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MSK II Final > Sachen: Introduction to the Peripheral Nervous System > Flashcards

Sachen: Introduction to the Peripheral Nervous System Flashcards

1
Q

Epineurium

A

-covers whole nerve

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2
Q

Perineurium

A

-fascicles (containing fibers)

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3
Q

endoneurium

A

-invdividual fibers

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4
Q

myelinated nerves

A
  • fast conducting

- saltatory conduction

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5
Q

unmyelinated neres

A

-slow conducting

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6
Q

smaller the diameter, the ….. the velocity

A

-the slower

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7
Q

what kind of fibers conduct pain,

A

small unmyelinated fibers

-the larger slower conducting ones are for motor and s proprioception

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8
Q

points of injury of the nerve

A
  • cell bodye
  • nerve root
  • peripheral nerve: axon, myelin sheath, CT, blood supply (vasa nervorum)
  • Wallerian degeneration
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9
Q

what is the radicular part of the nerve?

A

-the part that is exiting the spinal cord

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10
Q

What is radiculopaty?

A

-neve root dysfunction may be caused by structural or nonstructural conditions

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11
Q

Most common levels involved for radiculopathy?

A
  • cervical (C6, C7)

- lumbar (L5-S1)

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12
Q

if a nerve is compressed between C5 and C6, what is the nerve root compression called?

A

-C6 compression

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13
Q

sclerotome, what does it innervate?

A

-the perosteum of the bone

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14
Q

C5 radiculopathy

A
  • scapula shoulder
  • lateral arm
  • shoulder abd weaknes
  • DTR loss in biceps
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15
Q

C6 radiculopathy

A
  • scapula shoulder ish
  • 1 and 2 digit, lateral arm
  • shoulde abd and elbow flex weakness
  • DTR lossin biceps
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16
Q

C7 radiculopathy

A
  • scapula, shoulder/arm, elbow/forearm
  • 3rd digit
  • elbow ext, wrist ext
  • triceps DTR loss
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17
Q

C8

A

scapula, shoulder/arm, medial forearm

  • 4 and 5 digit
  • finger abd and flex weakness
  • loss of DTr in finger flexors
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18
Q

L4 radiuclopathy

A
  • antlat thigh, knee, medial calf pain
  • medial calf sensory loss
  • hip flexion, knee ext weakness
  • DTR loss in patella
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19
Q

L5 radiculopathy

A
  • dorsal thigh lat calf pain
  • lat calf dorsum foot sensory
  • hamstrings, foot dorsiflexion, inversion, everion weakness
  • no DTR loss
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20
Q

S1 radiculopathy

A
  • post thigh, post calf pain
  • post lat claf and lat foot sensory
  • weaknessin hamstrings and foot plantarflex
  • DTR loss in achilles
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21
Q

Do roots split fingers?

A

-no they don’t

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22
Q

is T1 dermatome on the chest?

A
  • no, it’s on the posteriormedial arm!

- watch out for this

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23
Q

Mononeruopathy

A
  • single nerve is affected
  • specific pattern of sensory loss
  • weakness only in specific muscles
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24
Q

Polyneuropathy

A
  • diffuse, symmetrical disease… motor sensory, or both
  • stocking/glove sensory loss
  • distal weakness, possibly atrophy
  • hypo or arreflexia
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25
Q

Mononeruopathy multiplex

A
  • focal involvement of two or more nerves

- may occur in some systemic disorders (DM, vasculitis)

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26
Q

Negative sx of peripheral nerve disease

A

-loss of sensation

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27
Q

positive sx of peripheral nerve disease

A
  • paresthesias.. secondary to large myelinated fiber disease “pins and needles”
  • pain, secondary to small unmyelinated fiber disease…. burning and dysesthesia
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28
Q

Motor sx for peripheral nerve disease

A
  • distal weakness
  • cramps
  • muscle fasciculations
  • atrophy
  • decreased eep tendon reflexes
  • reduced tone
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29
Q

what is the etiology of the sensory problems in peripheral nerve disease

A

-large myelinated sensorty fibers… impariment of light tocuh, 2 pt, bibration, joint position sense

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30
Q

if small unmyelinated sensory fibers are impaired, what will there be?

