Neuro: Inflammatory Neuropathy

Question 1

• Inflammatory autoimmune demyelination of Peripheral motor Ventral roots and Cranial nerves a/w infections.
• A/w previous Inoculation or Infection (1 - 3 weeks) by Herpesvirus, Campylobacter jejuni, Mycoplasma pneumoniae, and possibly w/ Flu vaccination
• M = F
• Manifests W/OUT FEVER
• Diminished lower extremeity Reflexes w/ rapidly evolving symmetrical Ascending muscle weakness and paresthsias
• Respiratory paralysis over time –> cardiac dysrhythmias, HTN, HypoTN
• Facial diplegia
• Deep muscle weakness
• Tx: Respiratory support is critical, Plasmapheresis and IV immunoglobulins

Answer 1

Guillain-Barre’ Syndrome

Question 2

• Mycobacterium leprae directly invade Schwann cells where they proliferate and eventually infect other cells
• Lesions include segmental demyelination and remyelination and remyelination, w/ Axonal loss and Endoneurial and Epineural fibrosis

Answer 2

Leprosy: Hansen Disease

Question 3

• Disease tends to be more severe and diffuse
• Pts. develop a symmetric polyneuropathy
• Mostly in extremities (Lower temperatures favor mycobacterial growth)
• Predilection for pain fibers renders pts. relatively insensitive to injurious stimuli
• Large traumatic Ulcers are common

Answer 3

Lepromatous Leprosy

Question 4

• Better host responsiveness, reflected by nodules of Granulomatous inflammation –> Leads to more localized nerve injury

Answer 4

Tuberculoid Leprosy

Question 5

• Lacerations occur w/ slicing injuries or bone fractures where sharp fragments cut a nerve
• Avulsions occur when a nerve is put under tension
• Traumatic neuromas, painful nodules of tangled axons and connective tissue from Regenerating axonal sprouts
• Compression neuropathy - nerve is compressed

Answer 5

Traumatic Neuropathy

Question 6

• Hereditary neuropathy (AD) - Heriditary Motor and Senory Neuropathy type I (HMSN type I)
• Primarily affects the Peroneal nerve –> Atrophy of the Lower leg muscles –> “Inverted bottle” appearance of the Legs
• 10 - 20 y.o.
• Tx: PT and Surgery for Contractures - No Cure; progressive peripheral neuropathy

Answer 6

Charcot-Marie-Tooth