Neurology Flashcards
1
Q
What is somatosensory evoked potentials (SEP) test used for?
A
- Diagnosing demyelinating process
* *Think testing for SEPeration of myelin from the nerve**
2
Q
When to order nerve conduction velocities
A
When concerned about peripheral neuropathy
3
Q
When to order EMG
A
- When concerned for muscular dystrophy
- Used to test for abnormal muscle activity (which may be due to neuropathy)
4
Q
Erb’s Palsy
A
- Brachial plexus injury at C5-6 or 7
- Results in paralysis of the upper arm
- “WAITER’S TIP” configuration if C7 involved
- Grasp and extension of the hand INTACT (i.e. the waiter can grasp his tip)
- May cause unilateral diagphragmatic paralysis in ~5% of cases (causing respiratory distress)
5
Q
Klumpke palsy
A
- Brachial plexus injury at C8 - T1
- Affects LOWER ARM and HAND -> CLAW HAND deformity with INABILITY to grasp
- Carries a worse prognosis than Erb’s palsy because nerves are typically torn
- Horner’s Syndrome (T1 lesion -> ptosis, miosis, anhydrosis and dry eye) usually present
6
Q
Horner’s Syndrome
A
- T1 lesion
- Ptosis, miosis, anhydrosis, dry eye
7
Q
Possible causes of CP
A
- Prematurity
- IUGR
- Intrauterine infections
- Asphyxia is responsible for only a small number of cases
8
Q
Athetoid cerebral palsy
A
- Motor impairment (spastic CP) + dystonia
9
Q
First step in evaluation a patient with progressive weakness or paralysis
A
ASSESS RESPIRATORY STATUS!
10
Q
Guillain-Barre Syndrome
A
- Classically ascending paralysis that progresses over days to weeks -> ataxia -> inability to walk
- May also present with back pain, fever, facial palsy and proximal muscle weakness prior to LE symptoms
- Decreased LE reflexes
- Associated with C. jejuni infection (recent diarrheal illness)
- Always consider tick paralysis in differential (look for history of camping, recent vacation, summertime, woods, or faster (hours - 2 days) progression of symptoms)
11
Q
Diagnosis of GBS
A
- LP that shows albuminocytologic dissociation (i.e. increased CSF protein in absence of increased WBCs)
- May also be referred to as absence of pleocytosis in CSF
12
Q
Treatment of GBS
A
- IVIG or plasmapheresis
- Steroids DO NOT HELP
13
Q
Symptoms of cord compression syndrome
A
- Loss of rectal tone
- Bowel/bladder incontinence
- Loss of sensation
- INCREASED LE reflexes (think of signal from LEs not being able to reach the brain, so the brain cannot dull the reflex that the spine produces)
14
Q
Tick paralysis symptoms and treatment
A
- Clinically can appear similar to GBS
- Ascending paralysis, ataxia, absent LE reflexes
- Caused by neurotoxin produced by ticks
- Normal CSF (GBS has increased CSF protein with no WBCs)
- Tx = remove the tick!
15
Q
Presentation of Myasthenia Gravis
A
- Baby with variable ptosis
- Older child with evidence of waxing and waning muscle weakness
- Diminished but NOT absent reflexes
