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END OF YEAR NEURO-ORTHO > Updated Neuro > Flashcards

Updated Neuro Flashcards

1
Q

What is compression neuropathy?

A

Compression neuropathy occurs when a nerve is compressed resulting in damage to the nerve fibers and interruption of the nerve’s ability to function.

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2
Q

pathophysiology of compression neuropathy?

A

Compression neuropathy involves a series of events that lead to nerve damage and the development of symptoms.

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3
Q

stages of Compression Neruopathy?

A

Pressure on Nerve

Impaired Blood Flow

Accumulation of Waste products

Inflammation

Axonal Degeneration

Wallerian Degeneration

Treatment

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4
Q

Pressure on a nerve

A

Pressure on a nerve can

  • impair blood flow, leading to a lack of oxygen and nutrients necessary for nerve health and function.
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5
Q

Accumulation of waste products in nerve tissue?

A

Accumulation of waste products such as lactic acid in nerve tissue can be toxic for nerve fibers.

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6
Q

Compression and accumulation of waste products

A

Compression and accumulation of waste products can

  • Produce an inflammatory response that further damages nerve fibers.
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7
Q

Axonal degeneration?

A

Axonal degeneration is the result of compression and inflammation persisting, leading to the degeneration of nerve fibers and loss of function.

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8
Q

Wallerian degeneration?

A

Wallerian degeneration is the entire degeneration of a nerve due to compression, resulting in permanent damage and loss of function.

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9
Q

treatment for compression neuropathy involve?

A

Treatment involves -
relieving the pressure on the affected nerve and promoting nerve regeneration, sometimes requiring surgery.

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10
Q

What is Neurapraxia?

A

Mildest form of nerve injury
Temporary damage to the myelin sheath
Brief interruption in nerve conduction
Nerve fiber remains intact
Self-resolves within weeks to months
Full nerve recovery expected

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11
Q

Axonotmesis?

A
  • Most severe type of nerve damage but surrounding connective tissues remain the same (endoneurim, perineurium and epinerium)
  • Axon damage leads to wallerian degeneration where the axon and myelin shearth distal to the site of injury degenerate
  • Recovery may take months - years and can be incomplete
  • Results in motor, sensory and autonomic changes
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12
Q

Neurotmesis?

A
  • Most severe form of nerve injury
  • Complete transection of the nerve fiber
  • Results in complete loss of function below the injury
  • Requires surgical intervention for repair
  • Slow recovery
  • Recovery depends on injury site, severity, patient age, and other medical conditions
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13
Q

What is Vertigo

A

Vertigo is a sensation of spinning, whirling or dizziness, often accompanied by a feeling of imbalance

It can be a symptom of various underlying medical conditions, including inner ear disorders, neurological disorders and medication side effects

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14
Q

What is peripheral vertigo?

A

Peripheral Vertigo is caused by a problem in the inner ear affecting balance and spatial orientation.

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15
Q

What conditions can peripheral vertigo cause

A

benign paroxysmal positional vertigo (BPPV), vestibular neuronitis, or Meniere’s disease.

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16
Q

What is benign paroxysmal positional vertigo (BPPV)?

A

BPPV occurs when small calcium crystals in the inner ear move into one of the ear’s semi-circular canals, causing a false sense of movement.

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17
Q

What is vestibular neuronitis?

A

Vestibular neuronitis is an inflammation of the vestibular nerve, responsible for sending balance and spatial orientation information from the inner ear to the brain.

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18
Q

What is Meniere’s Disease?

A

Meniere’s Disease is a disorder of the inner ear affecting hearing and balance, leading to symptoms like vertigo, tinnitus, and hearing loss.

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19
Q

What is Central Vertigo?

A

Caused by a problem in the brainstem or cerebellum

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20
Q

What is Central Vertigo?

A

Caused by a problem in the brainstem or cerebellum

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21
Q

What conditions can cause Central Vertigo?

A

Conditions such as Migraine-associated vertigo, multiple sclerosis, or a stroke

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22
Q

What is Migraine-associated vertigo?

A

A type of vertigo that occurs in people with a history of migraines and is thought to be due to abnormal brain activity during a migraine episode

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23
Q

How does multiple sclerosis relate to Central Vertigo?

