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NBB1 > Neuropathy > Flashcards

Neuropathy Flashcards

1
Q

What is peripheral neuropathy?

A

Lesions affecting the peripheral nervous system: spinal nerves, nerve plexuses, peripheral nerves, cranial nerves

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2
Q

What do the symptoms of neuropathy depend on?

A

1 Axons are myelinated or not
2 Which axons
3 Where axons are affected

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3
Q

What are potential symptoms of neuropathy?

A 
1 Weakness and muscle atrophy
2 Loss of reflexes
3 Loss of sensation/numbness
4 Abnormal sensation (tingling, burning)
5 Pain
6 Autonomic changes
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4
Q

How might a small fiber nerve present with neuropathy?

A

Pain, temp and autonomic loss

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5
Q

How might a neuropathic lesion present with myelin damaged?

A

Large fiber vibration and position sense loss + motor loss

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6
Q

How might a sensory ganglia lesion present?

A

Only sensory symptoms

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7
Q

How does neuropathic pain differ from nociceptive pain?

A

Nociceptive: tissue may be damaged, nerves intact

Nerves are damaged!

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8
Q

How does neuropathic pain arise?

A

Lesions in the PNS and CNS

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9
Q

What are common features of neuropathic pain?

A

Burning, shooting, stinging pain
Areas of numbness
Changes in pain threshold, quality of pain, spontaneous pain

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10
Q

What is a common feature of chronic pain?

A

Depression

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11
Q

How do we often treat neuropathic pain?

A

Antidepressants and anti-epileptic drugs

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12
Q

What is it called when symptoms follow a nerve root pattern?

A

Radiculopathy

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13
Q

What is a mononeuropathy or plexopathy?

A

Lesions affect specific nerves or plexuses

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14
Q

What is a mononeuropathy multiplex?

A

Stems from a specific disease like diabetes or vasculitis

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15
Q

What is a polyneuropathy?

A

Generalized process affecting peripheral nerves

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16
Q

What is a distal and symmetrical distribution neuropathy, and what causes it?

A

Glove and stocking pattern

Diabetes, alcohol, hypothyroidism, B12 deficiency (intensive care pts)

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17
Q

What is the prevalence of polyneuropathy?

A

31% with >=1 bilateral sensory deficit

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18
Q

What are the 3 things to injure to cause peripheral neuropathy?

A

Damage to: cell bodies, axons or myelin sheaths

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19
Q

What does axonal damage produce?

A

Wallerian degeneration = dying forward

  1. distal axonal degeneration
  2. chromatolysis of cell body: nucleolus expands and moves to cell wall, Nissl substance disintegrates)
  3. recruitment of macrophages
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20
Q

How quickly can a proximal nerve stump recover?

A

1-2mm per day

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21
Q

What causes a “dying back” of axons?

A

Conditions that affect the health of the neuron (e.g. metabolic dz)
Loss of myelin often accompanies!

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22
Q

Which axons are affected first in “dying back”?

A

Longer axons: distal extremities are affected first!

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23
Q

What causes “segmental demyelination”?

A
  • Myelin sheaths are damaged by trauma or disease

- Affected secondarily due to axonal death

24
Q

how are symptoms of demyelination detected?

A

Nerve conduction tests: conduction block or slowed CV

25
Q

How quickly can myelin and conduction return?

A

Days to weeks

26
Q

When do we see atrophy with neuropathy?

A

Only when the axon is interrupted:

Wallerian degeneration or axonal degeneration

27
Q

What are examples of non-traumatic peripheral neuropathies?

A

Nutritional/metabolic: DM, B12 deficiency
Toxic drugs: chemotherapies
Other toxins: alcohol, lead, arsenic, mercury
Vasculopathic: vasculitis, amyloidosis
Inflammatory: Guillain Barre
Infection
Inherited: Charcot-Marie-Tooth neuropathy

28
Q

What is the greatest source of morbidity and mortality in diabetes patients?

A

Diabetic neuropathy

29
Q

What is the most common complication of diabetics?

