diff dx neuro- pathologies

Question 1

diabetic sensory neuropathy
 presentation
 type of neuropathy
 onset
 early signs (2)
 clinical features

Answer 1

presentation: symmetrical, mainly sensory stocking and glove presentation

starts as isolated mononeuropahy and progresses to polyneuropathy

insidious onset

earl signs; loss of ankle reflex & decreased vibratory sense in foot

clinical signs tell us type of fiber involvement; small fibers (myelinated & unmyelinated) => distal pain and parasthesia

Question 2

neuropathic diabetic ulceration presentation

Answer 2

beefy red, because good vascularity

Question 3

diabetic autonomic neuropathy (5)

Answer 3

1. loss of sexual response & impotence
2. hypotonic bladder => incontinence or infection
3. disturbance of BP & HR control
4. GI dysfunction ( bloating, nausea, diarrhea)
5. diffuse or absent sweat response

Question 4

diabetic focal neuropathy (2)

Answer 4

1. appears sudden

2. improves in weeks or months w/o chronic damage

Question 5

alcoholic neuropathy
cause
presentation
common complaint

Answer 5

1. caused by vi-B deficiency (only seen with alcoholics)
2. typically mixed; primarily or solely lower limbs, pain, weakness & paraesthesia
3. c/o intense burning paraesthesia in soles of feet

Question 6

pathophysiology of alcoholic neuropathy

Answer 6

relatively mild reduction of motor and sensory conduction velocities => deceased amplitue of sensory action potentials

Question 7

Guillain-Barre syndrome (3)

Answer 7

1. ascending weakness
2. acute, progressive, symmetrical ridiculopathy
3. presents as inflammatory cell attack on the myelin sheaths with myelin breakdown and often axonal degeneration

Question 8

3 types of GBS

Answer 8

1. acute inflammatory demylinating polyridiculoneuropathy
   most common, affects motor & sensory
2. acute motor axonal neuropathy
   sensory intact
   not demylinating => destroys axon = destroys AHC
3. acute motor & sensory neuropathy
   rarest, with poor prognosis for recovery

Question 9

GBS recovery

Answer 9

can take from 2-3 months to 5 years

acute motor & sensory neuropathy has the worst prognosis

Question 10

GBS pt intervention
acute (4)
subacute (4)
chronic (5)

Answer 10

acute:
1. prevent contractures
2. manage pain
3. respiratory management
4. blood gas levels

subacute:

1. ROM
2. ADL
3. muscle strengthening** don’t over fatigue PNS when healing*
4. respiratory management continued

chronic:

1. strengthening
2. ROM
3. increased endurance & aerobic conditioning
4. ** always avoid undue fatigue
5. pain management

Question 11

charcot-marie-tooth disease
a.k.a.
dx (6)

Answer 11

a.k.a. hereditary motor & sensory neuropathy (HMSN)

dx

1. pt hx (atrophy and weakness)
2. family hx (genetic)
3. physical exam
4. nerve conduction studies
5. nerve biopsy
6. genetic testing

Question 12

CMT/HMSN type I
what type
pathophys
cause

Answer 12

demyelination

repeated cycles o demyelination & remyslination which thicken around axons (can be palpated) “onion bulbing”

mutation of peripheral myelin protein (PMP)

Question 13

CMT/HMSN type II

Answer 13

axonal

direct axonal death

Question 14

clinical presentation of CMT type I
 characterized by...
 cause
 clinical presentation (5)
 sensory

Answer 14

1. characterized by slow progressive weakness & atrophy beginning in distal limb muscles
2. histologically => onion bulbing

caused by autosomal dominant gene

clinical presentation:

1. high steppage gait due to foot drop
2. inverted “champange bottles” appearance of the limbs = significant distal atrophy*
3. bilateral pes cavus due to intrinsic foot muscle weakness and wasting
4. areflexia
5. gait ataxia, positive rhomberg test

sensory affected but pt doesnt complain because they never had normal sensory to being with

Question 15

thoracic outlet syndrome

def

Answer 15

compression neuropathy and vascular involvement of brachial plexus or subclavian vessels

Question 16

neurogenic TOS

characteristic sign

Answer 16

rarest/ least common

characteristic sign called Gilliatt-Summer hand = severe wasting in the fleshy base of the thumb. there may be numbness along the underside of the hand and forearm or dull aching pain in the neck, shoulder and armpit

Question 17

vascular TOS
presentation (5)
symptoms (4)

Answer 17

pallor, weak or absent pulse in affected arm.
may be cool to the touch and paler than affected limb.

symptoms

1. numbness
2. tingling
3. aching
4. heaviness

Question 18

4 locations/ types of T.O.S.

Answer 18

1. cervical rib (very rare)
2. anterior scalene syndrome
3. pec minor syndrome (usually postural)
   btwn muscle & rib with elevation/abduction above head
4. costoclavicular syndrome
   btwn clavice & 1st rib w/ depression and retraction

Question 19

adson test

Answer 19

testing for anterior scalene syndrome

turn head to involved side, extend head & neck, abduct arm & deeply inhale. check radial pulse and or replication of symptoms

Question 20

2 most common causes of TOS

Answer 20

1. acute trauma + anatomic predisposition

2. repetitive stress + poor posture

Question 21

pronator teres syndrome

symptoms

Answer 21

compression syndrome

1. more common in females
2. anterior proximal pain
3. point tenderness over pronator teres
4. positive tinels signe
5. resisted pronation => increased symptoms

Question 22

ulnar at the elbow / tardy ulnar palsy/cubita tunnel (3)

and who is at risk

Answer 22

1. comes on 15-20 years after fx of med epicondyle
2. pain in medial forearm
3. occurs with prolonged elbow flexion &/ or subluxation of nerve from ulnar groove

SCI pts are at high risk because of all the mat exercises, need elbow pads

Question 23

5 causes of compartmental syndromes

Answer 23

1. edema
2. tendon hypertrophy
3. repetitive motion
4. metabolic conditions = diabetes
5. anatomical changes (arthritic)

Question 24

5 pt interventions for carpal tunnel (CTS) and all compression injuries

Answer 24

1. 24 hr splinting
2. pulsed US (to increase blood flow)
3. nerve gliding - neural tension testing
4. tendon gliding
5. hand strengthening- intrinsics * not long finger flexors that are inn by medial nerve*

Question 25

bells palsy lesion presentation cause

Answer 25

LMN lesion, on CN 7 asymmetrical facial paralysis, frontalis affected caused by herpes zoster up to 50% of the time

Question 26

``` myasthenia gravis what is it initial presentation bulbar manifestation triggers pt intervention ```

Answer 26

autoimmune disorder linked to thymus gland that decreases ACH packets and receptors at NMJ initial presentation is ptosis and/or diplopia & weakness with abnormal fatigue in PROXIMAL muscles can have bulbar &/or respiratory weakness -> medical emergency bulbar manifestation => dysphagia, dysphonia triggers include pregnancy, stress & infection pt intervention = energy conservation, low impact aerobics

Question 27

botulism

Answer 27

blocks the release of ACH descending paralysis w/ dyspnea w/i 12 hrs

Question 28

muscles commonly affected by myasthenia gravis

Answer 28

PROXIMAL! 1. eye lid/ ptosis is first affected usually 2. UEs 3. neck 4. trunk 5. hip flexors

Question 29

what is double crush syndrome?

Answer 29

two distinct, local lesions on 1 nerve | Seen with CTS and a lot of diabetics