NEURO-Perip/Crania DZ

Question 1

This nerve is Sensory and Motor w/ mastication of the face..

Answer 1

CN V (V1- opthmalic, V2maxilla, V3 mandibular)

Question 2

During 5 weeks embryo what occurs?

Answer 2

Brachial Arches are innervated prior to limb buds forming
Arch 1- trigeminal nerve, mandible, maxilla teeth
Arch 2- facial nerve, muscle of facial expresion

Question 3

What are MCC of facial pain?

Answer 3

Hot
Sweet or Spicy foods
Dental infx

Question 4

Mrs. Shock has electric shock pain on R V2 and V3 lasting seconds. Excruciating along maxilla and mandible
What is dx and other findings?

Answer 4

Trigeminal neuralgia- compression by a vessel (superio cerebellar aa) at entrance by brain stem
Lacinating- electric shock pain, “Tic douloreux”

CP- MC >65yo
SX-UL, HA, TMJ, trigger pts

DDX-think MS IF young and BIL

Question 5

How do you treat trigeminal neuralgias?

Answer 5

PAIN
Antiepileptics: slow/low goal 1200. LIFELONG but tirate down to none. Risk seizures
Gabapentin-GREAT, but dosage
carbamazepine (Tegretol)
phenytoin (Dilantin)

**AVOID NARCOTICS/OPIODS

Surgery- rare, danger d/t posterior cranial fossa

Question 6

What are CP of CN VII dysfunction?

Answer 6

Weakness with frown, eyebrows, smile
Asymmetric Face
Inc muscle involved, the longer the problem

Question 7

If the chorda tympani part of CNVII is dysfunctional, what is outcome

Answer 7

1. loss of taste ANT 2/3 and palate
2. dec excretion of salivary, lacrimal glands
3. HYPERACUSIS- Sounds abnormally loud d/t middle ear innervation from infratemporal fossa

Question 8

Mrs. Ramsay has vesicular rash around ear, auditory issue, and facial neuropathy. What is DX?

Answer 8

RAMSAY HUNT
EMERGENT
Geniculate ganglion dys
Loss of taste may occurs

Question 9

What are DDX of facial weakness?

Answer 9

Cerebral Vascular accident- stroke
TIA- transient ischemica accident
Lyme DZ
HZV

Question 10

What is Idiopathic facial neuropathy attributed to inflammatory reaction of the facial nerve?

Answer 10

Bells Palsy- post viral prodrome, tumor, p/o middle ear surgery
CP- acute onset, ipslateral weakness, pain near ear, stiff face, lack of taste, hyperacusis
Droop eyelid- dry cornea

PE- CN, Peripheral neural, VA

TX- Self limiting, 60% recover, 10% permanent
steroids (yet suppress immune)
AVOID Acyclovir
eye patch prn

Question 11

Who is at risk of Bell palsy?

Answer 11

DM
Pregnant
Infections and traumas

Question 12

What are Bell’s palsy pt able to do?

Answer 12

Wrinkle forehead*

IF not most think GLOBAL problem not just CN 7

Question 13

What are the classification of ulnar nerve injury when you hit your medical epicondyle

Answer 13

● Mononeuropathies by
○ sensory and motor affected
○ compression d/t trauma ​
○ MC: ulnar, median, peroneal

○ Predisposition: pregnancy, DM, arthritis, tumors

Question 14

Mrs. Neuro has pins and needles in her feet w/ H/o DM? What classification is this nerve damage

Answer 14

POLYNEUROPATHIES
○ Toxic, ​metabolic in nature
○ Intermittent symptoms → normal exam early
○ Positive sx- paresthesias, Pins and needles
○ negative sx- numbness, ​reduction​ of sensation
○ SYMMETRIC

Question 15

What are the patterns of Neuropathies

Answer 15

■ Neuropathies come with both POLY/MONO
■ progress to Positive- early and negative - later
■ Distally 1st- stocking-glove
■ Feet_ankles, hands_ wrists
■ length susceptible to neurologic problems- Vagus nerve - could affect visceral structures
○ Sensory before motor

Question 16

Mrs Neuro has normal muscle size, but spastic MSK tone, w/ no spontaneous movements and INC reflexes.
ST- Babinski- present
Where is the lesion?

Answer 16

UPPER MOTOR
central so lacks specific direction
MSK lots of signal- TIGHT, TOO STRONG, UNContolled in cortex lesion
Nerves too much signal- DTR INC OR NORMAL,

Ex. MS/CVA

Question 17

Mr. Neuro has atrophy muscle, flaccid, fasciculations, DEC reflexes.
ST-BAbinski- Absent
Where is the lesion?

