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PNS Tx 600 > Week 1: Intro, Bell's Palsy > Flashcards

Week 1: Intro, Bell's Palsy Flashcards

1
Q

PNS

A

All neural structures outside the brain and spinal cord.

Sensory receptors, peripheral nerves, ganglia, efferent motor endings.

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2
Q

Nerve

A

Parallel bundles of peripheral axons enclosed by successive wrappings of connective tissue:

Endoneurium
Perineurium
Epineurium

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3
Q

Endoneurium

A

In a spinal or cranial nerve, the innermost layers of tissue surrounding an individual axon.

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4
Q

Perineurium

A

Intermediate (and thickest) layer of connective tissue in a spinal/cranial nerve. Covers fascicle.

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5
Q

Fascicle.

A

A bundle of endoneurium-wrapped axons, itself wrapped in perineurium.

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6
Q

Epineurium

A

Most superficial layer of connective tissue covering spinal/cranial nerves. Fibroblasts and thick collagen fibres.
Encases bundles of fascicles (ie the entire nerve).

Where the blood supply is.

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7
Q

Peripheral Nerves are classified as either:

A

Cranial or spinal

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8
Q

Ganglia

A

Collection of neuron cell bodies in the PNS.

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9
Q

The Cranial Nerves

A 
I. Olfactory
II. Optic
III. Occulomotor
IV. Trochlear
V. Trigeminal
VI. Abucens
VII. Facial
VIII. Vestibulocochlear
IX. Glossopharyngeal
X. Vagus
XI. Accessory
XII. Hypoglossal
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10
Q

Somatic Nervous System

A

Innervates all sensory organs, and voluntary muscles.

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11
Q

Nervus nervorum

A

The nerve’s nerve

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12
Q

Neuropathology

A

Study of diseases of the nervous system. Anatomic .

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13
Q

Neuropathy

A

Functional disturbance and/or pathological change in PNS. Typically causes numbness and/or weakness.

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14
Q

Neuralgia

A

Pain along the course of a nerve often in absence of objective signs

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15
Q

Neuritis

A

Inflammation of one or more nerves

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16
Q

Radiculopathy/Radiculitis

A

Damage to nerve root

Often results in pain along dermatome

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17
Q

Polyradiculopathy

A

Radiculopathy involving more than one nerve root

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18
Q

Causalgia

A

Peripheral nerve injury that causes severe SNS hyperactivity. (CRPS Type II)
Hyperalgesia
Sustained burning pain after nerve injury.
Should resolve after injury does.

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19
Q

Wallerian Degeneration

A

Demyelination and degeneration of axon distal to injury.

Neurolemma remains, Schwann cells multiply and form a regeneration tube, which guides the growth of a new axon.

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20
Q

Neuropraxia

A

1st degree damage
Transient conduction block

Local demyelination

Can affect either motor or sensory, but usually not both

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21
Q

Axonotmesis

A

2nd degree damage from prolonged, severe compression

Endoneural tube intact

Wallerian degeneration

Massage can help increase healing and maintain tissue health

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22
Q

Neurotmesis

A

Severance of nerve
Endoneural tube severed.

Sensory, motor and autonomic losses
Poor prognosis

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23
Q

Nerve lesions can be:

A

Complete or partial

Permanent or regenerating

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24
Q

Free Coaptation

A

Surgical procedure
Graft nerve without undue tension

When treating, be cognizant of new nerve position

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25
Q

Segmental Demyelination

A 
Local damage to the myelin sheath.
Often from (or synonymous with, or characteristic of) neuropraxia
Axon remains intact; remyelination and recovery occurs
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26
Q

Polyneuropathy

A

AKA polyneuritis

Widespread degeneration of peripheral nerves. Often symmetrical

Classically:

  1. symmetrical weakness
  2. symmetrical distal sensory symptoms (ie stocking and glove)
  3. hyporeflexia (esp with DM, leprosy, infections, Vit B deficiency)
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27
Q

Motor Neuropathy

A

Weakness, flaccid paralysis, atrophy, decreased DTR’s

Ex. Guillain-Barre syndrome

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28
Q

Sensory Neuropathy

A

Only sensory nerves affected.

Paresthesias, dysesthesias, numbness

29
Q

Paresthesia

A

A sensation of tingling, tickling, pricking, or burning of a person’s skin with no apparent and obvious long-term physical effect.

Pins and needles, foot falling askeep

30
Q

Dysesthesia

A

Abnormal, unpleasant sensation. Spontaneous or evoked

31
Q

Autonomic neuropathy

A

Can include hypotension, anhydrosis, diaphoresis, diarrhea or constipation

32
Q

Intraneural edema

A

Can develop after trauma. At first can impair normal surroundings and then nerve function.

