Neuropathy

Question 1

risk factors

Answer 1

• Increased length of diabetes
• Poor glycaemic control
• More common in T1DM
• High cholesterol/lipids
• Smoking
• Alcohol
• Genetics
• Mechanical injury

Question 2

peripheral neuropathy

Answer 2

• Pain/loss of feeling in feet, hands
• Distal symmetrical or sensorimotor neuropathy
• ‘Glove and stocking’ distribution

Question 3

symptoms of peripheral neuropathy

Answer 3

• Numbness/insensitivity
• Tingling/burning
• Sharp pains or cramps
• Sensitivity to touch
• Loss of balace and coordination

Question 4

complications of diabetic neuropathy

Answer 4

painless trauma
charcot foot
foot ulcer
claw foot and calus formation
argyll robertson pupil

Question 5

what might painless trauma lead to

Answer 5

infection

Question 6

what can differentiate between charcot foot and infection

Answer 6

MRI

Question 7

what does charcvot foot affect

Answer 7

affects the bones, joints, and soft tissues of the foot and ankle.

Question 8

how does charcvot foot develop

Answer 8

destructive inflammatory process
starts with hot red foot
healing phase
chronic phase

Question 9

management of charcot foot

Answer 9

Aim is to prevent/minimise bony destruction by keeping pressure off the foot - non-weight bearing, total contact cast or aircast boot

Question 10

findings on MRI of charcot foot

Answer 10

Bone Marrow Edema: Diffuse and subchondral, often involving multiple bones
Bone Destruction/Fragmentation: Characteristic of advanced Charcot changes.
Joint Subluxation/Dislocation
Periarticular Marrow Changes

Question 11

what does proximal neuropathy cause

Answer 11

dmaage to nerves of lumbosacral
weakness and often assoc with bone loss

Question 12

where is pain often in proximal neuropathy

Answer 12

affects larger, near torso regions
buttocks, hips, thighs

Question 13

examples of focal neuropathy

Answer 13

localised
sudden weakness in one nerve or a group of nerves causing muscle weakness or pain e.g. carpal tunnel syndrome, cranial nerve palsy

Question 14

management of painful neuropathy

Answer 14

• Amitriptyline, duloxetine, gabapentin or pregabalin
• Topical capsaicin cream can be used for localised neuropathic pain in patients who do not want or can’t tolerate oral treatments

Question 15

autonomic effect of diabetic neuropathy

Answer 15

sweat glands affected- uncontrolled sweating
slows digestive system
oesopahgus nerves affected so difficulty swalloing
heart rate - may stay high and blood pressure affected - drop sharply after standing etc

Question 16

mononeuropathy

Answer 16

VI cranila nerve palsy
infarction of sixth nerve
usually recovers
carpal tunnel

Question 17

what are foot ulcers a common cause of

Answer 17

hospitalization requiring prolonged hospital stay and often amputation