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Neurology_Clinical Medicine > Peripheral Nerve Disorders > Flashcards

Peripheral Nerve Disorders Flashcards

1
Q

What does peripheral neuropathy refer to?

A

Refers to many conditions that involve damage to the peripheral nervous system

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2
Q

How is nerve signaling disrupted in the neuropathy?

A

Either by loss of signals, inappropriate signaling, or errors that disrupt the messages

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3
Q

What are the symptoms with a motor nerve is damaged?

A

muscle weakness that can also include painful cramps, fasciculations, muscle atrophy

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4
Q

What are the symptoms when a sensory nerve is damaged?

A

Various symptom patterns
Loss of vibratory sense
Stocking glove sensation
Loss of reflexes
Loss of position sense
Loss of temperature sensation
Pain

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5
Q

What is autonomic nerve damage associated with

A

small-fiber neuropathies

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6
Q

What are the symptoms when autonomic nerve is damaged?

A

Excessive sweating, heat intolerance, inability to expand and contract small blood vessels regulating BP, GI symptoms

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7
Q

Mononeuropathy affects

A

One nerve

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8
Q

Multiple mononeuropathy or mononeuritis multiplex affects

A

several discrete nerves

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9
Q

Polyneuropathy affects

A

Multiple nerves diffusely

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10
Q

Plexopathy affects

A

a plexus

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11
Q

Radiculopathy affects

A

a nerve root

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12
Q

What are the two general causes of peripheral neuropathy

A

Acquired sources (trauma or diabetes) or genetics

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13
Q

Why does diabetes lead to peripheral neuropathy

A

Excess glucose, nerves are essentially getting drunk off the sugar and lead to nerve damage

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14
Q

What is a common vitamin deficiency that leads to peripheral neuropathy?

A

Low vitamin B12

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15
Q

HIV can cause what type of neuropathy?

A

Symptomatic acquired neuropathy

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16
Q

What is a genetic condition that commonly causes inherited peripheral neuropathy?

A

Charcot-Marie-Tooth

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17
Q

Are hyperreflexia and hypertonia typically associated with peripheral nerve lesions?

A

No

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18
Q

What is included in the evaluation of peripheral neuropathy?

A

Medical History
PE with full neurological exam
Labs (CBC, inflammatory markers, CSF)
Genetic tests
Nerve function tests (NCV, EMG)
Neuropathy tests of nerve appearance (nerve biopsy)
Autonomic Testing
Imaging

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19
Q

What is a cause to consider when you see unilateral deficits?

A

Focal disorders (mononeuropathies, plexopathies)

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20
Q

What is a cause to consider when you see symmetric, diffuse deficits

A

Diffuse disorders (toxic-metabolic, hereditary, infectious or inflammatory disorders, or immune-mediated disorders)

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21
Q

What diagnostic evaluation is considered the gold standard for diagnosing small fiber neuropathies?

A

Neurodiagnostic skin biopsy

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22
Q

How are you going to treat peripheral neuropathies?

A

Address neuropathy causes (glucose control, diet, immunoglobulins)

PT/OT, orthotics, acupuncture, behavioral strategies, TENS unit

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23
Q

How can motor neuron symptoms be treated?

A

Orthotics, mechanical aids

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24
Q

How can autonomic neuron symptoms be treated?

A

acupuncture, massage, CBT/psychotherapy, herbal remedies

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25
Q

How can sensory neuron symptoms be treated?

A

Behavioral strategies

26
Q

What are some pharmacological treatments for peripheral neuropathy?

A

TCA’s, SSRI’s, gabapentin, topiramate, duloxetine, topical/local anesthetics (capsaicin), lidocaine

27
Q

What treatment modality is used as a last resort in peripheral neuropathy?

A

Surgery (remove compression or cutting the nerve)

28
Q

What is the best way to treat neuropathies

A

By preventing

Vaccine against Shingles
Diabetes management
Minimize medication use with neuropathy SE
Unnecessary procedures

29
Q

When do you consider vascular or ischemic neuropathy?

A

If there is abnormal pain and temperature sensation and atrophy in proportion to the weakness

30
Q

When do you consider motor neuron disease?

A

Chronic progression of muscle weakness, fasciculations, muscle atrophy, and no sensory deficits

31
Q

What is complex regional pain syndrome?

