LMN and PNS Pathology

distal, spinal nerves, cranial nerves, outside skull

PNS includes structures _____ to _____ and axons of _____ that are _____

nerve roots, dorsal root ganglia, spinal nerves, sensory, motor, autonomic

PNS includes _____, _____, and _____, contains _____/_____/_____ neurons

spinal, myotomal, dermatomal, peripheral

PNS lesion distributions are _____ (_____/_____) and _____

31, 10, optic, olfactory, telencephalon

PNS includes _____ pairs of spinal nerves and _____ pairs of cranial nerves (_____ and _____ attach to _____ and are part of CNS)

enclosed by bone

if nervous tissue is _____ = CNS

brainstem, spinal cord

PNS cell bodies are located in _____ and _____

motor, cell body, axon, motor endplate, muscle fiber, sensory, ganglion, axon, sensory receptor

potential sites of involvement are _____ (_____/_____/_____/_____) or _____ (_____/_____/_____)

synapse, motor axon, muscle fiber

neuromuscular junction is location of _____ between _____ and _____

ACh, depolarization, muscle membrane, contraction, excitatory

neuromuscular junction releases _____ to facilitate _____ of the _____ to facilitate _____, action is ALWAYS _____

spontaneously, muscle health, endplate potential, atrophy, generate contraction, connection

even with inactive motor neurons small amounts of ACh are released _____ to maintain _____, cause miniature _____ (avoid muscle _____) but not enough to _____, keep _____ between LMN and muscle

impaired, pattern, weakness, fibrillation

sensory changes include _____ sensation, autonomic dysfunction depends on _____, motor changes include _____ and _____

trophic, nutrition

denervation causes _____ changes due to lack of _____

demyelination, axon, bare, myelin, segmental, conduction, speed, blunt, compression, ischemia

neurapraxia is _____ (leaves _____ intact but _____ where _____ is lost = _____), affects _____ through decreased _____, results from _____ injury/_____/_____

degeneration, directly, axon, connective tissue covering, physical, crush, stretch, laceration, disease, wallerian degeneration

axonotmesis is _____ that _____ affects the _____, _____ that support/protect the nerve remain intact, results from _____ injury (_____/_____/_____) or _____, causes _____

severe, complete severance, axon, disruption, connective tissue coverings

neurotmesis is most _____ loss, _____ of the _____ and _____ of _____

endoneurium, perineurium, epineurium

connective tissue covering layers (3)

immediately, separation, distal, cell body, few weeks, death, distal, communication

wallerian degeneration begins _____ after _____ of the _____ axonal segment from the _____ and is completed over period of _____, results in _____ of entire _____ segment, NO _____ between segments

single, focal

mononeuropathy is _____ nerve, _____ dysfunction

several, multifocal, asymmetrical, individual

multiple mononeuropathy is _____ nerves, _____ dysfunction, _____ involvement of _____ nerves

many, generalized, distally, symmetrically

polyneuropathy is _____ nerves, _____ disorder that presents _____ and _____

axon, myelin, both

neuropathy dysfunction results from damage to _____, _____, or _____

trauma, demyelination, complete, rapid, remyelination

traumatic myelinopathy cause _____, pathology _____, recovery is _____ and _____ by _____

trauma, axonal, slow, axonal regrowth, good, connective tissue, intact

traumatic axonopathy cause _____, pathology _____ damage, recovery is _____ by _____ but _____ because _____/Schwann cells are _____

trauma, axon, myelin degeneration, slow, poor, inappropriate reinnervation, neuroma

traumatic severance cause _____, pathology _____ and _____, recovery is _____ with _____ results due to _____ and traumatic _____

complication, diabetes, blood vessel inflammation, ischemia, slow, axonal regrowth, good

multiple mononeuropathy cause is _____ of _____ or _____, pathology is neuron _____, recovery is _____ by _____ usually _____

