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#1 BOARDS > Neurology > Flashcards

Neurology Flashcards

1
Q

Seddon classification

A

Neurapraxia
Axonotmesis
Neurotmesis

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2
Q

Neurapraxia

A

Bruised nerve, results in numbness that is reversible

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3
Q

Axonotmesis

A

Injury to axon that results in Wallerian degeneration
Wallerian degeneration is degeneration of the axon and eventually myelin sheath
Will regenerate over several months as long as the gap is not too big

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4
Q

Neurotmesis

A

Complete severance of the nerve resulting in irreversible numbness

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5
Q

Sunderland’s classification

A

1st through 5th degree classification of nerve damage

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6
Q

First degree

A

conduction deficit without axonal destruction

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7
Q

Second degree

A

axon is severed without reaching the neural tube, Wallerian degeneration with regeneration regeneration is likely (axonotmesis)

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8
Q

Third degree

A

degeneration of axon with destruction of fascicle with irregular regeneration

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9
Q

Fourth degree

A

destruction of axon and fascicle and with no destruction of nerve trunk, but a neuroma-in-continuity exists

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10
Q

Fifth degree

A

complete loss, neuroma is likely and spontaneous recovery is rare

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11
Q

Ankle block

A 
Tibial nerve
Saphenous nerve
Medial dorsal cutaneous nerve
Deep peroneal nerve
Intermediate dorsal cutaneous nerve
Sural nerve
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12
Q

Hallux block

A

1st dorsal digital proper nerve
Deep peroneal nerve
1st plantar digital proper nerve
2nd plantar digital proper nerve

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13
Q

Mayo block

A

Saphenous nerve
Deep peroneal nerve
Medial dorsal cutaneous nerve
Medial plantar nerve

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14
Q

Popliteal block

A

Sciatic nerve (tibial nerve and common peroneal nerve
Injection given at posterior knee, 7 cm proximal and 1 cm lateral to the transverse popliteal crease
Common epineurial sheath with common peroneal and tibial nerve
Saphenous is also blocked, just distal and anterior to the medial condyle of the tibia

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15
Q

Bier block

A

IV regional anesthesia
Veins, arteries and nerves run together so by injecting local anesthetic into a vein, it diffuses is to the surrounding nerves
A tourniquet is placed around the calf and in IV cannula is inserted as distal as possible
The leg is exsanguinated with elevation and an Esmarch bandage and tourniquet is inflated
Lidocaine plain is injected and the IV cannula is removed prior to operation
The block persists as long as the calf tourniquet is inflated, however effect of the block disappears shortly after deflation

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16
Q

Dermatomes of the lower extremity

A

L3, L4, L5

S1, S2

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17
Q

L3

A

Medial knee

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18
Q

L4

A

Medial hallux
Medial ankle
Knee cap

19
Q

L5

A 
Dorsal central foot
 Plantar central foot
 Anterior ankle
 Posterior heel
 Lateral calf
20
Q

S1

A

L lateral ankle and midfoot
Lateral 5th digit
Posterior lateral calf

21
Q

S2

A

Medial plantar foot
Medial heel
Posterior medial calf

22
Q

Sullivan’s sign

A

Toes adjacent to affected morton’s neuroma splay apart on weight bearing

23
Q

Mulder’s sign

A

Silent palpable click

24
Q

Joplin’s neuroma

A

A benign enlargement of the medial plantar digital nerve
Located on the plantar medial aspect of the first MPJ of the hallux
Signs and symptoms are similar to other distal focal neuropathies - parasthesias, burning pain at point of compression or entrapment
Cause is usually biomechanical (pronation, hallux limitus)

25
Q

Tarsal tunnel

A

Entrapment or compression neuropathy within tarsal tunnel beneath flexor retinaculum (laciniate ligament)
Tibial nerve divides into three branches beneath the flexor retinaculum (medial plantar nerve, lateral plantar nerve, medial calcaneal nerve
Tarsal tunnel syndrome is analogous to carpal tunnel syndrome in the wrist

26
Q

Borders of the tarsal tunnel

A

Medial and posterior: flexor retinaculum (laciniate ligament)
Lateral: calcaneus and posterior talus
Anterior: distal tibia and medial mal

27
Q

Causes of tarsal tunnel

A 
Trauma (fracture, sprain, dislocation) 
Inflammatory conditions (RA, tendonitis, synovitis, diabetes) 
Space occupying lesions (ganglion, varicosities, lipoma, neurilemoma, edema) 
Biomechanical (excessive pronation - results in stretching of the tibial nerve
28
Q

