Neuropathy Flashcards
what are the types of neuropathy?
peripheral: pain/loss of feeling in feet and hands
autonomic: changes in bowel, bladder function, sexual response, sweating, heart rate, blood pressure
proximal: pain in thighs, hips, buttocks - leading to weakness in the legs (amyotrophy)
focal neuropathy: sudden weakness in one nerve or groups of nerves causing muscle weakness or pain e.g. carpal tunnel, ulnar mono-neuropathy, foot drop, bells palsy, CN palsy
risk factors
increased length of diabetes poor glycaemic control more common in T1DM high cholesterol/lipids smoking alcohol genetics mechanical injury
what is peripheral neuropathy?
distal symmetric/ sensorimotor neuropathy
how does peripheral neuropathy present?
glove stocking distribution numbness/insensitivity tingling/burning sharp pains or cramps sensitivity to touch loss of balance and coordination
what are the consequences of peripheral neuropathy?
charcot foot
painless trauma
foot ulcer
what is diabetic foot?
peripheral neuropathy: neuropathic ulcer, clawing of toes, glove and stocking neuropathy, dry cracked skin, callus
peripheral vascular disease: proximal arterial occlusion, digital gangrene, Charcot foot, loss of leg hair, absent pulses, cold feet
what is charcot arthropathy?
a destructive inflammatory process causing fractures/ bony destruction and deformity of the foot
how does charcot arthropathy present?
hot swollen foot in someone with neuropathy
how is charcat arthropathy diagnosed?
hard to differentiate from infection
MRI can be useful
how is Charcot arthropathy managed?
non-weight bearing (total contrast cast or airiest boot)
natural history of Charcot arthropathy?
3 months of active destruction
1-4 months of healing (months 4-8)
then chronic phase after 8 months
how is Charcot arthropathy screened for?
podiatrist annually assess at risk patients
refer to specialist if active disease
what is the usual development of loss of sensation?
usually get pain before loss of sensation
how to treat painful neuropathy?
amitriptyline duloxetine gabapentin or pregabalin titrate up as needed if localised neuropathic pain and pain doesn't want/ can't tolerate oral treatments - can give topical capsaicin cream
what is diabetic amyotrophy?
amyotrophy = muscular atrophy
starts with pain in the thighs, hips, buttocks or legs - usually on 1 side of the body
more common in elderly patients with T2DM
proximal muscle weakness
associated with marked weigh loss
what is autonomic neuropathy?
affects the nerves which regulate heart rate and blood pressure
they also control internal organs
- gastric motility, respiratory function, urination, sexual function and vision
autonomic neuropathy in the digestive system can cause?
constipation (gastric slowing) or diarrhoea (frequent gastric emptying) - sometimes both
Gastroparesis (slow stomach emptying) - persistent N&V, bloating and loss of appetite, can cause wide fluctuation in BG levels because of abnormal food digestion
Oesophagus nerve damage - makes it hard to swallow and can lead to weight loss
how is gastroparesis managed?
improve glycaemic control
smaller and more frequent food portions - low fat, low fibre
may need liquid meals if severe
promotility drugs - metoclopramide, domperidone, erythromycin)
may need NSAIDs/analgesics (low dose tricyclic antidepressants, gabapentin, tramadol and fentanyl) for abdominal pain
botulinum toxin (works on pyloric sphincter)
gastric pacemaker
autonomic neuropathy of the sweat glands can cause?
profuse sweating at night or while eating (gustatory sweating)
prevent the sweat glands from working possibly
stop the body from being able to regulate temperature properly
Anhidrosis = inability to sweat normally
Hyperhidrosis = excessive sweating
how is sweat gland neuropathy managed?
topical glucopyrrolate
clondine
botulinum toxin
affect of nerve damage in the CV system?
disrupts body’s ability to adjust BP and heart rate
- postural hypertension
- persistent high heart rate (despite change in activity)
