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Neuro > Nerve Lesions > Flashcards

Nerve Lesions Flashcards

1
Q

How does carpal tunnel syndrome occur?

A

Results from pressure and compression on the median nerve as it passes through the carpal tunnel in the wrist

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2
Q

What is the compression in carpal tunnel syndrome usually the result of?

A

Inflammation of nearby tendons and tissues = oedema

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3
Q

What is carpal tunnel syndrome associated with?

A
  • Hypothyroidism
  • Diabetes mellitus
  • Pregnancy (third trimester)
  • Amyloidosis including in dialysis patients
  • Obesity
  • Rheumatoid arthritis - joint inflammation
  • Acromegaly
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4
Q

Is carpal tunnel syndrome more common in men or women and why?

A

It is more common in women as they have narrower wrists but similar sized tendons

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5
Q

How do the symptoms in carpal tunnel syndrome usually start?

A

Aching pain in the hand and arm (especially at NIGHT)

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6
Q

What can the symptoms of carpal tunnel syndrome lead to?

A

Paresthesia (tingling or prickling) in thumb, index, middle & 1/2 ring fingers + palm (median nerve distribution)

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7
Q

What can often relive the paresthesia caused by carpal tunnel syndrome?

A

Relieved by dangling the hand over the edge of the bed - “wake and shake”

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8
Q

Apart from pain and paresthesia what other symptoms can carpal tunnel syndrome cause?

A
  • Sensory loss and weakness of abductor pollicis brevis (thumb abductor) +/- wasting of the thenar eminence (muscles at the base of thumb)
  • Clumsiness with fiddly tasks
  • Light touch, 2-point discrimination and sweating may be impaired
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9
Q

What would you see on an Electromyography (EMG) in someone with carpal tunnel syndrome?

A
  • See slowing of conduction velocity in the median sensory nerves across the carpal tunnel
  • Prolongation of the median distal motor latency
  • Helps to confirm lesion site and severity
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10
Q

What is the Phalens test?

A

Patient can only maximally flex wrist for 1 minute and will produce symptoms of carpal tunnel.

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11
Q

What is the tinsel test?

A

Tapping on the nerve at the wrist induces tingling - but non-specific.

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12
Q

What symptoms would be present in a lesion in the oculomotor nerve (CNIII)?

A
  • Ptosis - dropping eyelids
  • Fixed dilated pupil - loss of PARASYMPATHETIC outflow from EDINGER WESTPHAL NUCLEUS which supply pupillary sphincter and ciliary bodies - lens accommodation
  • Eye down and out
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13
Q

What symptoms would be present in a lesion in the trochlear nerve (CNIV)?

A

A head tilt to correct the extortion that results in diplopia on looking down e.g. walking downstairs

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14
Q

What does the trochlear nerve do?

A

Innervates superior oblique muscle

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15
Q

What does the abducens nerve do?

A

Innervates the lateral rectus

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16
Q

What are the symptoms of trigeminal nerve palsy?

A
  • Jaw deviates to side of lesion

- Loss of corneal reflex

17
Q

What are the symptoms of facial nerve palsy?

A

Facial droop and weakness

18
Q

What are some causes of facial nerve palsy?

A
  • Bells palsy (most common) lesion of the facial nerve
  • Fractures of the petrous bones
  • Middle ear infections
  • Inflammation of the parotid gland - which facial nerve passes through
19
Q

What are the symptoms of a vestibulocochlear nerve palsy?

A
  • Hearing impairment

- Vertigo and lack of balance

20
Q

What are the causes of a vestibulocochlear nerve palsy?

A
  • Tumour (in the internal acoustic meatus - will press on the vestibulocochlear & facial nerve)
  • Skull fracture
  • Toxic drug effects
  • Ear infections
21
Q

What are the symptoms of a CN 9 (Glossopharyngeal) & CN 10 (Vagus) palsy?

A
  • Gag reflex issues
  • Swallowing issues
  • Vocal issues
  • Caused by a jugular foramen lesion
22
Q

What are the overall symptoms of Brown-Sequard syndrome?

A
  • Ipsilateral loss of; proprioception, motor & fine touch
  • Contralateral loss of; pain, temperature & crude touch
23
Q

What is paraplegia?

A

Paralysis of BOTH LEGS ALWAYS caused by spinal cord lesion

24
Q

What is hemiplegia?

A

Paralysis of ONE SIDE of body caused by lesion of the brain

25
Q

What are the signs of an UMN lesion?

A
  • Increased muscle tone - SPASTICITY: - Velocity dependent and non-uniform i.e. the faster you move the patients muscle, the greater the resistance, until it finally gives way in a clasp-knife manner
  • Weakness: - Flexors are generally weaker than extensors in legs and reverse in arms
  • Increased reflexes, they are brisk - HYPERREFLEXIA
26
Q

What are the signs of a LMN lesion?

A
  • Decreased muscle tone - WASTING (atrophy) +/- FASCICULATIONS (spontaneous involuntary twitching)
  • Weakness that corresponds to those muscles supplied by the involved cord segment, nerve root, part of plexus or peripheral nerve
  • Reflexes are reduced or absent - hyporeflexia

Neuro (17 decks)

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