B7-008 CBCL Neuropathy Flashcards
describe the pattern, etiology, and explanation for focal neuropathy
pattern: unilatera, asymmetric
etiology: structural
explanation: anatomy
describe the pattern, etiology, and explanation for diffuse neuropathy
pattern: bilateral, symmetric
etiology: toxin or metabolite
explanation: physiology
causes bilateral, symmetric pattern of deficits and can be mistaken for diffuse neuropathy
midline structural lesions
(herniated disc, spinal tumor at cauda equina)
describe the pattern, etiology, and explanation for multifocal neuropathy
pattern: bilateral, asymmetric
etiology: inflammatory, infiltrative
explanation: anatomy or physiology
when you have a patient presenting with diffuse neuropathy syndrome, it is important to look for
midline structural lesions
contrast the deficit patterns of myelinopathies and axonopathies
diffuse diseases that affect myelin cause both proximal and distal weakness
diffuse diseases that affect the axon start distal and move proximal, so patients often present with distal weakness first
contrast the deficit patterns of small and large fiber neuropathies
small fibers cause mostly pain/temperature loss
large fiber cause motor loss
T4 corresponds to
nipple line
T10 corresponds to
umbilicus
C8 corresponds to
medial hand (pinky)
C6 corresponds to
lateral hand (thumb)
S1 corresponds to
lateral foot
L5 corresponds to
medial foot (big toe)
most common nerve root to be affected by degenerative arthritis in the upper extremity
C7
most common nerve root to be affected by degenerative arthritis in the lower extremity [2]
L5/S1
common causes of focal neuropathy [2]
trauma (acute)
entrapment (chronic)
too much pressure on a nerve while sleeping causes a […] focal neuropathy
neuropraxic
focal demyelination
axons and connective tissue intact
neuropraxia
how long does recovery from a neuropraxic injury take?
1-8 weeks
axon injury
connective tissue intact
axonotmesis
how long does recovery from a axonotmestic injury take?
variable, 1mm per day
axon transected
connective tissue disrupted
neurotmesis
no recovery
median neuropathy at the wrist
carpal tunnel
symmetric distal-to-proximal sensory loss
absent ankle reflexes
with/without weakness
distal symmetric peripheral neuropathy
(diffuse, length dependent)
“stocking and glove” sensory loss is an example of
distal symmetric peripheral neuropathy
two most common causes of distal symmetric peripheral neuropathy
diabetic peripheral neuropathy
cryptogenic (unknown)
bilateral symmetric sensory loss
preserved reflexes
no weakness
distal symmetric small fiber neuropathy
(diffuse, length dependent)
symmetric sensory loss
generalized hyporeflexia
proximal and distal weakness
proximal and distal bilateral diffuse neuropathies
(diffuse, non-length dependent)
proximal and distal bilateral diffuse neuropathies are usually caused by
autoimmune destruction of myelin
proximal and distal bilateral diffuse neuropathies are categorized as [2]
time course
AIDP (acute)
CIDP (chronic)
Guillain-Barre syndrome falls under what category?
AIDP
acute inflammatory demyelinating polyneuropathy
Guillain-Barre causes […] paralysis
ascending
treatment for Guillain-Barre
IVIg
plasmapharesis
proximal weakness
generalized arreflexia
immune mediated neuropathy (AIDP or CIDP)
is AIDP or CIDP treatable with chronic immunosuppression?
CIPD
symmetric distal sensory loss
absent ankle reflexes
with/without weakness
upper extremity spared
midline structural process (cauda equina)
but can also be early diabetic peripheral neuropathy or toxin presentation
multifocal neuropathy involving multiple roots
polyradiculitis
multifocal neuropathy involving multiple nerves
monneuropathy multiplex
polyradiculitis is commonly caused by
chronic inflammation of meninges
monneuropathy multiplex is commonly caused by
vasculitis
causes of acute to subacute multifocal neuropathies [3]
neoplastic
autoimmune
infectious (Lyme)
cause of chronic multifocal neuropathies
hereditary predisposition to pressure palsies
acute focal neuropathy is often caused by
trauma
chronic focal neuropathy is often caused by
entrapment
acute diffuse, distal neuropathy is often caused by
acute toxin (drug) exposure
(chemotherapy, arsenic)
chronic diffuse, distal neuropathy is often caused by [5]
diabetes
cryptogenic
hereditary
chronic toxin
organ failure
acute diffuse, distal and proximal neuropathy is often caused by
AIDP (Guillain-Barre)
chronic diffuse, distal and proximal neuropathy is often caused by
CIDP
acute midline neuropathy is often caused by [3]
cauda equina syndrome
trauma
hematoma
chronic midline neuropathy is often caused by [3]
cauda equina syndrome
spinal stenosis
tumor
acute multifocal neuropathy is often caused by [3]
inflammatory
neoplastic
infectious
chronic multifocal neuropathy is often caused by
predisposition to pressure palsies
unilateral, asymmetric
focal neuropathy
bilateral, symmetric, distal
distal symmetric length dependent neuropathy (axonopathy)
bilateral, symmetric, distal and proximal
immune mediate neuropathies (myelinopathy)
bilateral, symmetric, sparing of hands
possible midline structural lesion of the cauda equina
bilateral, asymmetric
multifocal
three types of traumatic nerve injury
neuroprxia
axonotmetic
neurotmetic
innervates middle digit, triceps, and tricep reflex
C7
[…] radiculopathy would cause numbness of the first and second digits, weakness of bicep
C6
[…] radiculopathy would cause numbness of the fourth and fifth digits, week intrinsic hand muscles
C8
[…] neuropathy would cause triceps weakness
radial
[…] neuropathy would cause numbness to the palmar hand and digits 1-3
median
the presence of […] is a hallmark of immune mediated peripheral neuropathies
proximal muscle weakness
:)
diabetic neuropathy is an example of what pattern of involvement?
distal symmetric length-dependent sensory neuropathy
balance is dependent on what 3 sensory systems
vestibular
vision
proprioception through large fiber nerves
[…] fiber nerves provide proprioception
large
medications most likely to be beneficial for burning neuropathic pain [4]
gabapentin
amitriptyline
duloxetine
pregabalin
topical ointments for neuropathic pain [3]
capsaicin
lidocaine ointment
voltaren gel
ADIP is an example of what pattern of involvement?
distal and proximal symmetric sensorimotor peripheral neuropathy
systems involved in AIDP [3]
sensory
motor
autonomic
treatment for AIDP [2]
plasmapharesis
IVIg
elevated protein with normal WBC count of CSF analysis is common of
immune mediated neuropathies
the main difference between AIDP and CIDP is
time course
AIDP peaks in severity at […] weeks
8
proximal weakness and areflexia indicates
immune mediated neuropathy
treatment for CIDP [2]
IGIg
long term oral steroids
characterized by damage to sensory nerve cells bodies of dorsal root ganglia, leading to degeneration of central and peripheral sensory projections
sensory ganglionopathy (sensory neuronopathy)
vasculitic neuropathy usually presents with what pattern?
multifocal neuropathy
what pattern of neuropathy would a B12 deficiency cause?
bilateral symmetric
when a lesion involves the […] in presents with dermatomal sensory changes and myotomal weaknes
root
if a sensory loss pattern involves the […] it is non-length dependent
face
large fibers sense [3]
proprioception
fine touch
vibrations
small fibers sense [2]
pain
temperature
patients with […] experience symptoms in their hands before their lower extremity symptoms progressing above the knee
neuronopathy
