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Clinical Neurology > Peripheral Neuropathies 2 > Flashcards

Peripheral Neuropathies 2 Flashcards

1
Q

dermatome: definition

A

area of skin supplied w/ afferent n. fibers by a single posterior spinal root

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2
Q

myotome: definition

A

group of mm. innervated from a single spinal segment

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3
Q

sclerotome: definition

A

area of a bone innervated from a single spinal segment

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4
Q

injury to a peripheral n. can lead to ??

A
  • osteoporosis

- fibrosis or ankylosis of the innervated bones, joints and periarticular tissues

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5
Q

lumbar and sacral radiculopathies

A
  • aka “sciatica”
  • normally it’s an S1 radiculopathy; a true sciatic n. injury is rare - it’s most often a pinched n.
  • caused by bony abnormalities, herniated disc, trauma, inflammatory, tumor, DM, vasculitis, infection
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6
Q

Do herniations affect the n.: coming out above or below the herniation?

A

herniations affect the n. coming out below it i.e. an L4/5 herniation will affect the L5 n.

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7
Q

disc herniations: general info

A
  • nucleus pulposus penetrates the annulus fibrosis
  • bulging, extruded, sequestered
  • usually herniation is in a dorsolateral direction but it could be laterally or centrally
  • large disc herniations will involve multiple n. roots = cauda equina syndrome or spinal stenosis
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8
Q

disc herniations: clinical features

A
  • pain aggravated by valsalva maneuver or sneezing
  • radiating pain and paresthesias
    • SLR (straight leg raise) test
  • pt bent forward and lumbar curve flattened
  • paraspinal mm. spasms
  • most commonly involves L5 & S1 roots
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9
Q

common spinal root compressions and corresponding disc herniations causing them

A
  1. L4 root compression = L3/4 disc or laterally extruded L4/5 disc
  2. L5 root = L4/5 disc or laterally extruded L5/S1 disc
  3. S1 root = L5/S1 disc
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10
Q

best imaging for a herniated disc?

A

today you would mostly use MRI; could use a myelogram also

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11
Q

spondylosis

A
  • can be acquired or hereditary
  • caused by degenerative arthritis involving facet joints
  • hypertrophy and osteophyte formation are possible
  • involved discs become flattened and narrowed
  • subluxation of the facet joints
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12
Q

spondylolisthesis

A

slippage of one vertebra over another

basically you took spondylosis a step further

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13
Q

clinical features of bony changes

A
  • multiple root involvement
  • widespread arthritic changes –> more in older pts
  • long standing LBP (low back pain)
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14
Q

In a 30yo pt, would you more likely see a disc herniation or spondylosis?

A

herniations happen more in younger pts = <40

spondylosis seen in older pts = 50+

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15
Q

cauda equina syndrome

A
  • central disc herniation at L4/5 level usually
  • involves multiple roots L5-S3
  • intermittent neurogenic claudicaiton
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16
Q

what is the difference b/w vascular and neurogenic (i.e. cauda equina syndrome) claudication?

A 
vascular = pain in legs when you exercise b/c mm. not getting enough blood flow, like a lactic acid burn; during your PE you will find diminished pulses due to ischemia of mm.
neurogenic = pt w/ bony changes that crowd the canal containing the nn. roots; when you walk the vessels swell and compete for the space and the nn. get pinched = pain w/ walking; pts usually hunched over, normal pulses, could have reflex changes
17
Q

arachnoiditis

A
  • thick, scarred arachnoid adhering to the pia and dura

- caused usually by contrast dye and surgery

18
Q

possible causes of arachnoiditis

A
  1. intrathecal agents = dye, anesthetic drugs, steroids, amphotericin B, methotrexate
  2. infections = TB, Cryptococcus, syphilis, viral
  3. trauma = spinal surgery, vertebral injuries, disc herniations
  4. spinal subarachnoid hemorrhage
19
Q

arachnoiditis: dx and tx

A
  • dx = H&P, EMG w/ NCS, imaging
  • tx: conservative = OMT, PT, bed rest, meds (prednisone, NSAIDs, analgesics); chemonucleolysis (chymopapain) - usually not used b/c of allergic rxn
    can also tx w/ surgery
20
Q

cervical radiculopathy: symptoms for the different levels and tx for all

A
  • disc disease or spondylosis
  • C5 = shoulder pain/numbness
  • C6 = pain/numbness of thumb and index fingers
  • C7 = pain/numb middle finger; pectoral and upper back pain
  • C8 = pain/numb 4th and 5th digits and medial forearm
  • the level of herniation is the same as the n. root
  • tx = same as lumbar disc disease = cervical collar
21
Q

ddx for C5 or C6 radiculopathy

A
  • carpal tunnel
  • brachial plexopathy
  • mononeuropathy –> radial, musculocutaneous, or suprascapular
22
Q

ddx for C7 radiculopathy

A
  • carpal tunnel
  • radial mononeuropathy
  • brachial plexopathy
23
Q

ddx for C8 radiculopathy

A
  • brachial plexopathy

- ulnar mononeuropathy

24
Q

Raynaud’s disease: general info

A
  • episodic blanching of fingers precipitated by cold or emotion (red, white, blue phases)
  • idiopathic
  • can be symptomatic of a disease or medication (beta blockers)
25
Q

Raynaud’s disease: pathogenesis, causes, tx

A
  • pathogenesis = increased arterial constriction and decrease in intraluminal distending pressure
  • causes = arterial obstruction, connective tissue disease, trauma, medication
  • tx = tx underlying cause, eliminate precipitating factors, sympathectomy is usually ineffective
26
Q

Name 2 complex regional pain syndromes.

A
  1. causalgia

2. reflex sympathetic dystrophy

27
Q

causalgia

A
  • caused by trauma to a n. resulting in injury to sympathetic fibers
  • happens in 2-5% of cases
  • persistent, severe, burning, dysesthetic pain
  • associated sudomotor, vasomotor and atrophic changes
  • tx = procaine block or regional sympathectomy
28
Q

reflex sympathetic dystrophy: general info

A
  • caused by blunt trauma to soft tissue and bone
  • other causes = CVA, MI, angina, degenerative joint disease
  • believed to be secondary to autonomic dysfunction
29
Q

stages of reflex sympathetic dystrophy

A

Stage I = Acute
increased: temp, hair/nail growth, blood flow, rubor, edema; decreased ROM; may last up to 3 months
Stage II = Dystrophic
hyperesthesia, cold intolerance, decreased: temp, hair growth; brittle nails, pale limbs, cyanotic, demineralized bone
Stage III = atrophic
decreased pain, hyperesthesia, smooth and glossy skin, m. wasting, contractures
**want to tx in stage I; prognosis very poor if pt progresses to stage II before tx

30
Q

dx and tx of reflex sympathetic dystrophy

A
  • dx by H&P, bone scan, thermography, x-rays
  • tx options:
    sympathetic block - surgical or chemical
    regional IV meds
    psychological care
    PT, TENS unit for pain modulation
    OMT
  • possible meds to use = NSAIDs, propranolol, nifedipine, reserpine, guanethidine, prednisone, antidepressants, antiarrhythmics, anticonvulsants, phenothiazines, gabapentin

Clinical Neurology (8 decks)

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