Peripheral NS Disorders Flashcards
___ is a pinched N around N root (very proximal). __ is more extensive, effects any part of the axon, and usually occur more distally.
1) radiculopathy
2) neuropathy
S&S of PNS syndromes include motor dysfunction, sensory dysfunction, ANS dysfunction (vasodilation and loss of vasomotor tone). ___ pain and/or myalgia is also common. 4 S&S related to ANS dysfunction are __. Hyper-excitability can also occur. Some sensory S&S of hyper-excitability include __(5)_ and a motor S&S are fasciculations.
1) neuropathic pain
2) dryness, warm skin, edema, orthostatic hypotension
3) hyperalgesia, pins/needles, numbness, tingling, burning
Trophic changes cause weakness of the skin, muscles, bone, and nails. Some S&S include __ skin, __ nails, muscle atrophy, __ of skin tissue, poor wound healing, infections, and subcutaneous tissues __. Neurogenic joint damage can occur as well.
1) shiny
2) brittle
3) ulcerations
4) thicken
Most common causes of mononeuropathy (3).
Entrapment
trauma
prolong limb immobility (i.e. surgery)
Neurotmesis requires ___ for recovery. However, usually when a N is injured __ Degeneration occurs while macrophages clean out debris. After this N ___ to return to normal.
1) surgery
2) Wallerian Degeneration
3) regenerates
The PNS differs from the CNS in that it has the ability to ___ under certain circumstances. Axonal sprouting is the __ period and can be ___ or ___ (nearby healthy neuron connects w/ postsynaptic neuron that lost their corresponding N).
1) regenerate
2) regrowth
3) regenerative
4) collateral
__ __ involves 2 Ns in different parts of the body. A dangerous cause of this condition is ___, which requires an IMMEDIATE referral for electrodiagnostic evaluation if suspected. A __, __ presentation of signs occur with this condition.
1) Multiple Mononeuropathy
2) Vasculitis
3) random, asymmetrical
__ has SYMMETRICAL involvement of sensory, motor, and autonomic dysfunction. Major characteristics of this condition is tingling/numbness/stabbing in fingertips, pts feel like they are wearing ___, myalgia, and weakness. Progression of involvement is as follows:
__ → Motor → __
__ → __
Feet → legs → fingertips → hands
Affects __ peripheral nerves in extremities:
__ nerve fibers → __ nerve fibers
1) Polyneuropathy
2) gloves
3&4) Sensory → Motor → autonomic
4&5) distal → proximal
6) LONGEST
7&8) small N fibers → larger N fibers
Common causes of PN include autoimmune disorders, chronic __ disease, poor LE circulation, low __ vit levels, HIV and liver infection, and hypoactive __ gland, trauma, tumor, and alcoholism. The most common cause is __ __, 60-70% of these pts have PN.
1) kidney
2) B12
3) thyroid
4) diabetes mellitus
T/F: There is a high prevalence of DM Type II among the US population, and it incr. with age. There is also a slight prevalence of adults with undx DM type II.
true
Earlier in PN, sensory S&S include ___ and __ (think anterlat column). As disease progresses sensory S&S include __, __, and __ (think med lemn. pathway). Motor S&S include cramping, weakness, fasciculations, ___ degeneration, __ ankle reflexes, & __ changes. Autonomic S&S have diverse manifestations including impaired breathing, GI dysfunction, dysarthria, temp dysreg (decr. sweating), ___ of B/B ctrl & erectile dysfunction, & ___ d/t BP ctrl loss.
1&2) loss of temp and impaired pain sensory (hypo or hyper)
3-5) loss of vibration, light touch/discrimination, proprioception/kinesthesia
6) bone
7) absent
8) trophic
9) loss of B/B ctrl
10) orthostatic hypotension VERY COMMON
Diabetic PN is caused by __ or __ damage d/t high glucose and triglyceride levels in the blood. S&S appear in a ___ and __ like distribution w/ __ distribution appearing first. 6 RFs for diabetic PN are __.
1&2) vessel or N damage
3&4) stocking and glove distribution
5) stocking comes first
6) obesity, smoking, alcohol, sedimentary lifestyle, HTN, decr. glycemic ctrl
The best way to tx diabetic PN is ___ w/ appropriate management and compliance. Progression of S&S happen over ___ and depend on how well pt’s diabetes is ___. Progression can be stopped w/ strong __.
1) PREVENTION
2) years
3) managed
4) management
The #1 intervention for PN is __ __. Other interventions include resistance training, balance training, and aerobic conditioning. Aerobic condition dosage should be __ mins per week at __ HRmax or __ RPE. Balance training should focus on ____ to improve other balance system since ___ loss cannot improve.
