Neuro Diff Diag 1/14 Flashcards
description of Neuropathic (Neurogenic) pain
Sharp, shooting, burning, tingling, electric.
Burning, shooting, constant
Evoked with “non-noxious” stimulus eg. light touch, cold
central or peripheral NS disorder?
TBI, CVA, SCI
central
central or peripheral NS disorder?
Trigeminal neuralgia
Peripheral neuropathy (diabetes)
Trauma
peripheral
central or peripheral NS disorder?
MS, Parkinson’s
central
central or peripheral NS disorder?
Carpal tunnel, tarsal tunnel, thoracic outlet
peripheral
central or peripheral NS disorder?
Herpes Zoster
Guillain-Barre syndrome
peripheral
central or peripheral NS disorder? patient symptoms-
bilateral Carpal tunnel syndrome, tarsal tunnel syndrome,
asterixis “liver flap”
ammonia abnormality
peripheral
what is asterixis? causes?
UMN symptoms
hyperextend wrist > tremor of the hand
resemble a bird flapping its wings
causes: liver cirrhosis, encephalopathy, hepatic encephalopathy, liver failure, esophageal varices
central or peripheral NS disorder? patient symptoms-
start as weakness and tingling in the feet and legs that spread to the upper body. distal to proximal
Paralysis can occur, problem once affects phrenic nerve
starts from infection
peripheral
Guillain-Barre syndrome
how are SCI neurological level named?
- sensory
- motor
Neurological level named for lowest functional level (normal sensory/motor)
• Normal sensory
• MMT 3/5 (fair) and the immediately proximal level is at 5/5 (normal)
• Can vary between left/right sides of body
what Asia scale? complete or incomplete?
no motor
no sensory in S4-5
Asia A
complete SCI
what Asia scale? complete or incomplete?
sensory spared
no motor function below neurological level to S4-S5
Asia B
sensory incomplete
what Asia scale? complete or incomplete?
motor function below neurological level most key muscles have motor score <3/5
Asia C
motor incomplete
what Asia scale? complete or incomplete?
motor function below neurological level most key muscles have motor score 3-5/5
Asia D
motor incomplete
what Asia scale? complete or incomplete?
sensory and motor normal
Asia E
Normal
what does ASIA stand for?
american spinal injury association
what pathology? mechanism?
- onset 3-6 days s/p severe SCI, trauma
• sympathetic loss
• hypotension
• Immediate, TEMPORARY loss of power, sensation,
and reflexes below the lesion (and possibly above)
• Temporarily unresponsive to stimuli, flaccid paralysis
• Bowel/bladder flaccidity, loss of bulbocavernosus reflex (S2-4)
spinal shock syndrome
- due to inflammatory process, edema fills spinal canal
what SCI level may have autonomic dysreflexia? types of stimulus to trigger?
T6 or higher
restrictive clothing, tangled catheter, full bladder, fecal impaction, pressure area, ingrown toenail
symptoms of autonomic dysreflexia? first steps when you see patient with the symptoms?
symptoms: above SCI injury - vasodilation, flushed face, pounding headache, increased BP, decreased HR, increased sweating distended neck veins
below level of SCI - vasoconstriction, pale, cool, no sweating
next step - sit up patient (decrease blood to head avoid hemorrhagic stroke), quick check for noxious stimulus, activate EMS
what is orthostatic hypertension? what next to do?
drop 20mmHg SBP or 10mmHg DBP moving supine to sit/stand or on tilt table
- next step lay supine or trendelenburg to get blood flow back to head
- use tilt table to build up threshold
- “head is pale, raise the tail”
SCI sensory locations for
C2 to T2?
C2- occipital protuberance C3- supraclavicular fossa C4- tip AC joint C5- lateral side elbow C6 thumb C7 middle finger C8 pinky T1 medial elbow T2 apex axilla
SCI sensory locations for
T3 to T12?
T3- 3rd intercostal space T4- 4th IS @ nipple line T5- 5th IS T6- 6th IS @ xiphisternum T7- 7th IS T8- 8th IS T9- 9th IS T10- 10th IS @ umbilicus T11- 11th IS T12- midpoint inguinal ligament
SCI sensory locations for
L1 to L5?
L1 thigh between T12 and L2 L2 mid anterior thigh L3 medial knee, femoral condyle L4 medal malleolus L5 dorsum foot 3rd MTP
SCI sensory locations for
S1 to S5?
