Neuropathies and Neuralgias Flashcards
The two types of peripheral neuropathies
Axonal PN
Demyelinating PN
Describe Axonal PN
Conduction velocity is normal or mildly reduced, and the needle
electromyography shows evidence of denervation in affected muscles
Describe Demyelinating PN
Conductions may be slowed significantly and in more
severe cases conduction is blocked completely, without any evidence of
denervation
How can you determine Axonal PN from Demyelinating PN?
Use EMG/NCV used to differentiate between
Name some causes (categories) of peripheral neuropathy.
Hereditary
Metabolic
Toxic
What neuropathy is described below?
Autoimmune disorder
Causes destruction of myelin and/or axon by ganglioside antibodies
Demyelination disease of the peripheral nerves
Usually an ascending paralysis
Guillain-Barre
What is the progression of Guillain-Barre?
Usually an ascending paralysis
Which neuropathy follows an infection, an immunization (flu shot), or a surgical procedure?
Guillain-Barre
What are the signs and symptoms of Guillain-Barre?
Symmetric weakness 🡪 proximal emphasis
Usually starts in the legs and then involves arms and face
Paresthesias of hands and feet are typically the earliest symptoms
Gait disorder common
Back and leg pain common
Miller-Fisher Syndrome triad
Ataxia
Ophthalmoplegia
arefflexia
What marker is seen in Miller-Fisher Syndrome?
GQ1b antibodies
What is the workup for Guillain-Barre?
Lumbar puncture
Electrophysiology
What medication is important to avoid in Guillain-Barre and why?
Prednisone
Ineffective! (not an inflammatory process)
May delay recovery time
Which neuropathy is described below?
Similar to GBS
Has relapsing steady progressive course over months/years
May be motor or mixed sensorimotor distribution
Chronic Inflammatory Demyelinating Polyradiculopathy
What is the treatment for Chronic Inflammatory Demyelinating Polyradiculopathy?
Steroids
IVIG
What is the most common mononeuropathy?
Carpal tunnel
What mononeuropathy is described below:
Rare disorder of extremities
Autonomic and vasomotor instability
Syndrome most common in the hand
Not limited to the distribution of a single nerve
Most cases preceded by direct, minor physical trauma
Complex Regional Pain Syndrome
Vitamin C in large doses can help reduce this
Complex Regional Pain Syndrome
What mononeuropathy is described below:
Unilateral paralysis or weakness of facial muscles supplied by CNVII
Without evidence of neurologic disease or apparent cause
Inflammatory reaction of facial nerve at exit site
Bell’s Palsy
Bell’s Palsy is most common in which types of patients
pregnant women and diabetics
List some conditions that are associated with Bell’s Palsy?
Reactivation of herpes simplex or varicella zoster
Lyme disease
Cancer
DM
Pregnancy
Sarcoidosis
Guillain-Barre
Multiple sclerosis
Trauma
Viral infection
cholesteatoma
When should you refer a Bell’s Palsy patient to a neurologist?
If complete paralysis at day 5 – refer to neurologist
Steroids must be started within how many days of onset of Bell’s Palsy?
within 5 days
