asymmetric or there is a dramatic difference between UE/LE
When is a 1+ or a 3+ considered not normal?
When the gradings are assymetric between both sides or there is a difference between UE and LE
A grade of 0 for reflexes is indicative of?
A grade of 4+ for reflexes is indicative of?
0=LMN Lesion
4+=UMN Lesion
What are the 2 types of Somatosensory patterns?
- Central Distribution
2. Peripheral Distribution
For somatosensory patterns, what are the central distributions?
- Homunculus: Body Regions
- Selective Loss of certain modalities (pain/temp)
- Loss of higher-order perceptual functions (stereognosis, graphesthesia, extinction)
For somatosensory patterns, what is the peripheral distribution?
- Peripheral N. Distribution
- Dermatome (Spinal Nerve Roots)
- Stocking Glove
Within the CNS, what are the 3 sites for UMNs?
- Cortical
- Brainstem
- Spinal Cord
Within the CNS, what are the other regions not considered part of UMNs?
- Basal Ganglia
- cerebellum
- Other cortical brainstem or spinal cord
Within the PNS, what comprises the LMNs?
- Motor CN and Nuclei
- Anterior Horn
- Nerve Root
- Peripheral Nerve
- NMJ
- Muscle
In the peripheral nerves system, what is not considered part of the LMN system?
- Cranial Nerves: Sensory and Special
- Sensory (Nerve root, peripheral nerve)
- Autonomic
What are the 4 common clinical findings associated with cerebellar involvement?
- Dysmetria, Dysdiadochokinesa, Hyper/Hypometria
- Nystagmus
- Dysarthria
- Ataxia
What are the 3 common clinical findings for the basal ganglia?
- Bradykinesia, Hypokinesia
- Athetosis/Chorea
- Dystonia
When your arm falls asleep, and you can’t really move it, these symptoms are similar to __________
Ataxia
This is the inability to perform skilled tasks that cannot be explained by weakness, sensory loss, or ataxia
Apraxia
This is a disorder of language (Expressive, receptive)
Aphasia
This is the inability to identify things like, what is in your hand. It is a disorder of higher-order perception related to asterognosis and agraphesthesia
Agnosia
What are a PT’s skill set that can be used in a neurological exam?
- Reflexes
- Motor (Strength/tone)
- Sensory testing
- Coordination
- Cranial Nerves
- Gait/Balance
- Mental Status
