PNS Flashcards
ALS
upper and lower MN signs
degeneration of anterior horn cell
MOTOR ONLY no sensory loss
*fatal: affect swallowing, resp mm
As ALS progresses,
weakness, facial/respiratory, paresis–>plegia
NO SENSORY LOSS, NO COG FUNCTION LOSS
HOW DOES ALS usually present?
pseudobulbar palsy
laugh or cry inappropriately
disconnect btwn emotions and expression
COMMON IN ALS**, MS, strokes
LMN signs in ALS
weakness, atrophy, fasciculations
brainstem: jaw, face, palate, tongue, larynx
cervical: neck, arm, hand first
thoracic: diaphragm, back, abdomen
lumbosacral: back, abdomen, leg, foot
how does pain manifest in ALS?
cramps, contractures, pressure sores due to lack of mobility
West Nile Virus
asymmetric flaccid weakness and hypoactive/absent reflexes
*pure motor
anterior horn cell!!! changes in MRI, B&B affected too!
meningoencephalities
aseptic meningitis
plexopathy presents as
very painful at shoulder or hip, weakness in limb, more than one nerve/root distribution
plexopathy is due to
trauma
tumor
thoracic outlet syndrome (extra cervical rib)
*diabetes can cause ischemia to plexus (lumbosacral plexus)
mononeuropathy multiplex
neuropathy in several different nerves quickly in short period of time
polyneuropathy is
length dependent
(feet, then hands when knees get affected, abdomen affected in front)
*stocking/glove distribution
meralgia parasthetica
lateral femoral cutaneous nerve (compressed at inguinal ligament), sensory ONLY
***numbness
-Britney Spears
-L2, L3
demyelinating neuropathy
weakness without atrophy!
patchy/asymmetric
can be length independent
get better!
causes of demyelinating neuropathy
- compression/stretch (carpal tunnel, trauma)
- GBS and CIDP: inflammatory, get better
- multifocal motor neuropathy
- diphtheria
- Charcot Marie Tooth: gene absent
- hereditary neuropathy
- MAG neuropathy
- leukodystrophies
- diabetes
axonal neuropathy
most common: diabetes
alcohol (2nd most common)
toxic: vincristine, acrylamide, arsenic
cancer
amyloid
AMAN, AMSAN (axonal GBS)
uremia
collagen vascular diseases
small fiber neuropathy
a lot of times is diabetes
pain and temp loss, neuropathic burning pain
discolored skin, less sweat, loss of hair
PAIN, TEMP, AUTONOMIC
not proprioception, not motor
allodynia
emg may be normal!
large fiber neuropathy
sensory (proprioception) and motor nerves
*numb, walking on foam
autonomic neuropathy
Orthostatic hypotension
* Arrhythmias
* Severe constipation, urinary retention, erectile dysfunction
* Abnormal sweating
* Early satiety, lightheadedness with meals
inflammatory demyelinating polyneuropathies
disorders that cause weakness, sensory loss, areflexia
AIDP or GBS are rapid
CIDP are slow
AIDP
acute inflamm demyelin polyneuropathy
1. tingling/parasthesias
2. severe radicular back pain
3. weakness legs to arms
GBS
demyelinating
monitor/treat respiratory failure, autonomic dysfunction
rehab early! get better
chronic inflammatory demyelinating polyneuropathy
mainly motor over sensory
large fiber!
not atrophy (demyelinating)
but areflexic
symmetric weakness of prox and distal
diabetic neuropathy does not cause weakness!!! It is probably
CIDP in diabetic patient
diabetic neuropathies
stocking-glove sensory loss
autonomic changes after sensory
does not cause weakness
*can treat PAIN not weakness
neuropathic pain meds can cause sleepiness and dry mouth
what is charcot marie tooth disease
distal weakness, atrophy
length dependent sensory loss
foot deformities (hammer toes)
absent reflexes/decreased
CHRONIC, slowly prog
hereditary!
myasthenia gravis
post synaptic autoimmune disorder
*with very brief rest, much better! FATIGABLE!
EYE MUSCLES! asymmetric ptosis, diplopia
-difficulty chewing, dysarthria, dysphagia, nasal speech
-hoarse
-head drop
-limb weakness
presynaptic disorder
lambert eaton
botulism
triggers for MG exacerbation
Emotional upset
* Viral illnesses and other systemic illness, fever* Heat
* Hypo or hyperthyroidism
* Surgery
* Menstrual cycle
-MEDS
ocular cooling for myasthenia gravis
cold makes better conduction across neuromuscular junction
antibodies attack ACh junction…
what are negative signs of myopathy?
- Weakness
- Fatigue
- Atrophy
- Exercise
Intolerance
what are positive signs of myopathy?
-Myalgia
* Cramps
* Contractures
* Hypertrophy* Stiffness
* Myoglobinuria
difference between prox/distal for neuropathy vs. myopathy
myopathy: PROXIMAL WEAKNESS
neuropathy: distal
what does a myopathy physical exam look like
gower’s maneuver (all fours)
getting up from chair, reaching high is HARD due to prox weakness
**sensation usually intact
DTRs normal/slightly reduced
inclusion body myositis
most freq myopathy in patients over 50 yrs
prox leg and distal arms (finger flexors, quads)
-asymmetric
-dysphagia
-muscle atrophy
myotonic dystrophy type I
most common ADULT myopathy
frontal temporal balding
can’t smell
myotonia: sustained contracture of muscles (shake hand, can’t release it)
eyelid myotonia
cardiac problems
cataracts
facioscapulohumeral dystrophy
face and scapula weakness
(triple humps) in shoulder
oculopharyngeal muscular dystrophy
ptosis, weakness of eye muscles, prob with swallowing
emery-dreifuss muscular dystrophy
contractures
becker and dyshen
most common (children)