complication, diabetes, autoimmune disorder, genetic, metabolic, inflammatory

polyneuropathy cause is _____ of _____/_____ or _____, pathology is _____ or _____, recovery is variable based on type

mechanical stimuli, blood flow, transport, edema, thickening, myelin, axonal damage

traumatic myelinopathy is caused by repeated _____ = decreased epineurial _____ and axonal _____ = _____ of endo/epineurium = _____ of epi/perineurium = _____ and _____

sensitization, ectopic foci, sensation, movement

traumatic myelinopathy can also cause _____ of nociceptors, development of _____, and impaired _____/_____

symmetrical, distal to proximal, feet, hands, longest axons, stocking glove, gradient

polyneuropathy has _____ involvement progressing from _____ (symptoms begin in _____, then appear in _____ = areas of body supplied by _____), _____ distribution (_____)

toxic, metabolic, autoimmune, genetic, diabetes, nutritional, alcoholism, autoimmune, drugs, toxins, nutritional

polyneuropathy cause can be _____/_____/_____/_____, most common include _____, _____ deficiencies secondary to _____, and _____ diseases, other causes are therapeutic _____, industrial/agricultural _____, and _____ disorders

diabetes mellitus, distal, symmetrical, polyneuropathy, single

diabetic neuropathy occurs in setting of _____, occurs in _____/_____ pattern, termed _____ but _____ nerve involvement is possible

I, hyperglycemia, regeneration, duration

diabetic neuropathy is greater in type _____, risk factors include chronic _____ (control is known to enhance _____) and diabetes _____

myelinated, unmyelinated, vascular, ischemia, hypoxia, axonal degeneration

diabetic neuropathy causes loss of _____ and _____ axons, _____ changes affect peripheral nerves (multifocal regions of _____ and _____ result in _____)

rapidly reversible, hyperglycemic, generalized symmetric, acute sensory, chronic sensorimotor, autonomic, focal, cranial, focal limb

classification of diabetic neuropathy includes _____ (_____), _____ polyneuropathies (_____/_____/_____) and _____ neuropathies (_____/_____)

history, examination, electrodiagnostic, sensory, autonomic, single

diabetic neuropathy diagnosis is made based on _____, clinical _____, _____ studies, quantitative _____ evaluation, and _____ function testing, NOT based on _____ item

cardiovascular, gastrointestinal, genitourinary

autonomic diabetic neuropathy can manifest in _____/_____/_____ symptoms

control hyperglycemia, address symptoms, impairments, health condition, slowly progressive, body systems

diabetic neuropathy treatment includes _____ and _____, target _____ and _____, prognosis is _____ metabolic disorder that affects many _____

chronic alcoholism, distal, symmetric, direct toxic, alcohol, nutritional deficiencies, dietary habits, segmental demyelination, axonal degeneration

alcoholic neuropathy is seen with _____, _____/_____ involvement, attributed to _____ effects of _____ on nerve and _____ from poor _____, causes _____ and _____

muscle bulk, ankle reflexes, sensation, feet, aching, calves, pain, paresthesia, numbness, symmetrical stocking glove, weakness, atrophy

alcoholic neuropathy mildly presents with minor loss of _____/diminished _____/impaired _____ in _____/_____ in _____, distal sensory changes include _____/_____/_____ in _____ pattern, advanced presents with _____ and _____ of distal musculature

history, examination, electrodiagnostic, action potential amplitude, sensory, motor

alcoholic neuropathy diagnosis is made by _____, clinical _____, and _____ studies showing loss of _____ (_____ and _____)

aerobic, stress, coping, symptomatic, orthotics, mild improvement, total alcohol abstinence, slow, incomplete

alcoholic neuropathy is treated by _____ exercise to decrease ____/improve _____ mechanisms and _____ treatment (_____), prognosis is _____ with _____ but _____ recovery and often _____ with axonal degeneration

