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Flashcards in Wahba Notes Deck (26)
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1
Q

Differential for unilateral foot drop

A

Common peroneal neuropathy, L5 radiculopathy, lumbosacral plexopathy, sciatic n. lateral trunk

2
Q

Differential for chronic bilateral foot drop

A

Myotonia atrophica, Charcot Marie Tooth, polyneuropathy, ALS, distal myopathy (rare)

3
Q

What’s spared with peroneal mononeuropathy?

A

Ankle inversion, plantar flexion, and ankle jerk

4
Q

Presentation of CMT1

A

Distal weakness/wasting, pes cavus, arreflexia, mild sensory loss, thick peripheral nerves

5
Q

Presentation of CMT2

A

Later onset; nerve conduction velocity relatively normal - axonal>demyelinating pathology; Dx w/ slow nerve conduction, segmental demyelination, hypertrophy

6
Q

Anatomical course of common peroneal nerve

A

L5-S3 of sciatic nerve, travels w/ tibial division - motor branch to short head of biceps femoris, sensation to lateral knee. Separates in popliteal fossa, travels around fibular head, pass thru fibular tunnel, divides into superficial+deep peroneal nerves

7
Q

Presentation for compression at fibular head

A

Lose dorsiflexion, eversion; lose sensation to anterolateral leg+dorsum of foot. Pt would have tendency to invert foot and high stepping gait

8
Q

Presentation for entrapment of deep peroneal nerve in anterior tarsal tunnel

A

Weak toe dorsiflexion, sensory loss in 1st dorsal web space, spares eversion, foot drop, high stepping gait

9
Q

Presentation for entrapment of superficial peroneal nerve at fascial exit on anterolateral leg

A

Weak eversion, sensory loss to anterolateral leg/dorsum of foot, dorsiflexion spared

10
Q

Sensory loss for L5 Root

A

BIG TOE, MORE MEDIAL

11
Q

Etiology of L5 radiculopathy

A

L4-5 disc herniation, spinal canal stenosis, prolapsed disc

12
Q

Features of L5 radiculopathy

A

Lower back pain, pain radiating down leg (sciatica), weakness in extensor hallucis longus+ankle dorsiflexors+ peroneal muscles, ankle inversion+toe flexion weak, lose big toe sensation

13
Q

S1 radiculopathy

A

Weak gastrocnemius+soleus+no ankle jerk

14
Q

Innervation of gluteus muscles and tensor fascia lata

A

Gluts medius+maximus by L5-S1; TFL by L5

15
Q

Other causes of foot drop

A

Pushing something heavy (disc herniation?), pelvic surgery (retroperiotoneal hematoma of lumbosacral plexus), cancer of pelvis, tight cast,

16
Q

Muscles innervated by tibial nerve L5

A

Paraspinals, gluteus medius, TFL, flexor digitorum longus, tibialis posterior

17
Q

3 reasons to EMG a foot drop (instead of MRI)

A

1) asymptomatic discs (I’m assuming she meant the disc may not always cause the foot drop so MRI is less helpful) 2) MRI can miss lateral disc herniation 3) Pts in which MRI is xindicated

18
Q

Interpretation of Sensory Nerve Action Potential (SNAP)

A

Slow or absent across fibular head = common peroneal head entrapment; sural-saphenous SNAP absent = sciatic (higher); Normal SNAP = lesion in root only; SNAP gone = lesion in plexus or peripheral nerve

19
Q

Causes of peroneal nerve compression @ fibular head

A

Anesthesia/surgery, prolonged hospitalization, THA?, braces/cases, leg crossing, DM, polyneuropathy, Baker’s cysts

20
Q

What to do if you see a foot drop in first 12-24 hrs

A

Do stuff! Admit to hospital, consult neuro, imaging STAT, steroids

21
Q

Chronic Inflammatory Demyelinating Polyneuropathy -“GAINS” mnemonic

A
GRADUAL progressive weakness
ARREFLEXIA
INCREASED CSF w/o increase cell count
NERVE demyelination
STOCKING-glove pattern
22
Q

Stepwise progression in CIDP

A

Stepwise w/ periods of plateau - symmetric prox+distal weakness (esp hip flexors), mostly motor Sx, may start focal, spares breathing muscles

23
Q

Spinal tap findings for CIDP

A

Same as MS - increased protein >45, increased IgG, oligoclonal bands

24
Q

EMG findings

A

F WAVE

25
Q

Etiologies of CIDP

A

CTD, CMV, Hodgkin’s lymphoma, hepatitis, HIV, IBS, Lyme, MS, radiculoplexopathy

26
Q

Other issues w/ CIDP

A

Heme issues (M protein spike)