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NPTE > Neuro DDx > Flashcards

Neuro DDx Flashcards

PD, MS, ALS, GBS

1
Q

UMN lesion description

A

Structures: cortex, brainstem, spinal cord

Tone: INCREASED - hypertonia, velocity dependent (spasticity)

Reflexes: INCREASED - hyperreflexia, abnormal reflexes (clonus, babinski)

Sensation: DECREASED

Involuntary movements: muscle spasms

Voluntary movements: synergistic patterns

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2
Q

LMN lesion description

A

Structures: peripheral nerves, nerve roots, cranial nerves

Tone: DECREASED - hypotonia

Reflexes: DECREASED - hyporeflexia or absent

Sensation: DECREASED

Involuntary movements: denervation - fasciculations (twitching)

Voluntary movements: weak or absent

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3
Q

Basal ganglia lesion description

A

Structures: basal ganglia

Tone: INCREASED - rigidity

Reflexes: decreased or normal

Sensation: normal

Involuntary movements: resting tremors

Voluntary movements: hypokinesia, bradykinesia, akinesia

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4
Q

Cerebellum lesion description

A

Structure: cerebellum

Tone: decreased or normal

Reflexes: decreased or normal

Sensation: normal

Involuntary movements: none

Voluntary movements: ataxia, intention tremor, dysdiadochokinesia, dysmetria, nystagmus

Balance and coordination

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5
Q

Parkinson’s disease description

A

Basal ganglia
Depletion of dopamine in the substantia nigra
Older adults
Male > females

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6
Q

PD primary symptoms

A

TRAP
- tremors (resting, unilateral)
- rigidity (cogwheel or lead pipe, asymmetrical, proximal)
- akinesia
- postural instability (thoracic kyphosis)

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7
Q

Two types of rigidity

A

Lead-pipe: smooth, consistent, sustained through ROM

cogwheel: ratchet-like, jerky resistance through ROM (tremor + rigidity)

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8
Q

Hoehn and Yahr Stage 1

A

Minimal or absent, unilateral if present

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9
Q

Hoehn and Yahr Stage 2

A

Minimal bilateral or midline involvement. Balance not impaired.

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10
Q

Hoehn and Yahr Stage 3

A

Impaired righting reflex
Unsteadiness when turning or rising from chair
Some activities restricted, but patient can live independently and continue some forms of employment

Balance: B = 3

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11
Q

Hoehn and Yahr Stage 4

A

All symptoms present and severe. Standing and walking possible only with assistance.

Needs AD > 4WW > Stage 4

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12
Q

Hoehn and Yahr Stage 5

A

Confined to bed or wheelchair

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13
Q

PD other symptoms

A

Early: loss of smell (CN1), constipation, sleep disorders

Motor: hypophonia, mask-like face, micrographia

Cardio: orthostatic hypotension, abnormal response to exercise, fatigue, weakness

Respiratory: restrictive lung disease 2/2 posture, decreased lung expansion

Cognition/behavior: difficulty with dual tasking, depression, dementia

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14
Q

PD gait

A

Freezing of gait
Festinating gait
Decreased step width and length (shuffling)
Decreased trunk rotation and arm swing
En bloc turning (whole body)

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15
Q

Freezing of gait

A

Sudden inability to initiate movement
Cognitive overload

intervention: visual targets, distraction, music, wide doorways, mod environment

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16
Q

Festinating gait

A

Compensation for anterior momentum 2/2 kyphosis

Short stride, shuffling, increasing speed, anteropulsive

intervention: add toe wedge or declined heel to move COM posteriorly

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17
Q

PD interventions

A

caregiver education

gait training (metronomes, music, visual cues)

posture (rotation, crossing midline, prone lying)

hypokinesia (big movements and voice, stretching/ROM)

balance

tai chi, yoga, cycling, dance

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18
Q

Gold standard PD pharm treatment

A

Levodopa/carbidopa

Higher level L-dopa delivered to brain

Side effect: on/off phenomenon

Schedule PT 1 hour after dose

High protein diet can block med effectiveness

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19
Q

On/off phenomenon

A

Random fluctuations in motor performance and response. PD med side effect.

