neuropathy Flashcards
what is radiculopathy
compression of spinal nerve roots –> LM signs
what is plexopathy
dysfunction at level of plexus
what is brachial neruitis
post infection or trauma –> sudden onset shouler pain, numbness + weakness
what is peripheral neruopathy
dysfunction of peripheral nerves due to local damage
median nerve roots
C5-T1
median nerve motor
LOAF muscles: intrinsic hand + thumb
sensory median nerve
thumb + 2.5 digits
causes carpal tunnel
RA, pregnancy, diabetes
symptoms carpal tunnel
sensory less lateral 3.5 digits, thenar wasting (ape hand) + tinels + phalens +ive (flexion of wrist painful)
invx + mx carpal tunnel
nerve studies = prolonged AP // 6 week conservative -of steroid injection + splint –> surgery
ulnar nerve roots
C8-T1
motor ulnar nerve
adductur pollis, interossu, hypothenar muscles, medial lumbricals
sensory ulnar
medial 1.5 fingers
symptoms ulnar nerve (cubital tunnel)
sensory loss pinky + ring // ulnar claw// wasting of intrinsic hand and hypothenar
radial nerve roots
C5-T1
motor radial nerve
triceps, brachioradialus, wrist muscles
damage to radial nerve symptoms
wrist drop, sensory web loss between thumb and pointer, paralysis of triceps
meralgia paraesthica root damage + nerve
L2/3 - lateral cutaneous nerve of the thigh
rf meralgia paraesthica
obese, pregnant, asietces, trauma, iatrogenic surgery
meralgia paraesthica symptoms
SENSORY ONLY - neuropathic pain, numb, muscle ache, worse standing
invx meralgia paraesthica
pelic compression (below ASIS) –> pain // USS + anaesthetic injection // nerve conduction studies
causes foot drop
peroneal nerve legion!!! (L5 radiculopathy, sciatica) // fibular fractures // crossed leg
nerve foot drop
common peroneal
symptoms common peroneal lesion
foot drop // weak dorsiflexion // weak eversion
common drugs that cause peripheral neuropathy (5)
amiodarone // isoniazid // vincristine // nitro // metro
what is thoracic outflow syndrome (TOS)
compression of brachial plexus, subclavian artery or vein at site of thoracic outlet
who gets TOS
40 // thin people // anatomical anomalies // cervical rib
symptoms neurogenic TOS
painless hand weakness + wasting // sensory symtpoms // cold hands
symptoms vascular TOS
vein = painful swelling + veins // artery = painful claudication +/- gangrene or ulcer
most common cause TOS
vascular
invx TOS
xray // CT or MRI // angio
mx TOS
conservative + taping // decompression surgery // botox
what can cause bell’s palsy + who hets it
idiopathic (maybe HSV) // 20-40 // pregnant women
symptoms bells palsy
UNILATERAL: LMN –> forehead affected // post-auricular pain // altered taste // dry eyes
mx bells
oral pred within 72 hours symptoms // eye lubricant
when to refer bells palsy + recovery
3 weeks no improvement –> ENT // 3-4 month recovery
facial nerve function
facieal expression, stapedius, ant 2/3 tongue, parasymp to tears + saliva
causes bilateral CNVII palsy
sarcoid, GBS, lymes, NFT2
causes unilateral facial palsy
bells, ramsay hunt, acoustic neuroma, parotid tumour, MS, stroke (UMN)
UMN vs LMN facial palsy
UMN spares forehead // LMN = all facial muscles
what is charcot-marie-tooth disease
most common hereditary peripheral neuropathy
symptoms charcot marie tooth disease
LMN signs motor loss, sprained ankles, foot drop, high arch, hammer toes, muscle weakness and atophy, hyporeflexia
what is HSMN type 1 and inheritance
new term for charcot-marie-tooth // dominant
what usually triggers GBS
following food poisoning eg campylobacter jejuni
which antibodies may be present in GBS patients
anti-GM1
symptoms GBS
early back/leg pain –> ascending weakness of the limbs, reduced reflex –> resp weakness, CN palsy, autonomic dysfunction
invx GBS
LP: raised proteins + normal WCC // nerve conduction: decreased motor nerve velocity
mx GBS
IV Ig, plasmpopheresis
what is miller fisher syndrome
varient of GBS // descending, eyes affected first
antibodies miller fisher
anti-GQ1b
what is Chronic inflammatory demyelinating polyneuropathy
variant of GBS with onset years
what is neuropathic pain
inappropriate response from nervous system dysfunction
symptoms neuropathic pain
shooting or burning // tingling // allodynia - pain in response to innocuous things eg light touch // hyperalgesia
1st line mx neuropathic pain
amitryp (TCA) // duloxeteine (SNRI) // gabapentin or pregabalin (GABA analogue)
2nd line chronic pain mx
opioids, lignocaune, capsaicin, NMDA eg memantine
what is complex regional pain
chronic condition that causes pain, usually after surgery or minor injury
what is central post-stroke pain
mild hemiplegia + paraesthesia –> allodynia // chorea movements in affected side