Edema affects ability of nutrients to pass vessel walls, ECM and basal membrane of Schwann cells to reach nerves.

Can lead to fibroblast formation

33
Q

Compression can lead to

A 
Extraneural pressure -->
Intraneural pressure -->
yadda yadda yadda -->
Fibrosis (weakness)
Degeneration of the distal end (motor loss)
Conduction blockage (reflex)
34
Q

UMN vs LMN: reflexes

A

UMN hyperactive

LMN diminished or absent

35
Q

UMN vs LMN: Atrophy

A

UMN absent

LMN: present

36
Q

UMN vs LMN: Fasciculations

A

UMN: absent
LMN: present

37
Q

UMN vs LMN: Tone

A

UMN: increased
LMN: decreased or absent

38
Q

Neurogenic vs Myogenic: Distribution

A

Neuropathic: distal> proximal
Myopathic: proximal> distal

39
Q

Neurogenic vs Myogenic: fasciculations

A

Neuropathic: maybe
Myopathic: absent

40
Q

Neurogenic vs Myogenic: reflexes

A

Neuropathic: diminished
Myopathic: unaffected

41
Q

Neurogenic vs Myogenic: sensory Sx

A

Neuropathic: maybe
Myopathic: unaffected

42
Q

Hyperreflexia

A

overactive reflexes

Associated with UMN lesions (long motor tracts from the bran)

Twitch, spasm

43
Q

Clonus

A

Involuntary muscle contractions due to sudden stretching of the muscle. Usually reflex origin.

UMN.

44
Q

Fasciculation

A

Small, local, involuntary twitching
From spontaneous discharge of skeleton muscle fibres

LMN

45
Q

Dystrophy

A

Degeneration of tissue due to disease or (most commonly) malnutrition.
CNS involvement

46
Q

Flaccidity

A

Atonic muscles

47
Q

Spasticity

A

Involuntary muscle tone that is resistant to movement.

Mainly CNS

48
Q

Atrophy

A

Partial or complete wasting of part of the body.

49
Q

General Considerations of Neurological Exams

A

Right to left symmetry
Central vs peripheral deficits
7 categories of consideration

50
Q

What are the seven categories to consider in neurological exams?

A
  1. mental status
  2. cranial nerves
  3. motor
  4. coordination and gait
  5. reflexes
  6. sensory
  7. special tests
51
Q

Bell’s Palsy

A

Unilateral lesion of the Facial Nerve (CN VII).
LMN Mononeuropathy
Characterized by facial hemiparesis

Idiopathic. Maybe infection, maybe trauma, maybe tumours

52
Q

Motor Branches of the Facial Nerve

A
  1. Temporal (orbit, forehead)
  2. Zygomatic (orbital area)
  3. Buccal (buccinator, upper lip)
  4. Mandibular (lower lip, chin)
  5. Cervical (platysma, stylohyoid, post. digastric)
53
Q

Entrapment of Facial Nerve

A

Before Geniculate Ganglion: all functions

After exiting stylomastoid foramen, effects can be limited to motor (or sensory, or autonomic, one would think)

54
Q

Difference between CNVII innervation of the forehead vs lower face

A

Forehead: receives CL and IL innervation
Lower face only receive CL innervation
Xover occurs before pons nuclei

55
Q

Distinguishing between Bell’s Palsy and UMN lesion (ie stroke)

A

Stroke would spare forehead; affect lower muscles CL to lesion.

Bell’s Palsy has IL paralysis of upper and lower face.

56
Q

Chvostek’s Sign

A

Test for Facial Nerve lesion.

Tap facial nerve just anterior to earlobe, or between zygomatic arch and corner of moth.

Postive response: twitching of mouth to more wide-ranging spasm of facial muscles

57
Q

Testing CN I

A

Identify odours

58
Q

Testing CN II

A

Test visual fields

59
Q

Testing CN III

A

Upward, downward, medial gaze.

Rxn to light

60
Q

Testing CN IV

A

Look down and out

61
Q

Testing CN V

A

Corneal reflex
Face sensation
Clench teeth

62
Q

Testing CN VII

A

Close eyes
Smile, show teetch
Whistle. Puff cheeks.
ID tasts

63
Q

Testing CN VIII

A

Hearing test.

Balance and coordination test.

64
Q

Testing CN IX

A

Gag reflex

Ability to swallow

65
Q

Testing CN X

A

Gag reflex
Ability to swallow
Say “ahhhh”

66
Q

Testing CN XI

A

Resisted shoulder shrug

67
Q

Testing CN XII

A

Tongue protrusion

68
Q

Crocodile tears

A

Cross innervation. Tears while eating

PNS Tx 600 (1 decks)

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