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Neuro II > Nerve Root & Peripheral Nerve Disorders > Flashcards

Nerve Root & Peripheral Nerve Disorders Flashcards

1
Q

Are sensory or motor fibers usually involved first with peripheral neuropathy?

A

sensory

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2
Q

What diameter qualifies a nerve as a “large fiber” ?
They carry what types of information?

A

> 6 micrometer in diameter
motor
proprioception
vibration
light touch

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3
Q

What diameter qualifies a nerve as a “small fiber” ?
They carry what types of information?

A

< 6 micrometeres
sharp/dull pain, temperature, touch

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4
Q

Peripheral neuropathy of large fibers leads to what symptoms?

A
  • clumsiness
  • drop foot
  • frequent ankle sprains
  • Muscles
    • atrophy
    • weakness
    • decreased reflexes
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5
Q

Peripheral neuropathy of small fibers leads to what symptoms?

A
  • bruising or tingling
  • orthostatic hypotension, gastroparesis, impotence
  • Muscles
    • no weakness
    • normal reflexes
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6
Q

Identify the type of injury indicated by each of following terms:

neuropraxia

axonotmesis

neurotmesis

A
  • neuropraxia
    • compression
  • axonotmesis
    • crush
  • neurotmesis
    • cut
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7
Q

What are the characteristics of mononeurpathies?

A

focal

asymmetric neuropathy

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8
Q

What are the two sites of injury for median nerve neuropathy?

A
  1. Median neuropathy at the wrist
    1. carpal tunnel syndrome
  2. proximal median neuropathy
    1. anterior interosseus nerve syndrome
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9
Q

What are the classic symptoms you would expect to seen in a patient with a median nerve neuropathy?

Special tests?

A
  • Symptoms
    • Hypoesthesia/pain in first 3 digits & lateral aspect of 4th digit
    • pain is worse at night
  • Examination
    • positive Tinel’s sign
    • positive Phalen’s maneuver
    • look for weakness in C6 innervated muscles (to make sure not missing a C6 radiculopathy/more proximal median neuropathy)
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10
Q

What are the major causes of median neuropathy at the wrist?

A

occupational

diabetes

hypothyroidism

rheumatoid arthritis

pregnancy

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11
Q

Treatment for median neuropathy at the wrist?

A

OMG/PT

wrist splint

locak injections

surgery

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12
Q

Proximal Median Neuropathy includes all of the symptoms seen in carpal tunnel syndrome & what additional symptoms?

A
  • complete median sensory involvement including thenar
  • proximal median weakness (unable to flex thumb, middle & index fingers; extension of MCP joints 2&3 with flexion IP joints)
    • flexor pollicis longus
    • flexor digitorum profundus I & II
    • pronator teres
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13
Q

What symptoms would you see in a patient with anterior interosseus nerve syndrome?

A
  • weakness of flexor pollicis longus & flexor digitorum profundus 1 & 2
  • pronator teres is spared
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14
Q

What is the largest motor branch of the median nerve? It branches distal to what muscle?

A

anterior interosseus

distal to pronator teres

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15
Q

What are the two most common locations for ulnar neuropathies?

A

cubital tunnel (elbow) & guyon’s canal (wrist)

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16
Q

What is the clinical presentation of a patient with ulnar neuropathy at the elbow?

A

slow onset decreased grip/pinch strength

atrophy of hyopthenar & thenar eminences (abductor digiti minimi, adductor pollicis & deep head of flexor pollicis brevis)

weakness of writst flexion & flexor digitorum profundus digits 4 & 5

impaired digital, palmar & dorsal sensory function of digit 5 & lateral half of 4

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17
Q

What is the clinical presentation of a patient with ulnar neuropathy at the wrist?

A
  • Varies: motor, sensory, both → based on level of compression
    • thenar and/or hypothenar motor regions
  • dorsal hand ulnar sensation is spared
  • no wrist flexion weakness; no ulnar deep finger flexion weakness
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18
Q

What are the major sites for radial neuropathy & their common causes?

A
  1. Axilla- (crutches)
  2. Spiral groove- (arm over bench)
  3. forearm - (arcade)
  4. wrist - (handcuffs)
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19
Q

Which two muscles are supplied by the radial nerve proximal to the spiral groove?

A

triceps & aconeus

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20
Q

Which two muscles are supplied by the radial nerve distal to the spiral groove but proximal to the branching of the posterior interosseus nerve?

