Nerve Disorders

Question 1

Types of Brachial plexus disorders

Answer 1

Lateral stretch
Congenital anatomical variation
Erb’s palsy (C5-6, upper plexus)
Klumpke’s palsy (C8-T1, lower plexus)

Question 2

Neurapraxia

Answer 2

Reversible loss of nerve conduction
Will have recovery
No physical disruption

Question 3

Axonomesis

Answer 3

Variable severity

Physical disruption of nerves but preserved endonerium around axons

Question 4

Neurotmesis

Answer 4

Most severe

Complete physical disruption of nerves

Question 5

Avulsion

Answer 5

Preganglionic neurotmesis

Question 6

Rupture

Answer 6

Postganglionic neurotemesis

Question 7

Brachial Plexus Palsy RF

Answer 7

Shoulder dystocia
Multiparous mother
Large birth wt (>4500g)
Prior infant with Birth BPP

Question 8

Clinical features of Brachial Plexus palsy

Answer 8

Lack of AROM of arm
Lack of sensation in arm
Contractures common

Question 9

Brachial plexus palsy exam

Answer 9

Absent reflexes/motor func/sensation in involved distribution
Moro reflex asymmetry
ROM/contracturs
Decreased muscle bulk
Torticollis

Question 10

Electrodiagnosis in Brachial Plexus Palsy

Answer 10

H reflexes and F waves to look at proximal function

Question 11

Sensory NCS in BPP

Answer 11

Response present in area of sensory loss indicates preganglionic lesion

Question 12

Guillan-Barre Syndrome

Answer 12

Acute or subacute inflammatory process of the peripheral nervous system resulting in demyelination of axons

Question 13

Guillan-Barre Risk Factors

Answer 13

Campylobacter jejuni
CMV
EBV
VZV
Mycoplasma pneumonia
HIV

Question 14

Guillan-Barre Clinical Features

Answer 14

Ascending weakness from LE
Paresthesia and numbness
Vibration/position sense changes
Ataxia 
Autonomic sx
Respiratory involvement
Pain in extremities and back
Areflexia

Question 15

LP findings in GBS

Answer 15

Protein >45 mg/dL

Question 16

MRI of lumbosacral spine in GBS

Answer 16

Gadolinium will show enhancement of nerve roots

Question 17

EMG/NCS in GBS

Answer 17

Reduced conduction velocities
Conduction block or temporal dispersion
Prolonged latencies
Prolonged or absent F wave

Question 18

Hereditary motor sensory neuropathy OR Charcot Marie Tooth Dz (CMT HMSN)

Answer 18

Group of d/o with a chronic motor and sensory polyneuropathy in the upper and lower limbs resulting progressive symmetrical distal muscle weakness, atrophy, sensory loss and depressed DTR’s

Question 19

Etiology of CMT HMSN

Answer 19

Autosomal dominant (CMT 1, CMT2)
Autosomal recessive (CMT4)
X-linked (CMTX)

Question 20

CMT HMSN Clinical Features

Answer 20

Distal muscle wasting and weakness
Vibration and proprioception loss
Depressed or absent DTR's
Stork leg, inverted champagne bottle
Pes cavus (high arch)
Hammertoes
Hindfoot varus
Enlarged and palpable peripheral nerves
Thoracic scoliosis
Sensory gait ataxia

Question 21

Unique features to X-linked CMT HMSN

Answer 21

Intellectual disability

Sensorineural hearing loss

Question 22

Natural history of CMT HMSN

Answer 22

Onset 1st-3rd decades
Slowly progressive weakness
Normal lifespan

Question 23

EMG findings in CMT HMSN

Answer 23

Slow conduction velocity