Neuro Flashcards
Sequence of nerve recovery after injury?
Pain Temp Touch Proprioception Motor
What is the seddon classification?
Neuropraxia
Axonotmesis - Walerian regeneration.
Neurotmesis
Sunderland classification
First degree: Conduction deficit without axonal damage.
Second degree: Axon is severed without reaching the neural tube. Wallerian degeneration will occur.
Third degree: Degeneration and destruction of the fascicle with irregular degeneration.
Fourth degree: Destruction of the axon and fascicle and no destruction of the nerve trunk with a neuroma in existance.
Fifth degree: complete loss of the nerve with a likely neuroma.
Where is the popiteal injection given?
7 cm proximal and approximately 1 cm lateral to the transverse popliteal crease.
Muscle innervated by the medial plantar nerve
LAFF First Lumbrical Abductor hallucis Flexor digitorum brevis Flexor hallucis brevis
Muscles innervated by the lateral plantar nerve?
Abductor digiti minimi Quadratus planti Lumbricles 2-4 (Deep lateral plantar nerve innervates... Adductor hallucis muscle and dorsal interossei 1-3 plantar 1-2)
Superficial lateral plantar nerve hits flexor digit minimi and remaining interosei Dab 4 Pad 3
Name the innersapce neuromas from medial to lateral.
Joplins neuroma Housers neuroma Heuters neuroma Mortons neuroma Iselens neuroma
A sign that describes the splaying of the toes secondary to a mass caused by either a neuroma or local infiltrate
Sullivans sign
Multiple sclerosis
Best diagnosis modality?
Chronic inflammatory disease
Myelin sheath attacked
Progressive disruption between the brain and the body.
Diagnosed best with MRI!
Spinal tap can find IgG self directed antibodies.
Amytrophic lateral sclerosis? (ALS)
A devastating progressive degenerative disease of both UMN and LMN results in muscle weakness and atrophy.
Mental status preserved, men effected most often.
Death within 3-5 years of onset via respiratory failure.
Signs of an upper motor neuron lesion?
No muscle atrophy Clonus Babinski Hyperreflexia Spasticity* Spastic paralysis NO FASCICULATIONS
Signs of a lower motor neuron lesion?
Atrophy of the muscle Hyporeflexia of the deep reflexes Flaccid paralysis Fasciculations Hypotonicity
Guillain barre syndrome?
Acute progressive and self limiting inflammatory demylnating disorder.
Rapid weakness and paralysis that spreads within days.
It is autoimmune disorder with a common percipitating factor such as campylobacter infection, viral infections etc.
Look for symmetrical muscle weakness working from the legs to the arms.
Charcot Marie Tooth Disease (CMT, Peroneal muscle dystrophy)
Damage to the peripheral nervous system
Weakness from distal to proximal most commonly presenting with foot drop first.
May have some sensory deficiencies but most commonly motor.
Loss of the intrinsics of the feet happens first!!
What is the order of muscle loss seen in charcot marie tooth disease?
Plantar intrinsics Tibialis anterior EDL EHL Peroneus Brevis
Key is that peroneus brevis is effected while peroneus longus is spared creating pes cavus deformity*
The legs may end up with the “Inverted Champagne bottle or Stork Leg appearance!!”
Three stages of the eichenholtz charcot classification
Acute Charcot
Coalescense
Consolidation
What is friedriech ataxia?
An inherited disease resulting in spinal cord and peripheral nerve degeneration.
Results in scoloosis and awkward unstable movements.
Also effects the heart! Leads to hypertrophic cardiomyopathy.
What type of atrophy is seen most commonly with CRPS?
Sudecks atrophy is seen most commonly.
This is an atrophy of both the bone and the skin!
What is a type 1 CRPS?
Soft tissue or bone injury leading to a possible minor nerve injury (sprain, fracture, infection, fall)
Sometimes, the nerve injury cannot immediately be identified.
What is type 2 CRPS?
A direct nerve injury causing CRPS
What are the three stages of CRPS?
Stage 1: Acute 1 month - 3 months
Constant burning pain out of porportion. Will have edema, warm red and dry skin. Towards the end of the stage it will become cyanotic and cold/sweaty. Radiographs will be normal for 5-6 weeks.
Stage 2: Dystrophic 3-6 months
Continuous burning/achy pain. Allodynia. Skin becomes cool, pale, discolored and mottled with cyanotic appearance. Hair growth and nails are brittle and cracked. X-rays will show osteopenia and joints become contracted with musce wasting.
Stage 3: Atrophic (Greater than 6 months)
Pain in the entire limb with muscle wasting and limited movement due to digital contractions.
What does an EMG test?
Checks the electrical activity generated by muscle fibers at rest and with activity.
Looking at the muscles!!
What does an NCV test?
Nerve conduction velocity tests look at conditions effecting the myelin sheath from those effecting the axon.
One point of the nerve is stimulated and the time it takes for the conduction to travel is measured.
Normal speeds are 40 meters per second and above.
Name the treatments for neuropathy
Narcotic and non-narcotic analgesics: Coedine, acetametophen, ASA
Antidepressants: Amitriptyline
Anticonvulsants: Carbamazepine, phenytoin, clonazepam, **Gabapentin
Local anesthetics: Lidocaine
Vitamins: Vitamin B12, Biotin, Metanx
Antiarrythmics: Mexiletine
Antipsychotics: Prolixin
Selective serotonin reuptake inhibitors: Paroxetine, Fluoxetine, sertraline.
What process does nerve sclerosing injections invoke?
Wallerian degeneration by dehydration of the enrve.
0.5 cc of 4% alcohol is injected with 3-7 injections 1 week apart.
