neuro case study MAHONEY

Question 1

what group muscles is involved with standing on your heel vs tiptoes

Answer 1

tiptoes: posterior

Heels: anterior

Question 2

Direct injury to sciatic nerve effect what part of Spinal level

Answer 2

L4,L5, S1,S2,S3

Question 3

What does NCV show? What’s an abnormal response

Answer 3

Distinguish demyelination and axonal disease

speed of impulse is going to decrease.

• amplitude of negative peak is lowered
• distal latency is prolonged
• duration of response is prolonged

Question 4

what would show on NCV for axonal disease

Answer 4

NCV is only slowed slightly, but if axonal loss is severe,

NCV is 30% normal and amplitude is lowered

-duration is prolonged

Question 5

how is the neuron altered with demyelination vs damaged axon?

Answer 5

nerve impulse is slowed without myelin, but SPEED of impulse is not altered with axonal damage in the presence of normal myelin

Question 6

when is NCV normal

Answer 6

myopathy and anterior horn cells disorders

Question 7

what do fibrillation on muscle at rest indicate

Answer 7

acute denervation, acute metabolic neuropathy, or polymyositis

Question 8

treatment for sciatic nerve injury

when do you need to consider surgery?

Answer 8

THINK PT! to strengthen exercise and use of flexible dropfoot brace

• inject 3-5 ml f normal saline into SUBGLUTEAL space
• consider neuropathy drugs (gabapentin, pregabalin, duloxetine)

surgical neurolysis if pain persist for longer than 1-3 months

Question 9

Wallerian degeneration

Answer 9

(DIRECT INJURY TO AXON) antegrade of Axonal degeneration and myelin breakdown following proximal axonal or neuronal cell body injury)

Question 10

what is the relation with NSAID and asthma?

what is the Main preferred NSAID for asthmatic patient?

Answer 10

NSAIDS block COX, which will increase production of leukotrienes. Leukotrienes–>bronchospasm

COX2 inhibitor preferred : does not involve leukotriene pathway

Question 11

Preferred location of gluteal IM injection? what muscle will you inject this in avoiding what nerve?

Answer 11

VENTROGLUTEAL area, NOT dorsogluteal area

inject in gluteus MEDUIS muscle to avoid sciatic nerve injury

Question 12

What are some possible causes perineal nerve damage

Answer 12

Needle, chemical irritation from solution, or hematoma leading to ischemic injury

Question 13

what part of the nerve will get injured and what doesnt get injured

Answer 13

extrafascular-no damage

intrafascular: axonal degenartion and myelin breakdown with wallerian degeneration

connective tissue proliferation and scar formation