Neuro-peripheral Flashcards
controls the 1. Muscles of facial expression
VII- facial
You’re lucky if you get a facial
if you’re lucky you are smiling
all come out of the parotid
Temporal Zygomatic Buccal Mandibular Cervical
what CN involves the muscles of mastication
V- Trigeminal
snesory
if you TRI to kiss me i will feel it
V1-tip of the nose
V2
V3
the first brachial arch is innervated by the
trigeminal -5
the second brachial arch ins innervation by the
facial -7
remember nerves are in place before development and then carried with development
MCC of facial pain
Trigeminal nerve issue
dental, triggers include hot, cold, sweet foods
what is the term used to describe pain in the trigeminal nerve
Lancinating pain like zaps
dx associated with CNV pain
trigeminal neuralgia
tic douloureux”
trigeminal neuralgia
what divisions are most commonly hit by trigeminal neuralgia
V2 and V3
if you have neuralgic looking pain that is bilateral or in a young person what ddx do you want to consider
MS
nueralgic pain is usually described as iv. Pain at ____ points,_____ sensory deficit
iv. Pain at trigger points, without sensory deficit
tx for neuralgic pain
Neuropathic pain - AVOID narcotics
Antiepileptic agents have proven effective
a. Carbamazepine, phenytoin (Dilantin), gabapentin
what do you want to be careful of with antieplileptic prescribed for nerualgia?
need to titrate in order to avoid a seizure
what is the surgical intervention for neuralgic facial pain
a. Usually attempts to relieve decompression by tortuous vasculature in the posterior fossa or along path of CN V
why do we see hyperacusis with damage to the to the facial nerve
chorda typmani is a branch of the facial nerve If paralyzed, the TM moves more and it sounds louder
shingles like eruption in pharynx, ear canal distinguish what should we suspect
i. Ramsay Hunt
can cause facial paralysis and hearing loss in the affected ear.
geniculate ganglion vs CN VII
geniculate ganglion an L-shaped collection of fibers and sensory neurons of the facial nerve located in the facial canal of the head.
Bell’s palsy affects what CN
VII
this is why we see v. Hyperacusis
recover with bell’s palsy
- 60% recover c/o treatment
- Only 10% with permanent disfigurement or disability
- Assess severity in early disease
indicators of poor prognosis with bell’s palsy
Poor prognosis associated with age, hyperacusis (b/c its more into the CNS), severe early pain
two major classifications of neuropathies
mono =compression/trauma thing
poly= metabolic, toxic or hereditary cause
why do we typically see stocking-glove distribution with neuropathies
longest nerves are affected first
iv. Begin distally, usually (stocking-glove distribution) and move proximally
MC mono neuropathies
MC:
ulnar (elbow or lateral part of hand),
median (carpal tunnel), peroneal/common fibular (in the leg near tib/fib)
what predisposes you to mononeuropathies
pregnancy
DM
arthritis
tumors
positive and negative sxs associated with poly neuropathies
Positive (paresthesias = pins and needles)
negative (numbness) symptoms
preserved muscle bulk is a sign of uMN or LMN
UMN
LMN seen wiht atrophy
what type of muscle tone would we expect to see in UMN dz
spasctic knife opening
spontaneous movement seen with UMN or LMN dz
LMN
fasciculations
reflexes are increased in UMN or LMN
UMN
kickin can of preserved muscle bulk that you have to open wiht a knife and fan our like a bb
bibinski’s sign is present UMN or LMN
UMN
what is an example of UMN dz
CVA or MS
ii. Position in space and vibration tell us about
posterior columns)
Pain and temperature
spinothalamic tract
Discriminative sensations
involve cortical input
Most prevalent inherited ataxia
a. Friedreich’s Ataxia
first disturbance in friedreich’s ataxia
iv. Gait is first disturbance
onset of friedreich’s ataxia
ii. Presents in childhood (5-15), early adulthood
babinski positive of negative in friedreich’s ataxia
Babinski –> UMN
what is most commonly the cause behind trigeminal neuralgia
90% of the time caused by compression of CN by the superior cerebral artery
especially in older pt with less compliant artery
ddx of bells palsy
CVA/TIA, Lyme, herpes Zoster
classification of peripheral neuropathies
a. Axonal
b. Paranodal/segmental demyelination
c. Mononeuropathies by compression
the diminished ability to perceive pain, temperature, touch, or vibration.
