-
presentation traumatic SCI
- trauma
- spinal shock
- loss of sensation
- loss motor fxn
- altered DTRS (hypo at level of lesion)
- spasticity
-
presentation refute traumatic SCI
- no trauma
- no spinal shock
- deficits at only 1 spinal level
- cognitive deficit
- CN involvement
-
findings dx traumatic SCI
MRI/CT
-
presentation sc tumor
- motor weakness- segmental level progressing to UMN
- altered DTRs
- sensory changes (tract or root)
- increased ICP
- B&B/ sexual dysfunction
-
presentation refute sc tumor
- trauma
- cognitive changes
- infection
- degenerative conditions (bone and disc)
-
findings dx sc tumor
MRI, biopsy
-
presentation ischemic CVA
- rapid onset, slow onset
- sudden weakness face, arm, leg
- dizziness
- sudden headache
- loss of vision (1 eye)
- BP
- CN fxn
- motor, sensory, reflexes altered
-
risk factors ischemic CVA
- HTN
- diabetes
- heart disease
- high cholesterol
- smoking, alcohol
- obesity
- >65
- African American
- males> females
- family hx
- prior hx
-
presentation refute ischemic CVA
- anti-coagulant therapy
- onset during high activity level
- CT: bleeding
-
findings dx ischemic CVA
MRI, neg CT, doppler US
-
presentation subarachnoid hemorrhage
- worst headache ever
- neck stiffness
- vomiting
- convulsive seizures
- sudden onset
-
presentation refute subarachnoid hemorrhage
- may/may not have trauma
- progressive LOC
-
findings dx subarachnoid hemorrhage
- bleeding between pia and dura
- need CT or arteriography
-
presentation subdural hemorrhage
- progressive LOC
- tearing of perforating veins
- slower onset
-
presentation refute subdural hemorrhage
rapid onset of sx
-
findings dx subdural hemorrhage
- CT
- concave border
- can cross suture lines
-
presentation brain tumor
- insidious onset
- headeache (more w/ inc pressure such as when coughing)
- personality changes
- altered consciousness
- focal neurological signs (CN lesions or parts of cortex compromised)
- hx of cancer in other parts of body
- vision changes
- lethargy
- seizures
-
presentation refute brain tumor
- systemic presentation, distal or prox muscles
- onset after trauma
-
findings dx brain tumor
MRI or CT
-
presentation TBI
- trauma
- unexplainable s/s (motor and sensory don't match up)
- CN involvement
- UMN signs
- ICP increases
- cognitive changes
- pain w/ neck flexion
-
presentation refute TBI
- no trauma
- LMN signs
- specific distribution of involvement
-
-
presentation MS
- viral infection (autoimmune process)
- vision problems
- heat sensitivity
- weakness
- balance issues
- UMN signs
- spasticity
-
presentation refute MS
- sensory loss
- non-progressive
- no fatigue
- heat doesn't inc s/s
- CN deficits
- LMN signs
- no Lhermitte's sign
-
findings dx MS
- combination of presentation and imaging
- 2+ lesions at different spaces or at different time
- inc ICP
-
presentation ALS
- family hx
- slurred speech
- difficulty swallowing
- weakness (esp hand intrinsics)
- respiratory problems
- asymmetrical
- foot drop
- UMN and LMN
- distal to prox
-
presentation refute ALS
- UMN or LMN only
- nerve root distribution
- sudden onset
- cognitive changes
-
findings dx ALS
- EMG (fibrillations)
- R/O all other dxs
-
presentation peripheral nerve entrapment
- numbness, tingling, shooting pain
- slower developing
- lingering post trauma
- asymmetrical
- dermatome/myotome distribution
- s/s provoked w/ neural tension tests
-
presentation refute peripheral nerve entrapment
- autoimmune
- UMN signs
- no mechanical interface
- normal NCV
-
findings dx peripheral nerve entrapment
- inc s/s to sensitization w/ neural tension
- dec MMT of peripheral nerve
- hyporeflexia
- NCV normal prox to interface and slowed distal to interface
-
presentation Guillain-Barre
- rapid progression
- hx of recent illness
- primarily motor issue
- symmetrical
- peripheral nervous system involvement
- starts distal moves prox
-
presentation refute Guillain-Barre
- extraoccular eye involvement
- prox s/s
- UMN signs
-
findings dx Gullain-Barre
- clinical presentation
- inc albumin in CSF
- slow NCV
-
presentation SMA
- LMN signs (AHC)
- prox weakness
- atrophy of extremities
- scoliosis
-
presentation refute SMA
- sensory involvement
- no fibrosis or fat deposits
- cognitive dysfunction
- CN involvement
- UMN signs
-
findings dx SMA
- normal NCV
- EMG: fibrillations, fasciculations, sharp waves
- muscle biopsy- atrophic amongst hypertrophic
- genetic testing
-
presentation post-polio
- hx of polio
- partial recovery in region of illness
- fatigue
- dec function
- AHC involvement
- weakness decades after illness
- partial or complete recovery
- fatigue
-
presentation refute post-polio
- no hx of polio
- weakness outside original affected region
- trauma to affected
- infection
- sensory deficits
- UMN signs
-
findings dx post-polio
- EMG: denervation
- hx of polio followed by partial or complete recovery and s/s return decades later
-
presentation diabetic neuropathy
- loss of sensation distally
- sock and glove
- distal mm weakness (esp LE)
- LMN signs
- proprioceptive loss
- hx diabetes
-
presentation refute diabetic neuropathy
- no hx diabetes
- prox s/s
- UMN signs
-
findings dx diabetic neuropathy
-
presentation myasthenia gravis
- skeletal mm weakness
- fatiguability
- facial and ocular mm first
- weak cervical mm
-
presentation refute myasthenia gravis
- distal mm weakness
- no ocular involvement
- sensory deficits
-
findings dx myasthenia gravis
- fatiguability reduced w/ rest
- intact sensation
- improved strength w/ ACH inhibitors
- presence of ACH antibodies
- dec motor AP
-
presentation muscular dystrophy
- Gower's sign
- waddling gait
- calf contractures
- inc lordosis
- prox muscles affected first
- shoulder girdle weakness
-
presentation refute MD
- late onset
- asymmetrical presentation
- good LE strength
- low NCV
- no fibrillations
-
findings dx MD
- DNA testing
- muscle biopsy
- high creatine kinase levels
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