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Neuro Spring 2019 > Test 2 Clinicals > Flashcards

Test 2 Clinicals Flashcards

1
Q

Neural Tube Defects

A

1) Failure of neural tube to close

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2
Q

Rachischisis

A

1) Neural tube defect
- neural folds don’t join at midline
- undifferentiated neuroectoderm remains exposed
2) Rachischisis totalis
- AKA holorachischisis
- extreme form
- entire spinal cord remains open
3) Rachischisis partialis
- AKA merorachischisis
- spinal cord is partially open

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3
Q

Anencephaly

A

1) Neural tube defect
- anterior neuropore doesn’t close
- skull and brain do not develop
2) Anencephaly (Without brain)
- meroanencephaly (without part of brain)=more accurate
- brainstem intact but missing forebrain and cerebellum

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4
Q

Rachischisis vs Meroanencephaly

A

1) Most cases, especially meroencephaly

- DEATH

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5
Q

Spina Bifida

A

1) Neural tube develops normal
BUT surrounding vertebrae not formed properly
2) Spina Bifida OCCULTA
-partially missing vertebral arches
-area of defect indicated by patch of dark hairs
3) Spina Bifida CYSTICA- enlargements that contain:
-only meninges and CSF (meningocele)
-Meninges, CSF, portions of spinal cord (MENINGOMYELOCELE)

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6
Q

How is sensory info brought to the spinal cord?

A

1) Cell bodies- posterior root ganglia
2) Central Processess
- through spinal cord
3) Peripheral Processes
- through spinal nerves to innervate body structures

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7
Q

Sensory input originates from?

A

1) Body surface (GSA)
2) Deep structures such as: (GSA)
- muscles
- tendons
- joints
3) Internal Organs (GVA)

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8
Q

Injury to peripheral nerves

A

1) motor or sensory deficits distal to lesion
2) most notable in extermaties seen as:
- motor deficits (flaccid paralysis)
- decrease or loss of spinal reflexes (hyperreflexia, hyporeflexia, areflexia)
- Anesthesia (loss of sensation)
- Paresthesia (abnormal sensations)

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9
Q

Lumbar puncture

A

1) Obtain CSF
2) AKA spinal tap
3) L3/4 or L4/5

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10
Q

Spinal Reflex composed of:

A

1) Sensory neuron
2) motor neuron
3) resultant muscle contraction

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11
Q

Artery of Adamkiewicz

A

1) large spinal medullary artery
2) seen at L2 on Left side
3) important source of blood supply to the cord
4) must be preserved during surgery

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12
Q

Central Cervical Cord Syndrome

A

1) Trauma:
-hyperextension of c-spine
-mechanical injury to cord
2) Causes
-occlusion or spasm of anterior spinal artery
3) results:
Bilateral damage to cervical cord
4) Symptoms:
-bilateral weakness of extremities (primarily arms, forearms, hands)
-patchy loss of sensation below lesion
-urinary retention

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13
Q

Spinal Nerves

A

1) Formed by meeting of anterior and posterior roots
2) each nerve contains:
- afferent fibers->sensory input from periphery
- efferent fibers-spinal motor neurons
3) Fibers + circuit in gray matter=basis for spinal reflexes
- tested in neurological exams

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14
Q

Deafferentation pain

A

1) Anatomic pathways for pain perception are Partially or completely disrupted:
- nerve rootlets, tracts and nerves
2) May develop after:
- amputation
- peripheral nerve injury
- lesion of central tracts resulting in hemi/para/quadraplegia
- damage to posterior roots
3) Perceived As:
- dull and aching
- pins and needles (sharp pain)
- searing
- burning sensations
4) mechanism for pain is due to combo of:
- increased sensitivity of the central neurons (central sensitization)
- plasticity changes in damaged cell groups
- decrease in descending inhibitors
- increase in facilitate at he lesion site

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15
Q

Motorcycle Accident

A

1) Forcefull separation (avulsion) of posterior roots from spinal cord
- most often in brachial plexus

2) Tx: DREZ procedure (AKA PREZ)
- dorsal root entry zone
- small electron placed in posterior horn at entry zone
- radiofrequency lesions made at level of separation

3) Significant or total relief from pain seen in 80-90%

4) Complications:deficits related to adjacent
- corticospinal tract
- cuneate fasciculus

5) Symptoms:
- Ipsilateral weakness of upper or lower extremity
- Ipsilateral UE conscious proprioception and vibratory sense (pts describe buzzing sensation)

