Localisation of pathology Flashcards
What area will a CNS pathology affect?
Hemiplegia/ paraplegia
What are will a PNS lesion affect?
Peripheral or localised area
Can be a whole limb if due to a plexus
What area will a NMJ lesion affect?
Ocular or bulbar
What are will a muscle lesion affect?
Proximal and symmetrical
What will the description of weakness be like in a CNS lesion?
Heaviness
What will the description of weakness be like in a PNS lesion?
Positional/ with sleep
Ascending
What will the description of weakness be like in a NMJ lesion?
Fatiguable; worse after use of the muscles
Diurnal variation; worse towards the end of the day
What will the description of weakness be like in a muscle lesion?
Aching
Insidious
What are the additional features of a CNS lesion?
Spasms
Jerks
What are the additional features of a PNS lesion?
Cramp
Twitching (fasiculations)
What are the additional features of a NMJ lesion?
Bulbar: swallowing, speaking
Ocular: diplopia, ptosis
Resp: orthopnoea, SOBOE
What are the additional features of a muscle lesion?
Myalgia
Cramp
Are sensory symptoms possible in a CNS lesion?
Yes
Are sensory symptoms possible in a PNS lesion?
Yes
Are sensory symptoms possible in a NMJ lesion?
No
Are sensory symptoms possible in a muscle lesion?
No
Are there any specific difficulties associated with a CNS lesion?
Cognitive involvement
Sphincter involvement
Are there any specific difficulties associated with a PNS lesion?
Loss of grip
Tripping up
Unsteady with eyes closed
Are there any specific difficulties associated with a NMJ lesion?
Lots of chewing/ talking is difficult
Prolonged gaze hard (long drives/ reading)
Later in day
Are there any specific difficulties associated with a muscle lesion?
Getting up from low chairs
Hanging up washing
What will be seen specifical on inspection of a CNS lesion?
Limb posture
What will be seen specifical on inspection of a PNS lesion?
Wasting/ fasciculations
Pes cavus
What will be seen specifical on inspection of a NMJ lesion?
Additional ptosis/ opthalmoplegia
What will be seen specifical on inspection of a muscle lesion?
Proximal wasting
What will be seen specifically on tone of a CNS lesion?
Increased tone
Spasticity/ clonus
What will be seen specifically on tone of a PNS lesion?
Decreased tone
What will be seen specifically on tone of a NMJ and muscle lesion?
Neutral or decreased
What is the pattern of weakness in a CNS lesion?
Pyramidal: Arms; extensors weaker than flexors Legs; flexors weaker than extensors Brain; contralateral Spine; ipsilateral
What is the pattern of weakness in a PNS lesion?
Peripheral neuropathy; distal weakness
Root/ plexus/ mononeuropathy: dependent on innervated muscles
What is the pattern of weakness in a NMJ lesion?
Fatigability
What is the pattern of weakness in a muscle lesion?
Proximal weakness (symmetrical)
What will the reflexes show in a CNS lesion?
Increased; brisk
What will the reflexes show in a PNS lesion?
Decreased; hyporreflexic
What will the reflexes show in a NMJ or muscle lesion?
Neutral or hyporreflexic
What will the plantar response show in a CNS lesion?
Extensor response; positive babinski sign
What will the plantar response show in a PNS, NMJ and muscle lesion?
Flexor response; negative babinski sign
Are there any specific sensory symptoms associated with a CNS lesion?
Brain: hemisensory
Spinal cord: sensory level
Are there any specific sensory symptoms associated with a PNS lesion?
Peripheral neuropathy; glove and stocking
Root etc; dependent on dermatome
Are there any specific sensory symptoms associated with a NMJ or muscle lesion?
No
What will a L3/4 root entrapment result in?
L4 root:
Pain down medial ankle
Loss of quads power
Reduced knee jerk
What will a L4/5 root entrapment result in?
L5 root:
Pain down dorsum of foot
Reduced big toe dorsiflexion (extensor hallucis longus)
What will a L5/S1 root entrapment result in?
S1 root:
Pain to sole of foot
Reduced plantar flexion power
Reduced ankle jerk
What is erb’s palsy?
Injury to upper brachial plexus (C5/6)
Loss of motor innervation to deltoid, supraspinatus, infraspinatus, biceps and brachialis
Internal rotation; waiter’s tip posture
What is klumpke’s palsy?
Lower brachial plexus (C8 and T1) injury
Paralysis of intrinsic hand muscles +/- finger and wrist flexors
Flexed fingers