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Neuropathology > Lecture 1: Introduction To Neurologic Differential Diagnosis > Flashcards

Lecture 1: Introduction To Neurologic Differential Diagnosis Flashcards

1
Q

Define

Structure of nervous system with emphasis on centers (nuclei) and pathways

A

Neuroanatomy

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2
Q

Define

Combination of many factors coming together to cause an illness

A

Etiology

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3
Q

Mechanism by which a disease is caused

A

Pathogenesis

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4
Q

What are the steps to Neurological Differential Diagnosis? (5)

A
  1. Observation, Medical Record, Subjective
  2. Interpret
  3. Hypothesize
  4. Neuro Exam, Special Tests
  5. Diagnosis
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5
Q

A patient states they have fasciculations and atrophy, what do you suspect?

A

LMN disorder

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6
Q

A patients states they have hypermetria, dysdiadochokinesia, and ataxia, what do you suspect?

A

Cerebellum involvement

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7
Q

Patient states they have hypokinesia and bradykinesia, what do you suspect?

A

Basal Ganglia Involvement

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8
Q

A patient presents with Spasticity and (+) Babinskis, what do you suspect?

A

UMN Involvement

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9
Q

Patient presents with poor stereognosis and graphesthesia, what do you suspect?

A

Cortex Involvement

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10
Q

Patient has complete unilateral hearing loss and facial weakness, what do you suspect?

A

Cranial Nerve Involvement

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11
Q

How do you localize if the patient is suffered get from a central or peripheral nervous issue?

A

Test the Following

  1. Motor Patterns
  2. Sensory Panthers
    - Cognition
    - Basal Ganglia
    - Cerebellum
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12
Q

Are cranial nerves central or peripheral nerves?

A

Peripheral nerves

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13
Q

The Upper Motor Neurons come from the ____________

A

Cortex

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14
Q

The Upper Motor Neurons come from the cortex to the … (2)

A
  1. Motor Nuclei in Brainstem

2. Alpha Motor neuron in Spinal Cord

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15
Q

Lower motor neurons originate in the … (2)

A
  1. Motor Nuclei in Brainstem

2. Alpha Motor Neuron

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16
Q

Lower motor neurons that originate from the motor nuclei in the brain stem go where next?

A
  • > Motor Nuclei in the brainstem
  • –>Cranial Nerves
  • —–>Muscles in Face/Head
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17
Q

Lower motor neurons that originate in the alpha motor neuron go where next?

A
  • > Alpha Motor Neuron
  • –>Spinal Nerve Root
  • —–>Peripheral Nerve
  • ———>Muscles in the body
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18
Q

What do Upper motor neurons originate?

A

Cortex

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19
Q

Where do Lower Motor Neurons Originate?

A
  1. Motor Nuclei in brain stem

2. Alpha motor neurons in spinal cord

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20
Q

Termination of Upper motor neurons for the head and face occur where?

A

Motor Nuclei in the brainstem

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21
Q

Termination for lower motor neurons in the head/face occur where/how?

A

Through cranial nerves to muscles of head and face.

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22
Q

Termination of Upper motor neurons to the body occur where?

A

Alpha motor neurons in the spinal cord

23
Q

Termination of lower motor neurons for the body occur where?

A

Through spinal nerve roots then peripheral nerves to the body.

24
Q

When diagnosing UMN and LMN involvement, what is true for both in regards to Weakness?

A

Both UMN and LMN present with weakness

25
Q

When diagnosing UMN and LMN involvement, what is true for both in regards to Atrophy?

A

UMN lesions do not resent with Atrophy

LMN lesions present with Atrophy

26
Q

When diagnosing UMN and LMN involvement, what is true for both in regards to Fasiculations?

A

UMN lesions do NOT present with Fasciculations

LMN Lesions present with Fasciculations

27
Q

When diagnosing UMN and LMN involvement, what is true for both in regards to Reflexes?

A

UMN lesions lead to Hyperreflexia

LMN Lesions lead to Hyporeflexia

28
Q

When diagnosing UMN and LMN involvement, what is true for both in regards to Tone?

A

UMN lesions have INCREASED Tone

LMN lesions have DECREASED Tone

29
Q

With acute UMN lesions, what is true of reflexes and tone?

