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Neuro Diagnosis > Test 2 > Flashcards

Test 2 Flashcards

1
Q
  • vascular compromise to peripheral nerves
  • stocking glove sensory loss (numbness, pain, and parasthesia due to vibration and light touch loss)
  • Autonomic and motor loss (alpha motor, type Ia afferent→ DTR)
  • Leads to decreased healing
  • Retinopathy- try to make new vessels in the eye but have ischemia
  • Results in neurogenic joint disease
A

diabetic neuropathy

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2
Q
  • reflex sympathetic dystrophy syndrome (RSDS)
  • complex, regional pain
  • rapid, severe swelling
  • long term pain following a minor injury
  • may inclue regional osteoporosis
A

causalgia aka Sudeks atrophy aka RSDS

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3
Q
  • Peripheral vasospasm (hands and feet get ischemic)
  • Associated with migraine
  • Women
  • Autoimmune connection→ Raynaud’s phenomenon
  • Cold exposure (provocative)
  • White blue red (color changes in order)
  • Allen’s test
A
  1. Raynauds disease
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4
Q
  • Post viral reaction (respiratory, Epstein-Barr)
  • Inflammatory PNS demyelination
  • Stocking glove sensory dysfunction of hands and feet (similar to diabetes)
  • Weakness, LMNL signs
  • Varies from mild to total (no effect on CNS, does effect ANS)
  • Age 30-50 most common
  • 90% self resolving
A

Guillian Barre syndrome aka inflammatory polyneuropathy aka acute idiopathic polyneuritis

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5
Q
  • Autoimmune vs acetylcholine receptors
  • Young women or old men
  • Weakness of eyes (ptosis), lips, face, hands→ gets worse w/ repeated muscle use or later in day
  • No sensory findings
  • Thymoma or enlarged thymus
A
  1. Myasthenia gravis
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6
Q
  • Usually w/ underlying cancer
  • Presynaptic disorder, not enough acetylcholine
  • Considered myasthenic→ all symptoms of myasthenia gravis
A
  1. Eaton Lambert syndrome
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7
Q

disorders of NMJ

A
  1. Myasthenia gravis2. Eaton Lambert syndrome
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8
Q
  • space occupying lesion, medical emergency (referral)
  • urinary incontinence, fecal incontinence, impotence, lack DTR, atrophy, footdrop, bilateral sciatica with multiple nerve roots, saddle anesthesia
  • causes- central/median disc lesion, canal stenosis, vertebral fracture, luxation, tumor
A

Cauda Equina Syndrome

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9
Q

Conus Medullaris Syndrome

A

Conus Medullaris Syndrome

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10
Q
  • viral infection of anterior horn, LMN, via digestive system
A

polio

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11
Q
  • upper trunk brachial plexus (C5,6)

- traction injury, waiter’s tip

A

Erb Duchene Palsy

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12
Q
  • lower trunk brachial plexus (C8,T1)
  • Pancoast tumor, falling and hanging on, T1 TP or 1st rib fracture
  • possible Horner’s syndrome
  • hand and finger extension weakness, hypothenar atrophy
A

Klumpke’s Paralysis

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13
Q
  • location leads to how to manage (scalenes vs costoclavicular vs subcoracoid)
  • Roo’s test (EAST) is very sensitive but not specific
  • Scalene Triangle- subclavian a. (no venous insufficiency, hand swelling not seen), Adson’s and Halstead’s test, cervical rib, ulnar n. most affected
  • Clavical and 1st rib- Eden’s test, subclavian a & v (hand swelling), symptoms exacerbated by raising and externally rotating arm
  • Pec minor and coracoid- axillary a & v, Wright’s test, overdeveloped pecs, weakness of rhomboids (C5,6, dorsal scapular n.)
A

TOS

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14
Q

+ Wright’s only at 180 degrees, managed by anterior inferior humerus adjustment

A

Humeral Head Syndrome

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15
Q
  • due to apical lung tumor, may invade brachial plexus (lower trunk)
  • classic sign- Horner’s syndrome→ droopy eye, constricted pupil and no facial sweating (compressed sympathetics)
  • AP lower cervical film, increased density on percussion
  • Ptosis, miosis, anhydrosis
  • Possible Lambert Eaton
A

Pancoast Syndrome

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16
Q
  • Saturday night palsy, crutch palsy, honeymooners palsy (damage in spiral groove)
  • Wrist drop- weakness of arm, hand, finger extensors below shoulder
A

