-Trophy
Patient's getting a cast removed from their leg after 3 months. They were unable to use that leg and upon removal, the leg looked skinny as if it shrunk. The nurse explained to the patient that the muscle innervated due to long period of inactivity which caused the cells to shrink, lose contractile proteins, and weaken.
What is Disuse Atrophy?
Mya presents to the clinic with complaints of progressive muscle weakness that worsens with activity and improves with rest. She reports difficulty keeping her eyes open (ptosis), intermitten double vision (diplopia), and trouble swallowing over the last few weeks. She also experienced occasional slurred speech. The provider explains this is due to an autoimmune disorder of the neruomuscular junction caused by antibody-mediated loss of acetylcholine (ACh) receptors as a result of declining postsynpatic membrane area. The doctor said to administer coritcosteroids and immunosupressants; in the case that doesn't work, administer physostigmine and neostigmine or plasmapheresis. She may require ventilatory support.
What is Myasthenia Gravis?
Group of motor disturbances defined by tremor and involuntary movements, changes in posture and muscle tone, slowness of movement.
What is Basal Ganglia Disorder?
Mrs. R is 22 year-old patient and Our Smart Swimmer w/ Perfect Balance, Showing Mighty Persistence while suffering from demyelinating disorder of CNS where loss of myelin disrupts/stops nerve conduction due to autoreactive B cells and T cells crossing blood brain barrier.
What is Multiple Sclerosis?
This irreversible injury occurs at the time and expect to see hemorrhage in gray matter/edema in white matter → necrosis. Patient was diagnosed by Xray, CT, and MRI
What is (acute) primary neurologic injury?
Denver presented to the clinic with progressive weakness in his left leg over the past six months. He noticed difficulty climbing stairs and a visible reduction in muscle mass in the affected limb. The nurse explains this is due to the loss of neural innervation and contractile proteins.
What is Denervation Atrophy?
Damage to Shwann cells/myelin sheath which impairs proper remyelination, causing thinner myelin shealth and axonal injury
What is segmental demyelination?
*involves dopaminergic nigrostriatal neuronal pathway
* Depletion of dopamine and relative excess of cholinergic
Patient appears in the clinic reporting of resting tremors, rigidity, bradykinesia, and posture changes accompanied with thermal dysregulation. Their partner reports declining cognitive function and incontinence/constipation.
There is no treatment for this disease
What is Parkinson's Disease?
1. Relapsing-remitting: episodes of acute worsening w/ recovery & stable course between relapses
2. Primary-progressive: nearly continuous neurologic deterioration from onset of symptoms
3. Secondary-progressive: gradual neurologic deterioration with or without acute relapse
4. Progressive-relapsing: gradual neurologic deterioration from onset of symptoms with subsequent relapses
What are the subtypes of MS?
Spread of primary injury with characteristics of ischemia, ↑ permeability, edema, and spinal shock
Miguel was brought to the clinic by his parents due to difficulty walking long distances, frequent falls, and a noticeable waddling gait that has progressively worsened over the past two years. He also notes that although his muscles have grown, they feel weaker. After receiving genetic testing, results showed a genetic x-linked recessive disorder. The doctor explained that his symptoms are due to necrosis of the skeletal muscle fibers being replaced with fat and connective tissue.
What is Muscular Dystrophy?
A primary injury to neuronal cell body/axon where dead nerve cells are not replaced. The injured axonal branches may regenerate, depending on injury.
What is axonal degeneration?
Mr. K is a 55 year-old male who reports slowly progressive weakness and muscle atrohy in distal muscles of one upper extremity with spasticity, stiffness, and impaired motor control. After their admission, Mr. K started experiencing impaired swallowing, speaking, and hoarseness. There is no cure for this disease and Mr. K was given a prognosis of 3 years to live due to respiratory failure.
What is Amyotrophic Lateral Sclerosis (ALS)?
Acute attacks/initial demyelination: corticosteroids
Symptom treatment: DBD (dantrolene, baclofen, diazepam)
Modify course of disease: interferon-B & Glatiramer acetate
What are treatments for MS?
loss of vasomotor tone and spinal reflexes below level of lesion which impairs normal activity of spinal cord. Characteristics include flaccid paralysis, loss of tendon reflexes, absence of somatic & visceral sensations, and loss of bowel/bladder function. Other key characteristics include vasodilation, ↑ venous capacity, hypotension, bradycardia (VVHB)
▶ depends on degree of transection (complete at L1)
What is Spinal Shock?
Most severe form of muscular dystrophy. While more common in males, females are asymptomatic. This is due to a genetic mutation of the dystrophin coding which is crucial in sacolemma integrity.
What is Duchenne Muscular Dystrophy?
Patient Jay comes into the clinic complaining of pain, "pins and needle" sensation in her wrist, and grip weakness for the past 4 days. Jay crochets everyday (repetitive use of wrist). The nurse explains that this is due to compression of median nerve within carpal tunnel. The provider suggests avoiding crocheting for a while and nighttime splinting with administration of NSAIDs or corticosteroids. If the pain persists, the provider recommends surgery.
What is Carpal Tunnel Syndrome (Mononeuropathy) ?
Byproduct of resolved spinal shock as a result of an injury at T6 or above with massive, uncompensated sympathetic reflex response to stimulation of sensory receptors below the level of injury. Patient with this may have symptoms including " Icy Bears Venture Swiftly Up Hills" and "Chilly Vessels Perk"
This is treated with a bladder scan, correct stimulus, and upright position to decrease venous return of blood
What is Autonomic dysreflexia/Autonomic Hyperreflexia?
William's parents said the issue began when he was around 2-3 years old because they noticed him falling alot. As he got older, they noticed abnormal posture with his hips and shoulders and scoliosis and by age 10 he was in a wheelchair. He also had PMH of reoccurent respiratory infections that typically consisted of a weak/ineffective cough accompanied by cardiomyopathy. His diagnosis was confirmed with molecular genetic testing, assessing movement, his serum creatine kinase levels, a muscle biopsy, and EKG/CXR. His doctor recommended ambulation and glucocorticoid therapy for inflammation.
What are the clinical manifestations, diagnostic tests, and treatments for Duchenne Muscular Dystrophy?
Patient come in complaining of numbness with tingling and pain in her arm that has been progressively worsening (flaccid paralysis) the past couple days. She reports she is recovering from flu and is struggling with her breathing. The nurse explains that this is due to an infiltration of immune cells around capillaries of peripheral neurons, causing edema and demyelination. The provider puts the patient on plasmapheresis and immunoglobulin therapy. If her breathing worsens, patient will need to be intubated and have mechanical ventilation.
What is Guillain-Barre Syndrome (polyneuropathy)?