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16
Q

Myasthenia gravis

A

1) Moderate to profound muscle weakness
- muscle fatigue, worse as day progresses
2) presence of circulating antibodies against nicotine receptors on postsynaptic membrane
3) Result
- blockage at neuromuscular junction
4) Most common
- 20-40 y.o
- younger patients may exhibit symptoms

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17
Q

3 characteristics of Myasthenia gravis

A

1) Muscle weakness
- wax and wane for periods of mins to several days

2 Muscles controlling eye movement involved first (40%) –>result in DIPLOPIA AND PTOSIS (85% of pts)

  • muscles of pharynx or larynx, face, and extremities may eventually be involved
  • always with ocular muscles
  • exhibit dysarthria and dysphagia

3) Weakness to administration of drugs that ENHANCE cholinergic transmission

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18
Q

Spinal reflex

A

1) Afferent fibers in spinal nerves may:
- synapse on tract cells and relay info to higher levels of neuroaxis
-terminate on motor neurons or interneurons
BOTH participate in reflex circuit

2) Require:
- afferent fiber
- interneurons or motor neurons
- target tissue (skeletal muscle)

3) Intrasegmental:
- simple reflex confined to single cord level

4) Intersegmental
- complex reflex in multiple cord segments

5) Numerous reflex apart of standard neurologic exam

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19
Q

Muscle Stretch Reflex

A

1) AKA tendon reflex or deep tendon reflex
2) Stimulus
- stretch of a muscle spindle located within the muscle
- tapping any large tendon
- ex: Knee jerk or quad stretch reflex

3) Reciprocal inhibitions
- one group of muscles is excited
- other antagonist group inhibited

4) Autogenic Inhibition
- AKA inverse myotatic reflex
- Golgi tendon organ=receptor
- responds to high tension

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20
Q

Flexor reflex

A

1) AKA withdrawal reflex
- nociceptive reflex

2) stimulis
-cutaneous input
-response to nociceptive stimuli
-protects a body part by removing from source of injury
(TAC on ground)

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21
Q

Cross Extension reflex

A

1) Builds on flexor reflex

- involves muscle of the contralateral side of body

22
Q

Radiculopathy

A

1) Damage to (one or more) nerve root

2) Common cause
- spondylosis
- intervertebral disk disease

3) Due to dermatomes:
- k/o single root-> not significant sensory loss

4) Main symptom= perception of pain
- sharp burning pain (“shooting pains”

5) Cervical pain found in
- base of neck,
- over should
- down the UE

6) Lumbar problems:
- low back pain
- pain radiating down the LE (SCIATICA)

23
Q

Mononeuropathy

A

1) deficit reflecting one peripheral nerve
2) Caused by:
- trauma (most common)
- entrapment
- compression syndromes (carpal tunnel syndrome)

Deficits/symptoms:
A) deviation of tongue on protrusion (hypoglossal nerve)
B)loss of flexion
-adduction and extension of fingers (ulnar nerve)
- toes(tibial nerve)
C)loss of pronation of forearm and movement of fingers
D) loss of dorsiflexion of foot/toes

24
Q

Carpal Tunnel Syndrome

A

1) Most common entrapment mono neuropathies
2) median nerve compressed->large sensory deficits
3) Symptom:
- numbness
- tingling
- pain from the thumb, index finger, middle finger
4) Tx:
- section transverse carpal ligament to relieve pressure on median nerve

25
Q

Polyneuropathy

A

1) motor and sensory deficits
- reflect damage to multiple peripheral nerves
2) Most common cause:
- diabetes MELLITUS ->Distal Axonopathy-> distal portions of fibers affected first
- start in LE and progress to UE
- small diameter myelinated/unmyelinated fiber affected first

3) Symptoms: STOCKING-GLOVE SENSORY LOSS
- numbness and loss of pain and temp in feet up to knees
- same deficits in hands to forearm
- as disease progresses: large diameter fibers involved and vibratory and position sense diminished or lost.

