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MJ- F2 E4- Neuro > Neurology Potpourri — Peripheral Neuropathy - GK > Flashcards

Neurology Potpourri — Peripheral Neuropathy - GK Flashcards

1
Q

The _____ nervous system consists of nerve fibers connecting the rest of the body with the ________ (brain, spinal cord).

A

Peripheral

CNS

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2
Q

These connect the head, face, eyes, nose, muscles and ears to brain

A

Cranial nerves

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3
Q

These connect the spinal cord to the rest of the body

A

Spinal nerves

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4
Q

What four types of nerves does the peripheral nervous system include?

A
  • Cranial nerves
  • Spinal nerves
  • Nerves of extremities
  • Cervical, brachial and lumbosacral plexuses
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5
Q

___________, ____________ & ________ are the 3 elements of the peripheral nerves.

A

sensory, motor, autonomic

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6
Q

Peripheral neuropathy results from damage to ____________

A

any part of the nerve

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7
Q

What parts of the nerve can be damaged that would cause peripheral neuropathy?

A
  • axon
  • body of nerve cell
  • myelin sheath
  • neuromuscular junction
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8
Q

A peripheral neuropathy that affects one nerve

A

Mononeuropathy

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9
Q

A peripheral neuropathy that affects several discrete nerves

A

multiple mononeuropathy

OR

mononeuritis multiplex

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10
Q

Peripheral neuropathy that affects a plexus

A

plexopathy

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11
Q

Peripheral neuropathy that affects a nerve root

A

radiculopathy

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12
Q

Peripheral neuropathy is characterized by what?

A
  • motor weakness
  • sensory loss

AND/OR

  • positive sensory symptoms (tingling, burning)
  • may also have autonomic symptoms
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13
Q

T/F: Peripheral neuropathy is has a gradual onset and slowly progressive course.

A

TRUE

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14
Q

T/F: Autonomic symptoms of peripheral neuropathy happen in pts with DM & amyloidosis

A

TRUE

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15
Q

T/F: Peripheral neuropathy is usually bilateral & symmetric

A

True

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16
Q

T/F: Peripheral neuropathy is characterized by distal involvement

A

True

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17
Q

T/F: Etiologies of peripheral neuropathy include hereditary and acquired

A

True

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18
Q

What are the hereditary causes of peripheral neuropathy?

A
  • Charcot-Marie-Tooth dz (MC)
  • Porphyria (rare)
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19
Q

What are inflammatory acquired causes of peripheral neuropathy?

A
  • Guillain Barre Syndrome
  • chronic inflamatory demyelinating polyneuropathy
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20
Q

What are infectious acquired causes of peripheral neuropathy?

A
  • Lyme disease
  • HIV
  • herpes
  • VZV
  • CMV
  • EBV
  • hepatitis viruses
  • chagas dz
  • diphtheria
  • leprosy
  • rabies
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21
Q

T/F: Acquired etiologies of peripheral neuropathy include rheumatic reasons + organ failure.

A

TRUE

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22
Q

What are other acquired causes of peripheral neuropathy?

A
  • endocrine
  • GI
  • malignancy
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23
Q

Vitamin deficiency/excess of which vitamins can cause peripheral neuropathy?

A
  • B12
  • B1 (thiamine)
  • Vitamin B6 (pyroxidine)
  • Vitamin E
  • Niacin
  • Copper

“Mercedes [BBB]ENC”

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24
Q

What meds cause peripheral neuropathy?

A
  • Abx
  • antiretrovirals
  • chemo agents
  • phenytoin
  • thalidomide
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25
Q

What toxins cause peripheral neuropathy?

A
  • Heavy metals
  • industrial or environmental substances
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26
Q

Important things to ask when taking History

A
  • fam history for inherited disorders
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27
Q

T/F: You must complete a full neuro exam

A

True

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28
Q

What labs should you run if a pt comes in with complaints of peripheral neuropathy?

A
  • CBC
  • CMP
  • A1C (DM mc cause)
  • TSH
  • B12
  • folate
  • ESR
  • Rf
  • ANA
  • SPEP
  • immunoelectrophoresis or immunofixation
  • urine for Bence Jones Protein

**You don’t have to order them all**

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29
Q

What is the purpose of a nerve conduction study w/electromyography?

A

differentiates between nerve and muscle disorders

differentiates between axonal and demyelinating conditions

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30
Q

When would you order imaging?

