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NMSP - Exam 2 > Peripheral Nerve Diseases > Flashcards

Peripheral Nerve Diseases Flashcards

1
Q

What are 2 Inflammatory Neuropathies?

A
  1. Guillain Barre

2. Chronic Inflammatory Demyelinating Poly(radiculo)neuropathy

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2
Q

Guillain Barre is an acute inflammatory demyelinating polyneuropathy. What may precede muscular symptoms?

A

Flu-like illness

– resolves before symptoms appear

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3
Q

What occurs early in the disease process with Guillain Barre?

A

DTRs disappear

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4
Q

What is the main symptom of Guillain Barre patients?

A

ASCENDING paralysis

= Distal limb weakness –> proximal weakness

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5
Q

What is the main symptom of Guillain Barre patients?

A

ASCENDING paralysis

= Distal limb weakness –> proximal weakness

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6
Q

What are a few common causes of Guillain Barre?

A

Campylobacter Jejuni
CMV, EBV, Mycoplasma
Prior vaccination

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7
Q

What 2 things will be seen on histo with Guillain Barre?

A
  1. Perivenular and Endoneurial infiltration by inflammatory cells
  2. Segmental Demyelination
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8
Q

What 2 things will be seen on histo with Guillain Barre?

A
  1. Perivenular and Endoneurial infiltration by inflammatory cells
  2. Segmental Demyelination
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9
Q

What antibodies will be positive with Guillain Barre?

A

Anti-Myelin Antibodies

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10
Q

What change in CSF will be seen with Guillain Barre?

A

Increased CSF protein

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11
Q

What are 2 possible treatments for Guillain Barre?

A

Plasmapheresis

IVIg

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12
Q

Radiculoneuropathy is seen with both peripheral inflammatory neuropathies. What is it?

A

Demyelination of spinal nerve roots and peripheral nerves

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13
Q

What is the most common acquired inflammatory peripheral neuropathy?

A

Chronic Inflammatory Demyelinating Poly(radiculo)neuropathy

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14
Q

What are the signs of Chronic Inflammatory Demyelinating Poly(radiculo)neuropathy?

A

Symmetrical mixed sensorimotor symptoms > 2 MONTHS

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15
Q

Symmetrical mixed sensorimotor symptoms for longer than 2 months?

A

Chronic Inflammatory Demyelinating Poly(radiculo)neuropathy

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16
Q

What change to what nerve is seen with Chronic Inflammatory Demyelinating Poly(radiculo)neuropathy?

A

Surval nerve = Onion bulb

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17
Q

What distinguishes Chronic Inflammatory Demyelinating Poly(radiculo)neuropathy from Guillain Barre?

A

Time and response to steroids!

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18
Q

What are 3 Infectious Polyneuropathies of peripheral nerves?

A
  1. Leprosy
  2. Diphtheria
  3. Varicella-Zoster
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19
Q

What are the 2 types of Leprosy?

A

Lepromatous

Tuberculoid

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20
Q

What organism is to blame for Leprosy?

A

Mycobacterium Leprae

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21
Q

With Lepromatous Leprosy, Mycobacterium Leprae invades what cells and causes what to occur?

A

Invades Schwann cells

= Loss of BOTH myelinated and Unmyelinated axons

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22
Q

What 2 histological changes will be seen with Lepromatous Leprae?

A
  1. Endoneurial fibrosis

2. Thickening of perineural sheaths

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23
Q

Endoneurial fibrosis and thickening of perineural sheaths is seen with?

A

Lepromatous Leprosy

24
Q

What are the symptoms of Lepromatous Leprosy?

A

Symmetric polyneuropathy – loss of pain sensation

Large ulcers

25
Q

Lepromatous Leprosy preferentially affects where?

A

COOL extremities

– symmetric polyneuropathy and large ulcers

26
Q

Tuberculoid Leprosy is a cell mediated immune response. What differentiates it from Lepromatous Leprosy?

A

LOCALIZED nerve involvement

27
Q

What can be seen in the dermis of Tuberculoid Leprosy patients and what differentiates it from Lepromatous Leprosy?