hereditary, autosomal dominant, mutation, schwann cell myelination, demyelination, hypertrophic onion bulb, remyelination, fibular, forearm, hand

charcot marie tooth is _____ neuropathy (_____), _____ in proteins associated with _____ create extensive _____ along with _____ formation as _____ is attempted, initially involves _____ nerve, later progresses to muscles of _____/_____

childhood, adulthood, history, examination, hereditary, electrodiagnostic, biopsy

charcot marie tooth onset may occur in _____ or _____, diagnosis is by _____, clinical _____, _____ picture, _____ studies, and nerve _____

alter course, symptomatic, function, safety, monitor, progression, stretching, ROM, strengthening, endurance, bracing

charcot marie tooth has no treatment to _____, _____ treatment is used to maximize _____ and _____, _____ disease and modify based on _____, implement _____/_____/_____/_____/_____ to improve ambulation

slowly progressive, incurable, deformities, secondary complications, contractures, gait, hand

charcot marie tooth is _____ and _____, need to prevent _____ due to _____ (_____ further reduce _____ and _____ function)

clawing, varus, hammer

charcot marie tooth foot deformities include great toe _____, _____ alignment, and _____ toe

rapidly evolving, immune mediated, seasonal relationship, bacterial, viral infection, surgery, vaccination

guillain barre is most common cause of _____ motor/sensory deficits, _____ disorder, possible _____ associated, risk factors include _____/_____, _____, and _____

spinal nerve roots, distal termination, motor, sensory, antibody, demyelination, schwann cells

guillain barre has lesions throughout the PNS from _____ to _____ of fibers, can involve _____ only or with _____ degeneration, _____ mediated _____ primarily attacking _____

rapidly ascending, bilateral, symmetrical, distal, paresthesia, toes, weakness, distal legs, spreads, arms, trunk, face, mechanical ventilation

guillain barre has _____/_____/_____ motor and _____ sensory impairments, first neurologic symptom is _____ in _____ followed by _____ in _____ which _____ to _____/_____/_____, some require _____

4 weeks, less, 2-4 weeks, static, 2-4 weeks, recovery, months, years

guillain barre time from onset to peak is typically _____ or _____, progression lasts _____, then _____ phase begins for _____ before _____ which takes _____ to _____

proximal to distal

guillain barre recovery occurs in _____ progression

progressive weakness, more than one extremity, DTRs, rapidly, ceases, 4 weeks, symmetric, sensory, facial, oral bulbar, 2-4 weeks, ceases, tachycardia, arrhythmia, blood pressure, fever, CSF, nerve conduction velocity

guillain barre diagnosis requires _____ in _____ and loss of _____; supported by weakness developing _____ that _____ by _____, _____ weakness, mild _____ signs, _____ weakness common and _____ with involved _____ musculature, recovery begins _____ after progression _____, _____/cardiac _____/labile _____, absence of _____; _____ protein levels increase and _____ is slowed

high, IV, immunoglobulin, plasmapheresis, morality, complete, remaining neurological deficits, neuropathic pain, autonomic, distal weakness

guillain barre is treated with _____ dose _____ administration of _____ and _____, prognosis is variable from _____ to _____ recovery, some have _____, complications include _____/_____ changes/_____ in extremities

older, recovery, artificial respiration, evoked motor potential amplitude, younger, diarrhea, disability, admission, longer, ventilator support

factors that predict poor outcome with guillain barre include _____ age, increased time before _____, need for _____, significantly reduced _____

factors that predict better outcome with guillain barre include _____ age, absence of preceding _____, lower levels of _____ and _____, _____ interval between symptoms and admission, and absence of _____ need

