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Neuro > Neuropathy, myopathy, and motor neuron disease > Flashcards

Neuropathy, myopathy, and motor neuron disease Flashcards

1
Q

what is a neuropathy

A

any syndrome where one or more nerves are affected by any of several mechanisms

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2
Q

what is mononeuropathy

A

involvement of a single, major, named nerve (i.e. median nerve, peroneal nerve)

sensory or motor defects related to its anatomical distribution

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3
Q

what is a polyneuropathy or peripheral neuropathy

A

a disorder of multiple, major and small nerves

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4
Q

what usually causes a mononeuropathy

A

trauma or compression

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5
Q

what is more common poly neuropathy or mononeuropathy

A

poly/peripheral neuropathy

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6
Q

what are characteristics of a poly neuropathy

A

symmetrical signs and symptoms

early sensory loss or impairment in distal limbs (feet, with longest sensory fibers in body, then hands: “stocking & glove;”

paresthesia and dysesthesia;

distal limb weakness and atrophy

early loss or decrease of muscle stretch reflexes

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7
Q

How is the pattern of poly neuropathy described?

A

stocking and glove pattern

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8
Q

parasthesia

A

a spontaneous tingling. “pins and needles” sensation

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9
Q

dysesthesia

A

unpleasant sensation from a non-noxious stimulus

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10
Q

what symptoms indicated autonomic nerve involvement in a poly neuropathy

A

orthostatic hypotension, incontinence, impotence, or sweating abnormalities

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11
Q

how do you diagnosis a mononeuropathy

A

usually clinical findings, sometimes use nerve conduction/ EMG testing to help localize and assess the severity of the nerve lesion

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12
Q

what is the most common mononeuropathy

A

median mononeuropathy - carpal tunnel syndrome

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13
Q

what are common characteristics of a myopathy

A

proximal weakness or fatigue
normal sensation
late loss of reflexes only after significant atrophy

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14
Q

what are the 2 process of neuropathy

A

demyelination and axonal degeneration

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15
Q

what is the main mechanism of carpal tunnel syndrome

A

demyelination

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16
Q

what has a better chance of recover demyelination or axonal degeneration

A

demyelination

axon damage tends to be permanent

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17
Q

how does carpal tunnel sydnrom occure

A

flexor tendons passing through the carpal tunnel get inflamed or swollen, compressing the median nerve

fluid retention during pregnancy may also compress the median nerve here, in addition to rarer diseases depositing material in the carpal tunnel

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18
Q

what are the symptoms of carpal tunnel

A

tingling numbness of the hand may waken the patient, while thenar weakness and atrophy occur in more severe cases;

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19
Q

how do you treat carpal tunnel

A

treatment of carpal tunnel syndrome (and other compressive mononeuropathies) ranges from local rest, anti-inflammatory medication, splinting, to surgical decompression of the nerve;

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20
Q

where does Wallerian degeneration occur

A

at the site of severe nerve injury, involving myelin and axons distal to that point

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21
Q

what helps re-innervation to occur

A

if the perineurium and epineurium (connective tissue) remain providing a framework/scaffolding

shorter distances to reach the muscle

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22
Q

what is Wallerian degeneration

A

loss of axons due to a severe crush or penetrating injury. axons and myelin degenerated distal to the injury

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23
Q

what happens if there is not connective tissue to guide regeneration

A

re-sprouting axons pile up in a bulbous neuroma (often painful)

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24
Q

what is the primary pathology of polyneuropathies from toximetabolic causes

A

axonal degeneration (demyelination is a secondary or additional process)

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25
Q

what causes must be considered in a patient with multiple mononeuropathies

A

systemic illness which is inflammatory or autoimmune (SLE), infiltrative (sarcoidosis) or infectious (leprosy)

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26
Q

true or false: a cause is usually identified for non-acute polyneuropathies

A

false - 50-60% of patients may have an unknown etiology

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27
Q

what are some possible causes of a polyneuropathy

A
  • medications (chemotherapy)
  • neurotoxins (work place exposures, or alcoholism)
  • malnutrition and vitamin deficiencies (B)
  • hereditary neuropathy (presents early)
  • infections (AIDS, leprosy)
  • DM
  • metabolic or endocrine disorders
  • rheumatological disease
  • cancer or myeloma
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28
Q

what does an EMG do

A

an electromyogram tests the electrical activity and function of nerves and muscles.

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29
Q

what is a sural biopsy

A

sensory nerve biopsy - can be used to confirm the diagnosis if a poly neuropathy is due to an inflammatory, immune-mediated or vasculitic cause

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30
Q

what is the side effects of a sural biopsy

A

bc the sural nerve in the foot is removed the patient is left with permanent numbness along the lateral foot

31
Q

what oral medications are effective for nerve pain

A

anticonvulsants and antidepressants

32
Q

what does a slowing of nerve conduction velocity seen in EMG testing suggest

A

demyelination problem

33
Q

what does a decreased amplitude in EMG testing suggest

A

axonal loss

34
Q

when is needle EMG testing used

A

the electrical activity of muscles within individual motor units is assessed for evidence of denervation, reinnervation, or muscle disease.