hypoesthesia
decreased sensitivity to painful stimuli.
hypalgesia
ability of the patient to identify numbers or letters drawn in the palm of the hand.
●Graphesthesia
ability to recognize common objects such as keys, coins or paper clips by touching or handling them with one’s eyes closed.
●
Stereognosis
evaluated by simultaneously touching two separate points on either side of the body.
Extinction
why do we see a positive romberg test
when the patient has lost proprioception from feet
Mononeuropathies
pathology affecting an individual peripheral nerve
Radiculopathies refers to
Radiculopathies refer to pathology affecting the nerve root,
anterolateral spinothalamic tract AP are perceived as
pain
AP carried over the dorsal column medial lemniscal system are perceived as
touch or pressure
describe the neural transmition of touch of pressure
occurs through the medial lemniscal pathway
posterior columns receive signal on first order neuron that is translated to the medulla which then synapses with a second motor neuron and crosses over where it is transmitted to the thalamus synapses to a 3rd order neuron and then reach the sensory cortex of the brain (parietla lobe)
you can also have the transmission of pain going directly from the posterior horn to the anterior horn
–> reflexes
describe the neural pathway of pain
synapse is made in the posterior horn
vascular ischemic theory of diabetic neuropathy
- Hyperglycemic damage of capillaries that feed nerve cells so they can’t deliver proper blood flow (not enough blood to feed the axon)
iii. Laminin theory behind Diabetic neuropathy
lack of normal laminin in basement memebrane, effects growth of nerve fiber and capillaries
iv. Autoimmune theory behind diabetic neuropathy
- Immunogenic disruption of endotheliumí nerve damage
v. Altered neurotrophic effect
- Altered production/transport of NGF (nerve growth factor) that results in damage to the nerve
ii. Follows infection (Campylobacter), vaccine, surgery
seen commonly with Gi symptoms
and involves respiratory complaints 40% of the time
Guillain barre LMN
lab diagnostics for guillain abrre
protein in the CSF (you also see this with MS)
carpal tunnel is most bothersome at what part of the day
night
tx for carpal tunnel
Modify 2. Splint 3. Drugssss
iii. NSAIDs - pain relief in 20-30 mins; anti-inflammatory effects in 7-10 days – Keep the inflammation down w/ ices
etiologies of UMN lesions
stroke
multiple sclerosis
cerberal palsy
brain or spinal cord damage
etiologies of LMN lesions
guillan barre syndrome botulism poliomuelitis cauda equina syndrome bells palsy
spastic paralysis is more associated with umn or lmn lesions
UMN
fasciculation are associated with UMN or LMN
End stage LMN
iv. Discriminative sensations involve what type of input from the brain
cortical
if you can’t stimulate the ventral horn with sensory input you get
hyporeflexia
ventral horn is another name for the anterior horn
What can lack of Position and vibration sensation indicate?
posterior columns lesions, Fingers and toes first
What can lack of light touch sensation indicate?
posterior and spinothalamic
What can lack of discrimination sensation indicate?
involve cortical input
Describe the presentation of Diabetic Neuropathy
1] Sensory before motor,
2] Dulled perception of vibration, pain and temperature
3] Denervation of small muscles results in toe clawing,
4] Decreased pain, high pressures leads to ulcers
5] Also effects autonomic nerves
Antibodies to Cj cross react with nerve fibers
Describe pathophysiology of Guillain Barre Syndrome due to Campyloabacter
