Neuropathies, Myopathies

Question 1

Charcot Marie Tooth

Answer 1

peripheral nerve lesions, motor and sensory

• falls over ‘nothing’
• injured feet without noticing
• bad at running at school

IX: NCS, genetics

Question 2

Polymyositis (acquired muscle inflammation)

Answer 2

immune mediated inflammatory myositis

symptoms: aching in shoulders, unable to squat and stand, struggles to get out of chair,

FVC, ECG, CXR +/- CT thorax
CK
Broad spectrum of bloods for inflammatory/connective tissue conditions including myositis antibody screen.
Keep mind open to development of systemic problems and association with cancer.
Muscle biopsy

Question 3

Myasthenia Graivs

Answer 3

intermittent double vision
dribble when eating
slurred speech
power, reflexes and cranial nerve exam
droopy eelids
speech/swallow/drooling/head drop/jaw drop

Assessment of resp function- FVC
Swallow assessment

Bloods for TFT, anti-AchR Ab.
EMG/NCS
Consider giving treatment with pyridostigmine
Safety net advice
CT Thorax for thymoma

Question 4

Acute demyelinating polyneuropathy (Gullian Barre syndrome)

Answer 4

24 hr history
pain in back/flanks
tingling in feet
catching toes when talking upstairs to bed

previous resp/GI infection
assess breathing (FBC)
cardiac arrhythmias is common