Palsy Flashcards
Paralysis
Complete loss of muscle power, due to complete loss of nerve function.
Paresis
Muscle weakness, partial loss of muscle function
Cerebral Palsy
Acquired disorder (prenatal or postnatal within 30 days of life), abnormal development of, or damage to the brain–> Nonprogressive movement or posture disorders.
What populations will cerebral palsy be diagnosed in?
Infants/Toddlers usually identified before age two.
What is the m/c motor disability in childhood?
Cerebral palsy
What are the risk factors of developing cerebral palsy?
***Birth before 32 weeks (between 23-27 weeks)
* Genetic abnormalities
* Perinatal infection
* Birthweight <2000 g
* Placental Abruption
What is the most common form (type and distribution) of cerebral palsy and what is associated with it?
Spastic Quadriplegia; intellectual disability, seizure disorders
Pathophysiology of Cerebral palsy.
Ischemia-hypotoxia or hypertonia
Inflammation
Infection (Zika virus, TORCH infections)
Genetics
What are the infections that are most commonly transmitted mother to fetus? (TORCH)
Toxoplasmosis
Other congenital infections
Rubella
Cytomegalovirus
Herpes Simplex
History for CP
**Delays in developmental milestones
*Gestational age
*Weight at birth
*Complications of pregnancy/delivery
*Difficulty chewing/swallowing
*Seizures
*Speech difficulties
*Cognitive disorders
**Symptoms not evident at birth and vary based on CP form
What is the most significant symptom of hypertonic quadriparesis?
Flexor posture of arms and legs
What is the typical presentation of individuals with cerebellar ataxia
Unsteady wide-based gait, gross motor delay, coordination and balance problems
What will be seen on physical exam in patients with CP?
*Hyperreflexia
*Hypertrophy or atrophy
* Absent or abnormal fidgety movements
Diagnostics for CP
*Clinical diagnosis
*Labs/genetic testing can help confirm etiology
*MRI can show structural brain changes and developmental anomalies (variable and 20% can have normal MRI).
Treatment for CP
- Physiotherapy/OT
- Bracing
- Surgical: Selective dorsal rhizotomy (SDR)- for segmental/local spasticity, baclofen pump placement
- Pharmacologic: Antispasmodics (baclofen, benzos, tizanidine), Segmental/local spacticity (Botulinum toxin)
Radial Nerve Palsy
Complete wrist and finger drop.
Radial nerve palsy pathophys
Compression of the radial nerve against the humerus/humeral spinal groove.
Radial nerve compression can be associated with which type of injury?
Humeral fracture, nerve becomes trapped in healing callous
Physical exam findings radial nerve compression
- Wrist extension weak
*Elbow extension normal
*Abnormal sensation in lateral dorsum of hand and dorsum of 1st-4th digits - Brachioradialis reflex will be diminished/absent
Diagnostics and treatment of radial nerve palsy
*Clinical diagnosis
*EMG/Nerve conduction studies
*To treat splint with fingers extended
*NSAIDS
*Avoid activities in future
*Recovery takes weeks to a month in most cases, if no improvement may require surgical decompression
Ball’s Palsy
Unilateral lower motor neuromuscular paralysis due to compromise of CN VII.
* m/c form of facial paralysis
What groups are most commonly affected by bells palsy?
- T2 DM
*Pregnancy
Pathophys Bell’s palsy
- Inflammatory reaction with mononuclear cells
*Reactivation of HSV1 or VZV (Ramsay hunt)
Bell’s palsy history
- Sudden onset, progresses over 1-2 days
- Facial droop/weakness
***Impaired taste m/c
*Lacrimation
*Hyperacusis (sound sensitivity)
*Ear pain
Physical exam Bell’s palsy
- Unilateral facial droop
- Difficulty closing ipsilateral eye
- Cannot raise ipsilateral eyebrow
*Should not have any other neurological deficits
Diagnostics Bell’s palsy
*Clinical
* If other symptoms of the disease are present (Lyme, HIV) labs
*MRI if symptoms worsen or do not improve
*Rarely EMG or NCV
Treatment/management of Bell’s palsy
- Conservative (60% recover no treatment)
- oral steroids (prednisone taper)
- Anti-virals if concern for Ramsay Hunt
- Eye drops and or patch during sleep
Erb’s Palsy
Upper brachial plexus birth palsy, complication of dystocia-traction of the neck during childbirth
Presentation and treatment of Erb’s palsy
Arm hanging limply from shoulder w/ adduction at shoulder, internal rotation of upper arm, pronation of forearm and outaward direction of palm
*Treated with physiotherapy, hydrotherapy, OT
