NM Cranial And Peripheral Nerve Disorders Flashcards
Wallerian Degeneration: transection (_____) results in degeneration of ____ and ___ ___ distal to site of ____ interruption
NEUROTMESIS
Axon and myelin sheath
Atonal
Segmental demyelination: Axons are ____ (no _____ degeneration); demyelination restores function (Ex: _____)
Preserved
Wallerian
GBS
Axonal degeneration: degeneration of ____ ____ and myelin, progressing from ___ to ___, “dying back” of nerves (ex: ______)
Axon cylinder
Distal to proximal
peripheral neuropathy
Chromatolysis and repair occur in ____
nerve cell body
______ (sheath) does not regenerate in Wallerian Degeneration, but forms tube directing regeneration
Endoneurium
Neuropathy
Any disease of nerves characterized by deterioration of neural function
Polyneuropathy: _____ _____ involvement of peripheral nerves, usually ____ > ____ (UE vs. LE), distal segments earlier and more involved than proximal
B/L symmetrical
UE>LE
Mononeuropathy
Involvement of single nerve
Involvement of nerve roots
Radiculopathy
3 types of traumatic nerve injury
- Neurapraxia (class 1)
- Axonotmesis (class 2)
- Neurotmesis (class 3)
Neurapraxia (class 1): injury to nerve that results in ___ loss of function (conduction block ischemia); nerve dysfunction may be rapidly ___ or persist few weeks (ex: ____)
Transient
Reversed
Compression
Axonotmesis (Class 2): injury to nerve interrupting ___ and causing loss of function and ___ ___ distal to lesion; with no disruption of ___, regeneration possible (ex: ____)
Axon
Wallerian degeneration
Endoneurum
Crush injury
Neurotmesis (class 3): cutting of nerve with ___ of all structure and complete loss of function; reinnervation typically fails without ___ ___ because of aberrant regeneration (failure of regenerating axon to find its ____ ____)
Severance
Surgical intervention
Terminal end
Autonomic dysfunction from LMN may present as
Vasodilation and loss of vasomotor tone (dryness, warm skin, edema, orthostatic hypotension)
Hyperexcitability of remaining nerve fibers following LMN syndrome: sensory dysthesias (___, pins/needles, numbness, ____). Motor responses include ___ and ___.
Hyperalgesia
Burning
Fasciculations and spasms
Myalgia
Muscle pain
EMG studies for motor nerve function: examine for signs of widespread denervation atrophy (___ ___ potentials); evidence of reinnervation appears as ____ amplitude, ____ duration, _____ motor unit potentials)
Spontaneous fibrillation
Low
Short
Polyphasic
Trigeminal neuralgia usually due to degeneration or compression- what is compressed?
Tortuous basilar A or cerebellopontine tumor
Mean age for trigeminal neuralgia? Gradual or abrupt onset?
> 50, abrupt onset
Characteristics of trigeminal neuralgia?
Brief paroxysms of neuralgic pain (stabbing/shooting); recurring frequently
Trigeminal neuralgia autonomic instability exacerbated by ___ and ___, relieved by ____
Stress, cold
Relaxation
Bell’s Palsy is lesion of CN ___
VII
Bell’s palsy is compression of nerve within ___ bone
Temporal
Lack of salivation and lacrimation, paralysis/weakness of muscles of facial expression on 1 side
Bell’s Palsy
Testing for muscles of facial expression (Bell’s Palsy)- have pt:
Wrinkle forehead, raise eyebrows, frown, smile, close eyes tight, puff out cheeks
Etiology of bulbar palsy
Tumors, vascular degeneration, diseases of lower CN motor nuclei
Bulbar palsy refers to weakness or paralysis of muscles innervated by ____ ___ of lower brainstem, affecting muscles of face, ____, ___, ___.
Motor nuclei
Tongue, larynx, pharynx
Examine ___ and ___ paralysis: phonation, articulation, palatial action, gag reflex, swallowing
Glossopharyngeal and vagal
Possible complications of bulbar palsy
Aspiration pneumonia, severe airway restriction with dyspnea (B/L involvement), difficulty with coughing
Pseudobulbar palsy: ____ (U/L or B/L) dysfunction of ______ innervation of brainstem nuclei; central or UMN lesion analogous to _____ lesions disrupting function of anterior horn cells
B/L
Corticobulbar
Corticospinal
Pseudobulbar palsy: similar sx as bulbar palsy; examine for ____ reflexes, increased jaw jerk, ____ ____ (tapping lips results in pouting of lips)
Hyperactive
Snout reflex
PT goals/outcomes for bulbar palsy (4)
- Suctioning/oral care
- Maintenance of respiratory function, open airway
- Elevate HOB
- Dietary changes: soft foods, liquids
Acute ascending symmetrical polyneuropathy
GBS
GBS is polyneuritis with ___ muscle weakness that develops ____. Etiology unknown but usually associated with _____ attack, after recovery from _____ _____ (respiratory or GI).
Progressing, rapidly
Autoimmune
Infectious illness
GBS: Acute demyelination of both ___ and ___ (___ disease).
CN, peripheral nerves
LMN
GBS: Sensory loss ___ (< or >) motor loss
Less than
GBS: Motor paresis or paralysis shows relative ____ distribution of weakness. Progressive from ___ to ___ (UE/LE) , ____ to ____ (prox/distal). May produce _____ with ____ failure.
LE —> UE
distal —> proximal
Tetraplegia, respiratory
GBS: progression evolves over few days or weeks, recovery slow (___ - ____), usually complete (85% of cases), some mild weakness may persist, 3% mortality
6 mo-2 yrs
Complications with GBS (6)
- Respiratory impairment/failure
- Autonomic instability (tachycardia, arrhythmias, BP flux)
- Pain: myalgias
- Risk of pneumonia
- Prolonged hospitalization/immobility (contractures, DVT, skin)
- Relapse if tx inadequate
CN to examine for GBS
VII, IX, X, XI, XII
ALS: degenerative disease affecting ___ and ___. Degeneration of ____ ____ ____ and descending corticobulbar and ____ tracts.
UMN, LMN
Anterior horn cells
Corticospinal
ALS: etiology unknown (____ or ____). ______% genetic (___ dominant).
Autoimmune or viral
5-10%
Autosomal
ALS: progressive disease, often leading to death typically in ____ years. Highly variable symptoms: 2 onsets are?
2-5 yrs
- Bulbar onset: progressive bulbar palsy
- Spinal cord onset: progressive muscle atrophy
Stages of ALS:
Stage I: early disease, mild focal ____, ____ distribution; symptoms of ____ cramping and fasciculations
Weakness
Asymmetrical
Hand
Stages of ALS:
Stage II: ___ weakness in groups of muscles, some atrophy, ____ with ____ (assist level)
Moderate
Mod I with AD
Stages of ALS
Stage III: ___ weakness of specific muscles, increased ____, mild to moderate functional limitations, ____
Severe
Fatigue
Ambulatory
Stages of ALS
Stage IV: ___ weakness and ____ of LEs, ___ weakness of UEs. ______ and _____ required, _____ (assist levels)
Severe Wasting Mild ModA and ADs W/C user
Stages of ALS
Stage V: _____ weakness with deterioration of mobility and _____, increased ____, moderate to severe weakness of _____ and ____; ____, ____ (UMN), loss of head control, ____ (assist level)
Progressive Endurance Fatigue LEs and trunk Spasticity, hyperreflexia Total assist
Stages of ALS
Stage VI: _____, dependent for ADLs/FMS, progressive ___ ___
Bedridden
Respiratory distress
