Term
| What are the two structural divisions of NS |
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Definition
|
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Term
| What are the two functional divisions of the NS? |
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Definition
|
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Term
| what are the functions of the FRONTAL lobe? |
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Definition
behavior, emotion, problem solving
Primary MOTOR region of the PREcentral gyrus |
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Term
| What are functions of the Temporal Lobe |
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Definition
Language and hearing
short-term memory and identification of smell |
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Term
| What are the fxns of the PARIETAL lobe |
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Definition
Touch
primary SENSORY region on POSTcentral gyrus |
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Term
| What is the fxn of the basal ganglia? what do lesions cause? |
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Definition
Coordinate motor activity
lesions cause "extrapyramidal" movement disorder symptoms (autonomic sx) |
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Term
| What does the corticospinal tract control? |
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Definition
VOLUNTARY movement
aka Corticospinal tract |
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Term
| What are the two main SENSORY pathways |
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Definition
1. dorsal column
2. spinothalamic tract |
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Term
| What are the two motor regions? |
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Definition
1. pyramidal system
A) UMN: run from motor cortex --> spinal cord
B.) LMN: spinal cord--> target muscle
2. Extrapyramidal: Autonomic
A. basal ganglia
B. cerebellum |
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Term
| what does neuropathy mean? |
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Definition
| disturbance in function of a nerve |
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Term
| What does radiculopathy mean? |
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Definition
| pain/paresthesia/numbness along the distribution of the dermatome |
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Term
| What does plexopathy mean |
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Definition
| disturbance in the distribution of a nerve plexus DISAL to the spinal root but PROXIMAL to the formation of peripheral nerves |
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Term
| What is a purely sensory Neuropathy caused by? |
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Definition
| Leprosy, some industrial solvents, hereditary |
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Term
| What is purely motor neuropathy caused by |
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Definition
| Gullian Barre, hepatitis, lead poisoning |
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Term
| What is weakness the result of? |
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Definition
| can be the result of primary disease of muscles (myopathy) or nerves that stimulate them |
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Term
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Definition
| complete absence of strength |
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Term
|
Definition
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Term
| What does hemiplegia mean |
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Definition
| paralysis in both limbs on ONE side of the body |
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Term
| What does Paraplegia mean |
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Definition
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Term
|
Definition
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Term
| What are myopathic disorders characterized by? |
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Definition
weakness that is more PROXIMAL than distal
- muscle wasting, and DTR depression occurs in late stages
-the abdominal and plantar reflexes are NORMAL
- No sensory or sphincter disturbances |
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Term
| What does an abrupt onset of neuromuscular disorder sx suggest? |
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Definition
| stroke, or certain toxic or metabolic disturbances |
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Term
| What does SUBACUTE neuromuscular disorder sx suggest |
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Definition
| suggest neoplastic, infectious, or inflammatory |
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Term
| what does weakness that develops slowly suggest |
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Definition
| suggest hereditary, degenerative, endrocrinologic, or neoplastic |
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Term
| What are rapid fluctuation symptoms over a short period of time characteristic of? |
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Definition
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Term
| What does atrophy suggest? |
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Definition
| Lesion of the LMN or muscle itself |
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Term
| What do fasciculations suggest |
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Definition
| lesions of the LMN likely |
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Term
| What is hypertonia? What does it imply? |
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Definition
Spasticity= increased muscle tone that varies (UMN lesion)