35
Q

treatment options for polyneuropathy

A

Treatment of its primary, underlying cause (e.g., control of diabetes, abstinence from alcohol);

Orthotic devices to allow for safe ambulation;

Physical therapy to maintain joint range of motion;

Medications to relieve painful sensory disturbances (paresthesia, dysesthesia)
(topical creams or ointments,
oral anticonvulsants or antidepressants)

36
Q

how does Guillain-Barre progress

A

very acute
weakness progresses over hours to days
at its worst by 4 weeks

37
Q

what kind of paralysis does guillain-barre cause

A

an ascending (legs first), areflexic paralysis

(generalized (including respiratory) paralysis may occur;
some paresthesia, little objective sensory loss)

38
Q

what is Guillain-barre associated with

A

recent viral respiratory infection (50% of the time)

39
Q

what is the etiology of Guillain-Barre

A

misdirection of the immune system to attack normal peripheral nerve myelin (? antigen modification by the recent virus)

40
Q

what is the pathology of Guillain-Barre

A

inflammation and demyelination of peripheral nerves or roots (if severe, secondary axonal loss)

41
Q

how do you diagnose Guillain-Barre

A

evidence of demyelination by EMG testing of nerves;

elevated protein in CSF, with few if any WBCs;

42
Q

what is the prognosis of Guillain-Barre

A

good with medical care

43
Q

what treatments are available for Guillain-Barre

A

Plasmapheresis or immunoglobulin infusions (IVIG) may shorten the illness and hasten recovery;

44
Q

what are symptoms of hereditary neuropathies

A

onset in childhood - may be subtle

distal sensorimotor deficits, little to no paresthesia or dysesthesia

45
Q

what orthopedic deformities may be present with hereditary neuropathies

A

scoliosis, hammertoes, pes cavus

due to neuropathy in a growing child

46
Q

treatment of hereditary neuropathies

A

no curative treatment

give assistive devices or orthotics as needed

47
Q

what is a myopathy

A

primary disease of the muscle

48
Q

what are symptoms of a myopathy

A
  • Symptoms of weakness, fatigue, sometimes cramps
  • Proximal limb weakness and atrophy (shoulders, hips)
  • Late loss of reflexes (after significant atrophy present)
  • normal sensation
49
Q

how is a myopathy diagnosed

A
  • review of family history (muscular dystrophy)
  • serum muscle enzymes (CK) are often elevated
  • EMG demonstrates a disorder of muscle
  • muscle biopsy
50
Q

what is Polymyositis

A

Inflammation and weakness of multiple muscles may occur from viral infections or drug reactions;

51
Q

what is the most common cause of polymyositis in the US

A

Autoimmune

52
Q

what are common symptoms of polymyositis

A
  • proximal weakness over weeks to months;
  • a rash around the eyes or fingers may occur (dermatomyositis)
  • rarely related to underlying cancer;
53
Q

how is a diagnosis of polymyositis confirmed

A

EMG testing, and presence of inflammation and muscle fiber necrosis on biopsy;

54
Q

what are treatment options for polymyositis

A

corticosteroids or other immunosuppressive drugs

55
Q

how is Duchenne’s muscular dystrophy inherited

A

X-linked

56
Q

what is the etiology of Duchenne’s muscular distrophy

A

virtual absence of dystrophin, critical structural protein, in muscle; involves respiratory and cardiac muscles also

57
Q

what symptoms are commonly seen in Duchennes muscular dystrophy

A
  • proximal weakness begins in boys of childhood age;
  • calf pseudohypertrophy from muscle replaced by fat, connective tissue;
  • cardiorespiratory death by third decade
  • in order to stand from laying the child must “crawl” up
58
Q

what are motor neuron diseases (MND)

A

Disorders, occasionally hereditary, where degeneration of upper (UMN) or lower (LMN) motor neurons, or both, occurs with varying severity and rate of progression;

59
Q

spinal muscular atrophy involves what part of the spinal cord

A

anterior horn cell involvement

60
Q

what are symptoms of spinal muscular atrophy

A

LMN signs (weakness, atrophy, areflexia, fasciculations.

range from fatal to milder types (later onset)

61
Q

what is Werdnig-Hoffman

A

infantile onset of spinal muscular atrophy. A terminal condition due to rapid development of diffuse weakness with no current treatment

62
Q

what signs might be noticed in an infant with Werdnig-Hoffman

A

weak cry, not sucking well, lack of movement, breathing difficulties (usually die in first year)
bell-shaped thorax, frog leg posture

63
Q

what is Amyotrophic lateral sclerosis (ALS)

A

progressive degeneration of all motor neuron subgroups:

• UMN (corticobulbar and corticospinal tracts) and LMN (anterior horn cells, brain stem motor nuclei);

64
Q

what is the prognosis of ALS

A

worse prognosis of all MNDs

50% die within 3 years- with respiratory failure or complications of profound weakness

65
Q

what are clinical manifestations of ALS

A
  • drooling - impaired swallowing and poor facial muscle tone
  • difficulty chewing and swallowing
  • asymmetric atrophy, weakness, and fasiculations of the tongue w/ deviation
  • variable speech impairment
66
Q

how is ALS diagnosed

A

clinical picture and EMG testing

67
Q

how does ALS initaially present

A

Frequently begins with regional weakness and atrophy of a limb (e.g., shoulder), which spreads and becomes bilateral; or initial weakness of swallowing or speech;

68
Q

signs of ALS on exam

A

Diffuse fasciculations may be prominent;

Hyper-reflexia, spasticity or Babinski signs are noted;

69
Q

treatment for ALS

A

riluzole prolongs survival by months

70
Q

what are some possible causes of myopathy

A
  • influenza
  • medications (statins)
  • Endocrin disorders (cushings, hypothyroidism)
  • hereditary
71
Q

what do you expect to see on muscle biopsy in someone with polymyositis

A

inflammatory infiltrate, necrotic and regenerating muscle fibers

72
Q

what is Grower’s maneuver

A

seen in boys with Duchenne’s muscular dystrophy. Seen when the boy uses his upper limbs to compensate for weak trunk and pelvis muscles when getting up from the floor

73
Q

what disease to you commonly see pseudohypertrophy of the calves

A

Duchenne’s Muscular dystrophy

Neuro (11 decks)

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