A
  • temp perception problems

- pain perception (pin prick)

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31
Q

what muscles do we have to look at if there is a radiculopathy?

A
  • paraspinal muscles

- they have nothing to do with a plexopathy though

32
Q

most common site of nerve compression

A
  • median nerve

- carpal tunnel

33
Q

Median nerve distribution

A

-medial palmar surface of the lower forearm and palm, thenar eminence, thumb, and adjacent two and a half fingers

34
Q

clinical features of pronator syndrome

A
  • insidious onstet of diffuse ache about the prox forearm
  • pain exacerbatino with forced foreamr pronation
  • easyu fatigue of the forearm muscles
  • diffuse numbnees of the hjand mostly involving the 2 and 3 fingers
  • **absence of nocturnal awakening becuase of pain or numbness
35
Q

anterior interosseous syndrome

A
  • nerve conductino studies: routind meidna nand ulnar studies are normal
  • needle EMG: abnormaltieis in FPLm, DFDP, PQ
  • other median, medial cord, C8, muscles normal
36
Q

Ulnar mononeruopathy

A
  • axilla
  • elbow
  • cubital tunnel
  • wrist: guyons canal
37
Q

Froments sign, what is that for?

A
  • Ulnar neuropathy

- if they can’t hold a piece of paper with their thumb

38
Q

Radial mononeruopathy

A
  • axilla: crutch palsy
  • humerus/ spiral groove: saturday night palsy… most common
  • supinator (posterior interosseus branch)
  • wrist (superficial radial sensory branch)
39
Q

Radial nerve

A
  • as it winds around the humerus, it is culnerable to compression
  • radial nerve damage leads to the readily recognizable wrist drop that results from paresis of teh extensor muscle of the wirst, finger, and thumb
40
Q

clinical features of radial mononeruopathy

A
  • compressive lesion with good prognosis
  • weakness of wriste and finger extension
  • elbow extension spared
  • brachioradialis spared sometimes
41
Q

EDX features of spiral groove radial mononeuropathy

A
  • radial motor and sensory studies often normal

- emg findings in extensors of wrist and digits and perhaps brachioradialis

42
Q

What is the dermatome for the L5 radiculopathy?

A
  • the same as the peroneal nerve

- lateral part of the calf

43
Q

peroneal vs L5 radiuclopathy… how do we tell between them?

A
  • test foot inversion
  • if weak, L5 (this one innevates inversion muscles)
  • if it’s fine, then it’s peroneal (doesn’t innervate inversion muscles)
44
Q

peripheral neuropathy

A
  • usually symmetric
  • may be motor, sensory, autonomic or combo
  • usually progressive, butnot always
  • aquired or inherited
45
Q

difference between small and large nerve involvement

A
  • large nerves: position/vibratory sense

- small: pain and temp sense

46
Q

How does peripheral neuropathy present?

A
  • pain, sensory loss, weakness occurs symmetrically and most severly in the distal portions of the limbs
  • the legs are usually affected first and more severely than the arms
  • this distribution is termed “stocking glove” (hands and feet)
47
Q

What are the big etiologies of peripheral neuropathy we have to worry about?

A
  • lyme disease
  • HIV
  • Guillane barre
  • Monoclonal gammopathy
48
Q

what drugs will cause peripheral neuropathy?

A

-vinca alkaloids, phytoin, isoniazid, amiodirone, cis platinum

49
Q

CMT1

A

-demyelinating

50
Q

CMT2

A
  • axonal/neuronal
  • later life presentation
  • less common than 1
51
Q

How will the foot look like in CMT?

