peripheral nerve disease Flashcards
where might the median nerve be entrapped or compressed
carpal tunnel - wrist
where might the median nerve be entrapped or compressed
cubital tunnel - elbow
where might the radial nerve be entrapped or compressed
spiral groove of the humerus
where might the common peroneal nerve be entrapped or compressed
neck of fibula
where might the posterior tibial nerve be entrapped or compressed
tarsal tunnel - flexor retinaculum (foot)
what is foot drop most commonly associated with
disease or trauma affecting the common peroneal nerve
key motor finding of foot drop
weakness and paralysis of dorsiflexion and eversion
what is mononeuritis multiplex
peripheral neuropathy that affects multiple nerves in different parts of the body
name some conditions associated with mononeuritis multiplex
DM, vasculitis, rheumatoid arthritis, leprosy, lyme
how is the forehead innervated by upper motor neurones
each side of the forehead has upper motor neuron innervation from both sides of the brain
how is the forehead innervated by lower motor neurones
each side of the forehead has lower motor neurone innervation from one side of the brain
In an upper motor neurone lesion, will the forehead be affected?
No, the forehead will be spared and the patient can still move their forehead on the affected side.
Give two examples of conditions that cause an upper motor neurone lesion affecting the face
stroke, tumour
In a lower motor neurone lesion, will the forehead be affected?
Yes, the forehead will NOT be spared, and the patient cannot move their forehead on the affected side
Give two examples of conditions that cause a lower motor neurone lesion affecting the face
bell’s palsy and ramsay hunt syndrome
how does bell’s palsy present
unilateral lower motor neurone facial palsy
management of bell’s palsy in patients presenting within 72 hours of symptoms starting
prednisolone
what causes ramsay hunt syndrome
reactivation of varicella zoster virus in the geniculate ganglion of the facial nerve
is the forehead spared in ramsay hunt syndrome
no - its a lower motor neurone lesion
what are the 3 key features of ramsay hunt syndrome
ispsilateral facial weakness, vesicular rash in the ear, ear pain
how can you differentiate between Bell’s palsy and Ramsay Hunt syndrome clinically?
Ramsay Hunt syndrome presents with vesicular rash and more severe pain, while Bell’s palsy does not
first line management for ramsay hunt syndrome
oral aciclovir
why is eye care important in ramsay hunt syndrome
to prevent corneal damage due to incomplete eyelid closure
when should treatment for ramsay hunt syndrome be started to improve outcomes
within 72 hours of onset
what type of hearing loss can occur in ramsay hunt syndrome
sensorineural hearing loss
what is the most common hereditary peripheral neuropathy
charcot-marie-tooth disease
2 clinical features of charcot-marie-tooth disease affecting the feet
pes cavus and hammer toes
characteristic appearance of legs in charcot-marie-tooth disease
inverted champagne bottle legs - due to distal muscle wasting
what kind of neuropathy is charcot-marie-tooth disease
hereditary motor and sensory neuropathy
classic triad of symptoms in charcot-marie-tooth disease
distal muscle weakness
distal sensory loss
foot deformities
investigations for charcot-marie-tooth disease
nerve conduction studies
genetic testing - PMP22 duplication
nerve biopsy
what is the most common infection preceding Guillain-Barré syndrome
campylobacter jejuni
what kind of neuropathy is Guillain-Barré syndrome
acute inflammatory polyneuropathy
pattern of weakness in Guillain-Barré syndrome
symmetrical ascending muscle weakness starting in the legs
investigations for Guillain-Barré syndrome
lumbar puncture - raised protein with normal cell count and glucose
nerve conduction study
first line management of Guillain-Barré syndrome
IVIG
