5: Peripheral neuropathy

Question 1

What is an endocrine disease which causes peripheral neuropathy?

Answer 1

Diabetes

Question 2

What happens to the reflex response when peripheral nerves are damaged?

Answer 2

Reduced/absent reflexes

Question 3

What are some symptoms of autonomic neuropathy?

Answer 3

Sweating

Tachycardia

Gastroparesis

Question 4

What is dyesthesia?

Answer 4

Pain on touching caused by peripheral nerve damage

Question 5

Neuropathy of which nerve causes a high-stepping gait?

Why?

Answer 5

Deep fibular nerve

Responsible for foot dorsiflexion, so patient has to lift foot high to prevent dragging foot

Question 6

What is the most common mononeuropathy?

Answer 6

Carpal tunnel syndrome

Question 7

Mononeuritis multiplex is (symmetrical / asymmetrical).

Answer 7

asymmetrical

Question 8

Peripheral neuropathy tends to be (symmetrical / asymmetrical).

Answer 8

symmetrical

Question 9

What sort of distribution does diabetic peripheral neuropathy often take?

Answer 9

Glove and stocking

Question 10

In which two ways can large diameter nerve fibres be damaged?

Answer 10

Axonal loss (e.g infarction, trauma)

Demyelination

Question 11

What is a common acute-onset demyelinating neuropathy?

Answer 11

Guillain Barre syndrome

Question 12

What are the symptoms of GBS?

Answer 12

Progressive loss of sensation in limbs

Tingling pain

Question 13

When do symptoms peak in GBS?

Answer 13

2 weeks after onset

Question 14

What can be absent in GBS?

Answer 14

Reflexes

Question 15

1 in 4 GBS patients require ___.

Answer 15

ventilation

Question 16

How is Guillain Barre syndrome treated?

Answer 16

Admission to hospital

IV immunoglobulins (to buffer immune system)

Plasmapharesis (filtering of blood to strip out demyelinating substances)

Question 17

What is a less common type of demyelinating neuropathy?

Answer 17

Hereditary motor and sensory neuropathy (HMSN)

Question 18

What are common presentations of HMSN?

Answer 18

Just memorise:

LOWER LIMB MUSCLE WASTING (tibial / fibular nerve)

CLAW HAND (ulnar nerve)

HIGH ARCHED FOOT (imbalance between leg and foot muscles)

Question 19

What are some causes of peripheral neuropathy?

Answer 19

Infection

Drugs/Alcohol

Neoplasia

Vasculitis

Diabetes, vitamin deficiencies, porphyria…

Question 20

What are need-to-know causes of autonomic neuropathy?

Answer 20

Diabetes

Amyloidosis

HMSN

GBS

Porphyria

Question 21

A patient presents with an acute abdomen and peripheral neuropathy.

What is the likely diagnosis?

Answer 21

Porphyria

Question 22

A patient has tingling and muscle wasting over their thenar eminence.

What neuropathy do they have?

Answer 22

Carpal tunnel syndrome

Caused by compression of the median nerve within the carpal tunnel

Question 23

Describe two tests which can elicit carpal tunnel symptoms.

Answer 23

Phalen’s test: ask patient to do reverse prayer sign

Tinel’s test: tap on the carpal tunnel with your finger or a tendon hammer

Question 24

A patient describes a lack of sensation over their “regimental badge patch” area.

Which nerve is involved in this peripheral neuropathy?

Answer 24

Axillary nerve

Question 25

A patient experiences facial weakness.

Which nerve is involved in this neuropathy?

Answer 25

CN V

FOREHEAD SPARING - UMN disease (e.g a stroke)

NO FOREHEAD SPARING - LMN disease (Bell’s palsy)

Question 26

A patient presents with wrist drop.

Which nerve is likely involved in this peripheral neuropathy?

Answer 26

Radial nerve

Question 27

A patient presents with a claw hand.

Which nerve is likely involved in this peripheral neuropathy?

Answer 27

Ulnar nerve

Question 28

A patient presents with a hand of benediction.

Which nerve is likely involved in this peripheral neuropathy?

At which point in the upper limb is it damaged?

Answer 28

Median nerve

Forearm or elbow (because it’s not a carpal tunnel syndrome)