Dyskinesia (ON) vs dystonia (OFF)

20
Q

Dyskinesia

A

Involuntary, repetitive, smooth, muscle mvmt (snake-like twisting of arm)

Affects large muscle groups

Not usually painful

ON phase

21
Q

Dystonia

A

Prolonged, involuntary muscle contractions; muscle spasms (toe curling)

Affects a specific muscle or group of muscles

Causes pain

OFF phase

22
Q

Multiple sclerosis description

A

UMN
Autoimmune
Progressive demyelination of CNS neurons (brain and spinal cord)
Decreased nerve conduction

23
Q

MS signs and symptoms

A

Motor: spasticity

Sensory: numbness, paresthesias

Cerebellum voluntary movements: nystagmus, coordination, balance, ataxia, intention tremor (MS typically UMN but can sometimes affect cerebellum)

Gait: scissoring, extensor spasticity in LE, ataxia, uneven steps

Bladder: spastic, flaccid

Speech and swallowing: dysphagia, dysphonia

Emotion: pseudobulbar affect

Cognition: diminished attention, concentration

Optic neuritis, trigeminal neuralgia

Fatigue

24
Q

MS unique signs and symptoms

A

Lhermitte’s sign
Uhthoff’s phenomenon
Charcot’s triad
Cranial nerve II

25
Lhermitte's sign
"LAIR-MEES" > "hair messy" electric shock sensation down spine with neck flexion
26
Uhthoff's phenomenon
Heat worsens symptoms "U Turn Heat OFF"
27
Charcot's triad
S.I.N. (cerebellum) Scanning speech intention tremor nystagmus
28
MS CN II symptom
inflamed, optic neuritis Marcus Gunn pupil: pupils will dilate w/ light
29
MS types
Progressive relapsing Secondary progressive Primary progressive Relapse-remitting
30
Progressive relapsing MS
Steady increase in disability with superimposed attacks Worst kind
31
Secondary progressive MS
Initially RRMS, then symptoms increase without periods of remission
32
Primary progressive MS
Steady increase in disability without attacks or exacerbations
33
Relapse remitting MS
Short duration attacks with full or partial recovery, may or may not leave lasting symptoms/deficits Most common form of MS (80%)
34
MS interventions
Do not overfatigue Manage overheating/temp Energy conservation Exercise best in the morning Coordination and balance training
35
MS FITT
F: 3-5x/wk (alternating days, mornings preferred) I: Low intensity 3-5 METS, 50-70% VO2max T: 30 min per session T: cycle, walk, swim, circuit training
36
Amyotrophic lateral sclerosis (ALS) diagnosis
UMN & LMN Motor neuron disorder (MND), sensation intact Progressive neurological disorder that damages nerve cells and causes disability Death of motor neuron
37
ALS signs and symptoms
UMN/LMN presentation w/o sensory loss - muscle atrophy, fasciculations (LMN) - spasticity, hyperreflexia (UMN) - dysphagia, dysarthria (bulbar) Motor neurons affected only Cognition: dementia, attention deficits Emotion: pseudobulbar affect, emotional lability Muscles: cervical spine extensors weakness is common Respiratory muscle weakness > death
38
ALS management
No effective medical management PT - ADLs - energy conservation - soft foam collar for neck weakness - breathing exercises - avoid over fatigue (frequent breaks) - ROM, positioning No resistance training if muscle < 3/5 otherwise may cause overuse weakness
39
Guillain Barre Syndrome diagnosis
LMN autoimmune occurs commonly after infection acute inflammatory demyelinating polyradiculoneuropathy rapid asymmetrical loss of myelin in nerve roots, peripheral nerves, cranial nerves
40
GBS signs and symptoms
Motor loss/paralysis - distal to proximal - rapid, progressive Sensory loss - glove and stocking (B, symmet) - burning, tingling, numbness Decreased reflexes/areflexia Respiratory involvement CN VII, IX, X, XI, XII involved Fatigue
41
GBS intervention
Respiratory care Energy conservation techniques Avoid overuse/fatigue (can prolong recovery) Recovery: 6-12 mo, may recover fully
42
Which diagnosis? Increased tone, reflexes, and babinski
UMN > MS, stroke
43
Which diagnosis? Marcus Gunn pupil, trigeminal neuralgia, pain w/ neck flexion
MS
44
Which diagnosis? difficulty w/ neck extension and extreme weakness/fatigue
ALS
45
Which diagnosis? loss of sensation in hands/feet and weakness ascending the limbs
GBS

NPTE (40 decks)

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