Neuro II Lecture 5 - ALS/GBS/Sensation

Question 1

what is somatosensation

Answer 1

sensation received from skin and musculoskel system

Question 2

what is proprioception

Answer 2

position sense

Question 3

what is pallesthesia

Answer 3

vibration sense

Question 4

what is stereognosis

Answer 4

object recognition

Question 5

what is topognosis

Answer 5

tactile recognition

Question 6

what does the anterolateral spinothalamic system detect?

Answer 6

pain and temp

Question 7

what does the DCML detect

Answer 7

proprioception
vibration
2-point
stereognosis

Question 8

how do you begin sensory testing?

Answer 8

distal to proximal, bilaterally
random sequence and pace
vision occluded

Question 9

superficial sensory receptors detect what

Answer 9

pain, temp, light touch, pressure

Question 10

deep sensory receptors detect what

Answer 10

position sense, kinesthesia, vibration

Question 11

combined cortical sensation receptors detect what

Answer 11

stereognosis, two point, barognosis, graphesthesia, tactile localization, recognition of texture, double simultaneous stimulation

Question 12

What is the pathology for Guillain-Barré Syndrome?

Answer 12

spinal roots and peripheral nerves are infiltrated with macrophages and T-lymphocytes, attack/strip myeline sheaths (milder cases have intact axons and can re-myelinate)

Question 13

What are the clinical characteristics of Guillain-Barré Syndrome?

Answer 13

rapid progression of weakness and sensory changes starting symmetrically distally progressing proximal. Absent/diminished reflexes, flaccid paralysis

Question 14

What is the progression of Guillain-Barré Syndrome?

Answer 14

progression of symtpoms generally stops within 2-4 weeks, then a static/all time low phase beings for another 2-4 weeks, recovery(ranging from months-years) occurs in a proximal to distal pattern

Question 15

What is required for a Guillain-Barré Syndrome diagnosis?

Answer 15

loss of DTRs, progressive weakness in more than one extremity // in order of importance: rapid symmetric weakness plateauing around 4 weeks, mild sensory changes, facial weakness, recovery starts within 2-4 weeks, tachycardia/arrhythmyias/varying BP, NO fever

Question 16

What is the prognosis for Guillain-Barré Syndrome?

Answer 16

good prognosis, slow rate of peripheral nerve recovery at 1-2mm or 0.04-0.08in / day (1-2in/month)

Question 17

What factors predict a poor outcome for Guillain-Barré Syndrome?

Answer 17

older age onset, longer time before recovery begins, need for ventilation, indicated axonal degeneration

Question 18

does ALS have UMN or LML involvement

Answer 18

both

Question 19

what tests are done to “rule in” or diagnose ALS

Answer 19

clinical exam
motor only, progression of sx, UMNL and LMNL

Question 20

what tests are done to “rule out” ALS

Answer 20

imaging of brain/spine
blood tests
CSF sample
muscle biopsy

Question 21

What is Amyotrophic Lateral Sclerosis?

Answer 21

a degenerative terminal disease affecting BOTH upper and lower motor neurons

Question 22

What structures are affected in ALS?

Answer 22

the cortex, corticospinal tract, brainstem nuclei of CN V, VII, IX, X, and XII, and anterior horn cells in spinal cord

Question 23

How is ALS diagnosed?

Answer 23

LMN and UMN lesions found by clinical examination + progression of disease within a region(s) AND an absence of any evidence that may indicate another disease

Question 24

how does ALS present

Answer 24

UMNL+LMNL
no sensory changes
progressive/fatal
asymmetric