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Neurology > Disorders of the PNS > Flashcards

Disorders of the PNS Flashcards

1
Q

What is a nerve issue arising at the nerve root known as?

A

Radiculopathy/Ganglionopathy

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2
Q

What is a nerve issue arising at a nerve plexus known as?

A

Plexopathy

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3
Q

What are some forms of peripheral neuropathy?

A

Mononeuropathy - 1 nerve affected
Mononeuritis multiplex
Peripheral neuropathy (length dependant)

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4
Q
A
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5
Q

Where is the most common entrapment site of the median nerve?

A

Carpal tunnel (Wrist)

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6
Q

Where is the most common entrapment site of the ulnar nerve?

A

Cubital tunnel (Elbow)

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7
Q

Where is the most common entrapment site of the radial nerve?

A

Spiral groove of humerus

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8
Q

Where is the most common entrapment site of the posterior interosseous nerve?

A

Supinator muscle (Forearm)

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9
Q

Where is the most common entrapment site of the lateral cutaneous nerve of thigh?

A

Inguinal ligament

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10
Q

Where is the most common entrapment site of the common perineal nerve?

A

Neck of fibula

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11
Q

Where is the most common entrapment site of the posterior tibial nerve?

A

Tarsal tunnel (Flexor retinaculum - foot)

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12
Q

What is foot drop a sign of?

A

Disease or trauma affecting the common peroneal nerve

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13
Q
A
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14
Q

What is mono neuritis multiplex?

A

A condition in which there is damage to 2 or more distinct nerve areas

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15
Q

What peripheral nerve condition is shown?

A

Mononeuritis multiplex

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16
Q

What are some conditions that can cause mononeuritis multiplex?

A
  • Diabetes mellitus
  • Leprosy
  • Vasculitis, including eosinophilic granulomatosis with polyangiitis amyloidosis (most common cause)
  • Malignancy
  • Neurofibromatosis
  • HIV and hepatitis C infection
  • Multifocal motor neuropathy with conduction block
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17
Q

What are some forms of polyneuropathy?

A

Hereditary sensory motor neuropathy
Guillain-Barré syndrome
Idiopathic
Metabolic
Toxic
Autonomic

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18
Q

What is the old name for hereditary sensory motor neuropathy?

A

Charcot-Marie-Tooth disease

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19
Q

What is HSMN?

A

Inherited disease that affects the peripheral motor and sensory nerves

20
Q

Describe the genetics of HSMN?

A

AD, AR, X-linked - hundreds of mutations, demyelinating and axonal varieties

21
Q

What is the common sub-type of HSMN?

A

HSMN Ia is the most common type (70%) - autosomal dominant demyelinating neuropathy

22
Q

What are some symptoms of HSMN?

A

Typical presenting symptom is weakness of the feet and ankle

23
Q

What are some signs of HSMN?

A

Absent tendon reflexes
Foot and ankle weakness
Bilateral foot drop
Muscle atrophy below knee (Stork leg)
Pes cavus
Hand muscle atrophy

24
Q

What are some investigations required in HSMN?

A
  • Tests to exclude other causes of neuropathy e.g. bloods, serum and urine protein electrophoresis, muscle biopsy, CSF
  • Genetic studies
  • Nerve conduction studies
25
Q

How is HSMN managed?

A

No management
Just support from MDT members

26
Q

What is Guillain-Barré syndrome?

A

An ‘acute paralytic polyneuropathy’ that affects the peripheral nervous system

27
Q

What are some bugs that can cause Guillain-Barré syndrome?

A

Campylobacter jejuni
Cytomegalovirus
Epstein-Barr virus

28
Q

Describe the pathophysiology of Guillain-Barré syndrome?

A

Infection leads to molecular mimicry:
B-cells create antibodies against the pathogenic antigens, which also match those on the nerve cells, therefore targeting proteins on the myelin sheath or the axon

29
Q

How does Guillain-Barré syndrome present?

A
  • 4 weeks post-infection
  • Symmetrical ascending weakness
  • Reduced reflexes
  • Peripheral loss of sensation
  • Neuropathic pain
  • Possible cranial nerve weakness
29
Q

How is Guillain-Barré syndrome diagnosed?

A

Clinical diagnosis
- Nerve conduction studies
- Lumbar puncture (Raised protein)

30
Q

How may patients with respiratory failure be managed in Guillain-Barré syndrome?

A

Intubation
Ventilation
Admission to the ICU

30
Q

What vitamin deficiencies can cause metabolic neuropathy?

A

B12
Folate
Thiamine (B1)

30
Q

How is Guillain-Barré syndrome managed?

A
  • IV Ig (1st) or plasma exchange (2nd)
  • Supportive care
  • VTE prophylaxis
30
Q

What are some causes of toxic neuropathy?

A

Alcohol
Amiodarone
Phenytoin
Chemotherapy (Cisplatin/Vincristine)

31
Q

What are some possible causes of metabolic neuropathy?

A
  • Diabetes
  • Uraemia
  • Hepatic and thyroid disease
  • Acute intermittent porphyria
  • Amyloidosis
  • Vitamin deficiency
31
Q

What is Wernicke-Korsakoff’s syndrome?

A

Thiamine-responsive encephalopathy due to damage in the brainstem and its connections
Usually caused by alcoholism

32
Q

When may neuropathy be seen in cancer?

A

Polyneuropathy as a paraneoplastic syndrome
Myeloma
Plasma cell dyscrias

33
Q

What are some systemic diseases that may cause vasculitic neuropathy?

A

SLE
Polyarteritis nodosa
Granulomatosis with eosinophilia
Rheumatoid disease

34
Q

What are some symptoms of autonomic neuropathy?

A

Postural hypotension
Urinary retention
Erectile dysfunction
Nocturnal diarrhoea
Diminished sweating
Impaired pupillary responses
Cardiac arrhythmias

35
Q

What are some causes of chronic autonomic neuropathy?

A

Diabetes
Amyloidosis
Hereditary

36
Q

What are some causes of acute autonomic neuropathy?

A

Corticobulbar syndrome
Porphyria

37
Q

How are peripheral neuropathies managed?

A
  • Treat cause
  • Symptomatic treatment
38
Q

What are some symptomatic treatments of peripheral neuropathy?

A

Physiotherapy
Orthotics
Neuropathic pain relief

39
Q

How is vasculitis neuropathy managed?

A

Pulsed IV methylprednisolone + Cyclophosphamide

40
Q
A

Neurology (28 decks)

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