A

brachioradialis & extensor carpi radialis

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21
Q

The posterior interosseus nerve supplies what muscles?

A

extersor digitorum communis

extensor indicus proprius

extensor carpi ulnaris

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22
Q

What features would be included to suggest an issue with posterior cord as opposed to a radial neuropathy?

A

deltoid & latissimus dorsi weakness

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23
Q

What are the symptoms of a patient with posterior interosseus neuropathy?

A

weak extensors

no sensory loss

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24
Q

What are the symptoms of a patient with superficial sensory radial neuropathy?

A

dorsal sensory loss over first three digits & hand

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25
Q

What is the clinical presentation of a patient with peroneal neuropathy?

A
  • superficial peroneal nerve
    • ankle eversion
  • deep peroneal nerve
    • ankle dorsiflexion
    • toe extension
  • NO ankle inversion weakness
26
Q

What are the most common causes of peroneal neuropathy?

A
  • occupational (gardening/farming: squatting & kneeling)
  • habitual leg crossing (fibular tunnel entrapment)
27
Q

What is the clinical presentation of a patient with sciatic neuropathy?

A

weakness of knee flexion, ankle inversion, eversion, dorsiflexion & plantar flexion

peroneal sensory loss + sural sensory loss; NO saphenous involvement (medial calf)

peroneal + tibial nerve

28
Q

Why do you not see weakness in gluteal abduction & extension in sciatic neuropathy?

A

inferior & superior gluteal nerves are given off prior to sciatic nerve

29
Q

Sciatic nerve is derived from what nerve roots?

A

L4-S3

30
Q

What are the major causes of sciatic neuropthy?

A

trauma, buttock injections, acute compression

31
Q

What is the clinical presentation of a patient with femoral neuropathy?

A

loss of sensation for anterior/medial thigh & calf

weakness in thigh flexion (Iliacus) + knee extension (quads)

suppressed patellar reflex

NO weakness in hip abduction or extension or thigh adduction

32
Q

The femoral nerve is formed from what nerve roots?

A

lumbar plexus; L2, L3, L4

33
Q

What femoral neuropathy symptom is only present if the lesion is proximal to inguinal ligament?

A

weakness in thigh flexion (iliacus weakness)

34
Q

What are the common causes of femoral neuropathy?

A

compression during abdominal/pelvic surgery or d/t a mass

diabetes

35
Q

What is the clinical presentation of Meralgia paresthetica?

A

burning/tingling pain at lateral thing

36
Q

What neuropath is the cause of meralgia paresthetica & what are the common causes of this condition?

A

lateral femoral cutaneous nerve

pregnancy & tight fitting clothing

37
Q

What is mononeuritis multiplex & it is most common in what conditions?

A

multiple non-contiguous peripheral mononeuropathies

may occur rapidly → vasculitis/autoimmune conditions

38
Q

Distal symmetric polyneuropathy occurs in what pattern?

A

“length-dependent” pattern

sensory > motor symptoms

start distally & spread gradually; LE > UE

39
Q

Distal symmetric polyneuropathy is most commonly see with what condition? What if you notice acocmpanied proximal weakness?

A

diabetes

if proximal weakness → added myopathy or polyradiculopathy

40
Q

What are the 3 major components of diabetic peripheral neuropathy?

A
  1. sensorimotor polyneuropathy (loss of sensation in feet)
  2. autonomic neuropaty
    1. sweating, bladder dysfunction, gastroparesis, trophic changes in skin
  3. Mononeuropathy
    1. cranial nerve III - eye down & out w/ spared pupillary reaction (iscemic)
    2. femoral nerve - proximal leg weakness
41
Q

What is the most common cause of acquired distal symmetric sensorimotor neuropathy in north america?

A

diabetic peripheral neuropathy

42
Q

What is the clinical presentation of Charcot-Marie-Tooth Disease?

A

high arched, narrowed feet with distal foreleg atrophy (inverted champagne bottle)

pes cavus & hammer toes

43
Q

What is the most common cause of acute/subacute flaccid weakness worldwide?

A

Guillan-Barre Syndrome

44
Q

What is the cause of Guillain-Barre Syndrome?

A

Infections (C. jejuni), humoral-mediated molecular mimicracy → demyelination / axon loss

45
Q

What is the clinical presentation of a patient with Guillain-Barre Syndrome?