Radial Neuropathy

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17
Q
  • entrapped at clavicle and 1st rib or elbow (fds, biceps, pronator teres)
  • preachers hand/ ape hand- weakness of wrist flexion, abduction, thumb opposition, flexion of 2nd and 3rd digit, sensory loss of 1st 3 ½ digits
A

median neuropathy

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18
Q
  • entrapment in carpal tunnel, repetitive stress injury, women over 30
  • FOOSH, worse at night, sensory loss, may radiate back up arm
  • Lunate subluxation
  • Inspection- thenar atrophy, muscle- thumb opposition, ortho- phalens, reverse phalens, tinel’s
  • Adjusting- cervical, shoulder, elbow, wrist
  • Strength extensors, pronator quadratus
A

carpal tunnel

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19
Q
  • Ulnar groove at elbow (increased carrying angle)
  • Claw hand- weakenss of wrist flexion, abduction, adduction (froment’s sign), sensory loss of 4th and 5th digits
  • Differential- elbow, tunnel of Guyon (wrist) aka pisiform hamate syndrome
  • Bench press or military pres, handles for cyclists
A

Ulnar neuropathy

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20
Q
  • Differential from L3-4 radiculopathy→ femoral vs obturator

- Loss of DTR, anterior thigh weakness, sensation loss

A

femoral neuropathy

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21
Q
  • causes- posterior hip dislocation, acetabular fracture (dashboard), muscular injection in buttock
  • symptoms- weakness of all foot and ankle muscles, knee flexion, Achilles reflex, sensory loss of foot and lateral leg below the knee
  • differential- lesion in motor cortex
A

Sciatic Neuropathy

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22
Q
  • parasthesia along distribution
  • common cause- lumbosacral nerve root compression by disc or osteophyte
  • distal entrapment- piriformis syndrome (also L2,L3 subluxation)
A

Sciatica

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23
Q
  • head of fibula, kneeling

- differential- L5 radiculopathy, weakness of foot inversion

A

Peroneal Nerve Palsy

24
Q
  • compression of lateral femoral cutaneous nerve
  • mid-aged men→ weight fluctuation, waistband compresses ASIS
  • PI ilium
A

Meralgia Parasthetica

25
Q
  • tight fitting shoes
  • symptoms- pain, numbness, parasthesia between 3rd and 4th toes
  • nerve root lesions tend to have single distribution, peripheral nerves tend to involve multiple nerve roots
A

Morton’s Neuroma (Metatarsalgia)

26
Q

read chapt 10 review

A

okie dokie?

27
Q
  • Inflammation and demyelination of optic nerve (MS)
  • Under 45 years, eye pain with movement, monocular central scotoma, decreased visual acuity (blurry), decreased color vision (red)
  • Fundoscopic exam may show papillitis or optic disc pallor
  • Optic nerve inflammation only-funnel vision (retrobulbar neuritis)
  • Onset and progression can be fast or slow, 6-8 weeks of recovery, multiple attacks can lead to permanent deficit
A

Optic/Bulbar Neuritis

28
Q

Doesn’t go through thalamus.

A

olfactory Nerve CN1

29
Q

loss of smell

A

anosmia

30
Q

increased sensitivity

A

hyperosmia

31
Q

abnormal sensations of smell

A

paraomia

32
Q

CN1 lesions caused by

A
  1. cocaine or inhalants
  2. tumor of frontal lobe or pituitary tumor
  3. viral infection
  4. trauma at cribriform plate
33
Q
  • Stabbing electric pain, rare, women 30-50, attacks last 1-2 minutes and happen over 100/day.
  • Seems random but may have triggers: cold exposure, touch, pressure, eating, swallowing.
  • Patient considers/commits suicide.
  • Results from: blood vessel on trigeminal, MS, tumor, damage from dentistry/surgery, subluxation (dentate ligament), idiopathic
A

Trigeminal neuralgia: AKA tic douloureux

34
Q
  • Herpes zoster AKA varicella AKA chickenpox AKA shingles
  • Virus goes dormant and hides in nerve ganglia
  • Under stress patient’s susceptibility rises, virus reactivates with vengeance
  • Eruption of small extremely painful vessels along distribution of nerve. Any cutaneous nerve may be effected (unilaterally-doesn’t cross midline) trigeminal most common cranial nerve
A

Trigeminal nerve lesion:

35
Q

facial nerve paralysis. pain around the ear, drooling, speech impediment (B’s and P’s). eyelid may not close. Onset is sudden. beyond 12 weeks=permanence. Botox, hypersensitivity to sound

A

Bell’s Palsy

36
Q
  • tinnitus- ringing, buzzing, roaring, drugs, increased fluid pressure
  • auditory scotomas- loss of hearing at certain frequencies
  • auditory hallucinations- temporal lobe lesion
A

