NM Cranial And Peripheral Nerve Disorders

Question 1

Wallerian Degeneration: transection (_____) results in degeneration of ____ and ___ ___ distal to site of ____ interruption

Answer 1

NEUROTMESIS
Axon and myelin sheath
Atonal

Question 2

Segmental demyelination: Axons are ____ (no _____ degeneration); demyelination restores function (Ex: _____)

Answer 2

Preserved
Wallerian
GBS

Question 3

Axonal degeneration: degeneration of ____ ____ and myelin, progressing from ___ to ___, “dying back” of nerves (ex: ______)

Answer 3

Axon cylinder
Distal to proximal
peripheral neuropathy

Question 4

Chromatolysis and repair occur in ____

Answer 4

nerve cell body

Question 5

______ (sheath) does not regenerate in Wallerian Degeneration, but forms tube directing regeneration

Answer 5

Endoneurium

Question 6

Neuropathy

Answer 6

Any disease of nerves characterized by deterioration of neural function

Question 7

Polyneuropathy: _____ _____ involvement of peripheral nerves, usually ____ > ____ (UE vs. LE), distal segments earlier and more involved than proximal

Answer 7

B/L symmetrical

UE>LE

Question 8

Mononeuropathy

Answer 8

Involvement of single nerve

Question 9

Involvement of nerve roots

Answer 9

Radiculopathy

Question 10

3 types of traumatic nerve injury

Answer 10

1. Neurapraxia (class 1)
2. Axonotmesis (class 2)
3. Neurotmesis (class 3)

Question 11

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: ____)

Answer 11

Transient
Reversed
Compression

Question 12

Axonotmesis (Class 2): injury to nerve interrupting ___ and causing loss of function and ___ ___ distal to lesion; with no disruption of ___, regeneration possible (ex: ____)

Answer 12

Axon
Wallerian degeneration
Endoneurum
Crush injury

Question 13

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 ____ ____)

Answer 13

Severance
Surgical intervention
Terminal end

Question 14

Autonomic dysfunction from LMN may present as

Answer 14

Vasodilation and loss of vasomotor tone (dryness, warm skin, edema, orthostatic hypotension)

Question 15

Hyperexcitability of remaining nerve fibers following LMN syndrome: sensory dysthesias (___, pins/needles, numbness, ____). Motor responses include ___ and ___.

Answer 15

Hyperalgesia
Burning
Fasciculations and spasms

Question 16

Myalgia

Answer 16

Muscle pain

Question 17

EMG studies for motor nerve function: examine for signs of widespread denervation atrophy (___ ___ potentials); evidence of reinnervation appears as ____ amplitude, ____ duration, _____ motor unit potentials)

Answer 17

Spontaneous fibrillation
Low
Short
Polyphasic

Question 18

Trigeminal neuralgia usually due to degeneration or compression- what is compressed?

Answer 18

Tortuous basilar A or cerebellopontine tumor

Question 19

Mean age for trigeminal neuralgia? Gradual or abrupt onset?

Answer 19

> 50, abrupt onset

Question 20

Characteristics of trigeminal neuralgia?

Answer 20

Brief paroxysms of neuralgic pain (stabbing/shooting); recurring frequently

Question 21

Trigeminal neuralgia autonomic instability exacerbated by ___ and ___, relieved by ____

Answer 21

Stress, cold

Relaxation

Question 22

Bell’s Palsy is lesion of CN ___

Answer 22

VII

Question 23

Bell’s palsy is compression of nerve within ___ bone

Answer 23

Temporal

Question 24

Lack of salivation and lacrimation, paralysis/weakness of muscles of facial expression on 1 side

Answer 24

Bell’s Palsy

Question 25

Testing for muscles of facial expression (Bell’s Palsy)- have pt:

Answer 25

Wrinkle forehead, raise eyebrows, frown, smile, close eyes tight, puff out cheeks

Question 26

Etiology of bulbar palsy

Answer 26

Tumors, vascular degeneration, diseases of lower CN motor nuclei

Question 27

Bulbar palsy refers to weakness or paralysis of muscles innervated by ____ ___ of lower brainstem, affecting muscles of face, ____, ___, ___.

