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Tim CP3 @ UoN - Medicine & Surgery > Neuropathy > Flashcards

Neuropathy Flashcards

1
Q

What is a Radiculopathy?

A

Process affecting nerve roots

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2
Q

What is a Neuropathy?

A

Pathological process affecting a peripheral nerve(s)

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3
Q

What is a Mononeuropathy?

A

Process affecting a single nerve

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4
Q

What is a Mononeuritis multiplex?

A

Process affecting several individual nerves

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5
Q

What is a Polyneuropathy/peripheral neuropathy?

A

Diffuse, symmetrical disease, beginning peripherally

  • motor, sensory, autonomic or a combination
  • demyelinating/axonal types
  • loss of tendon reflexes, ‘glove & stocking’ sensory loss
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6
Q

What are the causes of a polyneuropathy/peripheral neuropathy?

A 
Metabolic
Toxic
Autoimmune
Inflammatory
Drugs
Infective
Vascular
Neoplastic
Inherited
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7
Q

What are the metabolic causes of a polyneuropathy/peripheral neuropathy?

A

Diabetes mellitus
B12/folate/thiamine deficiency
Uraemia (CKD)

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8
Q

What are the toxic causes of a polyneuropathy/peripheral neuropathy?

A

Alcohol
Chronic liver disease
Lead
Radiation

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9
Q

What are the autoimmune causes of a polyneuropathy/peripheral neuropathy?

A

RA
CTDs
Myxoedema

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10
Q

What are the inflammatory causes of a polyneuropathy/peripheral neuropathy?

A

Guillain-Barre syndrome

Chronic inflammatory demyelinating polyneuropathy (CIDP)

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11
Q

What are the drug causes of a polyneuropathy/peripheral neuropathy?

A 
Amiodarone
Statins
Hydralazine
Phenytoin
Antibiotics
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12
Q

What are the infective causes of a polyneuropathy/peripheral neuropathy?

A

Syphilis

HIV

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13
Q

What are the vascular causes of a polyneuropathy/peripheral neuropathy?

A

Vasculitis

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14
Q

What are the neoplastic causes of a polyneuropathy/peripheral neuropathy?

A

Myeloma

Paraneoplastic syndromes

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15
Q

What are the inherited causes of a polyneuropathy/peripheral neuropathy?

A

Charcot-Marie-Tooth
-present <20yrs w/ progressive neuropathy
Freidrich’s ataxia
-cerebellar ataxia in 1st decade, UMN limb signs & peripheral neuropathy

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16
Q

What are the most common causes of a polyneuropathy/peripheral neuropathy?

A

Diabetes mellitus
Carcinomatous neuropathy
B vitamin deficiency
Drugs

17
Q

What problems can longstanding polyneuropathy/peripheral neuropathy cause?

A 
Claw deformities of foot (pes cavus)
Joint arthropathies (charcot foot)
Ulceration
18
Q

What are the two broad pathological types of polyneuropathy/peripheral neuropathy?

A

Demyelinating

Axonal

19
Q

What are the features of demyelinating polyneuropathy/peripheral neuropathy?

A

Damage affects Schwann cells
More common in immune-mediate disease (GBS)
-decreased conduction velocity
-Schwann cells regrow, improves w/ treatment

20
Q

What are the features of axonal polyneuropathy/peripheral neuropathy?

A

Nerve cell body damage, degeneration starts at periphery and progresses towards neuronal cell

  • reduced amplitude of nerve impulses
  • axons cannot regrow, treatment outcomes poor
21
Q

What other, less common patters of nerve damage are there?

A

Wallerian degeneration - following nerve section/microinfarction
Compression neuropathy - leads to focal demyelination
Nerve infiltration - malignancy/granulomatous infiltration

22
Q

At what rate can nerves regenerate?

A

1mm/day

Requires intact cell bodies

23
Q

What investigations are appropriate in suspected polyneuropathy/peripheral neuropathy?

A

Bloods - FBC, U&Es, LFTs, HbA1c, B12/folate, ANCA, VDRL, autoantibodies
Nerve conduction studies (demyelinating/axonal)
LP (raised protein in GBS/CIDP)
Peripheral nn biopsy

24
Q

What is the underlying pathology of Guillain-Barre syndrome (GBS)?

A

Most common acute polyneuropathy
Demyelinating
Autoallergic basis, does not recur

25
Q

How does GBS present?

A

Paralysis 1-3wks after infection

  • ascending paralysis, loss of tendon reflexes
  • sensory loss rare
  • affects lower limbs initially
  • ascends/progresses over several days/weeks
26
Q

What are the infective causes of severe GBS?

A

Campylobacter

CMV

27
Q

What are the common complications of GBS?

A

Venous thrombo embolism
Autonomic involvement
-BP lability
-arrhythmias

28
Q

What is required for a diagnosis of GBS?

A

Clinical
Nerve conduction studies (slowed conduction)
CSF (protein raised)

29
Q

What is the management of GBS?

A

Severe cases progress rapidly over hrs/days
Admit to HDY (prevent sores, chest infections, DVTs etc.)
-s.c. heparin + TED stockings
High dose IVIG w/i 2wks
-reduce duration/severity

30
Q

What is the prognosis of GBS?

A

Mild - little disability before spontaneous recovery
Complete recovery over months in 80-90%
May be left w/ residual weakness
Mortality high in acute phase (10%

31
Q

What features suggest a poor prognosis of GBS?

A

Older age
Rapid onset of sx
Axonal patterns of damage

32
Q

What is Shingles?

A

Reactivation of VZV infection w/i dorsal root ganglia

33
Q

How does Shingles present?

A 
Occurs in lower thoracic dermatomes
Pain/paraesthesia for several days
Erythema/dermatomal eruption of vesicles
   -become pustular 2-3/7 later
   -may separate 3wks later
34
Q

What is Ophthalmic herpes?

A

Infection of 1st division of CN5

Can lead to uveitis, corneal scarring, 2o panopthalmitis

35
Q

What is Ramsey-hunt syndrome?

A 
Infection of geniculate ganglion
Facial palsy (often severe/irreversible)
Facial/ear pain
Vesicles in ear canal/pinna/soft palate
Sensorineural deafness
Vertigo
Neuropathy of CN 5/9/10
36
Q

What is the management of Shingles?

A

5-7 days Acyclovir PO

Paracetamol + Amitryptyline for pain

37
Q

What is Post-herpetic neuralgia?

A

Common complication of shingles (10%)
Pain in prev shingles zone
-burning, continuous pain
-responds poorly to anaesthesia

38
Q

How is Post-herpetic neuralgia managed?

A

Amitryptyline
Topical capsaicin
Recover over 2yrs

Tim CP3 @ UoN - Medicine & Surgery (136 decks)

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