Palsy Flashcards
what is a palsy
paralysis usually accompanied weakness, loss of feeling and with involuntary tremors or movements
what is cerebral pasly
non-progressive disorder of tone and posture from an acquired pre- or post-natal insult (up to 30 days of life)
not usually apparent at birth, may be noted as early as 4 months, definitely by 2 years
what are the risk factors of CP
include permaturity, perinatal deprivation of blood or oxygen to the brain via:
PVL(periventricular leukomalacia), IVH (Intraventricular hemorrhage) or Hypoxic-ischemic encephalopathy (HIE), maternal infection, trauma, and other processes involving ischemia, inflammation, infection, genetic predisposition
what maternal infections increase the risk of CP
Zika
TORCH -
Toxoplasmosis
Other
Rubella
CMV
HSV
what are the classifications of CP
Hypotonic
Hypertonic or Spastic
Dystonic
Cerbellar ataxia
what are the types of Hypotonic CP
quadriparesis or tetrapaesis
diaparesis or diplegia
hypotonia with choreoathetosis
what are types of Hypertonic or spastic CP
quadriparesis
hemiparesis
diparesis or diplegia
what is dystonic CP
facial rictus, stimultaneous contaction of agnoist and antagonist muscles, opsithotonus
what is cerebellar ataxia CP
unsteady wide - based gate, gross motor delay, coordination and balance problems (~3%)
how is CP diagnosed
labs - look for congenital infection in mothers and kids
imaging - mri for brain changes or normal
what are differential diagnoses for CP
some neurodegenerative and neurometabolic disorders can mimic, genetic testing is helpful in differentiating
what is the prognosis of CP
spasticity tends to worsen with time vs hypotonia can improve with age
what is the intelligence level in CP patients
cognitive impairment does not always match physical deficits. can have normal intelligence with more severe hyper- or hypotonicity
what is the treatment of CP
multidisciplinary approach:
PT/OT
Bracing
Pharmacologic treatment of spasticity
what are generalized medications treatments for CP
oral antispasmodics (baclofen, tizanidine, benzodiazepeine)
what are localized treatments for CP
botulinum toxin (botox), bracing, orthopedic surgery, neurosurgery
what is a selective dorsal rhizotomy
effective in young children with spastic dispraises who can walk - involved cutting abnormal nerve in lower spinal cord to relax muscles
what is radial nerve palsy
paralysis of radial nerve due to compression of nerve against humerus
what is the common cause of radial nerve palsies
fracture of the humerus - during fracture or repair
sedated with ETOH, falling asleep with chair over arm
during sleep with a parner resting on your arm
when are radial nerves more likely to be severed and need repair
open fractures, high energy traumas, open wounds
what are the symptoms of radial nerve palsy
pain, weakness, loss of function in wrist, hand and fingers
numbness over the lateral dorsum of hand
wrist drop or finger drop
what is the cause of axillary radial nerve compression
crutches and the triceps muscle is affected and interferes with elbow extension
how is radial nerve palsy diagnosed
ultrasound can be used to distinguish between nerve ruptures, swelling around nerve, neuroma formation
what is the initial treatment for radial nerve palsy
brace or spline and PT plus NSAIDs - 90% will improve with observation alone and can take 3-6 months
what is bells palsy
weakness or paralysis of facial muscles caused by damage to CN7, facial nerve (mononeuropathy)
Idiopathic
what are known conditions associated with Bells palsy
associated with viral infections (HSV, EBC, VZV)
associated with lyme disease
if caused by stroke, trauma it is NOT bells palsy
what neurons are responsible for saliva production as well as lacrimal glands and nasal oral mucous membranes
neurons from the motor complex
what carries info from anterior 2/3 of the tongue
neurons from the motor complex
are patients with Bells Palsy able to lift their eyebrow
NO
what must be excluded for bells palsy diagnosis
stroke, tumor or trauma
what are risk factors for Bells Palsy
PREGNANCY, DIABETES, OLD AGE , immune compromise - can also be caused by HIV, Sarcoidosis, lyme, meningitis
what is the presentation of Bells Plasy
sudden onset, muscle weakness maximal at 48 hours after onset
onset can be preceded or accompanied by retro-aural pain which lasts a few days
what labs and studies are done for the diagnosis of Bells Palsy
CBC, BMP, magnesium, and calcium, HgbA1c, ESR, Lyme titer, ANA,RF, HIV, +/- MRI if clinical exam suggests lesion
what is the treatment of bells palsy
usually resolves within 6 months - but can be permanent
treatment is not usually required but if severe - can use corticosteroid to reduce inflammation of the nerve (high dose pred)
where does the facial nerve originate
in the brainstem
what neurons travel along with the facial nerve
motor and sensory neurons
