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Neuromuscular Pathology (Midterm) > Disorders of the PNS I (Classification, CMT & Diabetic Neuropathy) > Flashcards

Disorders of the PNS I (Classification, CMT & Diabetic Neuropathy) Flashcards

1
Q

Which category of peripheral neuropathy is associated with motor and sensory loss in dermatomal distribution?

A
  • Radiculopathy
  • Often associated with disc & vertebral bone disease
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2
Q

RehabilitationConsiderations for diabetic neuropathies:

A
  1. Thorough assessment of sensory and motor systems
  2. Screen for autonomic neuropathy: specially cardiovascular AN: Squatting test: test for hydrostatic hypotension
  3. Safety assessment: at higher risk for falls
  4. Pain magament
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3
Q

Which category of peripheral neuropathy includes damaged to multiple peripheral nerves and is common in diabetes?

A

mononeuropathy multiplex

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4
Q

What is Acute Sensory Neuropathy?

A
  • A type of diabetic neuropathy
  • Rapid onset of severe burning pain, sharp “electric shock” hypersensitivity of feet
  • Sympstons worsen at night
  • Mild symmetric or no sensory loss but with allodynia
  • Recovery possible within 1 year if stable blood glucose maintained
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5
Q

Prognosis of peripheral neuropathies:

A
  • Depending on type of neuropathy recovery is usually slow.
  • May have full recovery
  • May have residual deficits
  • With severe neuropathy, can develop chronic muscular atrophy, contractures, deformities
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6
Q

Motor & sensory changes resulting from PNS disease occur in:

A
  • distribution of nerve roots
  • plexi or peripheral nn themselves.
  • Look at peripheral nerve distribution.
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7
Q

Which peripheral nerve disease involves mainly the peroneal nerve, affecting muscles in foot & lower leg but can progress to nereves of forearms & hands.

A

Charco Marie Tooth Disease AKA Hereditary Motor and Sensory Disease AKA peroneal muscular atrophy

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8
Q

The PNS includes motor, sensory and autonomic nerves:

A
  • Cranial nn
  • Spinal nn
  • Spinal nerve roots
  • Peripheral nn
  • Autonomic system
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9
Q

Which category of peripheral neuropathy includes damage to spinal roots?

A
  • radiculopathy
  • dermatomal distribution
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10
Q

In which type of diabetic neuropathy the patient shows a rapid onset of: severe burning pain, deep aching pain, sudden sharp “electric shock” sensation, and hypersensitivity of feet?

A

Acute Sensory Neuropathy

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11
Q

AUTONOMIC Signs & Symptoms of Neuropathic Dysfunction include:

A
  1. Vasomotor disturbances (orthostatic hypotension)
  2. Alterations in sweating
  3. Trophic changes of skin & nails
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12
Q

Medical Management of diabetic neuropathies:

A
  • Good metabolic control: control of blood sugar levels
  • Symptomatic management
  • Medication for painful sensory neuropathies
  • Prevention of complications
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13
Q

MOTOR Signs & Symptoms of Neuropathic Dysfunction include:

A
  1. Weakness (usually distal weakness first)
  2. Decreased DTRs
  3. Atrophy
  4. Cramping with fatigue
  5. Hypotonicity or flaccidity
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14
Q

Etiology of Charcot Marie-Tooth Disease:

A
  • Inherited as autosomal dominant, autosomal recessive or X-linked pattern
  • Various types: CMT1 most common autosomal dominant pattern.
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15
Q

which type of diabetic neuropathy presents with the characterictic “stocking - glove” sensory loss?

A

chronic sensorimotor neuropathy or diabetic polyneuropathy

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16
Q

Etiology/Pathogenesis of Diabetic Neuropathy:

A
  1. Metabolic impairments related to hyperglycemia
  2. Vascular changes
  3. Reduced nerve growth factor (NGF)
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17
Q

categories of peripheral neuropathy:

A

1. Symmetric polyneuropathy: stocking and glove

2. Mononeuropathy: mononeuropathy multiplex is common in diabetes

3. Plexopathy: injury to brachial, lumbar, or sacral plexus.

4. Radiculopathy: injury to spinal roots, dermatomal distribution

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18
Q

Diagnosis of CMT:

A
  • History,
  • Clinical exam,
  • genetic studies,
  • electrophysiologic studies (NCV/EMG),
  • nerve biopsy
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19
Q

Pathology and two types of Charcot Marie-Tooth Diseas:

A

Gene mutations result in abnormal structure &/or function of the peripheral nerves

  1. CMT1: Segmental demyelination of fibular (peroneal) nerve
  2. CMT2: Associated with axonal degeneration -Onset varies between 2nd and 7th decades
20
Q

What is the incidence of Charcot-Marie-Tooth Disease?

Onset?

A
  • 1 in 2500 persons in the USA
  • Onset in childhood or adulthood: Most often in adolescence or early adulthood
21
Q

what is chronic sensorymotor neuropathy?

A
  • AKA diabetic polyneuropathy
  • Most common
  • loss of position sense & vibration: large fibers
  • loss of pain & temp: small finbers
  • dull. aching pain in limbs and burning sensations especially at night
22
Q

Autonomic diabetic neuropathy is manifested where?

