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South College
Neuroanatomy Week 9 RB
31
Anatomy
Graduate
12/08/2008

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Term
Focal nerve disorders
Definition
mononeuropathy
Term
multifocal nerve disorder
Definition
mononeuropathy multiplex
Term
generalized nerve disorders
Definition
* polyneuropathy aka "peripheral neuropathy"
 
* axon-losing peripheral neuropathy
 
* demyelinating peripheral neuropathy (AIDP)
Term
axon-losing peripheral neuropathy
Definition
*sensory loss: distal, stocking-glove pattern, symmetrical
 
*cause: multiple mechanisms (ex: compromise of microvascular blood supply of the peripheral nerves)
Term

Demylinating peripheral neuropathy (AIDP)

Definition
*aka Guillain Barre Syndrome
*cause: immune-mediated demyelination of peripheral nerves
*onset: usu. 2 weeks after viral illness
*duration: peak at 3 weeks, recover over many months
* clinical presentation: PENPA
Progressive weakness
Elevated CSF protein
Nerve conductions show demyelination
Paresthesias
Areflexia
Term
Disorders of Neuromuscular Junction
Definition
* generalized symmetrical motor weakness
* weakness worsens throughout the day
*normal reflexes
*no sensory deficits, purely motor
*chronic condition
Term
Myasthenia Gravis
Definition
*disorder of neuromuscular junction
*antibodies against postsynaptic Ach receptors in NMJ
*Diagnosis: blood test - anti-Ach receptor Abs
*Thymomas present in 12%
*Treatment: pyridostigmine (Mestinon, cholinesterase inhibitor), plasma exchange, azathioprine (Imuran)
Term
Disorders of Muscle
Definition
*myopathy
*weakness greater proximally (neuropathy occurs distally)
*normal sensation and reflexes
*elevated CPK
*EMG: myopathic potentials
*causes: duchenne muscular dystrophy, polymyositis
Term
duchenne muscular dystrophy
Definition
* x-linked recessive inheritance - affects male kids
* absense of dystrophin protein
Term
spondylolisthesis
Definition
displacement of vertebral body relative to vertebrae beneath it
Term
osteophyte
Definition
bony spur
Term
spinal stenosis
Definition
narrowing of spinal canal
Term
radiculopathy
Definition
* pinched nerve root: affect dermatome area
Term
radiculopathy clinical features
Definition
* burning pain radiates into affected dermatome
* loss of reflexes
* weakness of myotome
* diagnostic tool: positive straight leg raising test
 
Term
T1 radiculopathy
Definition
Horner's syndrome (PAM) via sympathetic path to face and eye
Term
Radiculopathy causes
Definition
* disc hernation
* osteophytes
* spinal stenosis
* trauma
Term
Pancoast syndrome
Definition
*apical lung tumor extends into lower brachial plexus
*if entire plexus is invaded - flail insensate upper extremity
Term
axillary neuropathy
Definition
serves deltoid - weakened deltoid/atrophy
Term
radial neuropathy
Definition
* wrist drop
* injury usu. occurs at radial groove, aka Saturday Night Palsy
Term
Median neuropathy
Definition
* carpal tunnel syndrome
* nerve is compressed at wrist
* numbness or pain
* pain can radiate up to shoulder
 
**focal compressive nerve disorder
Term
ulnar neuropathy
Definition
90% of ulnar problems occur at elbow
Term
long thoracic nerve injury
Definition
* scapular winging worsened by pressing forward due to weakness of serratus anterior
 
* "the other scapular winging" = from the trapezius (innervated by accessory, helps to fixate scapula), winging worsens with abduction (not with pushing), winging disappears with flexion, forward elevation of arm
Term
femoral neuropathy
Definition
can be caused by pelvic fracture affecting nerve, in delivering babies can become stretched or compressed - numbness or weakness
Term
meralgia paresthetica
Definition
* from sensory portion of femoral nerve - can'te even tolerate clothes rubbing on skin
 
* responsive to Tegretol, Neurontin, Lyrica
Term
Sciatic neuropathy
Definition
pain radiates from buttock down leg, can travel as far as to the feet and toes
Term
Morton's metatarsalgia
Definition
* growth on nerve
* orthopedists' problem, not neurologists'
Term
peroneal nerve palsy
Definition
foot drop
Term
EMG: fibrillations in resting muscle imply
Definition
active denervation of muscle
Term
EMG: polyphasic motor unit potentials during contraction imply
Definition
chronic denervation of muscle
Term
EMG: low voltage motor unit potentials during contraction imply
Definition
myopathy
Term
nerve conduction studies
Definition
* diminished amplitude implies: axon loss
 
* reduced velocity implies: demyelination
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