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ENT, neuro, eyes > Metabolic neuropathy - B12 + diabetes > Flashcards

Metabolic neuropathy - B12 + diabetes Flashcards

1
Q

Causes ofperipheral metabolic neuropathy

A

diabetes mellitus, hypoglycemia, uremia, hypothyroidism, hepatic failure, polycythemia, amyloidosis, acromegaly, porphyria, disorders of lipid/glycolipid metabolism, nutritional/vitamin deficiencies, and mitochondrial disorders, among others

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2
Q

What fibres does diabetic neuropathy affect

A

Sesory A + C fibres

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3
Q

What anaemia does B12 deficiency present with

A

Megaloblastic anaemia

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4
Q

Who is at risk of B12 deficiency

A

Chronic malabsorption
History of gastric resections or bypass
Meds eg metformin and PPIs, antiepileptics

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5
Q

What us B12 deficiency level

A

<148 = probable
148-258 = possuble

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6
Q

What can still have if normal serum B12 levels

A

Pernicious anaemia

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7
Q

InvestigationsB12 deficiency

A

FBC, blood smear, serum B12, reticulocyte count
ConsiderL
MMA
Homocysteine
holotrasncobalamin
Anti intrinsic factor antibody

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8
Q

Treatment for B12 deficiency with neuro nvolvement

A

Hydroxocobalamin 1mg
IM on alternate days until no further umprovemetn
Then IM HCB 1mg IM every 2 moths

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9
Q

Treatment of B12 deficiency no neuro involvement

A

hydroxocobalamin 1 mg intramuscularly three times a week for 2 weeks
Non diet = hydroxyco. ever 2-3 months IM for life
Diet - oral cyanocobalamin 50-150 micrograms daily between meals OR twice yearly hydroxocobalamin 1mg

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10
Q

Foods high in vit B12

A

Eggs.
Foods which have been fortified with vitamin B12 (for example some soy products, and some breakfast cereals and breads) are good alternative sources to meat, eggs, and dairy products.
Meat.
Milk and other dairy products.
Salmon and cod.

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11
Q

First line management for neuropathic pain

A

One of:
Amitryptilline
Duloxetine
Gabapentin
Pregabalin
Capsaicin cream - avoid/intolerant to oral treatment
Cant have two oral meds together
Short ocourse of tramadol while qiating for referral

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12
Q

When refer to a specialist pain service

A

They have severe pain.
Their pain significantly limits their participation in daily activities (including self-care, general tasks and demands, interpersonal interactions and relationships, mobility, and sleeping).
The underlying health condition that is causing neuropathic pain has deteriorate

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13
Q

Features of SACD

A

Spasticity and up going plantars = UMN
Reduce proprioception and vibration sense - dorsal column
Normal sensation and fine touch
Bilateral symmetical lower limbs - spinal

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14
Q

Wha tracts are affeted in SACD

A

lateral corticospinal tract (motor) and dorsal columns (proprioception and vibration) - highly myelinated ones

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15
Q

What does length dependent/glove and stocking neuropathy suggest

A

SACD of cord
Degen of doral and lateral tracts of cord - mixed proprioception loss, ataxia, hyporeflexia with spasticity and upgoing plantars

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16
Q

Types of nerve damage

A

Demyelination - AI, GBS, MS, genetic
Axonopathy - chemo, compression, systemic conditions eg DM

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17
Q

Most to least myelinated neurons

A

Alpha motor
Sensory - alpha/beta - vibration/proprioception
Sensory - delta- pain/temp
Autonomic C - autonomic control

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18
Q

Negative sensory symptoms

A

Numb
Sensory loss
Proprioception loss
Temp sesnation loss

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19
Q

Positive sensory symptoms

A

hypersensitivity
Tingling
Pins and needles
Itching
Neuropathic pain

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20
Q

Negative motor symptoms

A

Weakess
Muscle wasting
Hyporeflexia

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21
Q

Positive motor symptoms

A

Fasciculations
Cramps

22
Q

Autonomuc symtoms

A

Postural hypotension, reduced exercise tolerance
Constipation, gastroparesis
Incontinence, difficulty emptying bladder
Erctility dysfunction
Reduced hypoglycaemia awareness, sweating disturbances

23
Q

What does parasympathetic NS cause

A

Safety - constrict pupils, sitmulates saliva, digestion, bile release, peristalsis, bladder contract
Constricts bronchi, slows HR
Vagus nerve, medulla oblongatta

24
Q

What does sympathetic NS cause

A

Panic
Dilate pupils
Accelerated HR, dilates bronchi
Inhibits slaive and digestion, peristalsis and secretion
Stimulates glucose release - epinephrine and norepinephrone release
Relaxes bladder
Cahin of sympathetic gagnglia

25
Q

Timing of neuro symptons - acute, sub acte or chronuc

A

Acute = hours to days BUT <4 weeks
Sub acute = days to weeks. 1-3 minths
Chronic = weeks to months >3 months

