NEURO-Perip/Crania DZ Flashcards
This nerve is Sensory and Motor w/ mastication of the face..
CN V (V1- opthmalic, V2maxilla, V3 mandibular)
During 5 weeks embryo what occurs?
Brachial Arches are innervated prior to limb buds forming
Arch 1- trigeminal nerve, mandible, maxilla teeth
Arch 2- facial nerve, muscle of facial expresion
What are MCC of facial pain?
Hot
Sweet or Spicy foods
Dental infx
Mrs. Shock has electric shock pain on R V2 and V3 lasting seconds. Excruciating along maxilla and mandible
What is dx and other findings?
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
How do you treat trigeminal neuralgias?
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
What are CP of CN VII dysfunction?
Weakness with frown, eyebrows, smile
Asymmetric Face
Inc muscle involved, the longer the problem
If the chorda tympani part of CNVII is dysfunctional, what is outcome
- loss of taste ANT 2/3 and palate
- dec excretion of salivary, lacrimal glands
- HYPERACUSIS- Sounds abnormally loud d/t middle ear innervation from infratemporal fossa
Mrs. Ramsay has vesicular rash around ear, auditory issue, and facial neuropathy. What is DX?
RAMSAY HUNT
EMERGENT
Geniculate ganglion dys
Loss of taste may occurs
What are DDX of facial weakness?
Cerebral Vascular accident- stroke
TIA- transient ischemica accident
Lyme DZ
HZV
What is Idiopathic facial neuropathy attributed to inflammatory reaction of the facial nerve?
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
Who is at risk of Bell palsy?
DM
Pregnant
Infections and traumas
What are Bell’s palsy pt able to do?
Wrinkle forehead*
IF not most think GLOBAL problem not just CN 7
What are the classification of ulnar nerve injury when you hit your medical epicondyle
● Mononeuropathies by
○ sensory and motor affected
○ compression d/t trauma
○ MC: ulnar, median, peroneal
○ Predisposition: pregnancy, DM, arthritis, tumors
Mrs. Neuro has pins and needles in her feet w/ H/o DM? What classification is this nerve damage
POLYNEUROPATHIES
○ Toxic, metabolic in nature
○ Intermittent symptoms → normal exam early
○ Positive sx- paresthesias, Pins and needles
○ negative sx- numbness, reduction of sensation
○ SYMMETRIC
What are the patterns of Neuropathies
■ 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
Mrs Neuro has normal muscle size, but spastic MSK tone, w/ no spontaneous movements and INC reflexes.
ST- Babinski- present
Where is the lesion?
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
Mr. Neuro has atrophy muscle, flaccid, fasciculations, DEC reflexes.
ST-BAbinski- Absent
Where is the lesion?
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
What are parkinson like movements?
Tremor, fasciculation, twitch, cogwheel UMN- basal ganglia affected lacking abiliyt to control movements Depression Flat affect Cognitively still there
What is ROAD test?
D/c criteria Ataxia Coordination- cerebellar, RAM, point, gait, Stance Watch feet as they turn Pill rolling Reduce movements
What travels from spine to thalmus-cortex to produce sensation for pain and temperature?
Spinothalmic tracts
afferent-towards
Light touch
crosses low posterior horn CNS
What detects finger and toe 1st during DM vibration neuro testing?
Posterior column tract
crosses high medulla
Proprioception
When we place a object in the hand of patient? What tract are we testing?
Cortiospinal tract
cortex to spinal- cause a reaction, response
Efferent
Discriminative, myotomes, RROM
What are ideal strategies for neuro testing?
Be confident Do test once Compare distal to proximal 1st Compare BiL Eyes closed Sharp vs. dull
What is an autosomal recessive genetic dz that affects corticospinal UMN first, which is d/t Loss of cells in dorsal root ganglion?
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