A

Granulomatous nodules in the dermis

– LOCALIZED nerve involvement

28
Q

What unique loss will present with Diphtheria?

A

Loss of proprioception and vibratory sensation

29
Q

What muscle dysfunctions will be prominent with Diphtheria?

A

Bulbar and respiratory muscle dysfunctions

30
Q

Bulbar and respiratory muscle dysfunctions with loss of proprioception and vibratory sensation is likely?

A

Diphtheria

31
Q

Varicella-Zoster Virus affects _____. And once it is reactivated it causes?

A

Affects sensory ganglia => Shingles

32
Q

What dermatomes are often affected with the painful vesicular eruption from Varicella-Zoster Virus?

A

Thoracic or Trigeminal Nerve Dermatomes

33
Q

What follows the death of sensory neurons with the Varicella-Zoster virus?

A

Axonal degeneration of peripheral nerves

34
Q

What is the most common cause of Peripheral Neuropathy?

A

Diabetes

35
Q

What type of polyneuropathy is seen with Diabetes and why?

A

Ascending distal symmetric sensorimotor polyneuropathy

= Decreased # of axons

36
Q

Ascending distal symmetric sensorimotor polyneuropathy is seen with Diabetes. What are some symptoms?

A

Numbness
Decreased pain sensation and balance
Paresthesias

37
Q

What are diabetic patients at risk for?

A

Increased foot/ankle fractures and ulcers

==> Amputation

38
Q

With Diabetes, what will the Endoneurial Arterioles show histologically?

A

PAS (+)

Thickened, and basement membrane reduplicated

39
Q

Vascular changes contribute to the damage seen with Diabetes. What histo change will be seen?

A

Endoneurial Arterioles = PAS (+) and thickened reduplicated basement membranes

40
Q

Paraneoplastic Neuropathies often precede cancer diagnosis. What is a common cause of a sensorimotor neuronpathy?

A

Small cell lung cancer (neuroendocrine)

41
Q

Besides Small cell lung cancer, what other neoplasm can cause paraneoplastic neuropathies?

A

Monoclonal Gammopathies (B cell neoplasms)

42
Q

Monoclonal Gammopathies (B cell neoplasms) can cause paraneoplastic neuropathies. What do they secrete that damage the nerves?

A

Monoclonal Immunoglobulins = Demyelination

43
Q

What are the symptoms of a paraneoplastic neuropathy from a Monoclonal Gammopathy (B cell neoplasm)?

A

POEMS

  • polyneuropathy
  • organomegaly
  • endocrinopathy
  • monoclonal gammopathy
  • skin changes
44
Q

Traumatic Neuroma

A

Axons continue to grow despite misalignment

45
Q

If you see small bundles of axons randomly oriented, it is likely a?

A

Traumatic Neuroma

46
Q

Peripheral nerves can also be subjected to physical forces causing compression neuropathies. What are 2 examples?

A

Carpel Tunnel

Saturday night palsy

47
Q

What anatomic structures are affected with Carpel Tunnel?

A

Median Nerve

Transverse carpal ligament

48
Q

Carpel tunnel is also associated with what endocrine change?

A

Hypothyroidism

49
Q

Saturday night palsy affects what nerve?

A

Radial nerve

50
Q

What is an inherited peripheral neuropathy?

A

Charcot-Marie-Tooth

51
Q

What is an inherited peripheral neuropathy?

A

Charcot-Marie-Tooth

52
Q

What are the signs of Charcot-Marie-Tooth?

A

Distal muscle atrophy
Sensory loss
FOOT DEFORMITIES

53
Q

Distal muscle atrophy, sensory loss and foot deformities may be?

A

Charcot-Marie-Tooth

– inherited peripheral neuropathy

54
Q

What is the more severe Charcot-Marie-Tooth form that can present at childhood?

A

CMT2 - axonal injury

55
Q

What is the less severe Charcot-Marie-Tooth that presents in the 2nd decade?

A

CMT1 - demyelinating neuropathies

56
Q

Charcot-Marie-Tooth is inherited how?

A

Autosomal Dominant

NMSP - Exam 2 (29 decks)

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