Neuropathy Flashcards

1
Q

what is neuropathy

A

disease of the peripheral nerves

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2
Q

what is the classification of neuropathy

A

mononeuropathy - individual nerve
polyneuropathy - many nerves, typically the longest nerves are damaged first (‘glove and stocking’ distribution)
mononeuritis - multiplex-multiple mononeuropathies

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3
Q

what are the affected modalities in neuropathy

A

sensory - large fibre (crude touch, vibration, proprioception) and small fibre (pain, temp)
motor
autonomic/visceral - digestion, heart rate and BP regulation, sweat, bowel/bladder and sexual functions
may affect one, some or all

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4
Q

what are the two categories of damage in neuropathy

A

demyelinating and axonal
determining this requires nerve conduction studies
the category is relevant to finding the cause and treatment

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5
Q

what are the clinical features of neuropathy

A

sensory disturbance
pain (typically burning stabbing or tingling)
weakness accompanied by wasting, loss of reflex
secondary features such as wounds, ulcers or fractures (including chronic poorly healed fractures)

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6
Q

describe mononeuropathy

A

symptoms reflect dysfunction, in a single peripheral nerve
sensory loss and paraesthesis, and/or motor weakness in select muscle groups
often compressive - nerves are vulnerable at specific site, fractures can also produce these

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7
Q

common mono-neuropathic nerves and compression site

A

median nerve - carpal tunnel
ulnar nerve - Guyon’s canal (wrist), cubital tunnel (elbow)
radial - axilla, spiral groove of humerus
lateral cutaneous - inguinal ligament
common peroneal - fibular neck

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8
Q

describe carpal tunnel syndrome

A

most common
pain and paraesthesia, typically at night, patients ‘wake and shake’
loss of function in important hand movements
associations with pregnancy, hypothyroidism, rheumatoid arthritis, diabetes
treatment is surgery or splints

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9
Q

what is polyneuropathy

A

many nerve fibres affected simultaneously
length dependent - longest nerves affected first, begins in toes>feet>shins, then glove stocking pattern, up to knees, involving hands

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10
Q

what are the causes of polyneuropathy

A

diabetes (microvascular nerve damage)
alcohol
medications (amiodarone)
b12 deficiency
immune (acute - Guillan-barre syndrome, chronic - CIPD)
hereditary (Charcot-marie tooth disease)

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11
Q

what is Guillan-barre syndrome

A

acute inflammatory disorder
autoimmune polyneuropathy
often an infectious trigger in prior weeks (c.jejuni)

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12
Q

what is the pathophysiology of GB syndrome

A

antibodies are generated against infection, then attack similar antigens in peripheral nerves (molecular mimicry)
‘ascending weakness pattern’ (length dependent)

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13
Q

treatment of GB syndrome

A

neurological emergency (patients require hospitalisation, weakness may affect diaphragm and ventilation may be needed)
supportive measures and IVIg or plasma exchange

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14
Q

what is diabetic neuropathy

A

chronic slowly progressive condition
associated with longstanding hyperglycaemia
often arises along with retinal and renal disease

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15
Q

what is the pathophysiology of diabetic neuropathy

A

microvascular damage to nerves, particularly small fibre nerves
poses risk to foot health as patients don’t receive painful stimuli
in association with poor vascular health patients are more prone to wounds with poorer healing

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16
Q

management of diabetic nueropathy

A

prevention
regular podiatry check-ups
sometimes amputations

17
Q

what is Charcot-marie tooth disease

A

family of disorders
autosomal dominant/recessive and x-linked versions exist
gradually progressive issues with walking, running, foot sensation (may lead to damage)

18
Q

what may someone with Charcot-marie tooth disease show upon examination

A

wasting
high-arched feet
hammer toes
ulcers
reduced reflexes
weakness (bilateral foot drop)

19
Q

what is the treatment for Charcot-marie tooth disease

A

no treatment beyond supportive care (orthotics, walking aids etc)