ROM, pain tolerance, monitor, strength, prevention, complications, immobilization, skin care, positioning, splinting, movement, stretching, active, active assisted, strength, resistive, higher, functional, disability, assistive, mobility, home

guillain barre therapy acute = maintain _____ within _____ and _____ muscle _____; ascending phase focus on _____ of _____ associated with _____ (_____/_____/_____); stabilization phase initiate _____ through gentle _____ and _____/_____ at level consistent with _____; descending phase integrate _____ exercise _____ intensity produces greater _____ improvements and reduces _____; impaired function may require use of _____/_____ equipment and _____ modifications

slower, relapses, remissions

chronic inflammatory demyelinating polyneuropathy is guillain barre variant with _____ onset with _____/_____

eradicated, vaccine, resurgence, infectious, deadly, person to person contact

poliomyelitis was virtually _____ in 1950s with _____, _____ due to antivaccination movement, highly _____ and potentially _____ disease that is transmitted through _____

new neuromuscular symptoms, decades, 25 years, recovery, weakness, functional mobility, fatigue

postpolio syndrome is _____ that occur _____ (average is _____) after _____ from acute paralytic episode, characterized by _____, decline in _____, and reports of _____

muscle denervation, original, alpha motor neuron, compensated, axonal sprouting, maintained, prunes, metabolic, support, new denervation

postpolio syndrome has ongoing _____ = evolution of _____ motor neuron dysfunction that began after poliovirus affected _____, _____ reinnervation (via _____) cannot be _____ = nervous system _____ back without _____ ability to _____ = _____

strength, affected, recovered, stability, 3-10 years, pain, atrophy, bulbar, myalgia, joint, atrophy, new, fatigue, vasomotor, endurance

postpolio syndrome causes declines in _____ in muscles that had previously been _____ with polio and had fully/partially _____, with periods of _____ for _____, experience _____/_____/_____ problems, may have _____/_____ pain/increased muscle _____/_____ weakness/excessive _____/_____ abnormalities/diminishing _____

clinical, exclusion, slowly progressive, stable

postpolio syndrome diagnosis is _____ by _____, prognosis is _____ with _____ periods

symptomatic, lifestyle, energy conservation, surgery, nonexhaustive, general conditioning, functional, submaximal, endurance, functional, exercise, rest, fatigue

postpolio syndrome treatment is _____ and modification of _____ (_____), _____ for residual ankle deformities, _____ exercise and _____, _____ exercises of _____ intensity, goal of maintaining and improving _____ and _____ capacity, balance between _____ and _____ for _____ management

fifth cranial nerve, intense paroxysms, lancinating pain, distribution

trigeminal neuralgia is disorder of _____ with _____ of _____ within nerve’s _____

women, 50-70, herpes zoster, MS, vascular, tumor

trigeminal neuralgia typically occurs in _____ between ages _____, associated with _____/_____/_____ lesions/_____ that affect the nerve

demyelinated, hyperexcitable, sudden, sharp pain, maxillary

trigeminal neuralgia occurs from _____ fibers becoming _____, _____ onset described as _____, restricted to _____ division

subjective report, pain, typical pattern, sodium channel blockers, carbamazepine, neurosurgery, unresponsive, difficult, spontaneous remittance, remain, remission

trigeminal neuralgia diagnosis is _____ of _____ in _____, treatment is _____ (oral _____) and _____ for _____ patients, prognosis is _____ to determine may have _____/_____/_____

sensory, carcinomas, subacutely, chronically, precede, tumor

cancer induced paraneoplastic neuropathies are _____ neuropathies associated with other _____, development of symptoms occurs _____ or _____ over weeks/months and may _____ discovery of _____ from months/years

autoimmune, cancer antigen, membrane receptors, within neuron

cancer induced neuropathies are _____ response initially directed against _____ subsequently attacks _____ or those _____

numbness, paresthesia, asymmetric, all extremities, weakness, sustain contraction, proprioceptive feedback, cerebellum

cancer induced neuropathies present with _____ and _____ initially _____ but progress to involvement of _____, _____ is NOT common but related to inability to _____ secondary to impaired _____ (_____ indirect involvement)

