B7-008 CBCL Neuropathy Flashcards by Felicia Jones

describe the pattern, etiology, and explanation for focal neuropathy

pattern: unilatera, asymmetric
etiology: structural
explanation: anatomy

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describe the pattern, etiology, and explanation for diffuse neuropathy

pattern: bilateral, symmetric
etiology: toxin or metabolite
explanation: physiology

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causes bilateral, symmetric pattern of deficits and can be mistaken for diffuse neuropathy

midline structural lesions

(herniated disc, spinal tumor at cauda equina)

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describe the pattern, etiology, and explanation for multifocal neuropathy

pattern: bilateral, asymmetric
etiology: inflammatory, infiltrative
explanation: anatomy or physiology

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when you have a patient presenting with diffuse neuropathy syndrome, it is important to look for

midline structural lesions

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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

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contrast the deficit patterns of small and large fiber neuropathies

small fibers cause mostly pain/temperature loss

large fiber cause motor loss

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T4 corresponds to

nipple line

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T10 corresponds to

umbilicus

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C8 corresponds to

medial hand (pinky)

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C6 corresponds to

lateral hand (thumb)

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S1 corresponds to

lateral foot

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L5 corresponds to

medial foot (big toe)

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most common nerve root to be affected by degenerative arthritis in the upper extremity

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most common nerve root to be affected by degenerative arthritis in the lower extremity [2]

L5/S1

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common causes of focal neuropathy [2]

trauma (acute)
entrapment (chronic)

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too much pressure on a nerve while sleeping causes a […] focal neuropathy

neuropraxic

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focal demyelination
axons and connective tissue intact

neuropraxia

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how long does recovery from a neuropraxic injury take?

1-8 weeks

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axon injury
connective tissue intact

axonotmesis

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how long does recovery from a axonotmestic injury take?

variable, 1mm per day

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axon transected
connective tissue disrupted

neurotmesis

no recovery

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median neuropathy at the wrist

carpal tunnel

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symmetric distal-to-proximal sensory loss
absent ankle reflexes
with/without weakness

distal symmetric peripheral neuropathy

(diffuse, length dependent)

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"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

[...] radiculopathy would cause numbness of the first and second digits, weakness of bicep

[...] radiculopathy would cause numbness of the fourth and fifth digits, week intrinsic hand muscles

[...] 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

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