Lecture 8: Peripheral Neuropathies Flashcards
1
Q
Peripheral Neuropathies: features
A
- axonal degeneration, paranodal or segmental demyelination
- mainly categorized by the basis of structure being affected
2
Q
Axonal neuropathies
A
- conduction velocity can be normal or slightly reduced
- see denervation at affected muscle
3
Q
demyelinating neuropathies
A
- conduction may be slowed considerably or completely blocked
- see no signs of denervation
4
Q
polyneuropathies
A
- lead to symmetric sensory, motor or mixed deficit; most marked distally
- involvement of motor fibers = flaccid weakness
- involvement of sensory fibers = impaired sensory perception
- tendon reflexes depressed
5
Q
Classification of Peripheral Nerve Dz’s
A
- spatial
- temporal
- etiology based
6
Q
polyneuropathy
A
- distal axonopathy; largest and longest axons first
- parasthesias, numbness in Feet first
- early motor deficit in feet
- “Glove stocking”
- early loss of ankle reflex
7
Q
Mononeuropathy
A
-single anatomically defined nerves in sequence
examples = sciatic, ulnar, median nerves
8
Q
ganglionpathy
A
asymmetric, pure sensory,
- hand > feet
- areflexia and ataxia
9
Q
Polyneuropathy: etiology classifications
A
- Metabolic dz
- toxic
- nutritional deficiency
- immune mediated
- paraneoplastic
- infectious
- genetic
10
Q
Diabetic neuropathy
A
- distal, symmetric, sensorimotor
- can affect autonomic system: BP, HR, GI, bladder fx, ED
- diabetic neuropathic cachexia
- large fiber ataxxia
- neuropathy with glucose intolerance
- diabetic amyotrophy
- diabetic truncal/cranial neuropathy
11
Q
Diabetic neuropathic cachexia
A
-symmetrical peripheral neuropathy with profound wt. loss and painful dysesthesias, affecting proximal lower limbs, hands and lower trunk
12
Q
diabetic amyotrophy
A
- affects thighs, hips, butt and legs
- pain affecting one side of body and can have sudden onset
- followed by intense weakness of proximal muscles in LE
13
Q
Diabetic neuropathy tx
A
- tight glycemic control
- experimental therapies: aldose reductase inhibs, PKCB inhibss, Alpha lipoicacid, gamma linoleic acid
- FLudrocortisone: for ortho hypotension
- pain: duloxene, tramadol, gabapentin
14
Q
Inherited polyneuropathies : types
A
- common cause of slowy progressive polyneuropathies
- variable clinical severity
- Charcot-Marie Tooth syndrome
- HnPP
- Familial amyloid neuropathy
15
Q
Chronic Inflammatory Demyelinating Neuropathy
A
- precipitating events: infxns, vaccines, surg, pregnancy, HIV,
- motor > sensory deficits
- mean onset = 47 y/o
- Features: weakness, areflexia, facial/eom palsy, sensory deficits
- CSF: high protein
- nerve conduction: slow
- Tx: steroids, IVIg, PE