A

Chronic (>6 months) pain condition that most often affects one limb usually after an injury

32
Q

What differentiates CRPS-I and CRPS-II?

A

CRPS-I doesn’t have a confirmed nerve injury and CRPS-II is with a confirmed nerve injury

33
Q

Does CRPS typically effect men or women more?

A

Women, peak age 40 years

34
Q

What nerves do you typically see CRPS?

A

Small unmyelinated or thinly myelinated sensory nerve axons carrying pain messages

35
Q

What is the key symptom in the presentation of CRPS?

A

Prolonged severe pain, that is consistent (present with all activities including sleep)

36
Q

What is allodynia?

A

Increased sensitivity in affected area, normal contact with the skin is very painful (even wind blowing by- think gout pain)

37
Q

What type of diagnosis is CRPS?

A

Clinical, no specific test to confirm CRPS

R/o gout, lyme disease, generalized muscle disease

38
Q

What is the hallmark to diagnosis in CRPS?

A

Injury in affected area

39
Q

What is the treatment for CRPS?

A

PT and rehabilitation, psychotherapy, sympathetic nerve block

40
Q

What are some of the pharmacological treatments of CRPS?

A

Bisphosphonates, NSAIDs, steroids, neuropathic pain meds (gabapentin)

41
Q

What is the premiss behind the lidocaine coma?

A

Turning the computer off (sensory nerves) and turning it back on again (rebooting)

42
Q

Why is vitamin B12 important?

A

Important in cellular metabolism and maintenance of the integrity of the nervous system

43
Q

What is the most common etiology of vitamin B12 deficiency?

A

Lack of intrinsic factor (pernicious anemia)

44
Q

Where is excess B12 stored?

A

The liver, strict vegans will deplete their stores after 3 years

45
Q

What patient cohort is vitamin B12 more common?

A

Elderly (regardless of cause)

46
Q

What should your history and physical focus on when vitamin B12 deficiency is suspected?

A

GI and neuro findings

47
Q

What are common symptoms in vitamin B12 deficiency?

A

Pallor, fatigue, glossitis (swollen tongue), GI disturbances, HA, peripheral neuropathy, neuropsychiatric disturbances

48
Q

What labs would you order to work-up a vitamin B12 deficiency?

A

CBC with peripheral smear, serum B12 and folate

Can also order methylmalonic acid (MMA), homocysteine, anti-intrinsic factor antibodies

49
Q

What is the treatment for Vitamin B12 deficiency?

A

Replace missing B12 (oral in vegans, or IV once monthly in intrinsic factor deficiency)

50
Q

What diseases would you chronically screen for vitamin B12 deficiency?

A

Crohn’s, Celiac

51
Q

What are some complications of undiagnosed vitamin B12 deficiency?

A

Heart Failure
Severe disabling neurological deficits
Increased risk for gastric cancer
Increased risk for autoimmune disease

52
Q

What are some other conditions that present similarly to vitamin B12 deficiency?

A

Lead toxicity
Syphilis
Multiple Sclerosis

53
Q

What is Guillain-Barre Syndrome?

A

Rare neurological disorder in which the body’s immune system mistakenly attacks peripheral nervous system

54
Q

What is a devastating effect of Guillain-Barre?

A

Respiratory compromise in which the patient can’t breath, can also potentially interfere with BP and heart rate

55
Q

When do most cases of Guillain-Barre start?

A

few days to weeks following a respiratory or GI viral infection

56
Q

What is the molecular mimicry/innocent bystander theory?

A

A virus makes the immune system less discriminating and no longer able to recognize own nerves- T lymphocytes and B lymphocytes produce antibodies against myelin (perceived as foreign)

57
Q

Is GBS symmetric or unilateral weakness?

A

Symmetric weakness

58
Q

When does pain worsen with GBS?

A

Pain can be severe at night

59
Q

What are they typical findings in GBS?

A

Symmetry and speed of onset of symptoms (days to weeks)

60
Q

What is the most common type of GBS seen in the US?

A

Acute inflammatory demyelinating polyneuropathy (AIDP)

61
Q

What is the acute treatment of GBS?

A

Admit and treat in ICU

Plasma exchange or IV IgG (both are equally effective, treat with one or the other)

62
Q

What are the rehabilitation treatments for GBS?

A

PT, OT, and vocational therapy

Neurology_Clinical Medicine (13 decks)

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