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Neuro finals KTB > Neuropathies > Flashcards

Neuropathies Flashcards

1
Q

What is mononeuritis multiplex? What are the causes?

A

Dysfunction of 2+ peripheral nerves
Most common: DM
-HIV, amyloidosis, sarcoid

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2
Q

Describe the presentation of an ulnar nerve palsy

A

Partial claw hand

  • Flexion of the intrinsic muscles of the hand
  • Hypothenar wasting
  • Loss of sensation to medial 1 1/2 fingers
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3
Q

What is the most common cause of an ulnar nerve palsy?

A

Elbow trauma eg. supracondylar fracture

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4
Q

What are the ulnar nerve roots?

A

C7-T1

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5
Q

Describe the presentation of a median nerve palsy

A

Carpal tunnel syndrome

  • Thenar muscle wasting
  • Parasthesia/anaesthesia of the palmar side of lateral 3 1/2 digits and palm
  • LLOAF muscle weakness
  • Tinel’s and Phalen’s test +ve
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6
Q

What are the causes of median nerve palsy?

A 
Carpal tunnel syndrome 
-Pregnancy 
-High BMI 
-Occupational factors
-Acromegaly
Trauma
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7
Q

What are the median nerve roots?

A

C6-T1

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8
Q

Describe the presentation of radial nerve palsy

A

Wrist drop

  • Weakness of the extensor muscles of the forearm and hand
  • Parasthesia/anaesthesia of the dorsal thumb
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9
Q

What are the radial nerve roots?

A

C5-T1

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10
Q

What are the causes of radial nerve palsy?

A

Trauma

  • Wrist fracture
  • Fracture of the humeral shaft
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11
Q

Describe the presentation of Erb’s palsy. What are the affected nerves?

A

Caused by lesion of upper branch of brachial plexus (C5-6)

  • Internally rotated shoulder
  • Flexed wrist (waiter’s tip)
  • Often present from birth
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12
Q

Describe the presentation Klumpke’s palsy. What are the affected nerves?

A

Caused by a lesion of the lower branch of the brachial plexus (C8-T1)
-Claw hand

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13
Q

What is the name of palsy of the lateral cutaneous nerve of the thigh?

A

Meralgia parasthetica

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14
Q

What are the nerve roots of the sciatic nerve?

A

L4-S3

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15
Q

What are the nerve roots of the common peroneal nerve?

A

L4-S2

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16
Q

What are the nerve roots of the tibial nerve?

A

L4-S3

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17
Q

Describe the presentation of a tibial nerve palsy

A

Inability to tip-toe walk

  • Weakness of ankle plantarflexion and inversion, digit flexion
  • Parasthesia/anaesthesia of the posterolateral leg, lateral foot and sole of the foot
18
Q

Describe the presentation of a common peroneal nerve palsy

A

Footdrop- inability to heel-walk

  • Weakness of ankle dorsiflexion and eversion, digit extension
  • Parathesia/anaesthesia of the lateral leg, dorsum of foot
19
Q

What are some causes of common peroneal nerve palsy?

A
  • Fracture of fibula

- Tight plaster cast

20
Q

Describe the presentation of sciatic nerve lesion

A
  • Weakness of knee flexion
  • Weakness of ankle and digits movements
  • Reduced sensation to posterolateral leg and foot
21
Q

What are the nerve roots of the femoral nerve?

A

L2-L4

22
Q

Describe the dermatomes of the lower limb

A 
L1: groin 
L2: anterolateral thigh
L3: medial thigh to the knee 
L4: medial leg
L5: big toe/ anterior leg 
S1: small toe and heel 
S2: posterior leg 
S3: buttock
23
Q

Describe the dermatomes of the upper limb

A 
C5: upper shoulder (deltoid), lateral arm 
C6: lateral forearm, thumb 
C7: middle finger 
C8: pinky finger, medial forearm
T1: medial arm
24
Q

Describe the presentation of Bell’s palsy

A

7th/facial nerve palsy

  • Sudden onset unilateral weakness of the facial muscles, non-forehead sparing
  • Altered taste sensation
  • Hyperacusis, otalgia
25
Q

What are the differentials for Bell’s palsy?

A
  • Lyme disease
  • Ramsay Hunt syndrome
  • UMN: stroke
  • Neoplasms
26
Q

Describe the diagnostic process for suspected Bell’s palsy

A
  • History suggestive
  • Examination: full cranial nerves, otoscopy
  • Consider: Lyme serology, EMG, MRI
27
Q

Describe the management of Bell’s palsy

A

Conservative: corneal protection (glasses, drops)
Medical: corticosteroids within 72 hours of onset
-60mg PO for 5/7 -> taper
Surgical: decompression in severe cases

28
Q

What is the prognosis of Bell’s palsy? Name some complications

A

70% fully recover within several months
Improved with steroids
Complications: corneal abrasion, keratoconjunctivitis sicca, crocodile tears (eat -> tears), synkinesis (blink -> upturn mouth)

29
Q

Describe the presentation of Ramsay Hunt syndrome

A

Otalgia followed by facial weakness, dysgeusia, hyperacusis (very similar to Bell’s palsy)
Presence of vesicles on the TM/ear canal, hard palate
-May also have 8th nerve involvement

30
Q

Describe the treatment of Ramsay Hunt syndrome

A

Valaciclovir and prednisolone

31
Q

Name some causes of bilateral polyneuropathy

A
  • DM
  • Inflammatory: GBS
  • Infectious: HIV
  • Toxins, medications, alcohol
  • Metabolic: B12 deficiency, hypothyroidism
  • Vascular
32
Q

What investigations would you consider for polyneuropathy?

A
  • History and exam
  • Bloods: FBC, CRP and ESR, U+Es, LFTs, HbA1c, TFTs, B12, HIV
  • Special tests: EMG, NCS
33
Q

Describe the presentation of diabetic neuropathy

A
  • Sensory neuropathy in a glove + stocking distribution
  • Reduced/absent deep tendon reflexes
  • Foot drop, muscle weakness
  • Joint deformity
34
Q

Describe the presentation of GBS

A
  • Acute onset symmetrical polyneuropathy
  • Distal sensory abnormality and progressive proximal ascending muscle weakness (LMN)
  • Following GI/resp infection
  • Peaking within 2 weeks, resolving within months
35
Q

Describe the diagnostic process in suspected GBS

A
  • History and examination suggestive
  • Bloods: general screen, anti-ganglioside antibodies, LFTs
  • NCS
  • LP for CSF analysis (raised protein w normal cell count)
  • Spirometry 6 hourly initially to determine ICU need
  • Consider MRI if unclear or ?spinal cord lesion
36
Q

Describe the management of GBS

A 
Supportive:
-Analgesia
-Airway
-Antithrombotic
-Autonomic support
IVIG or plasma exchange 
Rehabilitation
37
Q

What is Charcot Marie Tooth disease?

A

A group of hereditary peripheral neuropathies

38
Q

Describe the presentastion of CMT

A
  • Onset during puberty
  • Mixed motor and sensory polyneuropathy
  • Motor: weakness of anterior leg muscles: foot drop, champagne bottle legs, pes cavus, toe clawing. Absent ankle jerks
  • Sensory: stocking pattern loss
39
Q

What are the investigations for CMT?

A
  • NCS

- Genetic testing

40
Q

What is the use of nerve conduction studies?

A
  • To diagnose peripheral neuropathies

- Can differentiate between sensory and motor neuropathy

Neuro finals KTB (8 decks)

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