Diagnosis of Peripherl Neuropathy

Question 1

What is neuropathy?

Answer 1

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

Question 2

Where will neuropathy typicall start?

Answer 2

distally

Question 3

What is the pain describe like in neuropathy?

Answer 3

burning, shooting, electric. Allodynia

Question 4

Is neuropathy length dependent?

Answer 4

yes

Question 5

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

Answer 5

neuropathy

Question 6

Is there vertio associated with neuropathy?

Answer 6

no

Question 7

How can you distinguish between vertigo and unbalance?

Answer 7

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

Question 8

Neuropathy imbalance is due to (blank)

Answer 8

loss of proprioception

Question 9

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

Answer 9

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

Question 10

What are symptoms of bulbar/cranial nerve damage?

Answer 10

diplopia
ptosis
dysarthria/dysphagia

Question 11

Why do you get diplopia?

Answer 11

cuz your extraocular muscles arent working right :(

Question 12

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

Answer 12

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

Question 13

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

Answer 13

charcot foot syndrome

Question 14

What are the motor features of neuropathy?

Answer 14

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

Question 15

What are the bulbar features of neuropathy?

Answer 15

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

Question 16

How can you measure action potentials?

Answer 16

oscilloscope
reading electrode
reference electrode

Question 17

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

Answer 17

polyphasic

Question 18

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

Answer 18

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

Question 19

In muscle disease what will muscle fiber amplitudes look like?

Answer 19

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

Question 20

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

Answer 20

carpal tunnel syndrome

Question 21

decreased sensory or motor amplitudes may suggest (blanK)

Answer 21

axonal damage

Question 22

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

Answer 22

conduction disease

Question 23

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

Answer 23

cold

Question 24

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

Answer 24

demyelinating disease or focal nerve impingement

Question 25

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

Answer 25

demylinating disease or radiculopathy or focal nerve compressoin

Question 26

What exactly is temporal dispersion?

Answer 26

widening of peak as you move more proximal

Question 27

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

Answer 27

neuropathy and myopathy

Question 28

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

Answer 28

acute, ongoing neuropathy or myopathy

Question 29

On an EMG, what will complex repetitive discharges indicate?

Answer 29

chornic neuropathy; myotonic discharges in myotonic myopathies and other channelopathies

Question 30

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

Answer 30

high | recruitment

Question 31

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

Answer 31

low | increase

Question 32

What do you use EMG for?

Answer 32

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

Question 33

What is this: | Decreased or absent sensory and motor amplitudes on Nerve conduction study

Answer 33

axonal neuropathy

Question 34

What is this: | increased insertional activity with fibs and p-waves and possibly CRDs as abnormal spontaneous activity

Answer 34

axonal neuropathy

Question 35

What is this: | high-amplitude, polyphasic motor unit potentials with decreased recruitment on motor unit analysis

Answer 35

axonal neuropathy

Question 36

What is this: | Nerve conduction study showing markedly delayed distal latencies and slow conduction velocities

Answer 36

demyelinating neuropathy

Question 37

What is this: | abnormal temporal dispersion or conduction block

Answer 37

demyelinating neuropathy

Question 38

What is this: | markedly delayed F-wave latencies or absent F-waves

Answer 38

demyelinating neuropathy

Question 39

What is this: | A needle EMG shows increased insertional activity with p-waves, fibs as abnormal spontaneous activity

Answer 39

Demyelinating neuropathy

Question 40

What is this: | high amplitude, polyphasic motor unit potentials with decreased recruitment

Answer 40

demyelinating neuropathy

Question 41

What is this: | decreased sensory amplitudes or absent sensory responses

Answer 41

compressive neuropathies

Question 42

What is this: | decreased or absent motor responses

Answer 42

compressive neuropathies

Question 43

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

Answer 43

compressive neuropathies

Question 44

What is this: | normal sensory nerve conduction with normal or decreased motor amplitudes an delaed or absent F-responses

Answer 44

radiculopathies

Question 45

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.

Answer 45

radiculopathies

Question 46

What is mononeuropathy?

Answer 46

only selective nerves are affected

Question 47

(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.

Answer 47

Radiculopathy

Question 48

What is the number one cause of neuropathy world wide?

Answer 48

leprosy | diabetes is number 1 in US

Question 49

What are the four types of axonal neuropathy?

Answer 49

diabetic neuropathy other metabolic neuropathies vasculitic neuropathy hereditary neuropathy

Question 50

What are the mononeuropathy multiplex neuropathies?

Answer 50

vasculitic neuropathy sarcoid neuropathy cancer-related

Question 51

What is this: | polyarteritis nodosa, Wegeners granulomatosis

Answer 51

causes of vasculitic neuropathy

Question 52

What neuropathy is often associated with cranial neuropathy?

Answer 52

sarcoid neuropathy

Question 53

What do you need to differentiate mononeuropathy multiplex from?

Answer 53

HNPP (hereditary neuropathy with liability to pressure palsy)

Question 54

What are the four main demyleinating neuropathies?

Answer 54

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

Question 55

How can you do a nerve biopsy?

Answer 55

take sural nerve and some muscle-> same day surgery

Question 56

What will a nerve biopsy help you confirm especially?

Answer 56

vasculitic neuropathy

Question 57

What will a nerve biopsy help you delinate between?

Answer 57

an axonal neuropathy and a demyelinating neuropathy

Question 58

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

Answer 58

QSART

Question 59

What is this: Exclusively to confirm a small fiber neuropathy May not have bearing on treatment

Answer 59

Skin Punch Biopsy

Question 60

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

Answer 60

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)