SC Pathology Flashcards
how would you test for LMNs?
muscle testing
reflex testing
atrophy
hypotonia
how would you test for UMNs?
reflex (disuse) atrophy- weakness hoffman babinski proprioception romberg tactile sensation sensation testing pain/temp dull/sharp
all of the CNs are in the head except for the ?
vagus nerve
CN10
paralysis/paresis=
decreased voluntary motor unit recruitment
ipsilateral segmental motor syndrome=
paralysis hypotonia areflexia muscle atrophy fasciculation, fibrillation
polio is characterized by:
LMNL symptoms
nerve conduction’s are usually normal bc there are still some motor neurons alive
usually follows a phase of fever, myalgia (cramping/pain) and malaise (general discomfort)
asymmetrical weakness (focal or unilateral)
no sensory loss
lesion of the dorsal column
lose discriminative sensation (touch/pressure) and conscious proprioception and kinesthetic sense
always going to be ipsilateral at lesion and down
can still feel pain/temp/gross touch bc the pain tracts are on contralateral side
+Romberg= dorsal column problem (unconscious proprioception)
bilateral loss is more exaggerated- wide, swaying gait, looking down
tabes dorsalis is characterized by:
sensory symptoms and signs that indicate marked involvement of the posterior roots, esp in lumbosacral region
degeneration of dorsal column
common complaints of pt with tabes dorsalis :
unsteadiness
sudden lacerating somatic pains
urinary incontinence
excruciating abdominal pain
neuro exam for tabes dorsalis:
marked impairment of vibration and joint position
severe deficits in touch & pressure
ataxic gait
+romberg sign; abadie’s sign, tendon reflexes lost
later stages of pain fibers also become involved
where are tabes dorsalis symptoms?
ipsilateral
at and below the level of lesion
abadie’s sign of tabes dorsalis =
insensibility of the achilles tendon to pressure
+hoffman’s reflex reflects:
presence of an UMN lesion from SC compression
hemi section- brown sequard syndrome:
??
horner’s syndrome:
ptosis, dry face, red, warm, miosis (constricted pupil)
UMN
any lesion T1 and above (esp C5)
eye gets affected mostly (drooping eyelid, restricted pupil, dryness of face
also common in medulla lesions; bc sympathetic innervation face is T1-3 (ipsilateral)
lesion to the anterior white commissure:
bilateral pain and temp los
question is to what extent?
only get loss segmentally; nothing wrong above or below segment
if lesion is T8-L3, loss would be about T10-L5, goes up or down 1-2 segments
syringomyelia:
anterior white commissure lesion gets larger and larger in any direction; usually goes ventrolateral
always about 2 segments below in
amyotrophic lateral sclerosis (ALS)
sclerosis- hardening/plaquing disease on fibers in cortical spinal tract
as disease progresses it invade anterior horn cells (person now has both UMN and LMN symptom) these motor units continue to drop out – eventually die of respiratory insufficiency
“Lou Gehrigs Disease”
progressive hardening of pyramidal and rubospinal tracts; lose ability to control muscles. also affects anterior horn cells– mixed condition (UMN and LMN symptoms)
cells that are still alive are hyperreflexia and hypertonic
no sensory loss
+ Hoffman and Babinski
UMNS for ALS:
ipsilateral
paralysis, paresis spasticity hyper-reflexia clonus babinski hoffman
LMNS for ALS:
ipsilateral
paralysis, paresis hypotonia hypo-reflexia fibrillations muscle atrophy
what is the hallmark of ALS?
combo of UMN and LMN signs and symptoms
common complaints of ALS patient:
early- weakness in legs and arms
sometimes mention atrophy or fasciculations
neuro exam for ALS:
ms atrophy of small ms of hand and distal ms fasciculations hyperactive reflexes \+ babinski and + hoffman \+bing's reflex or sign
Bing’s reflex:
pathological reflex in spastic symptom- complexes
extension of the great tow following prickling of the dorsum of the toe or foot with a pin, seen in pyrimidal tract lesions
subtypes of ALS:
primary lateral sclerosis- pyrimidal tracts only
progressive muscular atrophy: AHCs only
progressive bulbar palsy- moto nuclei of BS
- slurred speech, problems with swallowing and coughing
- aspiration is a constant danger
