Spinal diseases, demyelinating myelophatyes, neuropathies Flashcards
C segments injury
tetraparesis/tetraplegia
Th to L segments injury
Paraparesis/paraplegia
Arnorld-Chiari syndrome
Meningomyelocele
Severe tonsilar herniation
Hydrocephalus
Neuromyelitis optica type of disease
Autoimmune disease
B12 deficiency leads to
Symmetrical sensory disturbances of lower limbs
Ataxia
Spasticity
Loss of reflexes
Loss of vibration and proprioception sense
Problem in posterior column
Spondylosis type of disease
Degenerative spine disease.
Spondylosis process
Dehydratation and disintegration of the nucleus pulpous–> decreased disc height–> spinal canal stenosis–> compression of the spinal cord
Spondylosis parts more often involved
Cervical and lumbar
Spondylosis. Clinical
Sciatica
Brachialgia
Cauda equina syndrome type of disease
degenerative disease
Cauda equina syndrome what happens
lumbar canal stenosis leads to compression of the cauda equina
Cauda equina syndrome. Clinical
Pain in back, legs
Weakness or paralisis
Urinary retention and urinary incontinence
Urinary retention, incontinence
Sexual disfunction
Anestesia in buttocks, anus, genitalis
Cauda equina treatment
Decompression surgery in 24h
Neuromyelitis optica treatment
inmunosupresors, corticoesteroids, anti-B therapy
Neuropathies. Clinical
Patient complains about weakness, sensory disturbance (numbness, pain), autonomic disturbance (diarrea, bladder dysfunction)
Exploration:
Pes cavas, ulceration, fasciculation
Nerve thickness, reduce muscle consistency
Axonopathy. Symptoms and signs
Burning, tingling and numb feet. Start distally and goes to proximally. Walking difficulties
Atrophy of small feet muscle
Weakness of toe and ankle dorsiflexion
Distal loss of touch and pinprick sensation
diminished/non-elicotable Achilles reflexes
Neuropathy with translation blocks
Asymmetric motor nerve impairment, usually starting in the hands
Positive anti-GM-1 antibodies
Good response to treatment with human immunoglobulins
Patient with a current sharp Knife.like” pain in her lower right jaw is likely to have
Trigeminal neuralgia
Polyneuropathy that affects nails
arsenic poisoning
Antibodies in Miller-Fisher syndrome
anti-ganglioside
Charcot-Marie tooth. Clinical
Feet deformation
Foot drop because of distal weakness
Atrophies
Sensory symptoms
Type of Charcot-Marie tooth that is demyelinating
type 1
Type of Charcot-Marie tooth that is axonal
type 2
Fibers that are more affected in Sjogren’s neuropathy
Sensory fiber
Gunyon’s canal syndrome
Pinched ulnar nerve in the wrist
Nerve that is biopsies in polyneuropathy
Suralis
Best treatment for trigéminas neuralgia
Carbamazepine
Hallmark of the meralgia of paresthetics is
Hypesthesia lateral to the thigh
Nerve affected in meralgia paresthetica
cutaneous femurs lateralis
The contraction of the biceps when the doctor elicited the styloradial reflex is due to
myelopathy
Diabetic neuropathy. Clinical
Painful CN III defect
Numbness of the toes
Inability to flex at the hip and extend at the knee
Unilateral flank pain along the rib arch
Painful paresis
Glove and stocking sensory loss
Subacute combined degeneration of the spinal cord. Clinical
Spastic weakness in the legs
Paresthesia in extremities
Loss of vibration and position sense
Cognitive impairment
Optic atrophy
Extensor plantar responses and absent ankle jerks
Subacute combined degeneration of the spinal cord is
Progressive degeneration of the spinal cord due to B12 deficiency
Neuromyelitis optica type of disease
Chronic autoimmune disease which affects atrocities. Antibodies against acquaporines. Necrotic lesion
Neuromyelitis optica. Clinica
Bilateral paraparesis o tetraparesis
Relapses
Long cervical cord lesion
Nausea and vomiting
Brain lesions
Blindness
Neuromyelitis optica treatment
Anti-B theraphy, inmunosupresor, corticoesteroids
Acute disseminated encephalomyelitis age
children and young adults
Acute disseminated encephalomyelitis
Infection or vaccination precedes the disease. Brain is infiltrated by LT
Fever
Headache
Nausea
Epileptic seizures
Encephalopathy: disartria, dysphonia, foggy vision, ataxia, tetraparesis
Coma
Acute disseminated encephalomyelitis treatment
Corticosteroids or plasmaforesis
Charcot-marie-tooth type of illness
Hereditary motor and sensory polyneuropathy
Charcot-marie-tooth. Clinical
Feet deformation (pes cause)
Foot drop because of distal weakness
Atrophies
Sensory symptoms
Guillain-Barré syndrome. Type of disease
Acute inflammatory demyelinating polyneuropathy
Guillain-Barré syndrome. Antibodies
Antibodies antigangliosides
