Peripheral Neuropathies

Question 1

What happens in PNs?

Answer 1

Damage to one or more peripheral nerves resulting in transmission blockages between the PNS and CNS

Question 2

What is the most common cause?

Answer 2

Diabetes

Question 3

What else can cause PNs?

Answer 3

Dietary deficiencies, medicines, alcohol excess, CKD, injury, infection, connective tissue disorders, inflammatory conditions, immunocompromised, SLE, thiamine deficiency

Question 4

What causes axonal degeneration?

Answer 4

DM, B12 deficiency, lead poisoning, paraneoplastic syndrome

Question 5

What causes segmental demyelination?

Answer 5

GBS, CMT

Question 6

What sensory symptoms can be present?

Answer 6

Loss of touch, proprioception, temperature/pain, paraesthesia, numbness/tingling/burning or shooting pains, positive Romberg test

Question 7

What is a Romberg test?

Answer 7

Patient cannot stand with feet together and eyes closed

Question 8

What motor symptoms can be present?

Answer 8

Distal weakness, proximal weakness, muscle wasting, fasciculations, absent tendon reflexes

Question 9

How does distal weakness present?

Answer 9

Tripping, difficulty opening jars

Question 10

How does proximal weakness present?

Answer 10

Difficulty climbing stairs

Question 11

What investigations would you do?

Answer 11

Full history, bloods, nerve conduction studies, EMG, nerve biopsy

Question 12

What blood tests would you do?

Answer 12

Glucose, B12, LFTs, TFTs, FBC, U&E, ESR, immunoglobulins

Question 13

How do you manage PNs?

Answer 13

Treat underlying cause, pain management, supportive therapy

Question 14

What would you give for pain?

Answer 14

Pregabalin or gabapentin