1) Pt edu
2) 150 mins/week
3&4) 50-70% HRmax or 5-7 RPE
5) COMPENSATION
6) sensory
__ __ __ disease is the most common inherited/genetic neurological disorder affecting the __ gender more common. The disease is caused by a gene mutation affecting myelin sheath, w/ secondary ___ degeneration as disease progresses. The Hallmark Sign for this disease is ___ __ __ __ secondary to repetitive segmental __ and __ of myelin causing __ of peripheral Ns. Peripheral Ns become enlarged and palpable.
1) Charcot Marie Tooth Disease
2) men
3) axonal
4) Hypertrophic onion bulb formation: Schwann cells compensate & produce excessive amts of myelin sheath
5) degeneration
6) regeneration
7) thickening
Dx of CMTD include electrodx testing (NCV>EMG), clinical exam, __ and N biopsy which is less common.
genetic testing
Clinical motor S&S of CMTD are distal, ___ muscle weakness, atrophy, and __ DTRs. __ are hit first and __ affected as disease progress. Most common LE S&S are ankle __ and __ weakness. Loss of muscle bulk distally + proximal hypertrophy create an “___ __ __” look. Other LE S&S include pes __, hammer toes, inverted heel, and flat feet. UE S&S include ___ d/t atrophy of __ muscles w/ finger flexor dominance (PIP ext, DIP flex) and lumbrical atrophy. __ scoliosis and __ dysplasia can also manifest.
1) symmetrical
2) diminished
3) LEs
4) UEs
5&6) DF and eversion weakness
7) inverted champagne bottle
8) cavus
9) claw hands
10) interossei
11) mild
12) hip
There is __ cure or disease-modifying therapy for CMTD. __ are used for symptom management. Rehab for these pts focuses on strengthening and incr. aerobic activity as pts S&S of quickly __ f/b prolonged __ can worsen if pt is deconditioned.
1) NO cure
2) Medications
3) fatiguing
4) fatigue
Sensory S&S present as disease progresses to include loss of ___, __, and __. __ remains intact as anterolateral pathway is NOT affected. __ pain may be present and if so it’s SEVERE. Pain also may be d/t skeletal/posture deformities, muscular fatigue, and cramping.
1-3) vibration, discriminative touch, and proprioception
4) Pain
5) Neuropathic
T/F: CMTD is a slow progressive disorder that is fatal and reduces pt’s life expectancy. Disability will occur d/t distal muscle weakness and deformities.
False, CMTD is NOT fatal and pts have a normal life expectancy. Disability IS likely though.
Trigeminal N (CN __), is responsible for facial sensation (V1-V3) and motor for muscles of mastication (V3). Trigeminal Neuralgia is caused by __ or __ of CN5 d/t abnormal contact w/ surrounding structures. It is characterized by brief paroxysms of ___ __ __ reoccuring frequently along the N __ and __ divisions (__ involvement is RARE).
1) 5
2&3) degeneration or compression
4) severe neurogenic pain
5&6) mandibular (V3) and maxillary (V2)
7) opthalmic (V1)
CMTD Dosage for strengthening and aerobics is __ intensity ( __ of 1RM). It will focus on large muscles group and ___ therapy is great to accompany overground therapy. Be wary of Fatigue! Interventions also include AFOs, proper footwear, podiatry consult, ROM, and balance training. ROM should include an HEP for __ and balance training should include a combo of __ balance tasks and ___ __ strategies. ADs are also used but younger pts may opt out, adjust therapy as needed.
1&2) moderate intensity (60-80% 1RM)
3) aquatic therapy
4) stretching
5) functional
6) fall reduction
Name 3 Cranial N disorders.
Trigeminal Neuralgia (tic douloureux)
Bell’s Palsy (facial paralysis)
Bulbar Palsy (bulbar paralysis)
Hallmark S&S of Trigeminal Neuralgia is UNBEARABLE neuropathic pain that last from __ to __ f/b a few mins to hrs of __, __ pain. Episodes of several attacks last days, weeks, months or longer. Remission b/w attacks can last __ to __.
1&2) seconds to mins
3&4) dull, achy
5&6) weeks to months
Trigeminal Neuralgia pain is usually (unilateral or bilateral) and __ __ can be aggravated by stress and cold but alleviated by relaxation
1) unilateral (remember we got 2 of ea. CN)
2) autonomic instability
Another S&S of Trigeminal Neuralgia is ___, pain from stimuli that normally doesn’t provoke pain. It often has triggers like eating, washing, talking, shaving, temp changes, or trigger points, but can be __. Sometimes it’s relieved by __ or some meds. Other S&S of Trigeminal Neuralgia include cluster __, and __.
