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
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
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
- Raynauds disease
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
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
- Myasthenia gravis
6
Q
- Usually w/ underlying cancer
- Presynaptic disorder, not enough acetylcholine
- Considered myasthenic→ all symptoms of myasthenia gravis
A
- Eaton Lambert syndrome
7
Q
disorders of NMJ
A
- Myasthenia gravis2. Eaton Lambert syndrome
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
9
Q
Conus Medullaris Syndrome
A
Conus Medullaris Syndrome
10
Q
- viral infection of anterior horn, LMN, via digestive system
A
polio
11
Q
- upper trunk brachial plexus (C5,6)
- traction injury, waiter’s tip
A
Erb Duchene Palsy
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
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
14
Q
+ Wright’s only at 180 degrees, managed by anterior inferior humerus adjustment
A
Humeral Head Syndrome
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
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
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
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
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
20
Q
- Differential from L3-4 radiculopathy→ femoral vs obturator
- Loss of DTR, anterior thigh weakness, sensation loss
A
femoral neuropathy
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
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
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
- 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
Morton’s Neuroma (Metatarsalgia)
26
read chapt 10 review
okie dokie?
27
* 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
Optic/Bulbar Neuritis
28
Doesn’t go through thalamus.
olfactory Nerve CN1
29
loss of smell
anosmia
30
increased sensitivity
hyperosmia
31
abnormal sensations of smell
paraomia
32
CN1 lesions caused by
1. cocaine or inhalants
2. tumor of frontal lobe or pituitary tumor
3. viral infection
4. trauma at cribriform plate
33
- 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
Trigeminal neuralgia: AKA tic douloureux
34
- 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
Trigeminal nerve lesion:
35
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
Bell’s Palsy
36
- tinnitus- ringing, buzzing, roaring, drugs, increased fluid pressure
- auditory scotomas- loss of hearing at certain frequencies
- auditory hallucinations- temporal lobe lesion
Cochlear Lesion
37
- 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
Schwannoma / Accoustic Neuroma
38
- 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)
Vestibular Nerve lesion (motion sickness)
39
- inner ear disorder, too much fluid (endolymph), overstimulates inner ear, flare ups and remissions, progressive cumulative deafness, possibly with vertigo
Meniere’s
40
- glossopharyngeal neuralgia
- tachycardia (loss of carotid sinus reflex)
- loss of gag reflex and dysphagia
- loss of bitter taste on posterior 1/3 of tongue
Glossopharyngeal Nerve lesion CN IX
41
- 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
vagus nerve lesion
42
- inspect for deviation and muscle test
| - atrophy, deviation, fasciculation (toward side of lesion)
hypoglossal nerve lesion
43
- 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
Spinal accessory nerve lesion
44
cross eye, LR weakness
- Estropia
45
eye pushed out laterally, wall eye, MR weakness
- Extraopia
46
- Hypertropia
superior, SO weakness
47
- 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)
Oculomotor palsy
48
- 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
Trochlear palsy:
49
- Increased intracranial pressure, important early sign
- Right palsy: ok when looking left, worse when looking toward the bad side
- Head rotation
Abducens palsy:
50
- 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
Intranuclear opthalmoplegia:
51
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
Anisocoria
52
- direct light reflex diminished, indirect normal.
- Afferent problem: optic nerve, retina, or eye lesion.
- Swinging flashlight test
Marcus Gunn Pupil:
53
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
Benign anisocoria:
54
- III, IV, VI: total opthalmoplegia with fixed dilated pupil.
- V1 and sometimes V2: loss of facial sensation
- Caused by space occupying lesion
Cavernous sinus syndrome:
55
- cavernous sinus syndrome and CN II
Orbital apex syndrome:
56
- Pineal tumor or hydrocephalus.
| - Bilateral light near dissociation, impaired convergence.
Parinauds syndrome:
Neuro Diagnosis
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Decks in class (13)
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