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Neuropath Feb 21st

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taylormaloney's version from 2017-02-21 19:01

Section 1

Question Answer
What is Post-Herpetic Neuralgia?Herpes Zoster- A condition caused by the Varicella-Zoster Virus.
What is the Varicella-Zoster Virus?A common herpes virus that affects the nervous system.
What may VZV present as in children?Chickenpox
When the VZV clears up in children, is the virus completely eliminated?No, it remains dormant in the sensory ganglia of CNs and SNs.
What may VZV cause later in life?A recurrence of the VZV in an adult may present as Shingles or Postherpetic Neuralgia.
What may cause a recurrence of the virus ?Age, Stress, Compromised immune system.
What is the Pathogenesis of Post Herpetic Neuralgia?Reactivation of virus causes inflammatory response, which begins to take place in the Sensory Ganglion. Can result in nerve demyelination or degeneration.
What are the S+S of PH NeuralgiaPain (often severe), tingling. Rash followed by blistering lesions. Leading to constant aching/burning/stabbing pain that occurs after the rash.
How long do PH Neuralgia outbreaks last?Months-Years after initial symptoms.
What may result if the VZV attacks motor neurons?LMN signs and symptoms.
Define Ramsey-Hunt SyndromeWhen a shingles infection affects the facial nerve near the ears- leading to loss of taste, vesicles on tympanic membrane and external auditory meatus.
How is PH Neuralgia diagnosed?By clinical presentation- seen by MD.
How is PH Neuralgia treated?Antiviral drugs can help limit disease course (though does not effectively prevent), NSAIDS/Analgesics, Topical Anesthetics, Gabapentin.
What is the overall prognosis relating to Shingles?Pain is resistant to treatment, (20% of people will have a reoccurance), Local massage over trigger zone is CI'd.
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Section 2

Question Answer
What is Polio- (Poliomyelitis, Infantile Paralysis)An acute, viral infectious disease that is spread from person to person via primarily fecal-oral route.
What does the term mean?Inflammation of the Grey Spinal Cord.
What are the symptoms found in most cases?90% have no symptoms at all.
How common is it for the virus to enter the central nervous system?1% only. Leading to the infection and destruction of motor neurons.
What does Polio essentially lead to? Muscle weakness and Acute Flaccid Paralysis.
What are the three types of Polio?Spinal- MOST COMMON. (asymmetric paralysis most often involving legs), Bulbar- affecting muscles innervated by the cranial N's. Bulbospinal Polio- Combination of Bulbar/Spinal.
What type of virus is Polio?An enterovirus.
Where is paralytic poliomyelitis most likely to be seen?In third world countries, where the vaccine is not available. (Salk-Sabine Vaccine).
What may the polio virus cause?Subclinical/Mild Gastroenteritis. May also invade nervous system.
What clinical manifestations are likely in CNS Infectious?Meningeal irritation, looks like aseptic meningitis, can stop at this point of continue to progress downwards to affect spinal cord.
What clinical manifestations are you likely to see in those with Spinal Cord involvement?Flaccid Paralysis, muscle wasting, hyporeflexia, potential death if respiratory mms affected. Myocarditis, and potentially cranial nerve weakness/encephalitis in rare cases.
Massage therapy and polio?CI'd until client completely recovers. (Very contagious)
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Section 3

Question Answer
Define Post-polio syndrome- (Post-polio muscular atrophy)A late neurological syndrome that typically happens 25-35 years after initial polio infection. A collection of symptoms seen in those who have recovered from Polio.
Who can potentially contract post-polio syndrome?ONLY those who are polio survivors.
What are the common S+S relating to post-polio?Progressive muscle/joint weakness and pain. General fatigue/exhaustion, muscle atrophy, difficulties with breathing and swallowing, sleep related breathing disorders, decreased tolerance to cold.
How is Post-Polio Syndrome Diagnosed?Relis nearly 100% on clinical information. Comprehensive medical history/physical exam, no lab tests available, excluding other disorders may be beneficial in diagnostics.
How is Post-Polio treated?No reliable pharmaceutical treatments yet. Non fatiguing exercise may improve mm strength/decrease fatigue.
How can massage therapy be used in treatment of PPS?Light massage for shorter treatments. Omilt/cautiously perform passive stretch + joint mobilizations.
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Section 4

Question Answer
Define Trigeminal NeuralgiaAlso known as Tic Douloureux- A cluster like type of headache.
How can the pain of TN be described?One of the most painful conditions that we can suffer from, intense paroxysms of piercing/stabbing pain within the Trigeminal N distribution.
How long do these 'clusters' last? What may be a potential complication?Lasts few seconds-minute. May cause paralysis of chewing muscles.
What causes TNAnything that presses on the trigeminal nerve or branches. As well as Herpes Zoster, MS, Tumors, and/or idiopathic.
Who is most likely to experience TN?Almost always in those over age 60. Typically women between 50-90 years.
TN may be the first sign of..MS, diabetes, Lack of B12.
Clinical Manifestations of TN?Pain suddenly- 'lightning' type pain. Maxillary division is most common. Opthalamic is least likely to be involves.
Is TN generally Unilateral or Bilateral?Mostly unilateral. (10% bilateral)
What is the most common TN treatment?Oral Carbamazepine- which may cause side effects including- blurred vision, dizziness, drowsiness, anemia, hepatotoxicity, teratogenic.
How else may TN be treated?Surgery- radiofrequency ablation. (electrical current produced by radio wave used to heat up small area of nerve tissue), Nerve decompression, Nerve Section, Alcohol Ablation.
What are the implications for Massage Therapy?Avoid Prone, and treatment in regions of face/scalp.
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