26
Q

Areas in nerve damage

A

Focal - one peripheral nerve- trauma, swelling, compartment, infectionetc
Multifocal - more than one area eg mononeuritis multiplex
Diffuse - wide area eg bilateral

27
Q

Types of neuropathy

A

Sensory
Motor
Sensorimotor
Autonomic

28
Q

Causes of focal nerve damage

A

Carpal tunnel syndrome
Cubital tunnerl syndrome
Meralgia paraesthetica
Peroneal nerve injruy

29
Q

Test for carpal tunnerl

A

Tinnels and phalens to initiate symptoms - upside down praryer and tap

30
Q

Risks for carpa tunnel syndrome

A
  • Age, pregnancy, obesity, hypothyroidism
    Tingling across median distribution, severe causing weakenss
31
Q

Cubital tunnel syndrome symptoms

A

Pain, tingling, numbness across ulnar distribution hand, grip/strength problems

32
Q

What is meralgia paraeesthetica

A

Entrapment of laterla femoral cutaneous nerve causing pain and paraesthesia over lateral aspect of thigh - sensitive to light touch and heat

33
Q

What causes meralgia paraesthetica

A

High weight - compression of nerve by tissue between inguinal ligament and ilium
Mangage conservatively - local anaeasthetic

34
Q

What does foot drop cause

A

Affects - Biceps, lateral leg compartment and anterior compartment muscles
- Sensory - lateral and anterior
Abnoraml dorsiflexion, knee flexion, sensory abnormalities in lower leg

35
Q

What does forehead involevment suggest about a facial palsy

A

LMN cause - UMN supplies both sides of forehead so would have collateral control

36
Q

Which nerves are affected first in aconoapthies

A

Less mmyelinated - pain and temp - first

37
Q

Causes of axonopathies

A
  • B12 deficiency
  • Diabetes
  • Alcohol
38
Q

What nerves are affeted first in demyelination

A

Longer more myelinated nerves 0 proprioception, motor control

39
Q

Causes of demyleination

A

GBS
Chronic inflammatory demyelinating polyneuropathy
#Charcot-marie tooth

40
Q

What antibodies see in [araneoplastic syndrome

A

Anti-Hu and antiCV2/CRP5 antibodies

41
Q

What malignancies is paraneoplastic syndrome ass with

A

small cell lung cancer, B cell lymphoma, waldenstoms macroglobulinaemia

42
Q

Types of paraneoplastic syndrome

A

Cerbeallar degneration/ataxia
Limbic encephalitis - emotions, behaviours, memory
Encephalomyelitis - inflammation of brain and spinal cord
Stiff person syndrome
Myelopathy - spinal cord
Lambert-Eaton myasthenic syndrome
Neuromyotonia
Opsoclonus-myoclonus

43
Q

What is lambert eaton syndrome

A

This is a syndrome caused by disrupted communication between nerves and muscles. Signs and symptoms include pelvic and lower extremity muscle weakness, fatigue, difficulty swallowing, difficulty speaking, irregular eye movement, and double vision. Autonomic nervous system problems can include dry mouth and erectile dysfunction in males. Ass with lung cancer

44
Q

What conditions can present as a neuropathy

A

MND
Myasthenia gravis
Cuada equina
Spinal cord cmpression Malignancy

45
Q

What is first motor loss in peripheral neuropathies

A

Ankle dorsiflexion

46
Q

Causes of chronic neuropathies

A
  • Diabetes
  • Alcohol excess
  • B12 deficiency
  • HIV
  • Medication - chemo, amiodarone, isoniazid
  • Autoimmune - sjrogens, lupus, sarcoidosis
  • Lyme disease
  • Advanced kidney disease
  • Critical illness
  • Myeloma/blood dyscrasias
47
Q

What is charcot marie tooth

A

Genetic snsorimotor neuropathy - demyelinating. Begins in childhood and causes loss of proprioception and muscle power

48
Q

Presentation of Charcot marie tooth

A

Foot drop - hammer toe deformity hooked under
Sensorimotor in hands
Distal muscle wasting

49
Q

Genetics of charcot marie tooth

A
  • Duplication of region of short arm chromosome 17 - PMP22 gene involved in myelin synthesis
    • Autosomal dominant or de novo, some X linked
50
Q

Investigations for sensorimotor presentation of neuropathy

A
  • FBC - macrocytic anaemia - B12 def, chronic alcohol excess
  • HbA1c - increased = new diabetes or poorly controlled
  • U+Es - obvious kidney/electrolyte abnoramlities
  • CRP/ESR
  • B12
  • TSH - hypothyroidism can cause neuro
  • HIV/hepatitis
  • Serum electrophoresis - myeloma
    MRI brain and spine to exclude central causes
    NC/EMG

ENT, neuro, eyes (34 decks)

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