Clinical Approach to Peripheral Neuropathies (Hon) Flashcards
What is a dermatome?
What is a myotome?
What is a sclerotome?
1) Skin are supplied by a single spinal root
2) Muscle group supplied by a single spinal root
3) Area of bone supplied by a single spinal root
What is radiculopathy?
Nerve root dysfunction may be caused by structural (discs, osteophytes, tumors, etc) or non structural (DM, infections, etc) conditions
What are the most common cervical levels involved with radiculopathy?
Which is more common?
1) C5-6
2) C6-7 (more common)
What does a C5-6 radiculopathy lead to?
What does a C6-7 radiculopathy lead to?
1) C6 nerve root compression
2) C7 nerve root compression
What are the most common lumbar levels involved with radiculopathy?
What does each lead to?
1) L4-L5 = L5 nerve root compression
2) L5-S1 = S1 nerve root compression
A C6 nerve root compression leads to:
1) Pain where?
2) Sensory loss where?
3) Weakness in what movement?
4) DTR loss where?
1) Scapula, shoulder, proximal arm
2) 1st and 2nd digit, lateral arm
3) Shoulder abduction, elbow flexion
4) Biceps
A C7 nerve root compression leads to:
1) Pain where?
2) Sensory loss where?
3) Weakness in what movement?
4) DTR loss where?
1) Scapula, shoulder, elbow
2) 3rd digit
3) Elbow and wrist extension
4) Triceps
A L5 nerve root compression leads to:
1) Pain where?
2) Sensory loss where?
3) Weakness in what movement?
4) DTR loss where?
1) Dorsal thigh and lateral calf
2) Lateral calf and dorsum of foot
3) Hamstrings and foot dorsiflexion, inversion, eversion
4) None
A S1 nerve root compression leads to:
1) Pain where?
2) Sensory loss where?
3) Weakness in what movement?
4) DTR loss where?
1) Posterior thigh and posterior calf
2) Posterolateral calf and lateral foot
3) Hamstrings and foot plantarflexion
4) Achilles
Match the dermatome level to the area it supplies:
1) C6
2) C7
3) C8
4) T1
5) T4
6) T10
7) L1
8) L4
9) L5
1) Thumb/Index Finger
2) Middle Finger
3) Fourth/Fifth Finger
4) Medial forearm
5) Nipple line
6) Umbilicus
7) Inguinal
8) Medial calf
9) Lateral calf
Parsonage-Turner Syndrome is a form of?
Brachial plexopathy
What is the clinical presentation of Parsonage-Turner Syndrome?
Severe pain in shoulder area followed within a few days by weakness and atrophy usually involving muscles of the shoulder girdle
What does the course look like for Parsonage-Turner Syndrome?
What can be given to help?
1) Spontaneous recovery in 6 – 18 months
2) Steroids
What are the different classifications of peripheral neuropathy?
1) Mononeuropathy
2) Polyneuropathy
3) Mononeuropathy Multiplex
Mononeuropathy Multiplex may occur in some systemic disorders such as?
DM
What are some sensory findings seen with Peripheral nerve disease?
1) Loss of sensation
2) Paresthesia (pins & needles)
3) Pain (Burning sensations)
What are some motor findings seen with Peripheral nerve disease?
1) Distal weakness
2) Cramps
3) Atrophy
4) Decreased DTRs
5) Muscle fasciculations (twitching)
Large myelinated sensory fibers can be impaired due to peripheral nerve disease and is tested with what exams?
1) Light-touch (cotton swab)
2) Two-point discrimination
3) Vibration (128 Hz tuning fork)
4) Joint position sense
Small unmyelinated sensory fibers can be impaired due to peripheral nerve disease and is tested with what exams?
1) Temperature perception
2) Pain perception (pin prick)
Carpal tunnel syndrome involves entrapment of?
Median nerve
The usual sensory distribution of the median nerve is?
1) Medial palmar surface of the lower forearm and palm
2) Thenar eminence and thumb
3) Adjacent two and a half fingers.
What hand motion is used to test Anterior Interosseous Syndrome (form of median mononeuropathy)?
The “ok” hand sign
What is the most common site of ulnar mononeuropathy?
Cubital tunnel
What sign is seen with lunar neuropathy?
Froment sign (bends thumb excessively to grasp)
What is the most common site of radial mononeuropathy?
What is it called when in this location?
1) Humerus/Spinal groove
2) Saturday Night Palsy
What sign is seen with radial nerve damage?
Wrist drop
What are the clinical features of peroneal mononeuropathy at fibular head?
1) Weakness of foot dorsiflexion and eversion
2) Weakness of toe extension
3) Sensory loss dorsum of foot
“Large fiber” sensory involves?
“Small fiber” sensory?
1) Position/vibratory sense
2) Pain/temperature sense
What is the most common autonomic abnormity seen with peripheral (Polyneuropathy) neuropathy?
Orthostatic hypotension
Polyneuropathy results in what sensory loss pattern?
Stocking/glove sensory loss
Which vitamin deficiency is most commonly associated with peripheral neuropathy?
B12
The Romberg Maneuver tests?
Proprioception
What signs are seen with Small Fiber Polyneuropathy?
1) Decreased pin-prick and temperature sensation
2) Dysesthesia to light touch
What is seen on skin biopsy for Small Fiber Polyneuropathy?
Decreased epidermal nerve fiber density
What is the most common identifiable cause of neuropathy?
DM
What CNs can be affected by neuropathy due to DM?
1) CN III
2) CN VI
3) CN VII
What is the most common form of Hereditary Motor Sensory Neuropathies (Charcot-Marie-Tooth)?
HMSN I
What is the inheritance pattern of HMSN I?
What is the age of onset?
What is the first symptom seen?
1) AD
2) Before age 20
3) Difficulty walking or running
What are the classic skeletal deformities seen with HMSN I?
1) Pes cavus
2) Hammer toes
What does EMG show for HMSN I?
Demyelination
HMSN III is a very severe demyelinating neuropathy of?
Childhood
What is the most common form of Acquired Demyelinating Polyneuropathies?
Acute inflammatory demyelinating polyneuropathy (Guillain-Barre)
Guillain-Barre Syndrome leads to?
Acute ascending motor paralysis (starts with legs first)
What are some causes of Guillain-Barre?
1) EBV
2) Mycoplasma pneumonia
3) Campylobacter jejuni
What is the most common cause of death with Guillain-Barre Syndrome?
Respiratory failure
What is the CSF finding for Guillain-Barre Syndrome?
Albumino-cytologic dissociation (Elevated protein and normal cell count/glucose
What is the direct treatment for Guillain-Barre Syndrome?
Plasma exchange or IVIg
Poor prognosis of Guillain-Barre Syndrome is assocaited with?
1) Low amplitude motor nerve response
2) Axonal involvement
What variant of Guillain-Barre Syndrome presents with ophthalmoplegia, ataxia, and areflexia?
What are the antibodies found with this variant?
1) Miller-Fisher Syndrome
2) GQ1b and GT1a antibodies
What antibody is elevated with Multifocal Motor Neuropathy?
GM-1 Ab