S1- lateral heel
S2- popliteal fossa
S3 ischial tubersoity
S4-5 perianal area
what is brown sequard syndrome injury?
what is affected - motor, pain/temp, discriminatory sensation
hemisection spinal cord
- ipsilateral below lesion - motor (corticospinal), fine touch/proprioception/vibration (DCML) - decussate at medulla
- contralateral below lesion - pain and temp (spinothalamic)
prognosis brown sequard
good
prognosis central cord
average
prognosis anterior cord
poor
cause of brown sequard?
penetrating trauma - gunshot, stab wound
cause of central cord?
forced hyperextension eg. MVA
cause anterior cord
forced flexion or vascular trauma
central cord affects what?
sensory and motor loss
cervical (more central than sacral) UE > LE
difficulty with hand function
anterior cord affects what?
- incomplete SCI, anterior 2/3 of SC
- complete all loss of motor (corticospinal) below level of lesion
- all pain, temp below injury (spinothalamic)
- maintain proprioception and vibration (DCML spared)
micturition control what spinal level?
bladder control S2-4
lesion above L1/conus medullaris leads to what kind of bladder? how is it managed?
spastic/hyperreflexic bladder
- Reflex arc intact,
reflexively empties with adequate filling pressure
- no voluntary control
-manage w intermittent catheterization initially, suprapubic tapping without dyssynergia
lesion below L1/conus medullaris leads to what kind of bladder?
flaccid/areflexic bladder
- unable coordinate between detrusor and sphincters
- managed with catheter or Valsalva maneuver training
lesion above S2 leads to what kind of bowel? how is it managed?
Spastic/reflexic bowel
• Reflex defecation when rectum fills or Digital stimulation
lesion below S2 leads to what kind of bowel? how is it managed?
Flaccid/areflexive bowel
• Manual evacuation
• gentle Valsalva maneuver
SCI level C1-3 what sensation/motor functional abilities? - ADL? - Elimination indep/dep? - what type of Mobility?
no movement or sensation below neck
- ventilator dependent
- ADL dependent
- elimination dependent
- mobility - voice or sip n puff controlled electric WC
SCI level C1-3 what sensation/motor functional abilities? - ADL? - Elimination indep/dep? - what type of Mobility?
no movement or sensation below neck
- ventilator dependent
- ADL dependent
- elimination dependent
- mobility - voice, tongue, or sip n puff controlled electric WC
SCI level C4 what sensation/motor functional abilities? - ADL? - Elimination indep/dep? - what type of Mobility?
movement + sensation head and neck
- partial diaphragm function, weak respiration
- ADL dep
- Elim dep
- head, chin-operated electric WC
SCI level C5 what sensation/motor functional abilities? - ADL? - Elimination indep/dep? - what type of Mobility?
- control head, neck, shoulders
- flex elbows
- ADL with assist, ModI
- dependent for transfers
- Elim dep
- AD: electric WC w joystick, electronic tilt/recline, driving possible with modifications
SCI level C6 what sensation/motor functional abilities? - ADL? - Elimination indep/dep? - what type of Mobility?
- use shoulder, extend wrist
- ADL indep, or with assist - Some set-up required, but mostly independent
- self-transfer
- Elim with assist
- AD: manual wheelchair possible with modifications, transfers with slide board
- driving with adaptive equipment
SCI level C7-C8 what sensation/motor functional abilities? - ADL? - Elimination indep/dep? - what type of Mobility?
- extend elbow, flex wrist, use some fingers
- ADL indep
- Elim indep
- AD: manual WC, manual pressure relief
SCI level T1-5 what sensation/motor functional abilities? - ADL? - Elimination indep/dep? - what type of Mobility?
- full hand and finger control use thoracic muscles
- ADL indep or modI
- Elim indep
- AD: manual WC
SCI level T6-10 what sensation/motor functional abilities? - ADL? - Elimination indep/dep? - what type of Mobility?
- controls abdominal muscles, good balance
- ADL indep
- Elim indep
- AD:manual WC
what level SCI can person self transfer to WC?
C6
has shoulder and wrist extension
SCI level T11-L5 what sensation/motor functional abilities? - ADL? - Elimination indep/dep? - what type of Mobility?
- flex and abduct hips
- flex and extend knees
- ADL indep
- Elim indep
- AD: ambulate w leg brace, short brace, or cane
SCI level S1-5 what sensation/motor functional abilities? - ADL? - Elimination indep/dep? - what type of Mobility?
- full control legs
- progressive bowel, bladder and sexual function
- ADL indep
- Elim indep
- AD: ambulate w leg brace, short brace, or cane
SCI level L1-3 what sensation/motor functional abilities? - ADL? - Elimination indep/dep? - what type of Mobility?
- hip flexion
- knee extension
- ADL indep
- Elim indep
- ambulate with HKAFO or KAFO (AFO possible)
SCI level L4-S1 what sensation/motor functional abilities? - ADL? - Elimination indep/dep? - what type of Mobility?
- flex and extend knees
- ankle PF, DF
- ADL indep
- Elim indep
- AD: Full ambulation, possibly needing AFO or assistive device
