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