A

It is a neurological disorder that can affect the brainstem and cerebellum, causing vertigo and other balance problems

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24
Q

How can a stroke cause Central Vertigo?

A

By affecting the blood flow to the brainstem or cerebellum

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25
Q

Brown-Sequard Syndrome?

A

hemisection lesion of the cord resulting in ipsilateral motor loss and contralateral loss of sensitivity to pain and temp.

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26
Q

What deficits occur on the contralateral side in Brown-Sequard Syndrome?

A

Loss of pain and temperature sensation below the level of injury due to damage of the spinal thalamic tract, which crosses to the opposite side.

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27
Q

What deficits occur on the ipsilateral side in Brown-Sequard Syndrome?

A

Loss of motor function (paralysis and weakness) below the level of injury due to damage to the corticospinal tract,

loss of proprioception and fine touch below the level of injury due to damage of the dorsal column.

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28
Q

Causes of Brown-Sequard Syndrome?

A

Traumatic injury (stab wound or gunshot wound), spinal cord tumors, ischemia, infections like Herpes Zoster, and inflammatory diseases such as Multiple Sclerosis.

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29
Q

What is Cauda Equina Syndrome?

A

L4/L5 disc injury putting pressure on the nerve roots of cauda equina

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30
Q

Symptoms of Cauda Equina Syndrome?

A
  1. Severe Lower Back Pain:
    Intense and persistent pain in the lower back
    Pain may radiate to one or both legs (sciatica)
  2. Sensory Deficits:
    Saddle anesthesia (loss of sensation in inner thighs, buttocks, perineum, genital area)
    Numbness or tingling in legs, feet, or toes
  3. Motor Weakness:
    Weakness in lower extremities (unilateral or bilateral)
    Difficulty walking, stumbling, changes in gait
    Foot drop (difficulty lifting the front part of the foot)
  4. Bladder and Bowel Dysfunction:
    Urinary retention (difficulty starting urination or emptying the bladder)
    Urinary incontinence (loss of bladder control)
    Bowel incontinence or constipation (loss of bowel control or difficulty passing stool)
  5. Sexual Dysfunction:
    Erectile dysfunction in men
    Reduced sexual sensation or function in both men and women
  6. Reflex Changes:
    Reduced or absent reflexes in lower extremities (e.g., knee-jerk or ankle reflexes)
  7. Radicular Pain:
    Sharp, stabbing, or shooting pain radiating down the legs (radiculopathy)
    Pain follows the distribution of affected nerve roots
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31
Q

Cause of Cauda Equina Syndrome?

A

Prolapsed disc, especially large central disc herniation, and infections of bowel and bladder

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32
Q

Demographics of Cauda Equina Syndrome?

A

Primarily adults, but can occur at any age

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33
Q

How does Cauda Equina Syndrome affect the bladder?

A

Loss of sensation leads to incomplete emptying, causing frequent urination with small amounts

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34
Q

S/S of Cauda Equina Syndrome?

A

Lower back pain, constipation, impotence, saddle anesthesia, inability to urinate

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35
Q

What is ALS?

A

Amyotrophic Lateral Sclerosis

A progressive neurodegenerative disorder that affects the nerve cells in the brain and spinal cord.

This condition is characterized by degeneration of the motor neurons, which leads to muscle weakness and atrophy

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36
Q

Pathophysiology of ALS

A

It is not fully understood but involves the progressive degeneration and death of motor neurons.

These neurons are responsible for voluntary muscle movements. When they degenerate they can no longer send signals to muscles

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37
Q

Pathomechanics of ALS

A
  • Upper motor neurons in the brain degenerate leading to Spasticity, & exaggerated reflexes
  • Lower motor neurons in the spinal cord degenerate leading to muscle weakness, atrophy and fasciculations
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38
Q

S/S of ALS

A

Muscle Weakness: Starts in the hands, arms, legs, or muscles used for speech and swallowing.
Muscle Wasting: Visible shrinking of muscles due to lack of use.
Fasciculations: Involuntary twitches, especially in the limbs and tongue.
Muscle Stiffness: Increased muscle tone and stiffness, particularly with upper motor neuron involvement.
Slurred Speech: Due to weakness in facial and throat muscles.
Difficulty Swallowing: Leads to choking and higher risk of aspiration.
Breathing Problems: Due to weak respiratory muscles, potentially leading to respiratory failure

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39
Q

Clinical Presentation of ALS?