Ridigity= stiffness or inflexibility ( suggest extrapyramidal dysfunction) |
|
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Term
| what does HYPOtonia suggest? |
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Definition
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Term
| What does HYPERreflexia suggest? |
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Definition
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Term
| What does HYPOreflexia suggest |
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Definition
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Term
| What does a focal reflex deficit suggest? |
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Definition
lesions in the root, plexus, or peripheral nerve lesion
(i.e. unilateral depression of ankle jerk may be due to S1 radiculpathy from Lumbosacral disc) |
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Term
| What are spinal cord symptom "red flags"? |
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Definition
1. history of TRAUMA (r/o fracture with plain films)
2. pain at night (R/O malignancy with CT or MRI)
4. Bowel or bladder incontinence ( R/O cauda equina syndrome with MRI stat) |
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Term
| What symptoms occur with Total Spinal Cord transection? |
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Definition
immediate flaccid paralysis and loss of sensation BELOW the level of injury
- Spinal Shock: loss of reflex below the injury and hypotension due to unopposed vagal tone
- urinary and fecal RETENTION |
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Term
| What is the treatment for Total spinal cord transection? |
|
Definition
tx with steroid burst
tx painful spasms with Baclofen & Benzodiazepine
-prevent skin breakdown
-urinary catheterizaiton, enemas PRN |
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|
Term
| What does Brown- Sequard syndrome result from |
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Definition
Partial cord transection
can be caused by trauma, tumors, infection |
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Term
| What are the S&S of Brown-Sequard syndrome? |
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Definition
diminished motor stregnth and fine touch position
diminished positions and vibratory sense on the SAME SIDE of the injury (posterior column sensory loss)
- loss of PAIN and TEMP sensation on the OPPOSITE side of the injury |
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Term
| What is not affected in Brown-Sequard Syndrome? |
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Definition
| Bladder function may be spared since bilateral lesions are required to interfere with bladder fxn |
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Term
| What is tx for Brown-Sequard Syndrome |
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Definition
|
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Term
| What is Epidural Spinal Cord compression caused by |
|
Definition
| caused by tumor pressing on the dural sac |
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Term
| What are the S&S of Epidural Spinal cord compression |
|
Definition
presents with PAIN (most common) , especially at night
- may get weakness (LMN deficiets) and radicular sensory defects
Late findings: 1.) loss of sensory fxn
2.)paraplegia
3.) incontinence |
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Term
| What site is most affected with Epidural Spinal cord Compression? |
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Definition
| Thoracic spine - often the site of tumor |
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Term
| What is intervertebral disc prolapse? |
|
Definition
when nucleus pulposus herniates and presses on the the nerve root
> get radicular symptoms along the nerve distribution on ONE side |
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Term
| What causes Cauda Equina Syndrome |
|
Definition
Centrally prolapsed disc that can lead to BILATERAL signs and symptoms
> can be caused by tumor, infection, fracture, or narrowing of canal |
|
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Term
| What are the S&S of Cauda Equina Syndrome |
|
Definition
| - "saddle anesthesia", bladder or bowel dysfunction, variable motor and sensory loss in LOWER extremities |
|
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Term
| What imaging is used to evaluate a patient without neurologic deficits with disc prolapse? |
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Definition
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Term
| What imaging is used to evaluate a patient WITH neuro deficits with disc prolapse? |
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Definition
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|
Term
| What is Amyotrophic Lateral Sclerosis? |
|
Definition
| a progressive disorder with degeneration of the CORTICOSPINAL pathways down the anterior horn cells |
|
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Term
|
Definition
30-60 y/o
>mixed UMN and LMN deficits
> weakness, easily fatigued
> sensation is NORMAL
> Corticobulbar involvement: difficulty speaking, swallowing, chewing, breathing. **Tongue fasciculation is a classic finding** |
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Term
| What type of studies are useful in ALS? |
|
Definition
1. Muscle biopsy: reveals denervation atrophy
2. Nerve biopsy
3. EMG: reveal fasciculations and fibrillations in both upper and lower limbs. Normal motor conduction and nromal sensory conduction |
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|
Term
|
Definition
Riluzole - inhibits presynaptic glutamate release
only slows the progress, no cure |
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Term
| What are the isolated peripheral neuropathies? (7) |
|
Definition
