Acute weakness 2

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  • Created by: z
  • Created on: 14-03-16 17:16

Spinal cord organisation

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Spinal cord organisation 2

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Peripheral nervous system pathology

  • Anterior horn cell
    • MND, polio
  • Spinal root
    • radiculopathy
  • plexus
    • brachial neuritis
  • peripheral nerve
    • neuropathy
  • neuromuscular junction
    • MG, LEMS
  • muscle
    • myopathy, dystrophy
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Motor control

  • lesions along primary motor pathway: weakness, paralysis
  • UMN
    • no wasting
    • incr tone, clonus
    • pyramidal weakness
    • incr reflexes
    • extensor (upgoing plantars)
  • LMN
    • wasting, fasciculation
    • flaccid/decr tone
    • weakness 
    • decr reflexes
    • flexor/downgoing/normal plantars
  • NMJ
    • no wasting, normal tone, normal reflexes, flexor plantars
    • weakness (fatiguability)
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Motor control 2

  • lesion in:
  • muscle
    • wasting, no fasciculation
    • normal (decr) tone
    • normal (decr) reflexes
    • flexor plantars
  • cerebellum
    • no weakness
    • incoordination
    • cranials: nystagmus, dysarthria/ limbs: FN, HS and gait ataxia
    • intention tremor
    • dysdiadochokinesis
  • basal ganglia
    • now eakness
    • hypokinetic movement (Parkinson's) or hyperkinetcic movement (Huntingdon's)
  • sensation - now eakness, sensory ataxia (partial compensation by vision)
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Sensory loss

  • sacral loss + urinary retention = cauda equina syndrome
    • acute severe back pain
  • sensory and motor "cape" loss (C4-T2) = syringomyelia
    • chronic progressive disease in which longitudinal cavities form in the cervical region of the spinal cord
  • pain, temp loss + controlateral motor, vibration loss = Brown-sequard syndrome
    • lesion in one lateral half of the spinal cord
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