Term
ALS is what type of disease?
Myesthenia Gravis?
Muscular Dystrophy? |
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Definition
Motor neuron
NMJ disorder
myopathies |
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Term
| Do peripheral neuropahies commonly haev sensory involvement? |
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Definition
| YES. (motor neuron diseases, neuromuscular junction disorders, and myopathies do not). |
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Term
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Definition
| Distal symmetric neuropathy is common. |
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Term
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Definition
| Only one nerve is affected. Accident? |
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Term
| Multiple Mononeuropathies |
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Definition
| More than one nerve involved, assymetric. May be nerve/blood vessel inflammation/infarct. |
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Term
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Definition
| Only involves light touch, pinprick, and/or temperature. |
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Term
| Sensory neuronopathy vs neuropathy |
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Definition
| There is no motor involvement in the first (usually only DRG) |
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Term
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Definition
| Term used for diseased motor nerves roots. Spine diseases or compression. |
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Term
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Definition
| reflexes are brisk below affected cord level. sensory band is present (below which impaired sensory). Mainly bowel/bladder issues. Babinski sign also present |
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Term
| Most common symptom of neuromuscular disorder? |
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Definition
Weakness (e.g. NMJ - fatigable weakness - myasthenia gravis - extraoccular, eyelid opening, neck flexor/extensor)
Other common signs are fatigue, muscle cramps (non-specific), twitiching. |
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Term
| Head drop seen in what diseases? |
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Definition
| ALS or Myasthenia gravis. Non-neuromuscular: parkinsons, focal muscle diseaese. HEAD DROP IS NOT COMMON IN PERIPHERAL NEUROPATHY. |
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Term
| History should allow you to differentiate: |
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Definition
| Weakness from numbness, which muscle groups are weak, and whether proximal or distal groups are affected. |
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Term
| Are foot and wrist drop common in patients with peripheral neuropathy? |
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Definition
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Term
| Functional Evaluation includes: |
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Definition
Examination of gait
gluteus medius - waddling
hip extensor/ back extensor - lumbar hyperlordosis (muscular dystrophies)
steppage gait/foot drop - ankle dorsiflexor weakness |
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Term
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Definition
Functional Evaluation
Palpation
Percussion
Manual Strength Evaluation
Reflex Examination
Sensory Examination |
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Term
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Definition
| Look for atrophy. Fasciculations are involuntary twitching. Myokymia - worm like movement. |
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Term
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Definition
| Examine texture + tone. Tone is degree of resistance when a patient is relaxed (increased might be upper motor lesion). |
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Term
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Definition
| May reveal a myotonia, involuntary/sustained contraction, lack of relaxation. |
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Term
| Manual Muscle Strength Eval |
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Definition
0 - No movement
1 - Trace Movement
2 - Active movement when gravity eliminated
3 - Active movement (full ROM) through gravity
4 - Active movement against gravity and some resistance
5 - Normal |
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Term
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Definition
Muscle stretch (bicep, triceps, knee, and ankle jerks).
myotactic reflexes may be:
0 - absent
1+ present but diminished
2+ normal
3 increased but not pathologic
4 markedly hyperactive
Hyper reflex may mean upper motor involvement |
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Term
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Definition
| pinprick, light touch, vibration. DISORDERS AFFECTING PERIPHERAL NERVES OR ROOTS COMMONLY CAUSE SENSORY ABNORMALITIES |
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Term
| What are the two major types of neuropathies? |
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Definition
| Those primarily affecting myelin (demyelinating neuropathies), and those primarily affecting axons (axonal neuropathies). |
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Term
| Most common cause of peripheral neuropathy? |
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Definition
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Term
| Most common hereditary demyelinating neuropathy is? |
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Definition
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Term
| Five questions to ask patients? |
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Definition
Which systems are involved? PN's usually have both sensory and motor deficits.
What is the distribution of the weakness? Proximal vs distal.
What is the nature of the sensory involvement?
What is the temporal evolution?
Is there evidence of a hereditary neuropathy? |
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Term
| Proximal and distal symmetric weakness of limbs is indicative of? |
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Definition
Acute (GBS) and chronic acquired immune demyelinating (CIDP) polyneuropathies.
Only distal symmetric weakness is a primary axonal peripheral neuropathy. |
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Term
| Most common neuropathies associated with severe pain? |
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Definition
| Cryptogenic sensory peripheral neuropathy (CSPN) and diabetic neuropathy (usually symmetric in feet). Could be vasculitic neuropathy if asymmetric and distal. |
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Term
| Dramatic asymmetric loss of proprioception with vibration loss and normal strength could mean a sensory neuropathy (ganglionopathy) |
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Definition
| Light touch and pain usually affected. |
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Term
| acute or subacute (4-8 weeks) indicates? |
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Definition
GBS, vasculitis, and diabetic lumbosacral radiculoplexoneuropathy.
Relapse - CIPD and porphyria |
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Term
| chronic, slowly progressing disease may indicate? |
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Definition
Hereditary neuropathy.
Hereditary Neuropathy with Liability to Pressure Palsies (HNPP). Recurrent episodes of wrist and foot drop. |
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Term
| Most useful tool for confirming a peripheral neuropathy and quantitate severity? |
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Definition
| Electrodiagnositc (nerve conducction studies and needle electromyography). |
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Term
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Definition
| Inflammatory demyelinating polyradiculopathy. Presents as ascending paresthesias, weakness, and areflexia. Top cause of acute, flaccid, non-traumatic weakness. Autoimmune. |
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Term
| Diagnosis of GBS made using? |
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Definition
| Nerve conduction study and CSF sample. |
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