Neuro II Lecture 5 - ALS/GBS/Sensation Flashcards
what is somatosensation
sensation received from skin and musculoskel system
what is proprioception
position sense
what is pallesthesia
vibration sense
what is stereognosis
object recognition
what is topognosis
tactile recognition
what does the anterolateral spinothalamic system detect?
pain and temp
what does the DCML detect
proprioception
vibration
2-point
stereognosis
how do you begin sensory testing?
distal to proximal, bilaterally
random sequence and pace
vision occluded
superficial sensory receptors detect what
pain, temp, light touch, pressure
deep sensory receptors detect what
position sense, kinesthesia, vibration
combined cortical sensation receptors detect what
stereognosis, two point, barognosis, graphesthesia, tactile localization, recognition of texture, double simultaneous stimulation
What is the pathology for Guillain-Barré Syndrome?
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)
What are the clinical characteristics of Guillain-Barré Syndrome?
rapid progression of weakness and sensory changes starting symmetrically distally progressing proximal. Absent/diminished reflexes, flaccid paralysis
What is the progression of Guillain-Barré Syndrome?
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
What is required for a Guillain-Barré Syndrome diagnosis?
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
What is the prognosis for Guillain-Barré Syndrome?
good prognosis, slow rate of peripheral nerve recovery at 1-2mm or 0.04-0.08in / day (1-2in/month)
What factors predict a poor outcome for Guillain-Barré Syndrome?
older age onset, longer time before recovery begins, need for ventilation, indicated axonal degeneration
does ALS have UMN or LML involvement
both
what tests are done to “rule in” or diagnose ALS
clinical exam
motor only, progression of sx, UMNL and LMNL
what tests are done to “rule out” ALS
imaging of brain/spine
blood tests
CSF sample
muscle biopsy
What is Amyotrophic Lateral Sclerosis?
a degenerative terminal disease affecting BOTH upper and lower motor neurons
What structures are affected in ALS?
the cortex, corticospinal tract, brainstem nuclei of CN V, VII, IX, X, and XII, and anterior horn cells in spinal cord
How is ALS diagnosed?
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
how does ALS present
UMNL+LMNL
no sensory changes
progressive/fatal
asymmetric