Cochlear Lesion

37
Q
  • unilateral hearing loss, tinnitus, facial fain and sensory loss from CN V involvement (loss of corneral reflex)
  • may involve CN VII, IX, X as well (cerebellopontine angle)
  • Hydrocephalus
A

Schwannoma / Accoustic Neuroma

38
Q
  • dizziness- unsteadiness with ataxia
  • impulsion- forward motion
  • vertigo- abnormal feeling of motion (nystagmus)
    o subjective- patient feels like they are moving while they are still
    o objective- patient feels like the room is moving while they are still
  • Peripheral Lesion- 2-5 second lag between motion and nystagmus that goes away in 30 seconds
    o Schwannoma, vestibular neuritis (viral), benign paroxysmal positional (BPPV), Meniere’s
  • Central Lesion- no lag time, no habituation (vestibular nucleus in medulla)
    o Vertebrobasilar infart or ischemia, tumor, toxin, MS, encephalitis, (anything in CNS)
A

Vestibular Nerve lesion (motion sickness)

39
Q
  • inner ear disorder, too much fluid (endolymph), overstimulates inner ear, flare ups and remissions, progressive cumulative deafness, possibly with vertigo
A

Meniere’s

40
Q
  • glossopharyngeal neuralgia
  • tachycardia (loss of carotid sinus reflex)
  • loss of gag reflex and dysphagia
  • loss of bitter taste on posterior 1/3 of tongue
A

Glossopharyngeal Nerve lesion CN IX

41
Q
  • unilateral- hoarseness, dyspnea, dysphagia, uvula away from affected side
  • bilateral- arrhythmia, laryngeal, paralysis, stomach dilation, death
  • irritative- increased PS (bradycardia), stomach dilation, esophageal and pyloric sphincter spasm
A

vagus nerve lesion

42
Q
  • inspect for deviation and muscle test

- atrophy, deviation, fasciculation (toward side of lesion)

A

hypoglossal nerve lesion

43
Q
  • anterior horns of C1-5
  • SCM and trap affected ipsilaterally
  • Internal medullary branch goes back into skull and out foramen magnum (phonation)
    LMNL- ipsilateral weakness of shoulder shrug and contralateral head rotation, look toward weak side
    UMNL- deficit turning head to contralateral side
A

Spinal accessory nerve lesion

44
Q

cross eye, LR weakness

A
  • Estropia
45
Q

eye pushed out laterally, wall eye, MR weakness

A
  • Extraopia
46
Q
  • Hypertropia
A

superior, SO weakness

47
Q
  • not SO or LR, down and out position
  • Ptosis, mydriasis
  • Diagonal diplopia- better far, worse near
  • Causes- Diabetes (spares pupil), head trauma, compression from aneurysm (painful, spares pupil), midbrain ischemia, opthalmoplegic migraine (reversible)
A

Oculomotor palsy

48
Q
  • Vertical diplopia, may show hypertropia
  • Head tilt makes it better
  • Most commonly injured CN in head trauma
  • Looking up and to the same side as problem makes it better, down and opposite makes it worse
A

Trochlear palsy:

49
Q
  • Increased intracranial pressure, important early sign
  • Right palsy: ok when looking left, worse when looking toward the bad side
  • Head rotation
A

Abducens palsy:

50
Q
  • sign of MS.
  • Lesion of yolking of eye muscles between VI and opposite III.
  • Look right: right eye goes right, left eye stops (right MLF lesion)
  • Accommodation ok
A

Intranuclear opthalmoplegia:

51
Q

different sized pupils

  • III lesion can give dilated pupil, obvious in lit environment
  • Horner’s syndrome: ptosis, miosis, anhydrosis due to lack of symp, obvious in dim environment
A

Anisocoria

52
Q
  • direct light reflex diminished, indirect normal.
  • Afferent problem: optic nerve, retina, or eye lesion.
  • Swinging flashlight test
A

Marcus Gunn Pupil:

53
Q

Idiopathic and benign.

  • Pharmaceutical: miosis
  • Light near dissociation: react to near vision, wont react to light
  • Argyll Robertson pupil: tertiary syphilis
  • Adie’s myotonic pupil: degeneration of ciliary ganglion. Mid dilated pupil reacts poorly to light and dark
A

Benign anisocoria:

54
Q
  • III, IV, VI: total opthalmoplegia with fixed dilated pupil.
  • V1 and sometimes V2: loss of facial sensation
  • Caused by space occupying lesion
A

Cavernous sinus syndrome:

55
Q
  • cavernous sinus syndrome and CN II
A

Orbital apex syndrome:

56
Q
  • Pineal tumor or hydrocephalus.

- Bilateral light near dissociation, impaired convergence.

A

Parinauds syndrome:

Neuro Diagnosis (13 decks)

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