Guillain-Barré syndrome. Clinical
Parestesia in the lower limbs that ascendents to the upper limbs
Reflexes attenuate or disappear in few days of onset
Nistagmus
Pain
Respiratory failure
Postural hypotension, arritmias, urinary retention, constipation, diarrea
Facial disparesis
Pupillary paralysis
Propioception is more affected than pain and temperature sensation
EMG: prolonge wave F
Antigangliosides antibodies
Lumbar puncture: more proteins with normal cell count
Guillain-Barré syndrome. Treatment
Immunotherapy. If there is no response, plasmapheresis
Progressive multifocal encephalopathy. Clinical
Subacute cortical disfunction: aphasia, mental changes, visual problems
Types of Multiple sclerosis
Relapsing remitting: most common, stable between relapses characterized by attacks of neurological dysfunction
Secondary progressive: evolve from relapsing remitting type. Disability progression independent of relapses. Consequence of secondary degeneration
Primary progressive: Slowly progressive symptoms or infrequent relapses. Disease onset after 40 years. Worse prognosis
Benign: Retrospecting diagnosis. Non accumulation of disability along time
Multiple Sclerosis. Clinical
- Visual problems: optic neuritis (pain, central scotoma, color vision disturbance). Vertical gaze palsy
- Paresis, paraplegia
- Parestesia Iof the trunk or legs. Lhermitt’s sign: electrical sensation that runs through the back and limbs, elicited by bending the head forward.
In advanced stages: - Cerebellar: incoordination, unbalance
- Picturing and sexual disfunction
- Fatigue
- Cognitive disorders, mood disorders
- Pain
- Brainstem signs and symptoms: nystagmus, internuclear ophthalmoplegia
- Paroximal symptoms: tonic spasms, trigeminal neuralgia, paroxymal dysarthria, ataxia, paroxysmal sensory and pain symptoms, double vision, akinesia, proximal paresis
What do you see in MRI of Multiple Sclerosis
Lesions in brain, in spinal cord.
Brain atrophy, bigger ventricles
Multiple sclerosis treatment
Symptomatic
Treatment of relapses: corticosteroids, metilprednisolone
Modifying therapies: INF beta (not for symptoms), glatiramer acetat, Dimetil fumaram, teriflunomid, Natalizumab
% of ALS familiar
5%
Patient with muscle atrophy, fasciculation and plantar response extension is likely to have
ALS
Riluzole works by
Glutamate receptors
Amiotrofic lateral sclerosis (ALS) what neurones involves
Upper and lower motor neuron
ALS clinical features
Hypo/hypereflexia
Disartria, disfagia
Spasticity
Amiotrofic
Babinski
Mutation of SOD1
ALS
Primary lateral sclerosis
A form of ALS in which only the corticospinal tract is affected
Reflex in a patient with ALS that is a sign of pseudobulbar impairments
Clonic masseter reflex
Incidence of ALS
2/100000 per year
Motor neuron damage that involves only the upper motor neuron
Primary lateral sclerosis
Pseudobulbar palsy
Monomelic amyotrophy
Spastic familiar paraparesis
Motor neuron damage that involves only the lower motor neuron
Progressive muscular atrophy
Lumbar puncture in multiple sclerosis
Oligoclonal bands, positive in CSF, negative in serum
Multiple sclerosis antopato
plaques of demyelination in the withe matter
Perivascular mononuclear infiltrate in the CNS
Axon collapse in the CNS
Treatment progressive multiple sclerosis
cystostatics
70 years old ataxia, forget things, hyperreflexia of the upper and lower limbs, positional sensitivity disturbed
Subacute combined degeneration of the spinal cord
Drug hyperexcitable bladder in MS
Anticholinergics (oxybutynin, imipramine, toterodine)
What do black holes on MRI in MS mean
Axonal collapse
Treatment for fatigue in MS
Amantadine
Treatment to reduce incidence of seizures in MS
Natalizumab
Azathioprine is used for
Liver damage
ADM-specific test
Extensive symmetrical changes on the head MRI in both hemispheres
Meningitic fluid
Negative oligoclonal bands in the lymphocyte after remission of the disease
Best test for multiple sclerosis
MRI
Form of MS that shouldn’t be treated with interferon beta
Primary progressive
Patient with Ms no responding to IFN beta what to give
Natalizumab
Optic neuritic a year ago now has spasticity is likely to have
MS
Patient with primmary progressive multiple sclerosis can be treated with interferons)
No
How do demyelinating lesions look in MRI sequences
flair-weighted
How do demyelinating lesions look in CT T2
increased signal T2
Treatment for spasticity in MS
Baclofen
Benzodiazepine
Tizanidine
Botulinum
Antibodies in a patient that lost her sight months ago and is paretic
anti-NMO
Vitamin deficiency associated with multiple sclerosis
Vitamin D