A

Diabetic neuropathy: 30% of them have it, 75-80% have subclinical neuropathy

30
Q

What is length-dependent diabetic polyneuropathy?

A

Begin at feet, move to more proximal legs and distal upper limbs = “glove and stocking” sensory loss

31
Q

What are the symptoms of length-dependent diabetic polyneuropathy?

A

paresthesias, dysesthesias, numbness, tingling, burning

motor weakness

32
Q

What conditions lead to the glove and stocking diabetic polyneuropathy?

A

Most nutritional, metabolic and toxic diseases

33
Q

What are long term sequelae of length-dependent diabetic polyneuropathy?

A

trophic changes like calluses and plantar ulcers

34
Q

What is the pathophysiology of diabetic neuropathy?

A

Axonal degeneration, dying back, demyelination
Ischemia, oxidative stress and inflammation
Sensory neurons > motor

35
Q

What is sensory-only diabetic neuropathy called and what is involved?

A

small fiber polyneuropathy: only small unmyelinated and myelinated fibers

36
Q

How do peripheral nerve fascicles appear in diabetic neuropathy?

A
  • Decreased number of myelinated and unmyelinated axons

- Thickening in the walls of blood vessels

37
Q

What’s the most prevalent metabolic neuropathy?

A

B12 deficiency

38
Q

What does B12 deficiency affect?

A

peripheral nerves, optic nerves, spinal cord and brain

39
Q

Where do the symptoms of B12 deficiency neuropathy present?

A

Distal limbs, more often in upper limb
Loss of vibration sense
May affect lateral + dorsal columns of SC

40
Q

What is subacute combined degeneration? How does it present?

A

In B12 deficiency, neuropathy affecting lateral/dorsal columns of SC –> ataxia and spasticity can occur together w/ peripheral neuropathy symptoms

41
Q

What causes B12 deficiency?

A

Lack of animal protein

42
Q

Who often has B12 deficiency?

A

vegetarians or gluten sensitive individuals

43
Q

What else can B12 deficiency cause?

A

pernicious anemia

myelin production is abnormal

44
Q

What is the most common cause of acute paralysis seen in clinical practice?

A

Guillain Barre or acute inflammatory demyelinating polyneuropathy

45
Q

What is the most rapidly progressing and potentially fatal form or neuropathy?

A

Guillain Barre

46
Q

What are the major features of Guillain Barre?

A

Motor primarily
Ascending symmetric paralysis that may affect breathing
Paresthesias in toes and fingers, aching thighs/back
Decrease nerve conduction velocity –> increase protein in CSF with normal cell count

47
Q

What is used to make a diagnosis of Guillain Barre?

A

Decreased nerve conduction velocity

Increased protein in CSF with normal cell count

48
Q

What is the cause of Guillain Barre?

A

1-3 weeks after infection or vaccination, causing an autoimmune or inflammatory attack on peripheral myelin

49
Q

How are myelin sheaths attacked?

A

Lymphocytes attach to vessel, migrate through and enlarge
Lymphocytes attack myelin and/or axons
Presence of polymorphonuclear leukocytes
Nerve cell body may die in severe cases

50
Q

What is Charcot-Marie-Tooth Disease?

A

Hereditary motor and sensory neuropathy

51
Q

What are the two types of Charcot-Marie-Tooth Disease?

A

CMT1: myelin affected
CMT2: axons affected

52
Q

How does CMT1 present?

A

Primarily distal muscle affected, particularly the peroneal nerve
Small fiber types carrying pain/temp NOT affected

53
Q

How do we identify CMT?

A

Slowly progressive nature

Reduced conduction velocity in all nerves

54
Q

What is the pathology of CMT1?

A

Fewer numbers of myelinated axons in peripheral nerves

55
Q

How do we diagnose neuropathy?

A 
Neuro exam
Small vs. large fibers
Pattern of symptoms
Neuropathic pain?
History
Temporal evolution
Nerve conduction velocity test
56
Q

What are two other big conditions that can produce neuropathy?

A

Renal failure

hypothyroidism

NBB1 (16 decks)

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