A

Limb onset: Begins with weakness in limbs (affecting fine motor tasks)
Bulbar onset: Begins with speech & swallowing difficulties (M/C in older patients)
Mixed Presentation: Symptoms of upper & lower motor involvement, such as combined muscle stiffness & weakness with visible atrophy

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40
Q

What are some late-stage symptoms of ALS?

A

ALS can affect the ability to control muscles, move, speak, eat, and breathe, eventually leading to death

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41
Q

Prevalance and Demographics for ALS include:

A

Prevalence: 1/2 cases per 100,000 annually
Age: M/C 55-75yo, peak incidence 65
Gender: More common in men than women
Environmental factors: Possible link to exposure to lead

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42
Q

What is Guillain-Barre syndrome?

A

Guillain-Barré Syndrome (GBS) is an

acute, inflammatory disorder of the peripheral nervous system characterized by rapid onset of muscle weakness and paralysis. It is often triggered by an infection and involves the immune system attacking the nerves.

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43
Q

Pathophysiology of Guillain Barre

A

Autoimmune: Immune system targets the myelin sheath or nerves in the peripheries
Demyelination: Inflammation & destruction of myelin slow down or block nerve signal transmission

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44
Q

S/S of Guillian Barre Syndrome

A
  • Initial symptoms: Tingling & weakness in the legs, spreading to upper body
  • Progression: Muscle weakness can progress to paralysis
  • Pain: Muscle ache and pain, particularly in the back and extremities
  • Respiratory failure: In severe cases, muscles involved in breathing can be affected
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45
Q

Clinical Presentations of Guillain-Barre syndrome?

A
  • Symmetry: Weakness usually symmetrical, affecting both sides equally
  • Reduced reflexes
  • Difficulty with eye and facial movements
  • Unsteady walking
  • Autonomic changes: Bladder/bowel dysfunction
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46
Q

Risk factors associated with Guillain-Barre syndrome?

A

Being male, elderly, having infections such as HIV/AIDS, or undergoing surgery
- Infections (Campylobacter)
- Viral Infection (HIV)
- Trauma (Severe injury)
- Male gender (more likely to develop GBS compared to females)

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47
Q

What is Myasthenia gravis?

A

Chronic autoimmune neuromuscular disorder, causing muscle weakness and fatigue.

48
Q

Demographic for Myasthenia Gravis

A

M/C affects young women aged 20-40.

49
Q

Symptoms of Myasthenia Gravis?

A

Symptoms include
- ptosis
- diplopia
- Dysphagia, Dyarthria
- muscle weakness after use
- fluctuating weakness during the day
- Easily fatigued muscles that improve with rest
- Altered voice, and choking.

50
Q

What is Parkinson’s disease?

A

Idiopathic neurodegenerative condition affecting dopamine cell degeneration, particularly in the substantia nigra

51
Q

Signs and Symptoms of Parkinson’s disease?

A

Tremor, rigidity (cogwheel or lead-pipe), akinesia/bradykinesia, postural instability, and resting tremor

52
Q

How does Parkinson’s disease affect motor movement?

A

Progressive degeneration of dopaminergic neurons in the substantia nigra can lead to altered motor movement, including loss of arm swing, shuffling gait, and postural instability

53
Q

Clinical presentation of Parkinsons?

A
  • Unilateral resting tremor
  • Decreased movement
  • Rigidity
  • Tremor disappears during finger-to-nose coordination testing, and patients may have difficulty with rapidly alternating movements
54
Q

How does Parkinson’s disease affect the “glabellar tap” reflex?

A

Patients with Parkinson’s disease often exhibit a persistent glabellar tap reflex (Myerson’s sign), where tapping on the forehead repeatedly causes sustained blinking.

55
Q

What is multiple sclerosis?