A

In multiple systems:

  1. Cardiavascular: tachycardia, exercise intolerance, orthostatic hypotension, dizziness.
  2. GI: esophagus dysfunction, diarrhea, constipation
  3. Genitourinary: incontinence, erectile dysfunction
  4. Other: sweating, heat intolerance, dry skin, blurred vision
23
Q

SENSORY Signs & Symptoms of Neuropathic Dysfunction:

A
  1. Anesthesia
  2. Hipothesia
  3. Hyperesthesia
  4. Impaired position sense and vibration: Large fiber problem
  5. Impaired pinprick & temperature: Small fiber problem
24
Q

Which is the most common hereditary disorder of peripheral nerves:

A

Charcot Marie-Tooth Disease AKA hereditary motor and sensory neuropathy (HSMD) or peroneal muscular atrophy

25
Q

Which category of peripheral neuropathy includes injury to nerves in brachial, lumbar or sacral plexus?

A

plexopathy

26
Q

Clinical Manifestations of CMT:

A
  • Distal symmetric muscle weakness: dorsiflexors and evertors: Footdrop (steppage) gait.
  • Atrophy
  • Decreased deep tendon reflexes
  • Skeletal deformities: pes cavus, hammer toes
  • Loss of proprioception in feet and amkle
  • Decrease cutaneous sensation in feet and lower legs.
  • With progression of the disease, distal UEs become invloved:
    • Weakness & wasting of hand intrinsics
    • Wasting of forearm mm
  • Rarely, respiratory muscle weakness in later stages
27
Q

What are the goals of physicial therapy in treating a patient with CMT:

A

Minimize deformity and Maximize function

28
Q

Which category of peripheral neuropathy includes dysesthesia and decreased sensation?

A

Symmetric polyneuropathy

29
Q

Which category of peripheral neuropathy results from compressive lesion of a single nerve? Ex. Carpal tunnel syndrome

A

Mononeuropathy

30
Q

Forms of neuropathies associated with diabetes:

A
  • Polyneuropathy
  • Mononeuropathy
  • Plexopathy
  • autonomic neuropathy
31
Q

Which is the most common diabetic neuropathy?

A

Chronic Sensorimotor neuropathy or AKAdiabetic polyneuropathy

32
Q

what is the pathology of peripheral neuropathy?

A

involves damage to myelin, axons, or both

33
Q

Which neuropathy can occur with poorly controoled DM?

A

Hyperglycemic Neuropathy

34
Q

How may petients with diabetes develop some type of neuropathy?

A

50%-60%

35
Q

Focal neuropathies:

A

Type of diabetic neuropathy:

  1. Cranial nerve focal nerupathies: oculomotor nerve most commonly affected
  2. Limb focal neuropathies: median (not to be confused with carpal tunnel syndrome), ulnar and peroneal nerve most commonly affected.
36
Q

what are trophic changes?

A
  • Autonomic neuropathic dysfunction; changes resulting from interruption of nerve supply.
  • Skin and nails
37
Q

Also known as hereditary motor and sensory neuropathy (HMSN) or peroneal muscular atrophy

A

Charcot Marie Tooth Disease

38
Q

Treatment of CMT:

A
  • No specific treatment
  • Symptomatic interventions to help maintain function.
  • Orthotics; skin care precautions
39
Q

What is hyperglycemic neuropathy?

A
  • Rapidily reversible
  • Occurs with poorly controlled DM
  • Distal symmetric sensory changes: burning, paresthesias, tenderness in legs & feet
  • Symptoms resolve when blood sugar becomes controlled
40
Q

Classification of diabetic neuropathies:

A

1.

41
Q

Interventions for CMT:

A
  1. Streteching
  2. ROM
  3. Orthostics
  4. Gait training
  5. Skin care education
42
Q

Prognosis of CMT

A
  • Slowly progressive disease
  • Weakness & contractures lead to gait abnormalities, falls, and difficulty with writing and manipulating objects with hands
43
Q

Pain Management (rahabilitation considerations) of Painful Diabetic Neuropathy: what works and what doesn work?

A
  • “electrical stimulation is probably effective in lessening the pain of PDN and improving QOL”
  • “electromagnetic field treatment, low-intensity laser treatment, and Reiki therapy are probably not effective for the treatment of PDN.”
  • Exercise
  • Functional treatment
44
Q

Course/ Prognosis of Diabetic Neuropathies:

A
  • Slowly progressive
  • Some improve; some plateau
  • Autonomic involvement associated with increased mortality risk
45
Q

What is Wallerian degeneration?

A
  • dying back of axon distal to lesion,
  • occurs in axonal degeneration
46
Q

Peripheral Neuropathy Etiology (causes)

A
  1. Systemic/metabolic diseases: Diabetes, hypothyroidism, renal failure, AIDS, Lyme disease, RA
  2. Vitamin deficiency
  3. Exogenous/environmental toxins
  4. Hereditary neuropathies:
    • Charcot-Marie-Tooth disease
  5. Mechanical pressure/trauma
    • Compression
    • Entrapment

Neuromuscular Pathology (Midterm) (9 decks)

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