Neuropathy and encephalopathy

Question 1

Peripheral neuropathy- Sx

Answer 1

• Sensory, motor or mixed deficits
• Axonal degeneration
• Paresthesias, pain, muscle tenderness
• Depressed or absent tendon reflex
• Due to DM, arteritis, leprosy

Question 2

Peripheral neuropathy - Dx

Answer 2

• Nerve conduction velocity and eletromyography

- Slowed responses

Question 3

Peripheral neuropathy - Tx

Answer 3

• Underlying cause

- Gabapentin for dysthesia and neuralgia

Question 4

Acute idiopathic polyneuropathy, GBS- Sx

Answer 4

• Proximal weakness, symmetric distribution
• Begins in legs
• Distal paresthesias, radicular pain
• Tachycardia, hypo/hyperTN, facial flushing, impaired sphincter control
• May follow infections, inoculations or surg procedures

Question 5

Acute idiopathic polyneuropathy, GBS-Dx

Answer 5

• High CSF protein
• Nerve conduction- marked abn
• Pathology- demyelination

Question 6

Acute idiopathic polyneuropathy, GBS-Tx

Answer 6

• Volume or pressers for hypotn
• Heparin to prevent PE
• IV immunoglobulin
• Resp toilet and chest PT

Question 7

Wernicke encephalopathy- Sx

Answer 7

• Confusion, ataxia, nystagmus leading to ophthalmoplegia
• Lateral rectus muscle weakness and conjugate gaze plasies
• Peripheral neuropathy
• Due to thiamine deficiency, alcoholism

Question 8

Wernicke encephalopathy- Dx

Answer 8

• Thiamine deficiency

- Response to tx

Question 9

Wernicke encephalopathy- Tx

Answer 9

• IV Thiamine, IM thiamine, proper diet

Question 10

Hepatic encephalopahty- Sx

Answer 10

• Metabolic encephalopathy
• Day night, reversal
• Asterixis, tremor, dysarthria
• Mild confusion to drowsiness to stupor to coma
• Failure to detox- ammonia

Question 11

Hepatic encephalopahty- Dx

Answer 11

• LFTs

- Elevated ammonia

Question 12

Hepatic encephalopahty- Tx

Answer 12

• Latulose
• Neomycin sulfate
• Withhold/ restrict protein

Question 13

Charcot-Marie-Tooth- Sx

Answer 13

• Foot deformities and gait disturbances
• Pes cavus
• Polyneuropathy, distal weakness and wasting in legs
• Distal sensory loss, depressed or absent tendon reflex
• Axonal loss

Question 14

Charcot-Marie-Tooth- Dx

Answer 14

Nerve conduction velocity

- Cutaneous nerve biopsy

Question 15

Charcot-Marie-Tooth- Tx

Answer 15

• PT

- Compression socks

Question 16

Postherpetic neuralgia- Sx

Answer 16

• 15% pts with shingles
• Elderly and immunicomp
• Sudden shooting, sharp, burning
• Allodynia- extreme sensitivity to lt touch

Question 17

Postherpetic neuralgia- Tx

Answer 17

• Oral acyclovir
• Analgesics
• Vaccination
• Topical lidocaine

Question 18

Meralgia paresthetica- Eti

Answer 18

• Mononeuropathy of lateral femoral cutaneous nerve

- Hyperextension, pregnancy, obesity

Question 19

Meralgia paresthetica- Sx

Answer 19

• Mild pain, paresthesia or numbness on outer aspect of thigh
• Unilateral
• Relieved with sitting
• Pain stops at knee

Question 20

Meralgia paresthetica- Dx

Answer 20

• Normal phys exam with clinical sx

Question 21

Meralgia paresthetica- Tx

Answer 21

• Hydrocortisone injections

Question 22

Notalgia paresthetica- Eti

Answer 22

• Intrascapular T2-T6 dermatomes

- Due to nerve entrapment

Question 23

Notalgia paresthetica- Sx

Answer 23

• Chronic, localized itch
• Paresthesias
• No cutaneous signs
• Neuropathic itch

Question 24

Notalgia paresthetica- Tx

Answer 24

• Topical antipruritic medications