CIS Clinical Approach to Peripheral Neuropathies

Question 1

What structure can be compromised in certain disease processes that will lead to the death of a neuron

Answer 1

Vasa Nervorum

blood vessels to the nerves

Question 2

What does Wallerian degeneration do to the nerve

Answer 2

as the myelin degenerates, the axon following that tract will send off projections to find a tract to be a part of.

Question 3

What is a radiculopathy

Answer 3

Nerve root dysfunction caused by a structural or nonstructural insult to the root

Question 4

What are the most common spinal levels involved in Radiculopathy

Answer 4

Cervical C6, C7 root compression

Lumbar L5, S1 root compression

Question 5

If a pt comes in complaining of scapula, shoulder, and elbow forearm pain, loss of sensation in the 3rd digit and has wrist and elbow extension weakness and no triceps DTR. What nerve root is compromised

Answer 5

C7

Question 6

What will likely separate an L5 v an S1 Radiculopathy

Answer 6

Absent Achilles Reflex in S1 but no reflex loss in L5

Question 7

Describe Parsonage-Turner Syndrome

Answer 7

Plexopathy

Severe pain in shoulder followed by weakness and atrophy

spontaneous recovery in 6-18 mo; steroid can help early on

Question 8

What is a mononeuropathy

Answer 8

Single nerve affected with specific pattern of sensory loss

Carpal Tunnel and Cubital Tunnel

Question 9

What is a polyneuropathy

Answer 9

Diffuse, symmetrical disease.
Stocking, glove sensory loss with distal weakness

eg Diabetic neuropathy

Question 10

What is mononeuropathy multiplex

Answer 10

Focal involvement of two or more nerves

May occur in systemic disorders

Question 11

Describe paresthesia

Answer 11

secondary to large myelinated fiber disease (pins and needles)

Question 12

Name the sensory deficits in the disease of Large myelinated sensory fibers

Answer 12

impairment of

light touch
two point discrimination
Vibration
proprioception

Question 13

What senses are lost in damage to small unmyelinated fibers

Answer 13

Temperature

Pain (pinprick)

Question 14

If you wanted to test if anterior interosseous syndrome was present, what would you do

Answer 14

Make the OK sign. If their thumb and index finger are flat then it is a positive sign.

Question 15

What are common sites of ulnar mononeuropathies

Answer 15

Axilla
Elbow
Cubital tunnel
Wrist

Question 16

What is froment sign in ulnar neuropathy

Answer 16

Have someone grab a piece of paper. If thumb is flat then that is normal. Flexed thumb is positive and indicates neuropathy

Question 17

What are common sites for radial mononeuropathy

Answer 17

Axilla (crutch)
Humerus/Spiral Groove (Tanner’s Palsy, AKA Saturday night Palsy
Supinator
Wrist

Question 18

What are the signs of radial mononeuropathy

Answer 18

Wrist drop.

Question 19

In peroneal nerve entrapment, what is the location, predisposing action, and sx

Answer 19

Location: Fibular neck
Actions: Leg Crossing, squatting
SX: Foot drop, weak evertors, sensory loss in dorsum of foot

Question 20

In femoral cutaneous nerve entrapment, what is the location, predisposing action, and sx

Answer 20

Location: Inguinal Ligament (meralgia paresthetica)
Actions: Tight Clothing, weight gain (AKA gun belt palsy)
Sensory loss in lateral thigh

Question 21

What test can be used to assess proprioception in peripheral neuropathy

Answer 21

Romberg Maneuver

Question 22

If you have a paraneoplastic peripheral neuropathy, what is the deficit likely to be

Answer 22

Pure sensory (dorsal ganglionopathy)

Question 23

Describe small fiber polyneuropathy

Answer 23

Pain or burning and loss of pain and temp sensation
EMG/NCV normal
Decreased epidermal nerve fiber density

Question 24

What is the most common identifiable cause of neuropathy in the US

Answer 24

Diabetes Mellitus

Question 25

What is the most common Hereditary Motor Sensory Neuropathy

Answer 25

HMSN I AKA Charcot-Marie-Tooth

demyelination

Question 26

Describe HMSN 1 AKA Charcot-Marie-Tooth I

Answer 26

AD pattern inheritance 
1st-2nd decade onset 
Difficulty walking/running 
Develop Pes cavus, hammer toe 
EMG slowing of motor nerve conduction

Question 27

What is the main difference between HMSN I and II

Answer 27

EMG shows normal motor nerve conduction velocities in HMSN I

Question 28

Describe Guillain-Barre syndrome

Answer 28

Acute ascending motor paralysis
Following EBV, Campylobacter
HIV
Hodgkin’s disease

Question 29

What are the key lab findings in Guillain-Barre syndrome

Answer 29

CSF: Albumino-cytologic dissociation (increase protein, normal cell count)

NCVs: slow conduction velocity, focal conduction block, prolonged F waves

Question 30

Someone has GBS, and they NCV/EMG shows low amplitude and denervation, what is the prognosis

Answer 30

BAD

Question 31

In 5% of GBS, pts will develop Miller-Fisher Syndrome. What is that biz

Answer 31

ophthalmoplegia, ataxia, areflexia
facial weakness, dysarthria, dysphagia
GQ1b and GT1a antibodies

Question 32

How does Chronic Inflammatory Demyelinating Polyneuropathy compare to AIDP

Answer 32

Slower to evolve and persistent

May occur spontaneously or after GBS

Question 33

Does EMG/NCV lead to specific diagnosis

Answer 33

nope