1) allodynia
2) spontaneous
3) rest
4) headaches
5) depression
Meds for Trigeminal Neuralgia include anticonvulsants, anti-spastic drugs, botox, and tricyclic antidepressants. Surgery includes gamma knife, thermal lesioning, and ___, which is the only surgery that doesn’t effect surrounding structures. ___ is commonly used in the clinic, but main tx will be pt edu.
1) Macrovascular Decompression
2) ESTIM
Another S&S of Bell’s Palsy is loss of ctrl of __ or __. Onset of facial paralysis is acute, w/ max severity within __ to __. Pain behind the __ for 1-2 days commonly precedes onset.
1&2) salivation or lacrimation
3&4) hours to days
5) ear
Overtime Trigeminal Neuralgia attacks become __ frequent, ___ __ triggered, and __ disabling.
1) more
2) more easily
3) more
Bell’s Palsy affects the __ N (CN __) and causes unilateral facial paralysis (bilateral RARE). The etiology is UNKNOWN, but it involves acute __ processes resulting in __ of the N within the temporal bone. RFs include __, preeclampsia, obesity, HTN, DM, and __ illness.
1&2) Facial N (CN 7)
3) inflammatory
4) compression
5) pregnancy
6) respiratory illness
Medical tx of Bell’s Palsy includes NO __, __ within __ of symptom onset, and analgesics. Rehab/PT will include protection of __ until recovery allows for __ closure, __ to maintain tone & support facial motor function, active facial muscle exercises, functional retraining (foods that can be easily eaten, chewing w/ unaffected side), and providing emotional support and reassurance. A __ __ may be used to prevent overstretching of facial muscles.
1) surgeries
2&3) corticosteroids (prednisone) w/in 72 hours of symptom onset
4) cornea
5) eyelid
6) ESTIM
7) facial sling
Besides drooping of corner of mouth, eyelids that con’t close, and no function of facial expression muscles on affected side, what also can be observed during the physical examination of a pt with Bell’s Palsy?
Loss of taste on anterior 2/3 of tongue
How do we know the facial droop isn’t the first sign of a stroke??
LMN will present as upper and lower facial droop. UMN will only present w/ lower facial droop b/c forehead is bilaterally innervated.
LOWER = LARGER
Prognosis for Bell’s Palsy is very __. W/ or w/out tx pts begin to see improvement w/in ___ after onset and recovery occurs in weeks/months. W/ proper management some or all facial function is recovered w/in __ months.
1) good
2) 2 weeks
3) 6 months
Bulbar Palsy is paresis/paralysis of muscle innervated by motor nu of the lower brainstem affecting __, __, and __. It is caused by tumors, vascular or degenerative diseases, malignancy, or inflammatory genetic disorders impacting lower CN motor nuclei. It can be progressive. We may see this in what other syndrome we discuss?
1-3) Glossopharyngeal N (CN 9), Vagus N (CN 10, and Hypoglossal N (CN 12)
4Q) GBS
Characteristics of Bulbar Palsy include __ atrophy and fasciculations, ___ (hoarseness or nasal quality), and CN 9&10 paralysis. CN 9&10 paralysis include loss of phonation (ability to produce sound w/ air from lungs), articulation, __ action (when you say “ahh”), __ reflex, and swallowing. W/ bilat. involvement watch for __ from severe airway restriction and difficulty w/ __. A possible complication is __ __.
1) tongue
2) dysphonia
3) palatal
4) gag
5) dyspnea
6) coughing
7) aspiration pneumonia
Bilateral dysfunction of Bulbar Palsy present similar to Pseudobulbar Palsy, an UMN lesion. However, Pseudobulbar Palsy will have CN __ and __ involvement, emotional incontinence (__ affect), tongue ___, “Donald Duck speech” known as __ __, and hyperreflexia of jaw jerk reflex (tap on jaw = mandible contraction) and snout reflex (tap on lips = pouting).
1&2) CN 5 & 7
3) Pseudobulbar Affect
4) spasticity
5) Spastic dysarthria
Bulbar Palsy has no know tx but supportive therapy include ___ meds to ctrl drooling, __ tube for severe dysphasia or recurrent aspiration pneumonia. Primary tx involves ___ pathologist. PT has __ evidence for tx of bulbar dysfunction in pts w/ ALS. Pts may maintain mobility but present with severe __ compromise & should be managed accordingly.
1) anticholinergic meds
2) PEG
3) Speech and language
4) inconclusive evidence for PT
5) respiratory
