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Neurology Part 3 (Myelopathies (spinal cord) (Compressive (level (sensory,…

- - - - bulging disc, location?
        
        L4?
        
        medial aspect of the leg
        
        L5?
        
        anterolateral aspect of the leg, dorsum of foot/large toe, cannot walk on heels foot drop peroneal
        
        S1
        
        lateral side of the foot, sole of the foot, cannot walk on toes (no plantar flexion)
        
        improves when leaning forward
        
        lumbar spinal stenosis
    - - motor
      - sensory
        
        T4 (dermatome - nipple), umbilicus (T10)
    - - MRI myelogram
        
        treatment
        
        emergent neuro consult/ high dose steroids/ surgery or radiation depending on cause
    - - leukemia, lymphoma, myeloma, and germ cell tumors
    - - syringomyelia
  - - - Argyl-Robertson pupil (accommodate but do not react), tabies dorsalis (position and vibration - ataxia)
    - - symptoms
        
        acute onset of progressive weakness (thoracic level)
      - autoimmune
        
        Lupus, Sjogrens, NMO
      - treatment
        
        steroids (, 1 g/d for 3 to 7 days), plasmaphoresis, cyclophosphamide
    - - more than 3 segments
    - - watershed infarcts in the area where the anterior spinal artery meets with the most prominent radicular artery (artery of Adamkiewicz), which is part of the vascular supply of the thoracic spinal cord, or artherosclerosis
  - - - balance problems, sensory ataxia, closing their eyes (wobbly), loss of position/vibration - dorsal and lateral column
        
        Treatment
        
        low B12, elevated serum methylmalonic acid level, an elevated serum homocysteine level, and (potentially) a macrocytic anemia
    - - Cu, Zinc
    - - Vacuolar (posterior column effect)
- - - - medial nerve, first 3-4 fingers, hand, shoulder, Tinel's sign.
      - Bilateral
        
        Thyroid, acromegaly, pregnancy, cushing's
    - - compressive neuropathy of the lateral femoral cutaneous nerve that causes isolated anterolateral thigh numbness without weakness
    - - radial nerve/ radial grove humerus (extensor)
    - - 3rd and little finger, cubital tunnel
    - - posterior compartment, difficult to stand on toes
    - - foot drop, proximal end of fibula (neck of fibula), high step step
      - treatment
        
        AFO
    - - move the eye-brow up, if they can't its Bell's, facial nerve
      - grading
        
        Houseman-Brackman Grade
      - treatment
        
        protect eye, prednisone 60 mg/day x 7 days
      - what is up with the forehead?
        
        in which forehead and periorbital muscles are spared because of bilateral innervation of the upper face in stroke
      - synkenesis
        
        synkinesis (concomitant movement of perioral and periorbital muscles) as a result of aberrant reinnervation.
  - - - pathophysiology
        
        molecular mimickrey with recent GI/respiratory, most common c. jejuni
      - symptoms
        
        ascending paralysis (motor), areflexia
      - LP
        
        albuminocytological dissociation (protein are high, cells are normal)
      - Miller-Fischer Variant
        
        opthalmoplegia, areflexia, ataxia - G/B disorder (up to down)
        
        antibody
        
        anti-GQ1b antibody
      - things to look out for/mortality
        
        dysautonomia and respiratory distress
    - - pathophysiology
        
        herited, demyelinating, family history.
      - classical phenotype
        
        high arches, hammertoe, and stork legs
    - - critical neuropathy
    - - definition
        
        does not resolve in 8 weeks, is the myelination getting better
    - - demyelinating - motor - speed (conduction velocity is slow, latency is long)
        axonal- amplitude - low, sensineural
  - - - Diabetes
        
        common neuropathy
        
        CN III, down and out with normal pupil
        
        what if there is pupillary dilation
        
        anyeursm compressing the outside of the 3rd nerve (parasympathetic), also think uncal herniation
        
        lumbar plexopathy
        
        glove and stocking neuropathy + proximal muscle weakness
      - Autoimmune
      - Vasculitis
- - - - upper and lower motor neuron sign ( focal weakness, muscle twitches or cramping, or difficulties with speech or swallowing, bulbar symptoms, fasiculations, atrophy)
    - - riluzole (glutamate release inhibitor), or edaravone
    - - T2 bright signal in bilateral corticospinal pathways
    - - respiratory compromise
  - - - antibodies against the Ach receptor
    - - Fluctuating, painless, and fatigable weakness involving the cranial, cervical, respiratory, and limb muscles is typical
    - - characteristic decremental response to repetitive stimulation
    - - Ach, MUSK
    - - CT chest to rule out thymoma
    - - inhibitor pyridostigmine, glucocorticoids, and immunosuppressant agents, during crisis always give IVIG first, because the glucocorticoids can make the weakness worse initially
  - - - autoimmune disorder caused by autoantibodies against voltage-gated calcium channels located at the presynaptic neuromuscular junction
    - - finding of facilitation of motor response to rapid repetitive stimulation
    - - Small cell lung, or any other malignancy
- - - - symptoms
        
        Bradykinesia, Rigidity, resting tremor, postural instability
        
        secondary causes
        
        stroke to basal ganglia, low DA (drug induced, neuroleptic, anti-emetics, reserpine/tetrabenazine
        
        pathology
        
        DA neurons in substantia niagra
      - Treatment
        
        give Dopa (Levodoapmine), stimulate receptor (Dopa agonist - ramipexole (young)), Reduce breakdown (MOA-B/COMT - Selegilline), Reduce Ach (anticholinergic - amantadine)
        
        young
        
        dopamine agonist
        
        side effect - compulsive shopping, gambling, hypersexuality
        
        sudden stopping of PD meds
        
        Parkinson's hyperpyrexia syndrome
      - surgical treatment
        
        deep brain stimulator (ventralis intermedius)
      - Parkisons (+)
        
        Progressive Supranuclear Palsy
        
        vertical gaze palsy (can't look down, supranuclear), bulbar symptoms, extension of the neck
        
        Shy-Drager Syndrome
        
        Autonomic insuffiency
        
        OlivePutamenCA
        
        Cerebellar signs, pseudobulbar signs
        
        SND
        
        Dementia
  - - - Slow involvuntary movement, chorea, dystonia, athetosis
      - main cause
        
        antipsychotics
    - - Rest
        
        Resting tremor (not doing anything
        
        tried to hold objects
      - Action
        
        persistent throughout movement
      - Essential tremor
        
        better with alcohol, family history, AD, head/voice tremor
        
        treatment
        
        propanolol
    - - rigidity, hyperthermia, ridigidty, increase temp
      - Treatment
        
        dantrolene
    - - tics - motor/vocal (uncontrollable)
      - treatment
        
        mild - clonidine, severe- haloperidol