Patho- Peripheral Nerve Disease Flashcards by Finlay Strivens

What cells can be damaged in peripheral nerve disease?

Nerve

Schwann cell

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What is a neuropathy?

Disease affecting peripheral nerve

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What is a polyneuropathy?

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

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What is a Radiculopathy?

Nerve root damage

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What is a Myelopathy?

Disease of the cord

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What can damage peripheral nerves?

Demyelination
Axonal degeneration
Wallerian degeneration
Compression
Infarction
Infiltration

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What occurs in nerve infiltration?

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

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What pathogen can infiltrate nerves?

Leprosy- Mycobacterium leprae

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Where can an infarct occur to affect the peripheral nerves?

Microinfarction of vasa nervorum.

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What can cause an infarct affecting nerves?

Diabetes

Vasculitis

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What can cause vasculitis?

SLE
RA
Sarcoidosis
Giant cell arteritis

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What can cause compression of nerves?

Entrapment neuropathies

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What happens when nerves are compressed?

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

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Give some major nerve compression locations

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

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What nerve and muscles are affected in carpal tunnel syndrome?

Median

Thenar muscles

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What nerve and muscles are affected in cubital tunnel syndrome?

Ulnar

Clawing of hand

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What does compression of the radial nerve lead to?

Saturday night palsy

Wrist drop and brachioradialis weakness

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What does compression of the common peroneal nerve lead to?

Foot drop

Ankle jerk preserved

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How do you diagnose nerve compression?

Nerve conduction

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What is Wallerian degeneration?

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

What can cause a peripheral nerve lesion?

Bell's palsy
Disc protrusion
Trauma
Entrapment
Neuralgic amyotrophy

What is neuralgic amyotrophy?

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

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

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

What happens in axonal degeneration?

Axon damage leads to dying back

What factors can cause axonal degeneration?

Metabolic Toxic Vitamin deficiency Charcot-marie-tooth disease

What metabolic conditions can cause axonal degeneration?

Diabetic neuropathy Chronic uremia Thyroid disease Acute intermittent porphyria

What are some symptoms of diabetic neuropathy?

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

What are some symptoms of chronic uremia?

Progressive sensorimotor neuropathy | Usually improves on dialysis

What kind of neuropathy does thyroid disease give?

Mild

What are some symptoms of acute intermittent porphyria?

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

What can cause toxic neuropathy?

Alcohol | Drugs

Where does alcohol induced neuropathy tend to show?

Lower limb

What drugs can cause neuropathy?

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

Lack of which group of vitamins can cause neuropathy?

How do you treat vitamin deficient neuropathy?

Replace vitamins

Lack of what three B vitamins tend to cause neuropathy?

B1- Thiamine B6- Pyridoxine B12- Cobalamin

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

Beri beri | Wernicke-korsakoff psychosis

What are some symptoms of beri beri?

``` Weight loss Emotional disturbances Impaired sensory perception Limb pain and weakness Oedema ```

What are some symptoms of Wernicke-korsakoff psychosis?

``` Encephalopathy Nystagmus Ataxia Amnesia Hypothermia Hypotension ```

What are some symptoms of B6/Pyridoxine deficiency?

Sensory neuropathy Anti TB therapy Give pyridoxine with isonaizid

What are some symptoms of B12/Cobalamin?

Damage to the spinal cord, peripheral nerves and brain

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

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

What can cause demyelination?

Guillain-Barré syndrome/post infection neuropathy

What is Guillain-Barré syndrome/post infection neuropathy?

Paralysis 1-3w after infection

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

Campylobacter jejuni | Cytomegalovirus

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

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

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

Clinical | Nerve conduction studies

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

Botulism Cord compression Muscle disease

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

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