Answer 17

LOWER MOTOR
damage lower cuts off at access to limb
Muscle no signal from local- WEAK- slow process, BIL
Nerves no signal locally- NO DTR

Ex. Neuropathy

Question 18

What are parkinson like movements?

Answer 18

Tremor, fasciculation, twitch, cogwheel
UMN- basal ganglia affected lacking abiliyt to control movements
Depression
Flat affect
Cognitively still there

Question 19

What is ROAD test?

Answer 19

D/c criteria
Ataxia
Coordination- cerebellar, RAM, point, gait, Stance
Watch feet as they turn
Pill rolling
Reduce movements

Question 20

What travels from spine to thalmus-cortex to produce sensation for pain and temperature?

Answer 20

Spinothalmic tracts
afferent-towards
Light touch
crosses low posterior horn CNS

Question 21

What detects finger and toe 1st during DM vibration neuro testing?

Answer 21

Posterior column tract
crosses high medulla
Proprioception

Question 22

When we place a object in the hand of patient? What tract are we testing?

Answer 22

Cortiospinal tract
cortex to spinal- cause a reaction, response
Efferent

Discriminative, myotomes, RROM

Question 23

What are ideal strategies for neuro testing?

Answer 23

Be confident
Do test once
Compare distal to proximal 1st
Compare BiL
Eyes closed
Sharp vs. dull

Question 24

What is an autosomal recessive genetic dz that affects corticospinal UMN first, which is d/t Loss of cells in dorsal root ganglion​?

Answer 24

FRIEDREICH ATAXIA- loss of posterior column
M=F
MC ataxia inherit dz

CP Gait affected 1st-cerebellar
Hands clumsy
Leg weak
Babinski UMN normal
Loss of Reflexes progress overtime

Question 25

Mrs. Franklin is starting to have pin and needles in feet

AIc 8.5. What other findings?

Answer 25

Diabetic Neuropathy- sytemic metabolic dz neuropathy
● MC Peripheral neuropathy
● Distal symmetric MC
● Stocking glove pattern – axonal
● sensory b4 motor- longer nerves loss of ankle reflexes
● DEC vibration sense
● Toe clawing, hammer toes
● DEC pain sensation, foot ulcers
● Autonomic nerves- digest, sex, urination
● Burning pain-LC
● Pos. sx parathesia-LC

Question 26

What is important for all DM to have a foot exam at every visit?

Answer 26

● Excess intracellular glucose disrupts normal axonal physiology, causes breakdown. Water inflam damage nerves. Na/K pump

○ Vascular-ischemic theory: Hyperglycemic damage of capillaries

○ Laminin theory: Lack of normal laminin, affects growth

○ Autoimmune theory: Immunogenic disruption of endothelium

○ Altered neurotrophic effect theory: Altered production/transport of NGF ​(nerve growth factor)

NERVES don’t regenerate

Question 27

Mrs. Barre started to notice leg weakness after having watery stool after eating at chipotle.

Answer 27

GUILLIAN BARRE SYNDROME
Acute Idiopathic Polyneuropathy
● infection Campylobacter, vaccine, surgery
○ Antibodies to Cj​ (Campylobacter)​ cross react with nerve fibers

Question 28

Mrs. Barre leg weakness is linked with what other findings

Answer 28

● DEC Sensory than motor
● +/- pain
● 40% URI c/c

● Physical Exam:
○ LE weakness – symmetric
○ Minimal objective sensory changes, no sensory level
○ DTR Absent, slow, Hypotonia
■ NO Babinski lower motor neuron defect

○ LAB: Protein on CSF

Question 29

What is initial treatment in Pt with Gullian Barre?

Answer 29

PREPARE for ventilation

○ **Spontaneous onset and recovery is hallmark of this disease

Question 30

Mrs. Key has pain, burning on palmar aspect of digits 1-4. PMH- RA and pregnant. What is DX

Answer 30

Median Nerve compression- entrapment by transverse carpal lig. MONONEUROPATHY
Carpal Tunnel Syndrom

CP- tingling finger 1-3 palmer, radiation of pain high to shoulder
thenar atrophy

Question 31

What are special test for CTS?

Answer 31

PE- Dermatomes Myotomes above and below c/c
Tinels
Phalens
2-pt discrim
PROM flex
Night pain
NERVE conduction not NEEDED

Question 32

Mrs. Key wants to get back to work. What are the initial steps?

Answer 32

#1 Modify activity
#2 Splint at night-neutral BIL- d/t likely onset
#3- NSAIDS- 2-3wks
Last- steroid inj