26
Q

Sensory Neuronopathy vs motor neuronopathy

A

BOTH-result in loss of function related to peripheral nerves

Sensory Neuropathy

  • loss of cell bodies in DRG
  • results in sensory loss in BOTH distal and proximal portions of an extremity
  • can include all sensory modalities

Motor NEuronopathy

  • loss of anterior horn motor nears
  • restuls in: flaccid weakness, muscle fasciculations, evental muscle atrophy
27
Q

Posterior Columns

A

1) Gracilis and Cuneate Fasciculus
2) composed of heavily myelinated Primary Sensory fibers
3) Convey
- proprioceptive
- tactile
- vibratory sense

28
Q

Gracilis Fasciculus

A

1) part of posterior columns

2) T6 and below`

29
Q

Cuneate Fasciculus

A

1) part of posterior columns

2) T6 and up

30
Q

ALS

  • composed of
  • damage
A

1) Anterolateral system
- Lateral Spinothalamic Tract (Pain and Temp)
- Anterior Spinothalamic Tract (General Tactile)
2) Damage to ALS
- begins 2 segments below lesion

31
Q

Syringomyelia

A

1) Cavitation/Crater of central regions of cord
- usually cervical region
2) TYPES:

NONCOMMUNICATING syringomyelia 
-no lining of ependyma cells thus NOT AN ENLARGEMNT OF CENTRAL CANAL
VS
Communicating Syringomeylia
-cyst connects with central canal 
VS
Hydrosyringomyelia
-cavitation of central canal

3) Small syringomyelia
-damage fibers crossing AWC
==>BILATERAL DEFICIT

4) Large Syrinx
- AWC and extends into anterior horn
- results bilateral loss of sensory and weakness of corresponding extremities
- one anterior horn=ispsilateraL weakness of uE
- both ant. horns=bilateral weakness

5) Ex: Lesion in mid to low cervical areas
- pain and temp sensory-Bilateral
- shoulders and arms=CAPE DISTRIBUTION

32
Q

Brown-sequard Syndrome

A

1) Functional Hemisection of spinal cord results:
- damage to lateral corticospinal tract, ALS, posterior columns
- Functional–>-cord is not perfectly cut always across but m injured/deformed by pieces of damaged vertebrae

2) Lesion on R C4-C5
- Hemiparesis or hemiplegia–>muscle weakness or paralysis
- loss of pain and temp on Left side (ALS damage)
- Loss of proprioception, vibratory sense and fine touch (Gracile and Cuneate fascicle damage)

3) NET RESULTS
- loss of functional on half of the spinal cord

33
Q

High Cervical Cord Lesion

A

1) Catastrophic event-> can’t breath
2) Potential for total loss of:
- sensation for the body below the lesion
- voluntary motor control below the lesion
3) Phrenic Nucleus
- Central regions of anterior horn C3-37
- innervates diaphragm
- lesion=disconnects from centers of medulla that control breathing

34
Q

Acute Central Cervical Spinal Cord Syndrome

A

1) AKA central Cord syndrome
- incomplete spinal cord injury
2) Caused by:
- hyperextension of neck that occludes blood supply to cord from anterior spinal artery
3) deficit reflects the region served by artery:
- Bilateral weakness of extremities (Upper more than lower)
- varying degree of pain and temp loss
- Bladder dysfunction
4) Most patients Recover most or all function within 4 to 6 days:
- LE return first
- Bladder function
- UE function LAST
- Pain and temp return at any time
- posterior column sensations not affected

35
Q

Opoids vs Opiates

A 
OPOIDS
1) Produced by body: (endogenous)
2) 5 receptors:
-u (mu)
-d (delta)
K (Kappa)
-sigma
-Epsilon
3) exs:
B-endorphin= u and D receptors 
 Enkephalin= u and D receptors 
Dynorphin= K receptors

OPIATES

1) bind to opoid receptors from outside body
2) Stops pain/EFFECTIVE analgesic
3) derived from opium poppy
4) ex:
- heroin
- morphine

36
Q

Intrathecal Injection

A

1) Spinal block during pregnancy (local)
- picks target
- potent analgesic effect

37
Q

CIPA

A

1) congenital insensitivity to pain w/anhydrosis
- anhydrosis (can’t sweat=sympathetic function)
2) RARE Genetic defect
- autosomal recessive
3) Child can’t feel pain
- cant diagnose until later in life
- won’t cry to pain
- die secondarily (not directly from disease)
4) Abnormal development of nociceptive receptors and some sympathetic neurons

38
Q

Endorphin

A

1) Opioid:

- Endogenous version of morphine (opiate)

39
Q

Fibromyalgia

A

1) thought to be CNS issue
- idiopathic-don’t know what causes
2) Symptoms-Wide and varied; bilateral presentation
- musculoskeletal pain
- tired
- cognitive difficulty
- maybe genetic
- maybe triggered by infection

40
Q

Allodynia thalami

A

1)hypersensitive to pain
pain resulting from stimulus that doesn’t always cause pain
-CNS processing pain in abnormal way
-causes free nerve endings to be more active
2) AKA hyperalgesia
3) ex: overresponsive to bruise

