Neuromuscular I

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33 terms · NPTE O'Sullivan 2009 General neuro info to memorize.

Sx include: ataxic limb movements, Intention tremor, irregular oscillatory voluntary movements. Dysdiadokinesia, Dysmetria, Dyssynergia. ie. MS

Cerebellar Disease of the Pontocerebellum/Neocerebellum

Sx include: Hypotonia, truncal ataxia: disequilibrium, static postural tremor, inc. sway, wide BOS, high guard arm position. Posture worse with eyes closed, narrow BOS (Rhomberg, Sharpened Romberg). Ataxic gait; unsteady, inc falls, uneven dec. step length, inc. step width. ie. alcoholic cerebellar disease, Fredrich's ataxia.

Cerebellar Disease of the Spinocerebellum/ Paleocerebellum

Sx include: ipsilateral sx:
Contralat sx: ocular dysmetria, poor eye pursuit, dysf. VOR, impaired eye-hand coordination, Gait /trunk ataxia
Little chance in tone/dyssynergia of extremity mvmts. (vertigo, nystagmus, unsteady gait.)

Cerebellar Disease of the Vestibulocerebellum/Archicerebellum

3 Types of Traumatic Nerve Injuries

Neurapraxia, Axonotmesis, Neurotmesis

Neurapraxia Class I

transient loss of function (conduction block ischemia) may be rapidly reversed or persist a few wks. ie. compression

Axonotmesis Class II

loss of function Wallerian degeneration distal to lesion; no disruption of endoneurium. (regen. distal to site is possible) ie. crush injury

Neurotmesis Class III

cutting of nerve severance of all structures, complete loss of function. Reinnervation typically fails with out surgical intervention.

Myopathy

inflammation of muscle, disease of muscle. sx: Proximal muscle weakness ie. MD

Radiculopathy

nerve rts, DDD, herniated disc, diabetes, spur, infection-trauma.

Mononeuropathy

single n. due to physical injury, prolonged pressure

Neuropathies

Sensory neuropathy(peripheral neuropathy)
Polyneuropathy
Charcots jt

Peripheral Neuropathy (Sensory)

most common is DM neuropathy

Polyneuropathy

symmetrical, Bilat, (related to glucose control), tingling in ft, dec sensation, affects LEGS > ARMS, and DISTAL> PROXIMAL.

Charcots jt neuropathy

affects jt, ft mostly, also compression of cranial autonomic neuropathies, Sx: DISTAL weakness of extremities

Asthenia

generalized weakness, F to G muscle grades.

Medial Medullary Syndrome

Sx include: ipsilat paralysis of tongue,
contralat-paralysis of arm, leg, with impaired sensation.

Medial Inferior Pontine Syndrome (branch of basiliar artery)

ipsilat-cerebellar (nystagmus, ataxia, paralysis of conjugate gaze to SIDE OF LESION, diplopia.
Central-hemiparesis, impaired sensation

Lateral inferior pontine Syndrome: AICA

ipsilat sx: cerebellar facial paralysis, conjugate gaze to SIDE OF LESION.
deafness, tinnitus, impaired facial sensation
Contralat sx: pain & temp 1/2 body

Lateral Medullary Syndrome (Wallenburgs)

ipsilat sx: ataxia, vertigo, nystagmus.
Horners Syn: miosis, ptosis, dec sweating.
Dysphagia, impaired speech, dec gag reflex
Sensory loss; ipsilat arm, trunk, leg
Contralat: loss pain& temp 1/2 body

Lacunar Stroke

occlusion of vessels of MCA or circle of Willis (branches) or vertebral art. and branches.

Vertebral Basiliar Artery Syndrome

Locked in syndrome
Bilat corticospinal tracts; vertigo, ataxia, dysarthria (corticobulbar tracts) hemiplegia, tetraplegia, LOC, CN 6 VI (Abducens)

Posterior Cerebral Artery

Supplies; midbrain, temp lobe, post 1/3 cortex.
Thalamic syndrome; pain and loss of sensation in face, arms, or legs.
Involuntary mvmts- athetosis, chorea, hemiballismus
Contralat hemiparesis
Webers syndrome-oculomotor n. palsy, contralat hemiparesis
Central sensory loss
Central homonymous hemianopsia
Visual sx-miosis, ptosis, dec. papillary light reflex.

Anterior Cerebral Artery (ACA)

supplies 2/3 of medial cerebral cortex
Contralat sensory, hemiparesis LE>UE

Middle Cerebral Artery (MCA)

supplies lateral cerebral cortex, basal ganglia, large portions of internal capsule.
Contralat- sensory loss, hemiparesis UE> LE
Motor speech- Broca's
Perceptual dysf.
Homonymous Hemianopsia
Loss of conjugate gaze on OPPOSITE side
Sensory ataxia (parietal lobe)

Most common type of CVA

CVA of Middle Cerebral Artery (MCA)

Souques phenomenon

Raising involved UE above 100 deg with elbow extension will produce extension and abduction of fingers.

Raimistes phenomenon

involved LE will ABD/ADD with applied resistance to uninvolved LE in the same direction.

Homolateral Synkinesis

flex pattern of involved UE, facilitates flexion of involved LE.

Opisthotonos

prolonged severe spasm of m. causing hd, neck, heels to arch backwards. Arms/hands held rigidly flexed, Seen in severe meningitis, tetanus, epilepsy, strychnine poisoning.

Ideomotor apraxia

pt cannot perform task on command but can do task when left on own.

Ideational apraxia

pt cannot perform task at ALL, either on command or on own.

Agnosia

inability to recognize familiar obj w/one sensory modality while retaining ability to recognize the same obj. w/ other sensory modalities.

Apraxia

inability to perform voluntary learned mvmts w/loss of some conceptual/motor system.

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