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Neurology > Patho- Peripheral Nerve Disease > Flashcards

Patho- Peripheral Nerve Disease Flashcards

1
Q

What cells can be damaged in peripheral nerve disease?

A

Nerve

Schwann cell

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2
Q

What is a neuropathy?

A

Disease affecting peripheral nerve

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3
Q

What is a polyneuropathy?

A

Diffuse, symmetrical disease, usually commencing peripherally
Widespread loss of tendon reflexes

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4
Q

What is a Radiculopathy?

A

Nerve root damage

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5
Q

What is a Myelopathy?

A

Disease of the cord

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6
Q

What can damage peripheral nerves?

A 
Demyelination
Axonal degeneration
Wallerian degeneration
Compression
Infarction
Infiltration
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7
Q

What occurs in nerve infiltration?

A

Infiltration of peripheral nerves by inflammatory cells occurs in leprosy and granulomas

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8
Q

What pathogen can infiltrate nerves?

A

Leprosy- Mycobacterium leprae

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9
Q

Where can an infarct occur to affect the peripheral nerves?

A

Microinfarction of vasa nervorum.

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10
Q

What can cause an infarct affecting nerves?

A

Diabetes

Vasculitis

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11
Q

What can cause vasculitis?

A

SLE
RA
Sarcoidosis
Giant cell arteritis

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12
Q

What can cause compression of nerves?

A

Entrapment neuropathies

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13
Q

What happens when nerves are compressed?

A

Focal demyelination at the point of compression causes disruption of the myelin sheath

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14
Q

Give some major nerve compression locations

A

Carpal tunnel- Median N
Cubital tunnel- Ulnar N
Spiral Groove- Radial N
Head of fibula- Common peroneal N

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15
Q

What nerve and muscles are affected in carpal tunnel syndrome?

A

Median

Thenar muscles

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16
Q

What nerve and muscles are affected in cubital tunnel syndrome?

A

Ulnar

Clawing of hand

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17
Q

What does compression of the radial nerve lead to?

A

Saturday night palsy

Wrist drop and brachioradialis weakness

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18
Q

What does compression of the common peroneal nerve lead to?

A

Foot drop

Ankle jerk preserved

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19
Q

How do you diagnose nerve compression?

A

Nerve conduction

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20
Q

What is Wallerian degeneration?

A

Changes following nerve section where both nerve and Schwann degenerate over several weeks

21
Q

What can cause a peripheral nerve lesion?

A 
Bell's palsy
Disc protrusion
Trauma
Entrapment
Neuralgic amyotrophy
22
Q

What is neuralgic amyotrophy?

A

Nerve damage and muscle atrophy preceded by severe pain
Episodic
Autoimmune
Steroids

23
Q

What are some signs of Wallerian degeneration/peripheral nerve lesion?

A 
Weakness
 Wasting
 Hypotonia 
 Reflex loss
 Fasciculation 
 Fibrillation potentials (EMG)
 Muscle contractures 
 Trophic changes in skin and nails
24
Q

What happens in axonal degeneration?

A

Axon damage leads to dying back

25
Q

What factors can cause axonal degeneration?

A

Metabolic
Toxic
Vitamin deficiency
Charcot-marie-tooth disease

26
Q

What metabolic conditions can cause axonal degeneration?

A

Diabetic neuropathy
Chronic uremia
Thyroid disease
Acute intermittent porphyria

27
Q

What are some symptoms of diabetic neuropathy?

A

Symmetrical sensory neuropathy
Acute painful neuropathy
Autonomic neuropathy- Hypertension, Urinary dysfunction, Erectile dysfunction

28
Q

What are some symptoms of chronic uremia?

A

Progressive sensorimotor neuropathy

Usually improves on dialysis

29
Q

What kind of neuropathy does thyroid disease give?

A

Mild

30
Q

What are some symptoms of acute intermittent porphyria?

A

Severe intermediate proximal neuropathy
Abdo pain
Confusion and coma
Alcohol, barbiturates and infection can induce

31
Q

What can cause toxic neuropathy?

A

Alcohol

Drugs

32
Q

Where does alcohol induced neuropathy tend to show?

A

Lower limb

33
Q

What drugs can cause neuropathy?

A

Lead- Motor neuropathy
Arsenic- Sensory neuropathy
Thallium- Sensory neuropathy

34
Q

Lack of which group of vitamins can cause neuropathy?

A

B

35
Q

How do you treat vitamin deficient neuropathy?

A

Replace vitamins

36
Q

Lack of what three B vitamins tend to cause neuropathy?

A

B1- Thiamine
B6- Pyridoxine
B12- Cobalamin

37
Q

What two diseases can be caused by B1/Thiamine deficiency?

A

Beri beri

Wernicke-korsakoff psychosis

38
Q

What are some symptoms of beri beri?

A 
Weight loss
Emotional disturbances
Impaired sensory perception
Limb pain and weakness
Oedema
39
Q

What are some symptoms of Wernicke-korsakoff psychosis?

A 
Encephalopathy
Nystagmus
Ataxia
Amnesia
Hypothermia
Hypotension
40
Q

What are some symptoms of B6/Pyridoxine deficiency?

A

Sensory neuropathy
Anti TB therapy
Give pyridoxine with isonaizid

41
Q

What are some symptoms of B12/Cobalamin?

A

Damage to the spinal cord, peripheral nerves and brain

42
Q

What are some symptoms of Charcot-marie-tooth disease?

A

Distal limb wasting and weakness- so severe legs said to resemble ‘Inverted Champagne bottles’
Slow progression

43
Q

What can cause demyelination?

A

Guillain-Barré syndrome/post infection neuropathy

44
Q

What is Guillain-Barré syndrome/post infection neuropathy?

A

Paralysis 1-3w after infection

45
Q

What pathogens tend to cause Guillain-Barré syndrome/post infection neuropathy?

A

Campylobacter jejuni

Cytomegalovirus

46
Q

What are some symptoms of Guillain-Barré syndrome/post infection neuropathy?

A

Paralysis 1-3w after infection
Symptoms progress proximally over 6w
Loss of tendon reflexes
Symptoms peak 10-14d after onset

47
Q

How do you diagnose Guillain-Barré syndrome/post infection neuropathy?

A

Clinical

Nerve conduction studies

48
Q

What is the differential for Guillain-Barré syndrome/post infection neuropathy?

A

Botulism
Cord compression
Muscle disease

49
Q

How do you treat Guillain-Barré syndrome/post infection neuropathy?

A

Ventilation if affects resp muscles
Subcut heparin
IV Immunoglobulin in 2 weeks- Reduces duration and severity of paralysis
Natural recovery

Neurology (30 decks)

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