A

Chronic inflammatory autoimmune attack on the central nervous system (CNS) , causing demyelination and axonal damage.

56
Q

S/S of MS?

A
  • Visual disturbances: Optic Neuritis (Pain and loss in one eye), Diplopia
  • Motor symptoms: Muscle weakness, spasticity, tremors, difficulty with coordination & balance (ataxia)
  • Sensory symptoms: Numbness, tingling and pain
  • Bladder/Bowel dysfunction: Urinary urgency, incompetence, constipation
  • Sexual dysfunction: Reduced libido, erectile dysfunction in men vaginal dryness in women
  • Speech and swallowing difficulties: Dysarthria, dysphagia
  • Emotional changes: Depression, mood swings, anxiety
57
Q

Pathophysiology of MS?

A

Autoimmune attack on the CNS (specificallly the myelin sheath), leading to inflammation, demyelination of nerve fibres and axonal damage

58
Q

Pathomechanics of MS?

A

Disruption of neural transmission d/t demyelination and axonal damage results in slowed or blocked electrical impulses causing motor, sensory & cognitive impairment

59
Q

Demographics of MS?

A

Age of Onset: Typically 20-50 years old, peak incidence in 30s-40s
Gender: M/C in Women

60
Q

Demographics of MS?

A
  • 20-50yo/Peak Incidence 30-40yo
  • Gender M/C in Women
    -Geographical: Higher prevalence in regions farther from the equator (North America, Northern Europe)
61
Q

What are some environmental factors linked to multiple sclerosis?

A
  • Genetic Factors: Family Hx
  • Environmental factors: Vitamin D
  • Infection (Epstein Barr virus)
  • Smoking
  • Obesity
62
Q

What are the types of multiple sclerosis?

A

Types include
Relapsing MS,
Secondary Progressive MS, Primary Progressive MS Progressive-Relapsing MS.

63
Q

What are some common symptoms of multiple sclerosis?

A

Symptoms include

Visual disturbance (Diplopia)

Electric shock sensation (Lhermittes sign)

Motor symptoms - Spasticity

Balance and coordination issues - (Ataxia, Tremor)

Speech difficulties - Dysarthria

64
Q

What is Lhermitte sign?

A

Lhermitte sign is an electric shock-like pain that radiates down the spine or into the legs when the neck is flexed, often seen in multiple sclerosis.

65
Q

clinical tests of multiple sclerosis?

A

Clinical testing presentations may include

  • Increased reflexes
  • Babinski sign
  • Clonus, indicating damage to the nervous system.
66
Q

What is the main function of the cerebellum?

A

Motor Control

67
Q

How does damage to the cerebellum affect the body

A

Damage is on the ipsilateral side

68
Q

Causes of cerebellar lesions?

A
  • Vascular (Ischemic stroke)
  • Tumour (Metastatic tumours)
  • Traumatic (Head trauma), - Toxic (Alcohol, Drugs)
  • Infections (Bacterial infections)
  • Degenerative disease (Multiple sclerosis)
69
Q

Tests can be used to assess cerebellar lesions?

A
  • Heel to toe walking
  • Rhombergs
  • Finger to nose
  • Rapid alternating movement (dysdiadochokinesia),
  • British constitution speech test
70
Q

What are the 3 functional areas of the cerebellum and their associated signs of damage?

A

Vestibulocerebellum (unsteady, trunkal ataxia, nystagmus)

Spinocerebellum (intention tremor, ataxic gait, dysarthria, dysdiadochokinesia, dysmetria)

Cerebrocerebellum (dysarthria, finger ataxia)

71
Q

What is neurogenic claudication?

A

Pain and discomfort d/t nerve compression, typically spinal stenosis (pseudoclaudication) narrowing of the spine d/t cord compression

72
Q

What are common symptoms of neurogenic claudication?

A
  • Pain, tingling and weakness in legs or buttocks
  • Worsens with standing/Walking. Relieved by bending/Sitting
  • May affect one leg or both
73
Q

How is neurogenic claudication usually affected by activity?

A

It is usually worsened by standing or walking and relieved by sitting, leaning forward, or lying down.

