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Block 5 Week 3 Dani > Diagnosis of Peripherl Neuropathy > Flashcards

Diagnosis of Peripherl Neuropathy Flashcards

1
Q

What is neuropathy?

A

disease or dysfunction of one or more peripheral nerves, typically causing numbness, pain or weakness.

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2
Q

Where will neuropathy typicall start?

A

distally

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3
Q

What is the pain describe like in neuropathy?

A

burning, shooting, electric. Allodynia

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4
Q

Is neuropathy length dependent?

A

yes

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5
Q

What should these make you think about?
Unsteadiness of gait. Multiple falls.
Unsteadiness typically worse when vision is taken away.

A

neuropathy

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6
Q

Is there vertio associated with neuropathy?

A

no

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7
Q

How can you distinguish between vertigo and unbalance?

A

you ask the patient if they feel the problem is in their legs or in their head

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8
Q

Neuropathy imbalance is due to (blank)

A

loss of proprioception

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9
Q

typically in neuropathy where do you get weakness? What will you lose the ability to do?

A

distally and you will lose ability to grip and execute fine motor tasks (i.e open jars), foot drop, dropping objects, problems with writing or typing

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10
Q

What are symptoms of bulbar/cranial nerve damage?

A

diplopia
ptosis
dysarthria/dysphagia

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11
Q

Why do you get diplopia?

A

cuz your extraocular muscles arent working right :(

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12
Q

What are the sensory features of bulbar/cranial nerve damage?

A

loss of pinprick sensation in distal extremities, mostly lower
loss of temp in distal extremities, mostly lower
proprioception testing/rhomberg test will let you know

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13
Q

What is the sign of the foot called when you have a high arch and hammer toes due to distal atrophy ?

A

charcot foot syndrome

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14
Q

What are the motor features of neuropathy?

A

distal atrophy with or without fasciculations
tremor
dimished/absent deep tendon reflexes
Pes cavus deformity of feet
steppage gait with foot drop or foot slap

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15
Q

What are the bulbar features of neuropathy?

A 
diplopia or dysconjugate gaze
ptosis
facial assymetry
tongue weakness/ atrophy
pupillary abnormalities
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16
Q

How can you measure action potentials?

A

oscilloscope
reading electrode
reference electrode

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17
Q

motor unit potentials that are (blank) may be an indication of pathology

A

polyphasic

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18
Q

In a muscle wiht loss of nerve supply, what will the amplitudes look like of the muscle fibers?

A

super high because we have loss recruitment so the left over muscle fibers have to compensate

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19
Q

In muscle disease what will muscle fiber amplitudes look like?

A

you will get polyphasic spike but will be low amplitude and you will see increased recruitment

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20
Q

If it takes longer to transmit a single in the median nerve than the ulnar nerve what does this indicate?

A

carpal tunnel syndrome

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21
Q

decreased sensory or motor amplitudes may suggest (blanK)

A

axonal damage

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22
Q

Delayedor slowed distal latencies or slowed conduction velocities may be suggestive of (Blank) disease

A

conduction disease

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23
Q

Slowing of all latencies and conduction velocities can be seen if limb skin temp is too (blank)

A

cold

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24
Q

Abnormal temporal dispersion or conduction block may be suggestive of (blank) or (Blank)

A

demyelinating disease or focal nerve impingement

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25
Q

F-responses or H-reflexes; if delayed or absent, could be suggestive of (blank) or (blank) or (blank)

A

demylinating disease or radiculopathy or focal nerve compressoin

26
Q

What exactly is temporal dispersion?

A

widening of peak as you move more proximal

27
Q

In an EMG, what is increased insertional activity and muscle irritability a sign of?

A

neuropathy and myopathy

28
Q

On an EMG, what will Fibs or P waves indicate?

A

acute, ongoing neuropathy or myopathy

29
Q

On an EMG, what will complex repetitive discharges indicate?

A

chornic neuropathy; myotonic discharges in myotonic myopathies and other channelopathies

30
Q

In denerevated muscle, motor units are (blank) amplitude, polyphasic with (blank) recruitment

A

high

recruitment

31
Q

In myopathic muscle, motor units are (blank) amplitude, polyphasic with (blank) recruitment

A

low

increase

32
Q

What do you use EMG for?

