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08 Neuro > Peripheral Nerve Diseases > Flashcards

Peripheral Nerve Diseases Flashcards

1
Q

resting membrane potential

A

-70 mb

more K than Na

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2
Q

definition of neuropathy vs neuronopathy

A

neuropathy: lesion either IN the cell body or the PERIPHERAL PROCESS
neuronopathy: lesions TO the cell body

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3
Q

mechanisms of pni

A

compression
sheath loss or demyelination
disconnection
degeneration

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4
Q

mechanisms of neuronopathy

A

anterior horn cell lesions = motor neuron disease

dorsal root ganglion lesions = sensory neuronopathy

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5
Q

seddon classsification for peripheral neuropathy

A 
neurapraxia = myelin
axonotmesis = myelin and axon
neurotmesis = whole nerve
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6
Q

suderland classification for peripheral neuropathy

A

1: conduction block: focal myelin injury or conduction block
2: axonal discontinuity: axon injured, neuriums intact
3: axonal and endoneurium
4: axon, endoneurium, perineurium
5: whole nerve

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7
Q

what is allodynia, hyperalgesia, and myokymia

A

allodynia: pain from non-noxious stimulus
hyperalgesia: enhanced pain from noxious stimulus
myokymia: worm-like or ripping movements of muscles on eyelids

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8
Q

presentation of myelinopathy

A

weakness without atrophy
length independent symptoms or distribution
proximal predominant or asymmetric/patchy distribution
early involvement of the reflexes

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9
Q

presentation of axonopathy

A

length-depended distribution

distal reflex loss with preserved proximal reflexes (LE > UE)

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10
Q

post-nerve biopsy complications

A

permanent numbness
neuropathic pain
painful neuroma formation

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11
Q

indications for nerve biopsy

A

amyloid neuropathy

vasculitis

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12
Q

sites commonly tested for nerve biopsies

A

sural nerve
superficial radial nerve
superficial peroneal nerve + peroneus brevis muscle

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13
Q

sensory nerve conduction series results for demyelination and axonal loss

A

demyelination: abnormal latencies and conduction velocities, temporal dispersion
axonal loss: decreased amplitude

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14
Q

motor nerve conduction study results for demyelination and axonal loss

A

demyelination: abnormal latency and conduction velocity, temporal dispersion, conduction block
axonal loss: decreased amplitude

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15
Q

emg findings in neuropathies

A

increased in spontaneous and insertional activities (fibrillation potential and positive sharp waves)
reduced recruitment pattern
motor unit aps (large amplitude, prolonged duration, polyphasic)

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16
Q

most common cause of acute generalized weakness

A

gbs

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17
Q

presentation of gbs

A 
acute illness 1-2 weeks prior to onset of neuro symptoms
ascending numbness and paresthesia
progressive weakness
hypo- or areflexia
autonomic instability
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18
Q

pathogenesis of gbs

A

not fully understood but assumed antibodies formed from the initial infection attach the body’s own nerves (myelin sheath)

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19
Q

frequent cn palsies in gbs

A

cn 7, 3, 4, 5, 6, 9, 11

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20
Q

csf features in gbs

A

elevated csf protein, <10 mononuclear cells/mm3

21
Q

electrodiagnostic findings in gbs

A

ncv slowing/conduction block
patchy reduction in ncv <10% normal
latency increased to 125-50% of normal (slow)

22
Q

what is miller fisher syndrome

A

more common in males, >40 yo
triad: ataxia, areflexia, ophthalmoplegia
most common complaint: diplopia

23
Q

what is chronic demyelinating polyradiculopathy

A

immune-mediated, relapsing or progressive course for at least 2 months or 8 weeks
(+) history of antecedent infection
(+) motor and sensory symptoms
(+) proximal and distal weakness

24
Q

clinical presentation of multifocal motor neuropathy

A

asymmetric weakness and atrophy in the distribution of individual peripheral nerves
usually misdiagnosed as ALS

