Neuropathies and Neuralgias

Question 1

The two types of peripheral neuropathies

Answer 1

Axonal PN
Demyelinating PN

Question 2

Describe Axonal PN

Answer 2

Conduction velocity is normal or mildly reduced, and the needle
electromyography shows evidence of denervation in affected muscles

Question 3

Describe Demyelinating PN

Answer 3

Conductions may be slowed significantly and in more
severe cases conduction is blocked completely, without any evidence of
denervation

Question 4

How can you determine Axonal PN from Demyelinating PN?

Answer 4

Use EMG/NCV used to differentiate between

Question 5

Name some causes (categories) of peripheral neuropathy.

Answer 5

Hereditary
Metabolic
Toxic

Question 6

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

Answer 6

Guillain-Barre

Question 7

What is the progression of Guillain-Barre?

Answer 7

Usually an ascending paralysis

Question 8

Which neuropathy follows an infection, an immunization (flu shot), or a surgical procedure?

Answer 8

Guillain-Barre

Question 9

What are the signs and symptoms of Guillain-Barre?

Answer 9

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

Question 10

Miller-Fisher Syndrome triad

Answer 10

Ataxia

Ophthalmoplegia

arefflexia

Question 11

What marker is seen in Miller-Fisher Syndrome?

Answer 11

GQ1b antibodies

Question 12

What is the workup for Guillain-Barre?

Answer 12

Lumbar puncture
Electrophysiology

Question 13

What medication is important to avoid in Guillain-Barre and why?

Answer 13

Prednisone

Ineffective! (not an inflammatory process)
May delay recovery time

Question 14

Which neuropathy is described below?

Similar to GBS
Has relapsing steady progressive course over months/years
May be motor or mixed sensorimotor distribution

Answer 14

Chronic Inflammatory Demyelinating Polyradiculopathy

Question 15

What is the treatment for Chronic Inflammatory Demyelinating Polyradiculopathy?

Answer 15

Steroids
IVIG

Question 16

What is the most common mononeuropathy?

Answer 16

Carpal tunnel

Question 17

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

Answer 17

Complex Regional Pain Syndrome

Question 18

Vitamin C in large doses can help reduce this

Answer 18

Complex Regional Pain Syndrome

Question 19

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

Answer 19

Bell’s Palsy

Question 20

Bell’s Palsy is most common in which types of patients

Answer 20

pregnant women and diabetics

Question 21

List some conditions that are associated with Bell’s Palsy?

Answer 21

Reactivation of herpes simplex or varicella zoster
Lyme disease
Cancer
DM
Pregnancy
Sarcoidosis
Guillain-Barre
Multiple sclerosis
Trauma
Viral infection
cholesteatoma

Question 22

When should you refer a Bell’s Palsy patient to a neurologist?

Answer 22

If complete paralysis at day 5 – refer to neurologist

Question 23

Steroids must be started within how many days of onset of Bell’s Palsy?

Answer 23

within 5 days