NeuroPathology - Lecture Nine Objectives - Diseases of the Peripheral Nervous System

Question 1

Mononeuropathy is described as…

Answer 1

damage to a single nerve usually due to injury

Question 2

Polyneuropathy is described as…

Answer 2

multiple nerves involved, glove and stocking pattern

Question 3

Radiculoneuropathy is described as…

Answer 3

involvement of nerve root as it emerges from spinal cord

Question 4

Polyradiculitis is described as…

Answer 4

several nerve roots are involved and occurs when infections create inflammatory response or trauma

Question 5

What are clinical features of PNS pathology / nerve injuries?

Answer 5

muscle atrophy, diminished reflexes, muscle weakness, contractures, edema, sensory impairments

Question 6

What are some PT implications for nerve injuries?

Answer 6

restore functional ROM, strength, and proprioception as well as balance and gait pattern

Question 7

What is Charcot-Marie-Tooth Disease?

Answer 7

Hereditary motor and sensory neuropathy/progressive peroneal muscular atrophy

Question 8

What nerves/muscles are initially affected in Charcot-Marie-Tooth Disease?

Answer 8

peroneal nerve/muscles in foot and lower leg initally, then progresses to forearm/hand muscles

Question 9

What is the etiology of Charcot-Marie-Tooth Disease?

Answer 9

autosomal dominant pattern with a genetic mutation, just one CMT gene

Question 10

What are the clinical characteristics of Charcot-Marie-Tooth Disease?

Answer 10

symmetric muscle weakness, diminished DTRs, weakness of dorsiflexors/evertors, foot drop gait pattern, pes cavus, sensory loss in feet and ankles. ***Legs look like inverted champagne bottle

Question 11

What are some PT implications for Charcot-Marie-Tooth Disease?

Answer 11

contracture prevention, stretching/ROM, splinting, POTENTIALLY strengthening

Question 12

What is Diabetic Neuropathy caused by?

Answer 12

it is a metabolic cause associated with diabetes mellitus

Question 13

What is the etiology of Diabetic Neuropathy?

Answer 13

chronic metabolic disturbanes that impact nerve and Schwann cells

Question 14

What are risk factors for Diabetic Neuropathy?

Answer 14

hyperglycemia

Question 15

What are the clinical characteristics of Diabetic Neuropathy?

Answer 15

insidious onset, sensory loss, burning pain stronger at night, walking on clouds, loss of ankle DTRs // mild weakness, hammer toes/pes cavus // cardiovascular and sympathetic disturbances

Question 16

What is Myasthenia Gravis and what is the etiology?

Answer 16

it is a fluctuating motor weakness autoimmune disorder / neuromuscular disorder involving ocular, bulbar, limb, and/or respiratory muscles

Question 17

What are the clinical characteristics of Myasthenia Gravis?

Answer 17

first affected are eyelid muscles and muscles moving the eyes leading to double vision/ptosis, chewing food is tougher leading to fatigue, lips wont close

Question 18

What are some PT implications for Myasthenia Gravis?

Answer 18

acute care: encourage coughing and deep breathing, observe for increasing weakness // in all settings: energy conservation strategies, strength training

Question 19

What is the pathology for Guillain-Barré Syndrome?

Answer 19

spinal roots and peripheral nerves are infiltrated with macrophages and T-lymphocytes, attack/strip myeline sheaths (milder cases have intact axons and can re-myelinate)

Question 20

What are the clinical characteristics of Guillain-Barré Syndrome?

Answer 20

rapid progression of weakness and sensory changes starting distally progressing proximal. Absent/diminished reflexes, flaccid paralysis

Question 21

What is the progression of Guillain-Barré Syndrome?

Answer 21

progression of symtpoms generally stops within 2-4 weeks, then a static/all time low phase beings for another 2-4 weeks, recovery(ranging from months-years) occurs in a proximal to distal pattern

Question 22

What is required for a Guillain-Barré Syndrome diagnosis?

Answer 22

loss of DTRs, progressive weakness in more than one extremity // in order of importance: rapid symmetric weakness plateauing around 4 weeks, mild sensory changes, facial weakness, recovery starts within 2-4 weeks, tachycardia/arrhythmyias/varying BP, NO fever

Question 23

What is the prognosis for Guillain-Barré Syndrome?

Answer 23

good prognosis, slow rate of peripheral nerve recovery at 1-2mm or 0.04-0.08in / day (1-2in/month)

Question 24

What factors predict a poor outcome for Guillain-Barré Syndrome?

Answer 24

older age onset, longer time before recovery begins, need for ventilation, indicated axonal degeneration

Question 25

What are some PT implications for Guillain-Barré Syndrome?

Answer 25

facilitate muscle contractions while montioring overuse/fatigue