A

1-2 weeks post infection

back/leg pain, ascending LE weakness w/ mild sensory loss (peaks 2-4 weeks); reflexes are low/lost

autonomic involvement is common (cardiac/BP instability, constipation, urinary retention)

46
Q

How do you diagnose Guillain-Barre Syndrome?

A
  • Lumbar puncture
    • elevated proteins by 3 weeks
    • WBC <50/uL
    • peripheral nerve root/cauda equina enhancement on MRI
    • nerve conduction studies
      • most pronounces 2 weeks after onset
      • over time, late responses become abnormal w/ signs demyelination sparing sural nerve
47
Q

What is the treatment & prognosis of Guillain Barre Syndrome?

A

IVIG/plasma exchange - corticosteroids are NOT helpful

20% cannot walk unaided 6 months post onset

48
Q

Small fiber neuropathy typically involves what types of symptoms?

If suspected, what types of tests should be used to evaluate?

A

burning pain with allodynia & autonomic involvement

  • evaluation
    • cardiovagal (parasympathetic) w/ neuro (ie HR variability w/ breathing & valsalva)
    • adrenergic (sympathetic) tilt table testing
    • sudomotor (sweat) function w/ QSART test
49
Q

What nerve functions are normal in small fiber neuropathy?

A

vibratory perception, proprioception & reflexes

nerve conduction studies are normal

50
Q

How do you diagnose small fiber neuropathy?

A

skin biopsy

looking at intraepidermal nerve fiber density

51
Q

Just draw the brachial plexus. Just do it. Do it now.

A

Did you cheat? dont cheat - draw it.

52
Q

If you have a upper trunk brachiaplexopathy, what nerve roots will be involved?

A

C5 & C6

53
Q

What is the clinical manifestation of a patient with an upper trunk plexopathiy?

A
  • Weakness
    • deltoids
    • biceps/brachialis
    • brachioradialis
    • supraspinatus/infraspinatus
    • extensor carpi radialis
  • numbness
    • axillary, musculocutaneous, median/superficial radial sensory branches of hand
  • muscle stretch reflex
    • low biceps & brachioradialis
54
Q

If you have a middle trunk brachiaplexopathy, what nerve roots will be involved?

A

C7

55
Q

What is the clinical manifestation of a patient with a middle trunk plexopathiy?

A
  • weakness
    • triceps
    • flexor/extensory carpi radialis
    • flexor digitorum superficialis
    • pronator teres
  • numbness
    • middle finger, posterior cutaneous nerve of forearm
  • Muscle stretch refled
    • triceps
56
Q

If you have a middle trunk brachiaplexopathy, what nerve roots will be involved?

A

C8-T1

57
Q

What is the clinical manifestation of a patient with a lower trunk plexopathiy?

A
  • Weakness
    • ulnar muscles
    • median C8-T1 (APB, FPL, FDP 1&2)
      • NOT pronator teres
    • Radial C8 muscles (EIP, EDC, ECU)
      • NOT extensor carpi radialis
    • numbness
      • median arm (medial brachial cuteous)
      • medial forearm (medial atebrachial cutaneous)
      • medial hand (ulnar)
  • Muscle Stretch Reflex
    • normal
58
Q

What nerves are damaged in Erb’s Palsy & what is the typical cause?

A

upper trunk plexopathy (C5 & C6)

shoulder dystocia w/ vertex presentation

stab wound, stretch upper trunk

59
Q

What is the clinical presentation of a patient with Erb’s Palsy? This is due to loss of function of what muscles?

A
  • Arm adducted, internally rotated
    • deltoid out - unopposed action sternal pec major & lat
  • Elbow extended/forearm IR
    • biceps out - unopposed triceps
  • Wrist/finger flexed
    • extensor carpiradialis weak
60
Q

What nerves are damaged in Klumpke Paralysi?

A

Lower Trunk Plexopathy (median & ulnar)

(C8-T1)

61
Q

What is the clinical presentation of Klumpke Paralysis? Most common causes?

A
  • Spresentation
    • preserved proximal strength
    • intrinsic hand weakness “claw hand”
    • Horner Syndrome (miosis, anhydrosis, ptosis)
  • Mechanism
    • hyperabduction of arm in birth
    • pancoast tumor

Neuro II (30 decks)

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