A
  • high arch, curled toe

- remember that there is variable penetrance with this disease,….. so not all of their families will have this

52
Q

Porphyria

A
  • defect in heme biosynthesis
  • this always presents as belly pain, so get’s mismanaged by GI things
  • hereditary neuropathy with liability to pressure palsies
53
Q

Fabry’s disease

A

-alpha galactosidase deficiency

54
Q

Metachromatic leukodystrophy

A
  • arylsulfatase a deficiency

- affect both central and peripheral nerve

55
Q

Tangier disease

A

-deficiency in HDL

56
Q

PHytanic acid storage diseas

A

they will have orange tonsils… fun

57
Q

Acquired demyelinating polyneuropathies

A
  • Guillane barre syndrome
  • chronic inflammatory demyelinating polyneuropathy (CIDP)
  • multifocal motor neuropathy (MMN)
  • multifocal acquired demyelinating sensory and motor neuropathy
58
Q

Guillan barre syndrome

A
  • acute/subacute ascending motor paralysis
  • often an antecedent illness, surgery, immunization: EBV, mycoplasma pneumonia, campylobacter jejuni enteritis
  • HIV
  • Hodgkin’s disease
59
Q

Key lab findings with Guillaine barre

A
  • CSF: albumino-cytologic dissociation (high ptn/normal cell count/normal glc)
  • NCVs: slow conduction vleocity, focal conduction block, prolonged F waves
60
Q

tx of guillaine barre?

A
  • supportive care

- direct tx with plasma exchange or IVIg

61
Q

Prognosis of Guillain Barre syndrome

A
  • 25 % require mechanical ventilator support
  • most recover in weeks to months
  • death in about 2-10%
  • persistent disability in about 20%
  • poor prognosis associated with NCV/EMG findings of low amplitude motor nerve responses and/or denervation as this implies axonal involvement
62
Q

Miller-fisher syndrome

A
  • variant of guillan barre
  • opthalmoplegia, ataxia, arreflexia
  • facial weakness, dysarthria, dysphagia also possible
  • GA1b and GT1a antibodies
63
Q

-Chronic inflammatory demyelinating plyneuropathy (CIDP)

A
  • similar to GBS but slower to evole and more persistent
  • may occur de novo or as sequellae of GBS
  • progressive or repasing course
  • 15% have a monoclonal antibody
  • tx: IVIg, steroids, plasma exchange, immunosuppressie agents
64
Q

Multifocal motor neuropathy clinical findings

A
  • adults, male moreso…. initially in distribution of a single nerve
  • slowly progressive distal weakness of hands>feet
  • no sensory signs/symptoms, no UMN signs
65
Q

Lab findings for Multifocal motor neuropathy

A
  • elevated serum GM1 antibody
  • EMG shows conduction block or other demyelinating features
  • CSF usually normal
66
Q

Tx for multifocal motor neuropathy

A
  • IVIg is tx of choice

- other immunosuprressants as secondary option

67
Q

Diabetes mellitus

A
  • most common identifiable cause of neuropathy in the US

- many different forms of nerve things

68
Q

HIV neuropathies

A
  • some pts get this
  • distal smmetrical polyneuropathy
  • acute inflammatory demyelinating polyneuropathy
  • CIDP
69
Q

What is Charcot Marie tooth disease known as in this lecture?

A

-Hereditary motor and sensory neuropathies

70
Q

What do we look for if there is hx of exposure/rash?

A

-lyme antiboyd titer

71
Q

systemic vasculitis, what lab do we want to run?

A

-aANCA

72
Q

Anti MAG, what does that test for?

A

-MGUS associated neuropathy

73
Q

Anti GM1, what does that test for?

A

-Mutlifocal motor neuropathy

74
Q

What antibody do we look for if there is miller fisher syndrome?

A

-Anti GQ1b

75
Q

What does Hu antibody mean?

A

-carcinomatous sensory neuropathy

76
Q

Urine tests for specific conditions

A
  • heavy metals…. wuith hx of exposure and clinical profiles
  • immunoelectrophoresis…. rarely positive when serum EP is normal

MSK II Final (13 decks)

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