Answer 27

Motor nuclei | Tongue, larynx, pharynx

Question 28

Examine ___ and ___ paralysis: phonation, articulation, palatial action, gag reflex, swallowing

Answer 28

Glossopharyngeal and vagal

Question 29

Possible complications of bulbar palsy

Answer 29

Aspiration pneumonia, severe airway restriction with dyspnea (B/L involvement), difficulty with coughing

Question 30

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

Answer 30

B/L Corticobulbar Corticospinal

Question 31

Pseudobulbar palsy: similar sx as bulbar palsy; examine for ____ reflexes, increased jaw jerk, ____ ____ (tapping lips results in pouting of lips)

Answer 31

Hyperactive | Snout reflex

Question 32

PT goals/outcomes for bulbar palsy (4)

Answer 32

1. Suctioning/oral care 2. Maintenance of respiratory function, open airway 3. Elevate HOB 4. Dietary changes: soft foods, liquids

Question 33

Acute ascending symmetrical polyneuropathy

Answer 33

GBS

Question 34

GBS is polyneuritis with ___ muscle weakness that develops ____. Etiology unknown but usually associated with _____ attack, after recovery from _____ _____ (respiratory or GI).

Answer 34

Progressing, rapidly Autoimmune Infectious illness

Question 35

GBS: Acute demyelination of both ___ and ___ (___ disease).

Answer 35

CN, peripheral nerves | LMN

Question 36

GBS: Sensory loss ___ (< or >) motor loss

Answer 36

Less than

Question 37

GBS: Motor paresis or paralysis shows relative ____ distribution of weakness. Progressive from ___ to ___ (UE/LE) , ____ to ____ (prox/distal). May produce _____ with ____ failure.

Answer 37

LE —> UE distal —> proximal Tetraplegia, respiratory

Question 38

GBS: progression evolves over few days or weeks, recovery slow (___ - ____), usually complete (85% of cases), some mild weakness may persist, 3% mortality

Answer 38

6 mo-2 yrs

Question 39

Complications with GBS (6)

Answer 39

1. Respiratory impairment/failure 2. Autonomic instability (tachycardia, arrhythmias, BP flux) 3. Pain: myalgias 4. Risk of pneumonia 5. Prolonged hospitalization/immobility (contractures, DVT, skin) 6. Relapse if tx inadequate

Question 40

CN to examine for GBS

Answer 40

VII, IX, X, XI, XII

Question 41

ALS: degenerative disease affecting ___ and ___. Degeneration of ____ ____ ____ and descending corticobulbar and ____ tracts.

Answer 41

UMN, LMN Anterior horn cells Corticospinal

Question 42

ALS: etiology unknown (____ or ____). ______% genetic (___ dominant).

Answer 42

Autoimmune or viral 5-10% Autosomal

Question 43

ALS: progressive disease, often leading to death typically in ____ years. Highly variable symptoms: 2 onsets are?

Answer 43

2-5 yrs 1. Bulbar onset: progressive bulbar palsy 2. Spinal cord onset: progressive muscle atrophy

Question 44

Stages of ALS: | Stage I: early disease, mild focal ____, ____ distribution; symptoms of ____ cramping and fasciculations

Answer 44

Weakness Asymmetrical Hand

Question 45

Stages of ALS: | Stage II: ___ weakness in groups of muscles, some atrophy, ____ with ____ (assist level)

Answer 45

Moderate | Mod I with AD

Question 46

Stages of ALS | Stage III: ___ weakness of specific muscles, increased ____, mild to moderate functional limitations, ____

Answer 46

Severe Fatigue Ambulatory

Question 47

Stages of ALS | Stage IV: ___ weakness and ____ of LEs, ___ weakness of UEs. ______ and _____ required, _____ (assist levels)

Answer 47

``` Severe Wasting Mild ModA and ADs W/C user ```

Question 48

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)

Answer 48

``` Progressive Endurance Fatigue LEs and trunk Spasticity, hyperreflexia Total assist ```

Question 49

Stages of ALS | Stage VI: _____, dependent for ADLs/FMS, progressive ___ ___

Answer 49

Bedridden | Respiratory distress