Radiculo, plexo, neuropathy Flashcards
Which nerve roots do not carry sensory nerve fibers?
C1 and Co1
What is the sensory domain?
The skin region innervated by the sensory nerve fibers contained within a nerve root
What is the muscle domain?
The muscles innervated by the motor nerve fibers contained within a nerve root
Two most common causes of radiculopathies?
Disk herniation and degeneration
Lumbosacral radiculopathies
Clinical features of radiculopathies?
Pain is the historical hallmark Sharp; stabbing; hot; electric Often radiating Often aggravated by maneuvers that stretch the root -Neck extension -Neck rotation -Spurling's maneuver
Other radiculopathic features?
Weakness and atrophy -Motor nerve fibers -Myotomal distribution Paresthesias and sensory loss -Sensory nerve fibers -Dermatomal distribution -Muscle stretch reflexes (diminished or absent)
Frequent causes of radiculopathies?
Disc herniation (50 yrs)
Types of spondylosis?
Cervical -myeloradiculopathy (spinal cord stenosis) Lumbosacral -Neurogenic claudication >>Ambulation --> LE pain and weakness -Cauda equina syndrome
Elements of brachial plexus plexopathies?
Anterieor primary rami Trunks Divisions Cords Terminal nerves
Most common compression of the median nerve causes?
Carpel Tunnel Syndrome
- Compressed at the wrist
- Numbness in the first 3.5 digits with pain
What happens if the median nerve is compressed at the arm?
Weakness of the hand (thenar muscles) and wrist flexion
Where is the ulnar nerve frequently compressed? Causing?
Elbow
Weakness and atrophy of the hypothenar and interosseous muscle with numbness in the 5th and half of the 4th digit
What does a nerve conduction test show in ulnar nerve compression?
Slowing of the ulnar nerve at the elbow
Might show denervation in the affected muscles
Saturday night palsy?
Compression of the radial nerve causing wrist drop
If you see foot drop, what nerve is compressed?
Peroneal Nerve
Classification of demyelinating neuropathy?
Weakness - distal & proximal
Areflexia
Decreased vibration & position sense with little deficit of pain & temperature sensations
Very slow NCV, conduction block with normal amplitude of nerve action potential
Prolonged distal latencies, F responses & H reflexes
Classification of axonal neuropathy?
Mostly distal weakness Distal areflexia Glove and stocking sensory deficits Nerve conduction is almost normal with reduced action potential amplitude Signs of denervation on EMG
Classification of Wallerian degeneration?
Severe acute damage to myelin and axons
If a disease is demylinating what is it associated with? If it is more axonal?
Autoimmune
Toxins
Characteristics of Charcot-Marie-Tooth Disease?
AD Demylinating (mostly) , Rarely axonal High arched feet Hammer toes Check NCV in relatives
Genes related to Type 1 Charcot-Marie-Tooth Disease?
Deletions on the genes that express myelin protein PMP 22(1A) or protein 0 P0(1B)
Types of diabetic neuropathies?
Mononeuropathy Mononeuritis multiplex Diffuse polyneuropathy Truncal neuropathy Diabetic amyotrophy
Characteristics of Diabetic mononeuropathy?
Limb or cranial neuropathy
Types of diabetic diffuse polyneuropathies?
Mixed
Sensory - Motor
Sensory
Autonomic
Origin of diabetic diffuse sensory motor neuropathy?
Metabolic
- Accumulation of sorbitol
- Deficiency of myoinositol
Presentation of diabetic diffuse sensory motor neuropathy?
Burning of feet, then numbness and weakness
How does diabetic diffuse sensory motor neuropathy improve?
Good control of diabetes
Are diabetics are more predisposed to entrapment neuropathies?
Yes
Tx of diabetic polyneuropathy?
Good control of diabetes Nerve growth factor Sorbitol antagonist Myoinositol & vitamin supplementation Be aware of other conditions
What is Guillain-Barre Syndrome?
An acute automimmune ascending paralysis accompanied by arreflexia and normal or mildly abnormal sensation with albuminocytological disassociation in the spinal fluid
Characteristics of Guillain-Barre syndrome?
Progressive (symmetrical) paralysis over a period of one to three weeks
Acute inflammatory radiculoneuropathy
Ascending paralysis, facial weakness, respiratory insufficiency
Paresthesia but little evidence of sensory deficiy
Areflexia, normal or almost normal sensation
