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Neuro - SENSORY
Terms in this set (24)
What warrants detailed exam of the sensory sys?
- pt volunteers sensory sx
- u suspect a specific pathology eg sc compression or mononeuropathy
~in pts w/o sensory sx, assessing light touch is enough
Pain from PNS or CNS damage;
Severe; burning, shooting in nature
Refractory to simple analgesia
Reduced ability to feel pain may be accomp by
scars from injury or burns (trophic injuries)
An unpleasant paraesthesia
Allodynia vs hyperalgesia vs hyperesthésia
Allodynia: painful sensation resulting from a non-painful stimulus
hyperalgesia: incr sensitivity to a painful stimulus.
hyperaesthesia: incr sensitivity to a stimulus
Axonal neuropathy/dz in n roots or SC first affect _____
Demyelinating dzs first affect _______
+ there may be autonomic sx
Hemisection of spinal cord
-> ipsilateral loss of light touch & vibration + pyramidal weakness/incr DTR & babinski (UMNL) below lesion
-> contralateral loss of pain & temp sensations (below lesion)
'large-fibre' neuropathies such as Guillain-Barré syndrome
---vibration & joint position may be disproportionately affected (red. vibration sense @ ankle may be normal in ppl > 60 yo)
--Pts may report staggering when they close their eyes during hair washing or in the dark (Romberg's sign)
--When joint position sense is affected in the arms, pseudoathetosis may be demonstrated by asking pt to close their eyes and hold their hands outstretched; the fingers/arms will make involuntary, slow, wandering movements, mimicking athetosis.
-- pain & temperature are mainly affected,
-- only finding may be reduced pinprick and temperature sensation;
--there may also be autonomic involvement.
The most common causes of small-fibre neuropathies worldwide are _______
DM & HIV
SC lesions, dermatome directly above??
Hyperaesthesia zone may be found
Syringomyelia can result in_____
a dissociated pattern of altered spinothalamic sensation and motor function, with sparing of DCML sensation.
pattern of sensory disturbances caused by Lower brainstem lesions?
Ipsilateral facial numbness & contralateral body numbness
Common carpal tunnel features
pattern of sensory disturbances caused by Thalamic lesions?
Contralateral patchy sensory impairment with unpleasant, poorly localised pain, often of a burning quality.
pattern of sensory disturbances caused by Cortical parietal lobe lesions?
typically: sensory inattention
--but may also affect
1) joint position sense,
2) two-point discrimination,
3) stereognosis (tactile recognition)
4) localisation of point touch.
((Two-point discrimination and touch localisation are not helpful signs and tests are not performed routinely.))
Nerves particularly prone to compression
Median nerve compression occurs between
Flexor retinaculum and carpal bones
Causes of radial nerve compression
1- Saturday night palsy: compression at the axilla and the spiral groove of the humerus
2 - fracture of the neck of humerus
Radial nerve palsy causes
Ulnar nerve gets affected by
Pressure at elbow
Injury eg elbow dislocation/ fracture
Causes of foot drop
1- fractures at the head of fibula
2- compressions, esp in thin immobile pts, or as a result of repetitive kneeling, squatting or sitting with the legs crossed at the knees.
Caused by compression of lateral cutaneous nerve of thigh
Typically burning numbness over antero-lateral aspect of thigh
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