NeuroPathology - Lecture Nine Objectives - Diseases of the Peripheral Nervous System Flashcards
Mononeuropathy is described as…
damage to a single nerve usually due to injury
Polyneuropathy is described as…
multiple nerves involved, glove and stocking pattern
Radiculoneuropathy is described as…
involvement of nerve root as it emerges from spinal cord
Polyradiculitis is described as…
several nerve roots are involved and occurs when infections create inflammatory response or trauma
What are clinical features of PNS pathology / nerve injuries?
muscle atrophy, diminished reflexes, muscle weakness, contractures, edema, sensory impairments
What are some PT implications for nerve injuries?
restore functional ROM, strength, and proprioception as well as balance and gait pattern
What is Charcot-Marie-Tooth Disease?
Hereditary motor and sensory neuropathy/progressive peroneal muscular atrophy
What nerves/muscles are initially affected in Charcot-Marie-Tooth Disease?
peroneal nerve/muscles in foot and lower leg initally, then progresses to forearm/hand muscles
What is the etiology of Charcot-Marie-Tooth Disease?
autosomal dominant pattern with a genetic mutation, just one CMT gene
What are the clinical characteristics of Charcot-Marie-Tooth Disease?
symmetric muscle weakness, diminished DTRs, weakness of dorsiflexors/evertors, foot drop gait pattern, pes cavus, sensory loss in feet and ankles. ***Legs look like inverted champagne bottle
What are some PT implications for Charcot-Marie-Tooth Disease?
contracture prevention, stretching/ROM, splinting, POTENTIALLY strengthening
What is Diabetic Neuropathy caused by?
it is a metabolic cause associated with diabetes mellitus
What is the etiology of Diabetic Neuropathy?
chronic metabolic disturbanes that impact nerve and Schwann cells
What are risk factors for Diabetic Neuropathy?
hyperglycemia
What are the clinical characteristics of Diabetic Neuropathy?
insidious onset, sensory loss, burning pain stronger at night, walking on clouds, loss of ankle DTRs // mild weakness, hammer toes/pes cavus // cardiovascular and sympathetic disturbances
What is Myasthenia Gravis and what is the etiology?
it is a fluctuating motor weakness autoimmune disorder / neuromuscular disorder involving ocular, bulbar, limb, and/or respiratory muscles
What are the clinical characteristics of Myasthenia Gravis?
first affected are eyelid muscles and muscles moving the eyes leading to double vision/ptosis, chewing food is tougher leading to fatigue, lips wont close
What are some PT implications for Myasthenia Gravis?
acute care: encourage coughing and deep breathing, observe for increasing weakness // in all settings: energy conservation strategies, strength training
What is the pathology for Guillain-Barré Syndrome?
spinal roots and peripheral nerves are infiltrated with macrophages and T-lymphocytes, attack/strip myeline sheaths (milder cases have intact axons and can re-myelinate)
What are the clinical characteristics of Guillain-Barré Syndrome?
rapid progression of weakness and sensory changes starting distally progressing proximal. Absent/diminished reflexes, flaccid paralysis
What is the progression of Guillain-Barré Syndrome?
progression of symtpoms generally stops within 2-4 weeks, then a static/all time low phase beings for another 2-4 weeks, recovery(ranging from months-years) occurs in a proximal to distal pattern
What is required for a Guillain-Barré Syndrome diagnosis?
loss of DTRs, progressive weakness in more than one extremity // in order of importance: rapid symmetric weakness plateauing around 4 weeks, mild sensory changes, facial weakness, recovery starts within 2-4 weeks, tachycardia/arrhythmyias/varying BP, NO fever
What is the prognosis for Guillain-Barré Syndrome?
good prognosis, slow rate of peripheral nerve recovery at 1-2mm or 0.04-0.08in / day (1-2in/month)
What factors predict a poor outcome for Guillain-Barré Syndrome?
older age onset, longer time before recovery begins, need for ventilation, indicated axonal degeneration
What are some PT implications for Guillain-Barré Syndrome?
facilitate muscle contractions while montioring overuse/fatigue