What kind of imaging would you order?

A

If concern for radiculopathy

MRI/CT cervical, thoracic +/- lumbar

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31
Q

What 7 key questions would you ask and what is the main thing you are listening for when asking these questions?

A
  1. What systems are involved? (motor, sensory, autonomic, combination?)
  2. What is the distribution of weakness? (distal vs. proximal, focal/asymmetric vs symmetric)
  3. What is the nature of the sensory involvement? (temp loss, burning, stabbing pain (small fiber) vibratory or propiocdeptive loss (large fiber)
  4. What is the temporal evolution? (acute = days-4wks, subacute 4-8wks, chronic >8wks, monophasic, progressive, relapse-remitting)
  5. Is there evidence of upper motor neuron involvement? (w/o sensory loss or w/sensory loss)
  6. Is there evidence for a hereditary neuropathy? (fam hx, lack of sensor symptoms despite sensory signs)
  7. Are there are associated medical conditions? (cancer, DM, conn. tissue dz, autoimmune dz. infection)
32
Q

T/F: Charcot Marie Tooth dz is the most common hereditary PN

33
Q

Charcot-Marie-Tooth dz is a ______ disorder that starts ________ in life and is a __________ loss of motor and sensory function of ______ & ________ extremeties

A

demyelination

early

progressive

upper & lower

34
Q

What are clinical presentations of CMT?

A
  • Distal leg weakness (footdrop)

- foot deformities (pes cavus (hyper arch), hammer toes)

  • muscle atrophy below the knee
  • reduced/absent DTRs
  • sensory deficits
35
Q

What is the tx for CMT dz?

A

PT/OT

bracing (ankle-foot orthotics)

36
Q

What is poyphyria?

A

A metabolic disorder caused by enzyme deficiency in the heme biosynthetic pathway.

37
Q

What are the 3 types of porphyria associated with peripheral neuropathy?

A
  • Acute intermittent porphyria
  • hereditary coproporphyria
  • variegate porphyria
38
Q

What is the inheritance of porphyria?

A

autosomal dominant inheritance

39
Q

Porphyria attacks are precipitated by what 3 things?

A
  • medications
  • hormonal changes
  • dietary restrictions
40
Q

Porphyria presentation

A

sharp abdominal pain followed by agitation, hallucinations, or seizures.

Days later, extremity pain followed by weakness

Weakness in arms or legs (can affect face & bulbar musculature)

Asymmetric, proximal or distal

41
Q

What is the MC PN in developed countries?

A

Acquired: Endocrine— DM (diabetic neuropathy)

42
Q

What types of polyneuropathy happen in diabetic NP?

A

_- MC*_ distal symmetric sensory or sensorimotor polyneuropathy (DSPN)

  • Autonomic neuropathy
  • Diabetic neuropathic cachexia
  • Polyradiculoneuropathy
  • Cranial Neuropathy
  • Other mononeuropathies

“PDACCO”

43
Q

What does autonomic neuropathy consist of?

A
  • abnormal sweating
  • dysfunctional thermoregulation
  • dry eyes/mouth
  • pupillary abnormalities
  • cardiac arrhythmias
  • postural hypotension
  • GI abnormalities (gastroparesis, postprandial bloating, chronic diarrhea, constipation)
  • GU dysfunction (impotence, retrogade ejaculation, incontinence)
44
Q

Risk factors of Diabetic PN?

A
  • long-standing, poorly controlled DM
  • retinopathy
  • nephropathy
45
Q

What is the main presentation of Diabetic PN?

A

Sensory loss:

+/- symptoms

starts in toes, progresses over time up legs and into fingers and arms: “stock-glove”

painless injuries

NOT distributed along a dermatome/myotome

46
Q

Describe the motor symptoms associated with Diabetic PN?

A

distal, proximal or focal weakness

47
Q

Describe the autonomic symptoms of Diabetic PN

A

Involves CV, GI, GU systems & sweat glands

  • ataxia (gait disturbance)
  • gait instability
  • syncope/near syncope

“AGS”

48
Q

What is charcot foot & what is it associated with?

A

Recurring mild fxs that cause this deformity

associated with Diabetic PN

49
Q

What 4 things do you do for the PE of Diabetic NP?

A

vibratory sense

monofilament

DTRs

Strength testing

50
Q

How to diagnose Diabetic PN?