A

diagnosis and classification of peripheral neuropathy
diagnosis of major compressive mononeuropathies, especially CTS
diagnosis of Myopathy
diagnosis of severe radiculopathy when positiv

33
Q

What is this:

Decreased or absent sensory and motor amplitudes on Nerve conduction study

A

axonal neuropathy

34
Q

What is this:

increased insertional activity with fibs and p-waves and possibly CRDs as abnormal spontaneous activity

A

axonal neuropathy

35
Q

What is this:

high-amplitude, polyphasic motor unit potentials with decreased recruitment on motor unit analysis

A

axonal neuropathy

36
Q

What is this:

Nerve conduction study showing markedly delayed distal latencies and slow conduction velocities

A

demyelinating neuropathy

37
Q

What is this:

abnormal temporal dispersion or conduction block

A

demyelinating neuropathy

38
Q

What is this:

markedly delayed F-wave latencies or absent F-waves

A

demyelinating neuropathy

39
Q

What is this:

A needle EMG shows increased insertional activity with p-waves, fibs as abnormal spontaneous activity

A

Demyelinating neuropathy

40
Q

What is this:

high amplitude, polyphasic motor unit potentials with decreased recruitment

A

demyelinating neuropathy

41
Q

What is this:

decreased sensory amplitudes or absent sensory responses

A

compressive neuropathies

42
Q

What is this:

decreased or absent motor responses

A

compressive neuropathies

43
Q

What is this:
EMG showing fibs, P-waves, fasciculations exclusively in muscles supplied by suspect nerve. Motor unit potentials of those muscles are large, polyphasic with decreased recruitment

A

compressive neuropathies

44
Q

What is this:

normal sensory nerve conduction with normal or decreased motor amplitudes an delaed or absent F-responses

A

radiculopathies

45
Q

What is tis:
EMG: fibs, p-waves, CRDs in appropriate myotome. In those muscles, motor unit potentials are large and polyphasic with decreased recruitment. Paraspinous muscles are most sensitive for these changes.
EMG/NCS can be normal in patients with a significant radiculopathy. Need to correlate with imaging.

A

radiculopathies

46
Q

What is mononeuropathy?

A

only selective nerves are affected

47
Q

(blank) is a condition due to a compressed nerve in the spine that can cause pain, numbness, tingling, or weakness along the course of the nerve.

A

Radiculopathy

48
Q

What is the number one cause of neuropathy world wide?

A

leprosy

diabetes is number 1 in US

49
Q

What are the four types of axonal neuropathy?

A

diabetic neuropathy
other metabolic neuropathies
vasculitic neuropathy
hereditary neuropathy

50
Q

What are the mononeuropathy multiplex neuropathies?

A

vasculitic neuropathy
sarcoid neuropathy
cancer-related

51
Q

What is this:

polyarteritis nodosa, Wegeners granulomatosis

A

causes of vasculitic neuropathy

52
Q

What neuropathy is often associated with cranial neuropathy?

A

sarcoid neuropathy

53
Q

What do you need to differentiate mononeuropathy multiplex from?

A

HNPP (hereditary neuropathy with liability to pressure palsy)

54
Q

What are the four main demyleinating neuropathies?

A

guillain-barre syndrome
MGUS related neuropathies
selected toxic neuropathies-Toluene
hereditary demyelinating neuropathies- Charcot-Marie-Tooth Disease

55
Q

How can you do a nerve biopsy?

A

take sural nerve and some muscle-> same day surgery

56
Q

What will a nerve biopsy help you confirm especially?

A

vasculitic neuropathy

57
Q

What will a nerve biopsy help you delinate between?

A

an axonal neuropathy and a demyelinating neuropathy

58
Q

What is this:
Mostly a research tool at present
Quantitative method of estimating thresholds for various modalities of sensation
Limited availability: Mostly in academic centers

A

QSART

59
Q

What is this:

Exclusively to confirm a small fiber neuropathy
May not have bearing on treatment

A

Skin Punch Biopsy

60
Q

So summarize how you should figure out what type of neuropathy someone has

A

H and P-> use EMG-> look at clinical and physiological symptoms-> order bloodwork-> biopsy/generic testing (as needed)-> If not treatable go with supportive care. (i.e treatment of neuropathic pain)

Block 5 Week 3 Dani (12 decks)

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