74
Q

Clinical presentation of Neurogenic Claudication

A
  • Gradual onset
  • Relieved by postural changes (Leaning forward)
  • Neurological deficits may be present
75
Q

What is vascular claudication?

A

Vascular Claudication is a condition due to inadequate blood flow to the muscles during physical activity because of narrowed or blocked arteries.

76
Q

What are the symptoms of vascular claudication?

A

Patients often complain of

  • Leg pain
  • Cramping
  • Fatigue in the muscles of the legs or buttocks during exercise, which is elevated by rest.
77
Q

Main cause of Vascular Claudication

A

Peripheral Artery Disease (PAD) involving fatty deposits in leg arteries ,blood clots, inflammation, or structural abnormalities in blood vessels

78
Q

Clinical Presentation of Vascular Claudication

A

Pain and cramping usually felt in the calf muscles but can also affect the whole leg

  • Patients may complain of weakness during exercise
  • Colour changes may be noticed due to the lack of blood flow to the legs
  • Cold or numb feet may be present as well

No neurological deficits may be present

79
Q

What is the primary cause of neurogenic claudication?

A

Nerve compression due to spinal stenosis

80
Q

How are symptoms of neurogenic claudication relieved?

A

By sitting or bending forward

81
Q

What distinguishes vascular claudication from neurogenic claudication?

A

Vascular claudication is due to inadequate blood supply caused by arterial blockages, while neurogenic claudication results from nerve compression.

82
Q

How are symptoms of vascular claudication alleviated?

A

Simply by resting, regardless of posture

83
Q

What additional symptoms can be present in vascular claudication but not in neurogenic claudication?

A

Changes in skin color and temperature in the legs

84
Q

Why is it important to differentiate between neurogenic and vascular claudication?

A

To ensure appropriate diagnosis and treatment tailored to each condition

85
Q

What is Meralgia Paresthetica?

A

Compression of the lateral femoral cutaneous nerve, causing numbness or tingling in the outer thigh.

86
Q

Demographic of Meralgia Paresthetica

A

Adults aged 30 to 60, more prevalent in men than women, often associated with risk factors like obesity, diabetes, and pregnancy.

87
Q

How can obesity contribute to meralgia paresthetica?

A

Excess weight can increase pressure on the nerve

88
Q

How can tight clothing lead to meralgia paresthetica?

A

Wearing tight belts, corsets, or clothing that compresses the waist or thighs

89
Q

How can prolonged sitting or standing affect meralgia paresthetica?

A

Extended periods in one position can compress the nerve

90
Q

How can pregnancy be a risk factor for meralgia paresthetica?

A

Weight gain and changes in pelvic structure can lead to nerve compression

91
Q

How can injury or trauma contribute to meralgia paresthetica?

A

Direct injury to the pelvis or thighs

92
Q

Clinical presentation of Meralgia Paresthetica

A
  • A burning, aching, or sharp pain on the outer part of the thigh.
  • Sensations of numbness or tingling (paresthesia) in the affected area.
  • Increased sensitivity to light touch or pressure on the outer thigh.
  • Symptoms often worsen with standing, walking, or other activities that increase pressure on the nerve and improve with sitting or lying down.
93
Q

What are the conservative measures for treating Meralgia Paresthetica?

A

Weight loss, avoiding tight clothing, physical therapy

94
Q

How does weight loss help in treating Meralgia Paresthetica?

A

Reducing excess weight alleviates pressure on the nerve.

95
Q

What is central stenosis?

A

Narrowing of the central spinal canal

96
Q

What can central stenosis cause?

A

Compression of the spinal cord or cauda equina, leading to neurological symptoms

97
Q

Demographic Central Stenosis?

A

Older adults, typically over the age of 50, due to degenerative changes in the spine.

98
Q

What are the degenerative changes that can cause central stenosis?

A

Osteoarthritis leads to bone spurs, thickened ligaments, and herniated discs.

99
Q

How can spinal injuries contribute to central stenosis?

A

Fractures, dislocations, and scar tissue can narrow the spinal canal.

100
Q

In rare instances, what can cause central stenosis?

A

Tumors that compress the spinal cord.