25
Q

lab/emg features of mmn

A

(+) igm antibodies to gm1 or gm2 gangliosides

emg: demyelinating findings
als: axonopathy

26
Q

neuropathies associated with infections

A

hiv (usually distal symmetric polyneuropathy)

herpes varicella zoster

27
Q

clinical presentation of herpes varicella zoster virus

A

(+) pain and paresthesia in dermatomal distribution followed by vesicular rashes after >1 week
(+) postherpetic pain (T1-T12 > cn v1 > L2-S4)
involvement of motor nerves (cn7 / ramsay hunt syndrome > cervical and lumbosacral > thoracic)

28
Q

most common metabolic disease correlated with neuropathy

A

diabetes mellitus

29
Q

most common form of dm neuropathy

A

diabetic distal symmetric sensory or sensorimotor polyneuropathy

30
Q

course and symptoms of DDSS/SP

A

sensory loss beginning at toes, gradual progression over time to involve legs then hands
(+) tingline, lancinating pain, burning and deep aching pains
sensory loss to all modalities in stocking-glove distribution

31
Q

most common toxic neuropathies

A

alcohol, isoniazid, ethambutol

32
Q

what are radiculopathies

A

arise from process that affects the nerve root

may be due to compressive or non-compressive causes

33
Q

presentaiton of radiculopathies

A

dermatomal or myotomal distributions
radiating pain
weakness, numbness, decreased reflexes

34
Q

types of radiculopathies

A

direct neural compromise (acute herniated nucleus pulposus, excess bony formation and spurring, hypermobility of vertebral segment)

vascular compromise (compression, inflammatory response) – can also lead to spinal nerve compression

35
Q

clinical presentation of cervical radiculopathy

A

pain, numbness, and tingling sensation in the spinal nerves affected
(severe: motor weakness and atrophy)
(+) spurling test

36
Q

distributions of cervical radiculopathy

A

c5, c6: deltoid

c7: triceps (most common)
c8: thenar eminence
t1: first dorsal interosseous

37
Q

clinical presentation of lumbosacral radioculopathy

A

pain in the lower back or leg
numbness and tingling sensation in le
(+) straight leg test

38
Q

what is brachial plexopathy

A

peaks during birth or age of 2-30 years

erb’s palsy: c5-c6
klumpke’s paralysis: lower brachial plexus

39
Q

what is lumbosacral plexopathy

A

lumbar plexus: l1-l4

sacral plexus: l5-s2/s3

40
Q

pathophysiology of entrapment neuropathies

A

develop at common sites of chronic or recurrent constriction

due to pressure, stretch, angulation, or friction

41
Q

most common entrapment neuropathy

A

carpal tunnel syndrome, entrapment of median nerve

more common in females

42
Q

clinical presentation and causes of carpal tunnel syndrome

A

pain and numbness in first 1/4 of fingers
weakness and atrophy of the thenar eminence

causes: tenosynovitis, trauma, tumors

43
Q

what is cubital tunnel syndrome

A

entrapment of ulnar nerve at elbow region

causes: chronic irritation, tumors, valgus deformity

44
Q

what is sciatica

A

entrapment of sciatic nerve due to overuse or compression

presents with pain in hip, buttock, and radiating down the leg

45
Q

what is tarsal tunnel syndrome

A

entrapment of posterior tibial nerve in tarsal tunnel (medial malleolus, medial calcaneal wall, flexor retinaculum)
presents with pain at medial hind foot or plantar aspect of foot

46
Q

most common inherited neuromuscular disorder

A

charcot marie tooth disease

47
Q

features of cmt disease

A 
slowly progressive, with onset in first decade
distal muscle wasting and weakness
reduced or absent tendon reflexes
distal sensor loss
high incidence of foot deformities
48
Q

features of cmt1

A

table 10

49
Q

features of cmt2

A

table 11

08 Neuro (24 decks)

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