A

With acute UMN lesions, reflexes and tone may be decreased.

30
Q

Although UMN lesions do not lead to Atrophy, how does one still develop atrophy?

A

Mild atrophy may develop due to disuse

31
Q

Lesions in the Cortex present with weakness where in the body?

A

Contralateral Face and Body

=>Right Cortex Lesion
==>Left Sided weakness in face and body

32
Q

Lesions in the Brainstem present with weakness where in the body?

A

Ipsilateral Face, Contralateral Body

=>Brainstem Lesion on the Right
==>Right Facial Weakness
===>Left Sided Body Weakness

33
Q

Lesions in the Spinal Cord (injury) present with weakness where in the body?

A

At and below the level of lesion

34
Q

Patients with polyneuropathy present with what general pattern of weakness?

A

Distal > Proximal

-Hands and Feet First

35
Q

Patients with Neuromuscular junction abnormalities present with what general pattern of weakness?

A

Patchy

-Face is commonly affected.

36
Q

Patients who present with myopathy show signs of what general pattern of weakness?

A

Proximal > Distal

Hips and shoulders > Hands and Feet

37
Q

What are the grades for Reflexes?

A

0 Absent
1+ Diminished
2+ Average
3+ Brisker than average, but not indicative of disease
4+ Very Brisk, Hyperactive, may have clonus

38
Q

What grades for reflexes should be we concerned about?

A

0 and 4

1+ to 3+ are normal unless they are asymmetric or there is a dramatic difference between UE/LE

39
Q

When is a 1+ or a 3+ considered not normal?

A

When the gradings are assymetric between both sides or there is a difference between UE and LE

40
Q

A grade of 0 for reflexes is indicative of?

A grade of 4+ for reflexes is indicative of?

A

0=LMN Lesion

4+=UMN Lesion

41
Q

What are the 2 types of Somatosensory patterns?

A
  1. Central Distribution

2. Peripheral Distribution

42
Q

For somatosensory patterns, what are the central distributions?

A
  1. Homunculus: Body Regions
  2. Selective Loss of certain modalities (pain/temp)
  3. Loss of higher-order perceptual functions (stereognosis, graphesthesia, extinction)
43
Q

For somatosensory patterns, what is the peripheral distribution?

A
  1. Peripheral N. Distribution
  2. Dermatome (Spinal Nerve Roots)
  3. Stocking Glove
44
Q

Within the CNS, what are the 3 sites for UMNs?

A
  1. Cortical
  2. Brainstem
  3. Spinal Cord
45
Q

Within the CNS, what are the other regions not considered part of UMNs?

A
  1. Basal Ganglia
  2. cerebellum
  3. Other cortical brainstem or spinal cord
46
Q

Within the PNS, what comprises the LMNs?

A
  1. Motor CN and Nuclei
  2. Anterior Horn
  3. Nerve Root
  4. Peripheral Nerve
  5. NMJ
  6. Muscle
47
Q

In the peripheral nerves system, what is not considered part of the LMN system?

A
  1. Cranial Nerves: Sensory and Special
  2. Sensory (Nerve root, peripheral nerve)
  3. Autonomic
48
Q

What are the 4 common clinical findings associated with cerebellar involvement?

A
  1. Dysmetria, Dysdiadochokinesa, Hyper/Hypometria
  2. Nystagmus
  3. Dysarthria
  4. Ataxia
49
Q

What are the 3 common clinical findings for the basal ganglia?

A
  1. Bradykinesia, Hypokinesia
  2. Athetosis/Chorea
  3. Dystonia
50
Q

When your arm falls asleep, and you can’t really move it, these symptoms are similar to __________

A

Ataxia

51
Q

This is the inability to perform skilled tasks that cannot be explained by weakness, sensory loss, or ataxia

A

Apraxia

52
Q

This is a disorder of language (Expressive, receptive)

A

Aphasia

53
Q

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

A

Agnosia

54
Q

What are a PT’s skill set that can be used in a neurological exam?

A
  1. Reflexes
  2. Motor (Strength/tone)
  3. Sensory testing
  4. Coordination
  5. Cranial Nerves
  6. Gait/Balance
  7. Mental Status

Neuropathology (7 decks)

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