Professional Documents
Culture Documents
Medulla Spinalis
Medulla Spinalis
Medulla Spinalis
Medulla Spinalis
Medulla Spinalis
Medulla Spinalis
Medulla Spinalis
Medulla Spinalis
Medulla Spinalis
Medulla Spinalis
Medulla Spinalis
Medulla Spinalis
Medulla Spinalis
Infeksi = - Mielitis - Spondilitis - Absces Vaskular = Tumor = - Neoplasma : Primer & Metastasis Lokasi - Non-neoplasma : Degeneratif = - HNP - Spondilosis Trauma =
ALS
50 % dead in 3 years, 80% dead in 5 years, 5-10% live more than 10 years Death usually from respiratory failure Etiology still only theoretical
Excess glutamate Oxidative stress Free radicals Mitochondrial dysfunction
Mononeuritis multiplex (DM, vasculitis) Plexopathies (immune, neoplastic) Radiculopathies (discs, immune) Peripheral Neuropathies
Mononeuritis multiplex
Multiple nerves affected in a random pattern
Acute onset, frequently painful Diabetes mellitus, vasculitis
Polyneuropathies
Can affect different types of fibers
Autonomic Motor Sensory
Large well myelinated Small poorly myelinated or unmyelinated
Symptoms of a Polyneuropathy
Sensory symptoms
Start in feet, move proximally Hand sxs appear when LE sxs up to knees Positive
Pins and needles Tingling Burning
Negative
Numbness Deadness Like Im walking with thick socks on
Polyneuropathy Symptoms
Motor
Weakness first in feet
Tripping Turn ankles
Polyneuropathy: Signs
Distal sensory loss
Large fiber Small fiber
Classification of Polyneuropathies
By types of fibers involved
Pure sensory Sensory motor Pure motor Autonomic
By pathology
Demyelinating Axonal Mixed
By tempo
Acute Subacute Chronic
Acute Polyneuropathies
Guillain Barre Syndrome Porphyria
Neuropathy, psychiatric disorder, unexplained GI complaints
Toxins
Glue sniffing (n-hexane) Arsenic
Subacute Polyneuropathies
Vasculitis
Can be isolated to peripheral nerves or part of a more systemic process
Paraneoplastic
May be presenting symptom of the cancer
Toxins Drug
Chronic Polyneuropathies
Metabolic
Diabetes mellitus Chronic renal failure Chronic liver failure Thyroid disease
Nutritional
B12 deficiency
Infections
HIV Leprosy
Inherited
Evaluation of a Polyneuropathy
Lab work Nerve conduction study/electromyography
Distinguishes between axonal and demyelinating Helps ascertain severity
Nerve biopsy
Frequently non-diagnostic Can establish the dx in certain disorders, such as vasculitis and amyloidosis
NMJ
Pre-synaptic
Lambert Eaton myasthenic syndrome Botulism
Post-synaptic
Myasthenia Gravis
Myasthenia Gravis
Antibody that alters the acetylcholine receptor
Binding Blocking Modulating
Antibody detected in
50% of pts with pure ocular MG 90-95% of pts with generalized MG
Clinical Manifestation of MG
Sxs worsen with exercise, end of day (Fatigue) Ocular
Droopy eyelids (ptosis) Double vision (diplopia)
Extremity weakness
Arms > legs
Bulbar
Dysarthria Dysphagia
Respiratory
Shortness of breath
Approach to treating MG
Remove any exacerbating factors
Infections, medication, endocrine disease
Myopathies
Cramps with the metabolic myopathies Myalgias with the inflammatory myopathies Swallowing and breathing difficulties, when present, are usually late
Congenital Myopathies
Glycogenoses Mitochondrial
Acquired Myopathies
Polymyositis Dermatomyositis Inclusion body myositis Drug related
Muscles replaced by fat may appear hypertrophic Frequently mildly mentally retarded Life expectancy < 20 years with death related to respiratory failure or cardiomyopathy
Polymyositis
Presents with proximal muscle weakness in 92% Myalgias in 25% Associated symptoms may include fever, weight loss Slightly increased risk of cancer
Bladder, lung, lymphoma
Extremity Weakness ALS Polyneuropathy LEMS Random Distal> Proximal LE > UE Prox>distal UE>LE +/-prox>distal Prox>distal
CN
Reflexes
Sensation
yes rare
rare
MG
yes
Normal
Myopathy
occ
Normal or dec
Normal
Terima Kasih