neuropathy Flashcards
diabetic peripheral neuropathy presentation
sensory loss only !!
glove + stocking distribution
lower legs affected first (due to length of sensory neurons in this area)
- can be painful
management of peripheral diabetic neuropathy
- amitriptyline
- duloxetine
- gabapentin
- pregabalin
if first doesnt work, try one of the others
tramadol = rescue therapy for exacerbations
resistant sx = pain mx clinic
management of localised neuropathic pain e.g. post-herpetic neuralgia
topical capsaicin
GI autonomic neuropathy px + mx
sx = erratic blood glucose control, bloating + vomiting
mx = metoclopramide, domperidone or erythromycin (prokinetic agents)
drugs that cause peripheral neuropathy
amiodarone !!
isoniazid
vincristine
nitrofurantoin
metronidazole
peripheral neuropathy conditions which are predominatly motor loss
guillain barre
porphyria, lead poisoning
diphtheria
hereditary sensorimotor neuropathies (HSMN) - Charcot-marie tooth
chronic inflammatory demyelinating polyneuropathy
peripheral neuropathy conditions which are predominatly motor loss
diabetes
leprosy
alcoholism
vit b12 def
amyloidosis
alcoholic neuropathy
2nd to both toxic effects + reduced absorption of B vitamins
sx present prior to motor
reduced vit B12 causes what, which tracts are affected?
subacute degen of spinal cord
-> resulting in impairment of dorsal colums, lateral corticospinal tracts, + spinocerebellar tracts
sx of dorsal column impairment
distal tingling/burning/sensory loss
–> symmetrical, legs > arms
impaired proprioception + vibration sense
sx of lateral corticospinal tract impairment
muscle weekness
hyperreflexia + spasticity
brisk knee reflexes
absent ankle jerks
extensor plantars
sx of spinocerebellar tract impairment
sensory ataxia -> gait abnormalities
positive rombergs !
