Life Support: Lecture 5:

How do you come to the final therapy of a patient

History, Neurological Exam, Localisation of Lesion, Differential Diagnosis, Plan of Testing and Plan of Therapy

What is Localisation of Lesion

Process of finding where the pathology/lesion is located through the history and neurological exam

Question in the History:

Where/what are the complaints, when did it start (aute or chronic), any other complaints

What is the Neurological Exam:

look at what neurological functions are disturbed

What Belongs to the CNS

Spinal COrd, Brain, Cerebellum and Brainstem

What belongs to the PNS?

Neuromuscular Junction, Nerves, Nerve Roots, Muscles, Plexus

How does the Sensory Information enter the Spinal Cord

via the nerve root through the dorsal and lateral/anterior columns

How does Motor information exit the brain

Through the pyramidial tract in the nerve root

What is the Peripheral Nervous System Layout

Starts from the nerve root, to the plexus and to the peripheral nerves

What is the Plexus?

A braid of nerve fibers found in the neck/shoulder (Branchial Plexus) or Groin (Lumbar Plexus) that are resorted into peripheral nerves

• This causes peripheral nerves to have both sensory and motor pathways (mixed nerves)

How does the Neuromuscular Junction work?

• 1. An action potential reaches the end of the nerve terminal and Ach is released into the synaptic cleft

• 2. Ach binds to the receptors on the muscle receptors end plate, which causes sodium channels to open and the cell depolarises

• 3. The influx of sodium creates an electrical charge, triggering an action potential across the muscle fiber, which results in contraction

PNS or CNS Problem with Atrophy

CNS: Atrophy is Absent

PNS: Atrophy is Present

What is Atrophy?

The wasting, shrinkage or decrease in size of body cells, tissues or organs resulting in reduced function

CNS or PNS Problem: Tone

CNS: Hypertension (in the form of spasticity or rigidity)

• Spasticity: Problem with either Upper Limb Flexors (elbow and wrist) or Lower Limb Extendors (knee and ankle

• Rigidity: stiffens all muscles surrounding a joint evenly throughout the full range of movement.

PNS: Hypontonia (too floppy)

CNS or PNS Problem: Reflexes

CNS: Hyperreflexia (very enthousiastic reflex)

PNS: Hyporeflexia (not enthousiastic reflex)

CNS or PNS: Plantar Reflex

CNS: Babinski Reflex (all toes go upwards)

PNS: Areflexia (no , diminished or weak response)

What is the Plantar Reflex:

Someone strokes the sole of the foot to which your toes should curl downwards

What are the Effects of Lesion in The Spinal Cord:

Could be Paralysis in Legs, CNS Disorder

• The spinal cord is used as communication for messages between the brain and body, if its interrupted there are deficits that affect the trunk and legs

What are the Effects of Lesion in The Median Nerve:

It would cause weakness in the thumb opposition (can’t touch other fingers) and causes atrophy of the THENAR MUSCLES of the thumb

The median nerve is found in the arm and connects to the thumb, index, middle and half of the fourth finger

What are the Effects of Lesion with Polyneuropathy:

Problems here start in the limbs where the nerves are the longest (legs which causes patients to feel tingling in the feet)

• After they go to shorter nerves (like in the arm which will cause tingling in hand)

What is Carpal Tunnel Syndrome

Problem: Median nerve is compressed in the carpal tunnel

Symptoms: Pain snd tingling in left hand, Less strength in Left hand and Atrophy (Long term) (PNS)

What is the Carpal Tunnel

• Narrow passage in palm side of wrist that contains several tendons and the median nerve

• If pressure increases here the median nerve is affected as it is sensitive to compression

What is Facial Nerve Palsy?

Symptoms: Left mouth corner is lower than right, but both eyes are still open (Asymmetrical Face)

Diagnosis: Lesion in the CNS on right side (The CNS only affects the bottom half of the face, PNS is whole face)

What is Spastic Left Hemiparesis

Symptoms: Muscle weakness on left side of the body, High reflexes on left side, Left Plantar reflex

Diagnosis: CNS (High Reflex, Plantar Reflex, Spastic is accompanied by muscle weakness)

• Problem with Right side of brain as CNS is contralateral

What is Hypoglossal Nerve Palsy:

Symptoms: “weird tongue”, problem with chewing and swallowing, tongue is tilted to one side, atrophy on tongue

Diagnosis: PNS because atrophy is present, Muscles deviate towards the side of the lesion and get weak overtime turning into atrophy (hypoglossal nerve)

What is the Hypoglossal Nerve:

The hypoglossal nerve controls the nerves in the tongue, left hypoglossal nerve palsy meaning tongue deviates to the left

What is the Polyneuropathy Problem?

Symptoms: Slowly progressive weakness in legs and hands, tingling hands and feet, atrophy and low reflexes

Diagnosis PNS lesion, Both legs and hands are slowly progressing motor problems

What is Polyneuropathy?

a medical condition where multiple peripheral nerves outside the brain and spinal cord become simultaneously damaged