Signs and symptoms of tarsal tunnel

A

Pins and needles, numbness, burning, shooting over entire plantar foot
Symptoms are usually exacerbated by activity such as prolonged weight bearing, walking or running
Intrinsic muscle atrophy with hammertoe formation is a late manifestation

29
Q

Signs and symptoms of tarsal tunnel

A

Pins and needles, numbness, burning, shooting over entire plantar foot
Symptoms are usually exacerbated by activity such as prolonged weight bearing, walking or running
Intrinsic muscle atrophy with hammertoe formation is a late manifestation

30
Q

Surgical treatment of tarsal tunnel

A

Longitudinal incision of flexor retinaculum
Excise any space occupying lesions
Do not damage medial calcaneal branch of tibial nerve
Flexor retinaculum should not be sutured back after surgery

31
Q

Multiple sclerosis (MS)

A

Inflammatory disease
Patchy demyelination of the CNS
Diagnosis in teens to 35
Highly variable clinical course - relapsing and remitting
Male to female 1:2
Motor, sensory, cerebellar or visual attacks that come on over 1-2 weeks and resolve over 4-8 weeks, sometimes do not resolve or only partially
Diagnosis with MRI, spinal tap

32
Q

Amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease)

A

Progressive degenerative disease of upper motor neurons and lower motor neurons
Diagnosis in 40’s
Male to female 2:1
Fatal within 2-5 years
Wasting, weakness, cramps, stiffness, slurred speech, symptoms begin in the hands, spread to the arms and legs
Mental status is preserved

33
Q

Guillan Barre syndrome (Landry’s paralysis)

A

Acutely progressive self-limiting acquired inflammatory demyelinating polyneuropathy
Rapid weakness and paralysis, can be life threatening due to breathing difficulty
Ages 30-50
Spontaneous recover 1-3 weeks from onset, complete recovery takes months, can have residual foot drop
Likely autoimmune cause, precipitating factors (viral infeciton, vaccination, recent surgery)
Weakness begins in legs and progresses, sensory involvement may occur, muscle involvement always occurs

34
Q

Charcot-Marie-Tooth

A

Named after 3 physicians who first recognized the disease
Hereditary demyelinating hypertrophic neuropathy of the PERIPHERAL nervous system
Characterized by slow progressive distal muscle atrophy (especially the peroneals resulting in foot drop)
Possibly sensory changes, less severe than muscle atrophy
Autosomal recessive → 8 years of age
When dominant → 30 years of age
The earlier the onset, the poorer the prognosis

35
Q

Signs and symptoms of CMT

A

Weakness of peroneals
Pes cavus
Stork leg skinny legs due to peroneal atrophy
Inverted champagne bottle legs
Foot drop (slapping gait)
Unsteady gait, tending to trip easily
Stocking-glove sensory loss
Decrease ankle DTR’s
Hallux becomes fixed in plantarflexion late in disease state
Hands may become involved
Treatment is symptomatic with AFO for foot drop

36
Q

Charcot’s joint

A

Destructive arthropathy resulting from impaired pain perception and increased bone blood flow from reflex vasodilation
Increased bone blood flow to bones, they become washed out and weak
With impaired deep pain sensation and proprioception, small periarticular fractures go unnoticed until the entire joint is destroyed

37
Q

Friedreich’s ataxia

A

A spinal form of the hereditary sclerosis
Onset in childhood or adolescence (5-15 yrs)
Decreased DTRs, ataxia, pes cavus, scoliosis are common
Life expectancy is limited

38
Q

EMG

A

Electromyography

Assesses the electrical activity generated by muscle fibers at rest and with activity

39
Q

Normal EMG

A

At rest, the electrical signal should be silent and with voluntary movement until potentials are roughly proportional to effort

40
Q

Denervation on EMG

A

In denervated muscles, there are fasciculations at rest
With voluntary movement the number of motor units under voluntary control are decreased and the duration and amplitude of the individual potentials are increased
The increase is due to collateral sprouting of axonal processes from surviving axons

41
Q

NCV

A

Nerve conduction velocity

42
Q

Purpose of NCV

A

Used to distinguish conditions involving the myelin sheath from those affecting the axon
Helpful in determining the distribution of a nerve lesion, including areas of focal nerve compression (tarsal tunnel)
NCVs measure the latency of motor nerve conduction, which is the time from stimulation of a nerve to the evoked muscle response

43
Q

How NCV is calculated

A

The test is performed by stimulating one point on a nerve and measuring the time taken before the muscle response
The test is then repeated at a second site closer to the muscle
By subtracting one time from the other, it is possible to determine the time taken for the impulse to cover the measurable distance between the two sites of stimulation
The result is a rate of meters per second (mps)

44
Q

Normal NCV value

A

Normal values vary but are almost always greater than 40 mps

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