1. Facial = bell's palsy
2. Radial = "Saturday night palsy"
3. Median = Carpal tunnel syndrome
4. Ulnar = "funny bone" tingle
5. Lateral femoral cutaneous nerve = Meralgia paresthetica
6. Deep peroneal nerve = compartment syndrome
7. Posterior tibial nerve = Tarsal tunnel syndrome |
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Term
| What is Multiple Sclerosis? Where do lesions occur? |
|
Definition
Focal demyelination and damage to axons due to immune rxn against myelin
>lesions occur in white brain & spinal matter and in CN II |
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|
Term
|
Definition
- young adults (20-40 y/0)
- women >>men
- sx are TRANSIENT: paresthesia, gait disorder, focal weakness, diplopia, internuclear opthalmoplegia |
|
|
Term
| what is internuclear ophthalmoplegia? |
|
Definition
- caused by MS and lesion in the medial longitudinal fasciculus (MLF)
Eyes can converge but there is Paresis of eye adduction in lateral horizontal gaze
> the ABducting eye exhibits nystagmus |
|
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Term
| What are the LATE S&S of Multiple Sclerosis? |
|
Definition
-Ataxia
-UMN deficits in limbs: spasticity, impaired vibratory, pain, temp sense, impaired RAMs
-Optic neuropathy
- nystagmus
-dysarthria
- internuclear opthalmoplegia |
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Term
| What is the test of choice to diagnose MS? |
|
Definition
| MRI --> requires at least two different regions of the central white matter |
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Term
| What MS subtype is characterized by unpredictable relapses followed by periods of months to year of remission with no new signs of disease activity? |
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Definition
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Term
| What MS subtype is characterized by neurologic decline between their acute attacks without any definite periods of remission with new neuro deficits? |
|
Definition
Secondary Progressive
- most common type of MS |
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Term
| What MS subtype is characterized by continuous decline without clear attacks? |
|
Definition
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Term
| What MS subtype is characterized by a steady neuro decline but also suffer superimposed attacks |
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Definition
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|
Term
| What is the tx for Acute relapses in MS? |
|
Definition
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|
Term
| What is the tx for long-term immunodulation in MS? |
|
Definition
1. Beta - interferon (Avonex)
2. Glatiramer acetate |
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Term
|
Definition
| viral infection causes destruction of the anterior horn cells in the spinal cord |
|
|
Term
| What is Herpes Zoster (Shingles)? |
|
Definition
| a reactivation of the varicella virus that presents with pain and a maculopapule rash |
|
|
Term
| What nerve roots are most commonly affected by Herpes zoster? |
|
Definition
| Thoracic and Lumbar roots |
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|
Term
| What is Guillain-Barre Syndrome? What is it associated with? |
|
Definition
POLYNEUROPATHY that may follow an illness or vaccination
- associated with preceding C. jejuni enteritis |
|
|
Term
| what are the S&S of Guillian-Barres syndrome? |
|
Definition
Main complain is SYMMETRICAL WEAKNESS
-weakness begins in legs and ascends
NO pain
DTR = absent |
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Term
| What studies are useful in evaluating Guillian-Barre? |
|
Definition
1. CSF = high protein, normal cell count
2. NC study shows slowing of motor and sensory conduction (demyelinated pattern) |
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Term
| What is the treatment for Guillian Barre? |
|
Definition
1. hospitalization -->airway is a main concern!
2. IV immunoglobulins
3. plasmapheresis
4. steroids are NOT helpful |
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|
Term
| What does diabetic peripheral neuropathy present as? |
|
Definition
presents as distal symmetric sensorimotor polyneuropathy
> muscle weakness, balance problems, pain, anesthesia |
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Term
| What occurs with Clostridium tetani? |
|
Definition
| the toxin binds irreversibily to receptors in the brain and spinal column, blocking release of GABA (inhibitor) |
|
|
Term
| what are the S&S of Clostridium tetani? |
|
Definition
| unchecked excitatory impulses --> increased muscle tone, spasms, rigidity |
|
|
Term
| how do you treatment Clostridium tetani? |
|
Definition
treat with tetanus immune globulin
Hospitalize |
|
|
Term
| What occurs with Clostridium botulinum? |
|
Definition
| toxin binds to presynaptic sides of the peripheral cholinergic synapses at NMJ, irreversibily disrupting acetylcholine release |
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|
Term
| What are the clinical finding in Clostridium botulinum? |
|
Definition
weakness to limbs (late manifestation)
-Blurry vision, dryness of mouth, paralytic ileus, postural hypotension
- NO sensory deficit, normal DTRs
- facial weakness, diplopia, ptosis, dysphagia, difficulty breathing |
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|
Term
| What is Myasthenia gravis caused by? |
|
Definition
| variable block of transmission at NMJ due to decreased number of functioning ACh receptors |
|
|
Term
|
Definition
-diplopia, ptosis (EOMs first affected)
- difficulty chewing, swallowing, and speaking
-general weakness
- symptoms worse at the END of the day
- normal sensation and reflexes |
|
|
Term
| What may a CT reveal in Myasthenia gravis? |
|
Definition
|
|
Term
|
Definition
| Anticholinesterase drugs: Pyridostigmine (symptomatic relief only) |
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