extensive, medical, holistic, neuropathy symptoms, health condition, immunosuppression, integumentary, safety, falls, deterioration, stabilization, disability

cancer induced neuropathies differential diagnosis is _____, treatment has minimal _____ options, care should be _____ addressing _____, overall _____, and effects of _____, recognize and prevent _____ problems, preserve _____ with gait and mobility, and prevent _____, prognosis is _____ over weeks/months and then _____ with _____

toxic, environment, medications

_____ substances in the _____ and some _____ prescribed to treat condition can be toxic to PNS

segmental demyelination, upper extremities

lead neuropathy causes _____ in CNS and PNS, affects neurons innervating _____

inhibition, acetylcholinesterase, overstimulation, neuromuscular junction, nausea, vomiting, diarrhea, fasciculations, weakness, paralysis, death, vasomotor, respiratory paralysis, 1-4 days, chronic, delayed

pesticides and organophosphates cause _____ of _____ activity = _____ at _____, symptoms include _____/_____/_____ and muscle _____/_____/_____, _____ can result from _____ collapse that coincides with _____, symptoms appear within _____, _____ can persist for months/years, _____ can have onset weeks after exposure

neuromuscular transmission, autoimmune, fluctuation, weakness, fatigability, skeletal muscle

myasthenia gravis is most common disorder of _____, _____ disorder, characterized by _____ of _____ and _____ of _____

thymic, diabetes, immune, familial, exacerbations, menstrual period, pregnancy

myasthenia gravis risk factors include _____ disorders, _____/_____ disorders, _____ association, and _____ may occur before _____/shortly after _____

ACh receptors, neuromuscular junction, efficiency, neuromuscular transmission, impulses, pass, neuromuscular junction, stimulate contraction

myasthenia gravis has impaired _____ at _____ resulting in decreased _____ of _____, nerve _____ fail to _____ the _____ to _____

skeletal muscle weakness, fatigability, normal, ocular, mild generalized, acute fulminating, late severe, history, observation, symptoms, weakness, continued use, rest

myasthenia gravis presents with _____ and _____, other neurologic findings are _____, classified as _____/_____/_____/_____, diagnosis is made by _____ and clinical _____ of _____ of _____ with _____ and improvement with _____

acetylcholinesterase inhibitor, weakness, underlying disease, surgical, thymus, immunosuppression, plasmapheresis, slowly progressive, complete, permanent, fluctuate, day

myasthenia gravis treatment includes _____ medication for improvement of _____ but does NOT treat _____, _____ removal of _____, _____, and _____, prognosis is _____, remissions are rarely _____ or _____, symptoms _____ in intensity during the _____

supportive, respiratory, crisis, weakness, respiratory, talking, chewing, swallowing, strength, maximal isometric, secondary, corticosteroid, monitor, participation, quality of life

myasthenia gravis therapy should be _____ care, _____ management, being alert to signs of impending myasthenic _____ (increasing _____, _____ distress, difficulty _____/_____/_____), establish _____ training eliciting _____ contractions, reduce _____ complications from long term _____ use, and _____ symptoms and impact of _____/_____

normal, quiet, no motor unit potential, decreased

segmental demyelination EMG has _____ insertional noise, _____ at rest, affected fibers have _____ during minimal contraction and _____ interference pattern during maximal contraction

increased, spontaneous potentials, fibrillation, positive sharp wave, no motor unit potential, decreased, no

axonal degeneration EMG has _____ insertional noise, _____ (_____/_____) at rest, affected fibers have _____ during minimal contraction and ______ (partially affected) or _____ (completely affected) interference pattern during maximal contraction

increased, quiet, fibrillation potentials, low amplitude polyphasic potential, low amplitude full, frequency, firing, effort

myopathy EMG has _____ insertional noise, _____ at rest with _____ at end stage, _____ during minimal contraction, and _____ interference pattern during maximal contraction with increased _____ of _____ and moderate _____