A

H&P

labs, imaging as needed

51
Q

Treatment of Diabetic NP

A
  • glucose control: tx DM, prevent progressino
  • foot care education
  • consider podiatry referral
  • medications for pain
  • Medications for autonomic dysfunction
52
Q

What meds would you rx for pain for Diabetic PN pts?

A

anto-epileptics

anti-depressants

Na channel blockers

Other analgesics

53
Q

___________ is more commonly associated with proximal neuropathy than neuropathy

A

Hypothyroidism

54
Q

Most common neuropathic manifestation of hypothyroidism is ____________

A

carpal tunnel syndrome

55
Q

What is the treatment for hypothyroidism PN?

A

treat the hypothryoidism

56
Q

What are examples of acquired GI PN ?

A

celiac dz that does not respond to gluten-free diet

IBD

57
Q

Is it possible to get PN with the following Rheumatic dzs?

Granulomatosis with polyangiitis (Wegener granulomatosis)

eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

immunoglobulin A vasculitis

IBD

RA

Juvenile idiopathic arthritis

Sjogren syndrome

SLE

scleroderma

mixed connective tissue dz

sarcoidosis

polyarteritis nodosa

A

Yes, is someone has a rheumatologic or autoimmune condition, they can get PN

58
Q

T/F: There is often no vasculitic component to the underlying etiology of rheumatic PN

A

FALSE; there is often a vasculitic component

59
Q

How does malignancy lead to PN?

A
  • from cancerous invasion or compression of nerves
  • paraneoplastic effect
  • effect of tx
  • from immune compromise
  • lymphoma
  • multiple myeloma
60
Q

____% of pts with renal failure develop polyneuropathy

61
Q

Chronic liver failure is associated with what type of PN?

A

generalized sensorimotor neuropathy: numbness, tingling, minor weakness in distal aspects of primarily lower limbs.

62
Q

What does this describe?

complication of sepsis and multiple organ failure

often presents as inability to wean patient from ventilator

A

critical illness polyneuropathy

63
Q

What type of PN is this describing?

spirochete infection, Borrelia burgdorferi

Transmitted by deer tick, Ixodes dammini

neurologic complications occur in 2nd & 3rd stages of infection and include facial neuropathy, polyradiculoneuropathy or multiple mononeuropathies

A

Lyme Disease

64
Q

What is the most commonly seen PN of lyme dz?

A

Bell’s Palsy

65
Q

The following are causes of…

pernicious anemia

dietary deficiency/avoidance

gastrectomy

gastric bypass surgery

IBD

pancreatic insufficiency

bacterial overgrowth

medication related (H2 blockers, PPIs, metformin)

A

Vit B12 (Cobalamin) deficiency

66
Q

Clinical Presentation of Vitamin B12 (cobalamin) deficiency PN

A

Glossitis (tongue soreness that looks bright red & smooth)

Paresthesias that starts with hand numbness

sensory loss affecting proprioception and vibration

unsteady gait due to sensory ataxia

diffuse hyperreflexia, absent achilles reflexes

Behavioral changes: mild irritability, forgetfulness, severe dementia and frank psychosis

67
Q

Diagnostics of B-12 deficiency PN

A
  • Low B-12 level
  • anemia and macrocytosis may be absent
  • elevated methylmalonic acid
  • elevated homocysteine

antibodies to intrinsic factor

antiparietal cell antibodies

68
Q

Treatment of B-12 deficiency PN

A
  • dietary changes if MILD
  • Vit B12 supplementation
  • 1000 microgram IM weekly x 1 month, then monthly
  • 1000 microgram PO daily
69
Q

Prognosis of B-12 deficiency PN?

A

complete reversal of symptoms not always attained

70
Q

Beriberi dz (dry beriberi references neuropathic symptoms) associated with what?

A

Thiamine (vit B1) deficiency

71
Q

Etiologies of B1 deficiency (BeriBeri dz)

A

MC: chronic alcohol abuse

recurrent vomiting

total parentaral nutrition (tube feedings)

bariatric surgery

restrictive diets

72
Q

Clinical presentation of BeriBeri (B1 def)

A

mild sensory loss and/or burning dysesthesias in toes and feet

aching and cramping in lower legs

later: generalized polyneuropathy with distal sensory loss in feet & hands

73
Q

Treatment of Thiamine (vit B1) deficiency

A

parenteral thiamine replacement until proper nutrition restored

MJ- F2 E4- Neuro (19 decks)

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