neuropathy Flashcards
what is carpal tunnel
median nerve entrapment. hypothyroid, pregnancy, rheumatoid, acromegaly
what are the symptoms in carpal tunnel
nocturnal painful tingling in hand and or foream not confined to anatomical sensory territory of the nerve. weakness and wasting is a late sign
what is Tinels test
tap on the flexor aspect of the wrist get tingling and pain
what is Phalens test
symptoms on maximal wrist flexion
what symptoms do you get with lesions median nerve at the wrist
sensory loss over radial 3 1/2 fingers and palm, weakness abductor pollicis brevis
what is the ulnar nerve vulnerable to
elbow trauma. in the cubital tunnel.
signs of ulnar nerve damage
weakness/wasting of medial side wrist flexors, interossei (cant cross fingers), medial 2 lumbricals (claw hand), hypothenar wasting (weak little finger abduction), sensory loss over medial 1 1/2 fingers
treatment carpal tunnel
wrist splint at night or local steroid injections
treatment ulnar cubital tunnel
night time soft elbow splinting
what does the radial nerve do
opens the fist
why can radial damage take place
against the humerus, eg when arm draped over hard chair for several hours
signs radial damage
wrist and finger drop. sensory loss variable but can affect anatomical snuff box.
what is lateral cutaneous nerve of the thigh compression called
meralgia paraesthetica
lateral cutaneous nerve of the thigh compression signs
anterolateral burning thigh pain from entrapment under the inguinal ligament
lateral cutaneous nerve of the thigh roots
L2-L3
what is common peroneal nerve palsy
originates from sciatic nerve just above the knee. often damaged as winds around the fibular head due to trauma, cross legged sitting, yoga, in a cast
signs common peroneal nerve palsy
foot drop, weak ankle dorsiflexion/eversion. sensory loss over dorsum of the foot
causes of mononeuritis multiplex
occurs in DM, leprosy, vasculitis, amyloidosis,l malignancy, neurofibromatosis, HIV and hep C
causes of polyneuropathies- metabolic
hypothyroid, DM, hypoglycaemia
inflammatory causes of polyneuropathies
GBS, CIDP, sarcoidosis
nutritional causes of polyneuropathies
low B1, B12, high B6, low folate
causes of polyneuropathies malignancy
polycythaemia rubra ve ra, paraneoplastic syndromes
causes of polyneuropathies infection
HIV, lyme disease, syphilis, leprosy
causes of polyneuropathies vasculitides
RA, PAN, wegeners
causes of polyneuropathies drugs
alcohol, cisplatin, vincristine, isoniazid, phenytoin, metronidazole
what is guillain barre
immune mediated , symmetrical ascending muscle weakness. acute inflammatory demyelinating polyradiculopathy (AIDP)
what can GBS follow
campylobacter jejuni and CMV around 1-3 weeks after
what are the symptoms GBS
weakness distal limb muscles, and or distal numbness, low back pain can be an early feature. progresses proximally. loss of tendon reflexes and some autonomic
what % GBS get facial and respiratory weakness
20%
how is GBS diagnosed
clinically, nerve conduction studies- slowed conduction. CSF- protein increased
what can be a variant of GBS
Miller Fisher Syndrome- proximal muscles- ocular motor palsy and ataxia, antibodies against GQ1b (ganglioside). CIDP- slower onset and recovery. AMAN (acute motor axonal neuropathy)- no sensory loss
features required for diagnosis GBS
progressive weakness all 4 limbs, areflexia
features excluding diagnosis GBS
purely sensory symptoms, diagnosis of MG, botulinism, poliomyelitis, diphtheria, porphyria, toxic neuropathy
management GBS
IV Ig. plasma exchange. monitor ventilaiton (vital capacity) to see whether needs ventilatory support
what tests can be done in polyneuropathies
FBC, ESR, glucose, U&E, LFT, TSH, B12, electrophoresis, ANA and ANCA, CXR, urinalysis, lead level, antiganglioside antibodies, nerve conduction- distinguish between demyelinating and axonal causes
what neuropathies can you get in diabetes
distal symmetrical sensory (glove and stocking), acute painful sensory, mononeuropathy and mononeuritis multiplex, diabetic amyotrophy, autonomic neuropathy
what can deficiency of B1 cause
thiamine. Wernicke-Korsakoffs. alcohol main cause is West
signs in Wernicke Korsakoffs
eye signs-nystagmuc, conjugate gaze palsy; ataxia- broad based gait, cerebellar signs; cognitive- stupor and coma, confabulation and amnesia
how to treat Wernickes Korsakoffs
thiamine
genetic example of neuropathy
Charcot Marie Tooth
what happens in Charcot Marie Tooth
distal limb wasting and weakness progresses slowly over years, mostly in legs. severe foot drop. pes cavus (high arch) and toe clawing
what signs can be seen in autonomic neuropathy
postural hypotension, urinary retention, erectile dysfunction, nocturnal diarrhoea, diminished sweating
in what can autonomic neuropathy be seen
diabetes, amyloidosis, GBS
