Lesson 25 Flashcards
Types of syndromes
Radicular syndrome
Plexus syndromes
Nerve trunk syndromes
Clinical manifestations
Sensory:
- pain, numbness, reflex alterations
Motor
- Paralysis, hypotonia, atrophy, weakness
Radicular syndrome
Nerve root alterations due to tumours or hernias
Plexus syndromes
Nerve plexus alterations
Nerve trunk syndrome
Can be divided into three groups:
Mononeuropathies: mechanical lesion of one nerve
Multi-neuropathies: asymmetric ischemic lesion of different
nerves
Polyneuropathies: symmetric lesion of different nerves
Autonomic nervous system produce clinical manifestation at the level of effector organs
- Cardiovascular: tachycardia vs bradycardia
- Digestive system: increase vs decrease of gastrointestinal motility
- Urinary system: urinary retention vs hyperactive bladder
- Eye: mydriasis vs miosis
- Reproductive system: impotence vs priapism; ejaculation disorders
Concept of neuropathies
A set of disorders that affect the
peripheral nerves.
- Quite common, usually painful, sometimes debilitating, rarely lethal
- Acquired or inherited
- Systemic or localized affection.
Syndromes involving the motor system affect the anterior motor neuron, its axon, the neuromuscular junction and muscle fibers.
Peripheral nerves: Sensory, motor and autonomic fibers (mixed nerves).
Neuropathies may affect the cell body, axon or myelin.
Motor nerves:
- Usually large diameter
- Myelinated
Sensory nerves may be:
- Large diameter: proprioception and vibration
-Intermediate diameter and myelinated fibres or non-myelinated fibres: pain and temperature.
Autonomic nerves:
- Small diameter
NEUROPATHIES
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Classification
Based on onset and evolution
Acute:
- progress in three weeks
- (guillain-barre syndrome or polyneuropathies with collagenosis)
Sub-acute:
- Progress in four weeks
Chronic:
- Progress in more than one month
- (diabetic neuropathy, amiloidosis neuropathy, toxic or nutritional neuropathy, inherited neuropathies).
NEUROPATHIES
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Classification
Based on functional impairment
- Pure motor, it affects motor nerves.
- Pure sensory, it affects sensory nerves.
- Autonomic, it affects autonomic nerves.
- Motor and sensory, it affects mixed nerves.
NEUROPATHIES
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Type of lesions
Parenchymal lesions
The neuron or Schwann cells suffer degeneration:
Axonal degeneration: neuronal body and axon are primarily affected.
Wallerian degeneration: disorganization of the axon and myelin.
Demyelination: Occurs without affecting the axon
Causes of neuropathies
Infectious causes
* Local infections, bacterial or viral.
* Polyneuritis as a complication of an infection (mumps).
* Bacterial toxins with affinity for CNS (diphtheria, tetanus).
Post-infectious polyneuropathies
* Guillain-Barré syndrome
Toxics
* Mercury, lead, arsenic
Nutritional deficiency
* Vitamin deficiency, alcoholism, liver impairment.
Trauma
* Physical injuries
Connective tissue diseases and related disorders
* They are due to serum protein alterations (systemic lupus, cancer)
Genetic disorders
* Hereditary radicular sensory neuropathies (Charcot–Marie–tooth
disease)
Pure vascular disorders
* Collagen disorders, diabetes mellitus
Unknown origin
polyneuropathies
Motor clinical manifestations
Muscular weakness
Muscular atrophy
Hypotonia
Areflexia
Paralysis
Muscular cramps
Resting and action tremor
Fasciculations
Non-motor clinical manifestations
Gastrointestinal disorders
Sweating disorders
Skin and glands atrophy
Bladder functionality disorders
Circulatory disorders
Body temperature alterations
Heart rate/respiratory rate alterations
Erectile dysfunction
Pain
Plantar ulcers
Positive sensory clinical manifestations
- Prick
- Tingle
- Swelling (feeling)
- Pain
- Electric shock
- Burning
- Frozen
- Oppression
- Pulsation or vibration
- Hyperalgesia
Negative sensory clinical manifestations
- Imbalance
- Proprioception
- Anaesthesia / hypoesthesia
- Somnolence
- Loss of sensitivity