101
Q

What is cervical myelopathy?

A

Cervical myelopathy is a condition resulting from compression of the spinal cord in the cervical spine (neck), leading to neurological deficits.

102
Q

Demographics of cervical myelopathy?

A

Typically affects older adults over 50 years old and individuals with a history of neck injuries or degenerative spine conditions.

103
Q

What are the common symptoms of central stenosis in the lumbar spine?

A

Neurogenic claudication, radiculopathy (sciatica), weakness, pain, numbness in lower back, buttocks, and legs

104
Q

What are the potential complications of severe central stenosis?

A

Bladder or bowel dysfunction

105
Q

What symptoms are observed in central stenosis affecting the cervical spine?

A

Myelopathy (weakness, numbness, clumsiness in arms and hands), radiculopathy (shoulder or arm pain, tingling), gait disturbances, impaired fine motor skills

106
Q

Vertebral Artery Insufficiency

A

A condition characterized by reduced blood flow to the brain due to compression or blockage of the vertebral arteries, which supply oxygen and nutrients to the brainstem and cerebellum.

107
Q

Pathophysiology of Vertebral Artery Insufficiency?

A

Compression or obstruction of one or both vertebral arteries, usually due to atherosclerosis, neck trauma, or vertebral bone spurs. The reduced blood flow can cause transient or permanent neurologic deficits, including dizziness, vertigo, headaches, visual changes, weakness, numbness, or difficulty speaking or swallowing.

108
Q

Signs and symptoms of Vertebral Artery Insufficiency

A

Symptoms:
Dizziness, vertigo, unsteadiness, or lightheadedness
Symptoms worsen with head movement or changes in posture
Nausea, vomiting, sweating
Difficulty swallowing.
5d’s n, a

109
Q

What is Stroke?

A

Neurological disorder where poor blood flow to the brain leads to death, leading to neurological movement. Theres 2 main types: ISchemic (d/t blockage) & Hemorrhage (d/t Bleeding)

110
Q

Demographics of Stroke?

A

M/C in older adults, particularally those over 65
- Gender: Slightly M/C in men
- Ethnicity: Higher incidence in african american, Hispanics and South Asians
- Risk Factors: Hypertension, diabetes, Smoking, Obesity & high cholesterol

111
Q

Underlying Pathology of Stroke?

A

Ischemic Stroke: Caused by blockage in a blood vessel supplying the brain often d/t a blood clot (Thrombosis)

112
Q

Vertebral artery dissection?

A

Vertebral artery dissection (VAD) occurs when there is a tear in the inner lining of the vertebral artery. This tear allows blood to enter the wall of the artery, creating a false passage or lumen.

This can lead to complications such as restricted blood flow to the brain and blood clots, potentially causing a stroke.

VAD is a notable cause of stroke, especially in younger people

113
Q

Cause of VAD?

A

Trauma: Physical Trauma to the neck, such as from RTA, sports injuries or chiropractic manipulations can lead to VAD
Spontaneous: Sometimes VAD occur without any apparent trauma or injury. This can be associated with Marfans Syndrome or Ehlers-Danlos syndrome
Acitivities: Certain actions that involve sudden neck movements or hyperextension, such as yoga, heavy lifting or even coughing or sneezing can cause VAD

114
Q

S/S of VAD?

A
  • Headache (Posterior)
  • Neck pain (Posterior)
  • Dizziness
  • Ataxia
  • Dysphagia (Cranial Nerves 9 - 10)
  • Disequillibrum
  • Unilateral hearing loss
  • Dysarthria
  • Diplopia
  • Vertigo
115
Q

What is CAD?

A

Tear in the inner lining of the cartoid artery that can lead to formation of a false lumen, reduced blood flow to the brain, and the risk of stroke

116
Q

Vertebral Artery Dissection

A

Tear in the inner lining of the vertebral artery, creating a false lumen that can disrupt blood flow to the brain and increase the risk of stroke.

117
Q

S/S VAD

A

Dizziness
Ataxia
Difficulty swallowing (CN 9&10)
Vertigo
Diplopia
Dysarthria

END OF YEAR NEURO-ORTHO (5 decks)

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