Neuropathies Flashcards
What nerve stimulates the deltoid?
C5
What nerve does the biceps?
C5, 6 (pick up sticks)
What nerves do the triceps?
C7, 8 (shut the gate)
What nerves do wrist extension?
Radial nerve (7,8) (shut the gate cont.)
What nerve does wrist flexion?
C8 (median nerve)
What nerves do the thumbs?
C8/ T1
Quadriceps innervation
L2,3,4 Kick the door
Hip flexion
L1-L3
Hip Extension
L5-S2
Ankle movement
S1, 2 Buckle my shoe
Signs of Lower motor neuropathy
Decreased tone- flaccid Weakness Decreased reflexes Flexor Plantar response Fasciculations and wasting IPSILATERAL
Signs of Upper Motor Neuropathy
Increased tone- spasticity (clasp knife) Weakness Increased reflexes Extensor plantar response Pronator drift Contralateral
When is the forehead spared?
UMN
Brachial plexus mononeuropathy
Pain, weakness, paraesthesia caused by heavy rucksacks
Causes of phrenic nerve palsy
Lung cancer, myeloma, cervical spondylosis,
Symptoms of phrenic nerve palsy
Orthopnoea, raised hemidiaphragm on CXR,
Symptoms of sciatic nerve palsy (L4- S3)
Foot drop, loss of sensation below knee
Common Peroneal Nerve Palsy symptoms (L4-S1)
Foot drop, weal ankle, sensory loss dorsal foot.
caused by sitting cross legged
Tibial nerve palsy
L4-S3 Cant stand on tip toe (plantar flexion)
Are neuropathies usually proximal or distal?
Distal
What are systemic causes of neuropathies?
Wegeners AIDs Amyloidosis Diabetes Rheumatoid PAN Sarcoidosis Leprosy
Local causes of neuropathies
Entrapment or trauma
Ulnar Palsy symptoms (C7-T1)
Elbow trauma cause Wrist flexors Interossei (cross fingers) Claw hand (lumbricals) Sensory loss
Radial nerve palsy (C5-T1)
Wrist drop
Finger drop
Variable sensory loss
Carpal Nerve is entrapment of which nerve?
Median Nerve
What are the characteristics of peripheral neuropathy?
Chronic, slowly progressive deficit in motor and/or sensory usually starting in glove and stocking distribution
What are the skin changes in peripheral neuropathy?
Trophic changes- Thin, dry skin, hairless and numb
What are the 2 kinds of peripheral sensory nerve fibres?
C fibres- small fibres pain and temp sensation
A fibres- large fibres proprioception and vibration
Common causes of peripheral neuropathy
B12/folate deficiency
Alcohol/toxins
Infection- HIV, Lyme, Leprosy
Drugs- chemo, ionazid, phenytoin, amiodarone
Idiopathic
GBS
Endocrine: Diabetes, Hypothyroid, Cushings, Agromegaly
CIDP (chronic inflammatory demyelinating polyneuropathy) similar to GBS but chronic
Charcot Marie Tooth (children)
Multifocal Motor neuropathy (MMN)
What investigations would you do for peripheral neuropathy?
FBC ESR U + E Glucose TFT CRP B12 Folate Antigliadin ANA ENA ANCA RhF antidsDNA (Vasculitis screen)
Peripheral Neuropathy Treatment
Gabapentin, Pregabalin, Amytriptyline
Remove cause (DM, gluten)
If inflammatory: steroids (prednisolone), or azathioprine
If vasculitis: Prednisolone and immunosupressant (cyclophosphamide)
