Neuro pathologies general Flashcards
Blood vessel supply to nerve
Vasanervorum
No lymphatic vessel to drain extra fluid contributes to longer recovery of nerve damage
Compression syndromes of peripheral nerves
Result in a local conduction block in a peripheral nerve but no structural damage to the axon or to tissue distal to the lesion
Symptoms: numbness, tingling, pain weakness due to impaired oxygenation (ischemia) of nerve, impaired local neural conduction
Single peripheral nerve is affected
Mononeuropathy
Several peripheral nerves are involved
Polyneuropathy
Involvement of the nerve root as it emerges from the spinal cord
Radiculoneuropathy
Involvement of several nerve roots and occurs when infections create an inflammatory response
Polyradiculitis
Brachial plexus injuries
Erb-Duchenne palsy - weiter’s tip position
Klumpke’s paralysis
Homer’s syndrome
Radial nerve - Crutch palsy, saturday night palsy, posterosseous syndrom, cheiralgia paresthetica
Median nerve - Ligament of Struthers, pronator Teres Syndrome, Anterior interosseous syndrome, Carpal Tunnel syndrome
Ulner Nerve - Tardy ulnar palsy, Thoracic outlet syndrome (Cervical rib, Anterior scalene syndrome, interscalene triangle, costoclavicular, pectoralis minor syndrome)
Lumbar plexus injuries
Injury to femoral nerve
Injury to obturator nerve
Meralgia paresthetica
Sacral plexus
Tarsal Tunnel syndrome
Sciatic nerve lesions
Neuritis
Inflammation of the nerve
Mainly sheath and connective tissue are affected (usually the axon is not)
Constant dull pain
what causes Neuritis
Secondary to pathology (DM, Leprosy, TB)
Trauma to nerve
Chronic exposure (to a toxin like lead, rugs or alcohol)
Neuralgia
Nerve pain intense zapping pain, electric
Recurrent attacks of sudden excruciating pain along distribution of the nerve
No associated pathology
has a trigger zone - are that causes an attack when stimulated
usually its an area of skin supplied by the nerve
Movement of the area increases pain
Which nerve does Neuralgica commonly affect?
Trigeminal and intercostal nerves
Intercostal neuralgia
affects intercostal nerves that ravel between the internal and innermost intercostal muscles
What causes intercostal neuralgia
Diabetes
Post herpes zoster
Herpes zoster (shingles)
Start with Varicella zoster virus (chicken pox)
when reactivated, the virus causes a generalized inflammatory response starting in the sensory ganglion and spreading along the nerves causing demyelination and degeneration
inflammation produces pain and tingling in the involved dermatome with a rash and then vesicles that burst and encrust.
Most commonly Trigeminal and thoracic nerves are affected.
What is traction injury of superior roots of the brachial plexus (C5-C6)?
Erb-Duchenne palsy
Forceful pulling away of head from shoulder
Sensory loss C5 and C6 dermatome)
What is the common sign of Erb-Duchenne palsy?
Waiter’s tip position
arm is adducted, medial rotation, forearm pronated, elbow extended,wrist and fingers flexed
What is injury when the arm pulled away from neck?
Klumpke’s paralysis
Traction injury of lower brachial plexus
Poor positioning at birth (breech) or pulled by forces
sensory loss affecting C8 + T1 dermatome
Can get Horner’s syndrome (smaller pupil, drooping eyes)
what is the sign of Klumpke’s paralysis
Claw hand - thumb on same plane as palm (whole hand…both median and ulnar)
Horner’s syndrome
Miosis: constriction of pupil
Ptosis: drooping of eyelid
Anhydrosis: loss of sweating to face and neck
Enophthalmos: recession of eyeball into orbit
Neurapraxia
1st degree nerve injury, mild focal compression. Segmental demylination, reversible in hours to months.
Axonotmesis
Second degree nerve injury, prolonged severe compression. Wallerian degeneration (degeneration of the axon, distal to injury). more than 6 months to recover, sensory, motor, and autonomic loss
Neurotmesis
Third degree nerve injury
Damaged endoneurium
Wallerian degeneration, hard to regenerate. Surgical intervention to suture.
1st degree nerve injury
Neurapraxia, segmental demyelination
2nd degree nerve injury
Axonotmesis, wallerian degeneration, endonerium is intact
3rd degree nerve injury
Neurotmesis, damaged endonerium, wallerian degeneration