41
Q

TENS

A

Transcutaneous Electrical Nerve Stimulation

  • though to stimulate tactile afferent in pain gating
  • reduces pain
  • ex: rubbing injured area`
42
Q

Thalamic pain syndrome

A

1) AKA dejerine roussy syndrome
2) Pain being stimulated from CNS (central pain)
- location of pain depends on where thalamus is damaged
3) Can result from Thalamic stroke
4) can’t be controlled
- meds help but limited

43
Q

UMN lesion vs LMN lesion

A 
1) UMN
Symptoms:
-Paralysis, spastic (muscle spasm)
-Hyperreflexia (deep tendon reflex)
-no muscle atrophy (except by disuse)
-Abnormal reflex--> + Babinski Sign
2) LMN
Symptoms:
-Paralysis, flaccid
-hyporeflexia
-muscle atrophy
-fasciculations (quiver)
44
Q

Central Herniation

A

1) AKA transtentorial herniation
- supratentorial compartment
2) Elevated Intracranial pressure
- forces diencephalon down through tectorial notch
3) Symptoms:
- initially change in respiration
- eye movement irregular
- dilated pupils
4) As damage progresses downward:
- Cheyne-stokes respiration w/intermittent tachypnea and apnea
- loss of motor and sensory
- loss of consciousness
5) Immediate muses to decrease ICP

45
Q

Uncal Herniation

A

1) uncut down over edge of tentorium cerebeli
2) most common cause:
-expanding hemorrhagic lesion in the hemisphere
3) Initially compresses midbrain
-not checked damage can extend into lower brainstem levels
4) Progresses:
-respiration affected
-abnormal reflexes
-rapid decline
4) Early signs:
-dilated pupil
-abnormal eye movement (oculomotor nerve), w/double vision ipsilateral to herniations
Followed by:
-weakness of Extremities opposites to dilated pupil

46
Q

Upward Cerebellar Herniation

A

1) Mass in posterior cranial fossa
-force portions of cerebellum up through tentorial notch
-compress midbrain
2) Result:
-occlusion of branches of superior cerebellar artery w/ infraction of cerebellar structures
and/OR
-increase in ICP (vomiting, headache, lethargy, decreased level ofc consciousness)

47
Q

Dejerine Syndrome

A

1) AKA medial medullary syndrome
-occluded anterior spinal artery
-bilateral deficits
2)Anterior Spinal Arteries service
Medial structures of medulla @ all levels
-pyramid
-medial lemniscus
-hypoglossal nucleus/roots
3) Symptoms:
-Contra hemiparesis (pyramidal and corticospinal damage)
-Contra loss of conscious prop and vibratory sense (ML)
-Deviation of tongue to psi side when protruded (hypoglossal root or nucleus injury)

48
Q

Wallenberg Syndrome

A 
1) AKA Lateral medullary syndrome
PICA syndrome
2)Affect Posterolateral medulla 
-Rostral to obex
-served by branches of PICA
3)) PICA serves
-ALS
-Spinal trigeminal Tract and nucleus
-vestibular nuclei
-Solitary tract and nucleus
-Nucleus Ambiguus
4) Deficits:
-contra loss of pain/temp of body (ALS)
-Ipsi loss of pain/temp of face (Spinal Trigeminal Tract and nucleus)
-some vertigo and nystagmus (vestibular nuclei)
-loss of taste from ispilateral half of tongue (solitary tract/nucleus
-Hoarsenss and dysphagia (nucleus ambiguous
5) Associated with Horner's syndrome
49
Q

referred pain

A

1) Noxious stimuli that originates in visceral structure (heart/stomach)
- perceived by patients from somatic portion of body wall (skin, bones or skeletal muscles)
2) Pain in chest
- perceived as intense pressure that radiates down left arm
- indicates serious heart problem

50
Q

Agina

A

1) Referred pain w/diseases of heart
2) Agina pectoris
- perceived as a pain of chest
- sternum and pectoral muscles
3) 80% of patients perceive agina as:
- squeezing sensation ordination from behind sternum
4) Also perceived:
- pain radiating down L arm
- Bilateral down both arms, neck, jaw, and temporomandibuular joints (RARE)

51
Q

Baroreceptor Reflex

A

1) Hypertension
- abnormally elevated BP
- major health issue
- variety of causes
2) Hypotension
- abnormally low BP

Neuro Spring 2019 (21 decks)

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