Neuropathy 2014 short section PPT

Question 1

General rule of a peripheral nerve problem?

Answer 1

Areflexic

Question 2

Define peripheral neuropathy

Answer 2

• Impaired function of nerves outside brain and spinal cord
• Sensory, motor, or autonomic
• Guillain Barre
• Reflexes are lost EARLY

Question 3

Define neuromuscular junction disorders

Answer 3

• Hinders production, release or uptake of ACh
• Myasthenia gravis
• Reflexes NORMAL

Question 4

Define myopathies and muscular dystrophy

Answer 4

• Muscle tissue is primary site of pathology

- Reflexes are proportionate to weakness

Question 5

Define motor neuron disease

Answer 5

• Degenerative w/progressive weakness and wasting of muscles
• WITHOUT sensory changes
• ALS
• Reflexes are HYPER w/atrophy

Question 6

Reflexes of peripheral neuropathy

Answer 6

Lost early

Question 7

Reflexes of neuromuscular junction disorders

Answer 7

NORMAL

Question 8

Reflexes of myopathies and muscular dystrophy

Answer 8

Proportionate to weakness

Question 9

Reflexes of ALS

Answer 9

Hyperreflexic with atrophy

Question 10

Define radiculopathy

Answer 10

Irritation of a nerve root (cervical, thoracic, lumbar)

Question 11

What does small sensory nerve fiber damage cause?

Answer 11

Temporary loss or burning/stabbing pain

Question 12

What does large sensory nerve fiber damage cause?

Answer 12

Vibratory proprioceptive loss

Question 13

Median nerve neuropathy

Answer 13

Carpal tunnel syndrome

Question 14

Ulnar nerve neuropathy

Answer 14

Cubital tunnel syndrome

Question 15

Radial nerve neuropathy

Answer 15

• Wrist drop, weak finger extension

- MC from transient compressive injury at spiral groove of humerus

Question 16

How to diagnose radial nerve neuropathy vs. C7 radiculopathy?

Answer 16

• Radial nerve damage: triceps are OK

- C7 radiculopathy: triceps are defective

Question 17

Define meralgia paresthetica

Answer 17

• L2/3 numbness
• Pain in lateral thigh
• Can resolve spontaneously or lose weight, avoid tight belts

Question 18

How to diagnose meralgia paresthetica vs. L4 radiculopathy?

Answer 18

Quad reflex and muscle are spared in meralgia paresthetica

Question 19

MC cause of sciatic nerve injury

Answer 19

Hip and pelvic procedures which put patient in a prolonged lithotomy position

Question 20

How does sciatic nerve injury present?

Answer 20

• Sensory loss of entire foot and distal lateral leg

- Ankle jerk absent or reduced

Question 21

How does femoral nerve injury present?

Answer 21

• Difficulty extending knee and flexing hip

- Sensory symptoms of anterior thigh

Question 22

How does peroneal nerve injury present?

Answer 22

• Foot drop and variable sensory loss (dorsum of foot)

- Usually no pain

Question 23

Treatment of peroneal nerve injury

Answer 23

• Weight loss
• Avoid leg crossing
• Most resolve spontaneously

Question 24

How to diagnose peroneal nerve injury from L5 radiculopathy?

Answer 24

L5 radiculopathy has diminished ankle jerk

Question 25

Describe diabetic peripheral neuropathy

Answer 25

• Can affect any peripheral nerve (including cranial) but usually symmetric/distal/length dependent (so LE affected first)
• Occurs from metabolic or vascular insufficiency a/w hyperglycemia

Question 26

Diabetic peripheral neuropathy presentation

Answer 26

• MC in LE
• Numbness, pain, weakness
• Decreased DTR/vibratory sense loss

Question 27

Treatment of diabetic peripheral neuropathy

Answer 27

• Tight control of glucose

- Drugs to prevent stabbing pain (phenytoin, gabapentin, amitriptyline, carbamazepine)

Question 28

MC causes of radiculopathies

Answer 28

• Herniated disc
• DJD
• Infection (zoster)
• Trauma
• Diabetes

Question 29

MC causes of brachial plexopathy

Answer 29

• Post op
• Tumor
• Idiopathic

Question 30

MC causes of lumbosacral plexopathy

Answer 30

• Diabetes (MC)
• Retroperitoneal hematoma
• Psoas abscess

Question 31

How does thoracic outlet syndrome present?

Answer 31

• Pain, numbness of nerves and roots of UE

- Made worse with raising arms overhead