Module 4: Weakness

Question 0

Most common cause of radiculopathy? Examples?

Answer 0

Compression injury

#Degenerative conditions
#Neoplastic
#subdural hemorrhage
#Infection (epidural abscess)

Question 1

Auto immune ganglionopathy that affects sensory neurons?

Answer 1

#Celiac
#Sjogrons

Question 2

Noncompressive etiologies of radiculopathy?

Answer 2

#Infectious – TB, Cryptococcus, Lyme, syphilis, HIV
#neoplastic - Leptomeningeal disease
#inflammatory – GPS, CIDP, sarcoidosis
#Metabolic (diabetes, arachnoiditis)
#Radiation

Question 3

Causes of plexus injuries?

Answer 3

#Inflammatory – diabetic amyotrophy, Parsonage-Turner  (idiopathic)
#Infiltrated – neoplasm, sarcoidosis
#Traumatic – birth injury, MVA

Question 4

In peripheral nerve injury

1. Disruption of myelin with intact axons and stroma
2. Axon transected the nerve trunk is intact
3. Transection of entire nerves?

Answer 4

1. Neurapraxia
2. Axonotmesis
3. Neurotmesis

Question 5

Most common cause of mononeuropathy is? Most common examples?

Answer 5

Compression injury or entrapment

#Median nerve within carpal tunnel
#Ulnar nerve within cubital tunnel
#Peroneal nerve across neck of fibula

Question 6

Natural history of compression injury?

Answer 6

#Nerve gets compressed against tissue
#Blood vessels get compressed
#Local ischemia
#Demyelination
#Axonal loss

Question 7

Roots of median nerve? Formed from what cords?

Lateral versus medial cord fibers – origin? Supply?

Answer 7

C6, C7, C8, T1

Lateral and medial cords

Lateral – SENSATION to thumb, index finger, middle finger and MOTOR to proximal median forearm muscles

Medial – SENSATION to ring finger and MOTOR to distal median forearm muscles and hand muscles (thenar muscles)

Question 8

Symptoms of carpal tunnel syndrome?

Provoked by?

Answer 8

#Pain in the lateral fingers
#Numbness or paresthesias involving fingers
#Clumsiness or hand weakness

#Sleep
#Repetitive activities
#Driving, doing hair, holding book

Question 9

Carpal tunnel syndrome associated with what other diseases?

Answer 9

# endocrine – hypothyroid, diabetes
#Pregnancy
#Lyme disease
#Sarcoidosis

Question 10

Clinical progression of carpal tunnel syndrome?

Answer 10

Intermittent sensory symptoms – persistent sensory symptoms – motor symptoms (thenar atrophy, hand weakness)

Question 11

Physical exam signs in carpal tunnel syndrome?

Answer 11

#Tinel's sign – tapping over nerve induces symptoms
#Phalen's Sign – wrist flexion induces symptoms

Question 12

Diagnostic studies for carpal tall syndrome?

Answer 12

#Nerve conduction studies
#Needle electromyography

Question 13

Treatment for carpal tunnel syndrome?

Answer 13

#Neutral wrist splints and NSAIDs
#Local corticosteroid injection
#Surgical decompression

Question 14

Etiologies of polyneuropathy?

Answer 14

#Vasculitis
#Infectious – Lyme, HIV, VZV, leprosy
#Neoplastic – multiple myeloma, MGUS, paraneoplastic
#Drugs – Chemo, antibiotics, alcohol, lead
#Inflammatory – GPS, CIDP
(#trauma)
#Immune-mediated – lupus
#Metabolic – diabetes, renal failure, liver failure, hyperthyroid, hypothyroid

Question 15

Most common worldwide cause of peripheral neuropathy?

Most common cause of peripheral neuropathy in the developed world?

Answer 15

Leprosy

Diabetes

Question 16

Described diabetic neuropathy

Answer 16

Distal, symmetric, chronic, sensorimotor polyneuropathy

Question 17

Most frequent cause of nontraumatic limb amputation in US?

Answer 17

Diabetic neuropathy

Question 18

Only treatment proven to prevent or slow course of diabetic polyneuropathy?

Answer 18

Tight glycemic control