Peripheral Neuropathies Flashcards
What is a neuropathy?
Any pathological process affecting nerves
Mononeuropathy?
Process affecting single nerve
Mononeuritis complex?
Process affecting several individual nerves
Polyneuropathy?
Diffuse, symmetrical disease, usually commencing peripherally (glove and stocking distribution)
Radiculopathy?
Disease affecting nerve roots (dermatomal or myotomal synptoms)
Plexopathy?
Disease affecting the brachial or lumbosacral plexus (symptoms in whole limb)
Mononeuropathies due to peripheral nerve compression and or entrapment?
- Carpal Tunnel Syndrome
- Cubital Tunnel syndrome
- Radial Nerve Compression
- Common Peroneal Palsy
What is carpal tunnel entrapment?
-Median nerve entrapment at the carpal tunnel in the wrist
What conditions are usually associated with carpal tunnel syndrome?
Hypothyroidism Pregnancy RA Acromegaly Amyloidosis
Presentation of carpal tunnel syndrome?
Numbness Tingling Pain in media nerve Symptoms often worse at night Wasting of thenar muscles
Management of carpal tunnel syndrome?
Involves splinting
Steroid injections
If persistent can do surgical decompression
What is cubital tunnel entrapment?
Ulnar nerve entrapment at the cubital tunnel in the elbow
-Usually due to prolonged or recurrent pressure on the elbow or an elbow fracture
Presentation of cubital tunnel syndrome?
Clawing of hands
Wasting of interossei muscle
Can be difficult to surgically decompress
What is radial nerve compression?
Compression of radial nerve by the humerus
Presentation of radial nerve compression?
Wrist drop
Weakness of wrist and finger extension
What is common peroneal palsy?
Common peroneal nerve can be compressed against the head of the fibula
Presentation of common peroneal palsy
Foot drop and weakness of ankle eversion
What conditions does mononeuritis occur in?
- DM
- Leprosy
- Vasculitis
- Amyloidosis
- Malignancy
- Neurofibromatosis
- HIV and Hep C
- Multifocal motor neuropathy
Diabetes and neuropathy?
-Good glycaemic control is protective
What type of neuropathy is immune mediated?
Guillan-Barre syndrome
What is Guillan-Barre syndrome?
Most common acute demyelinating disorder
Post infection basis of GBS?
Usually campylobacter jejuni
CMV
Presentation of GBS?
- Weakness of distal limb muscles and/or distal numbness
- Weakness and sensory loss progress over days to 6 weeks
- Loss of tendon reflex almost always occurs
- Paralysis can progress rapidly
Diagnosis of GBS?
Confirmed by nerve conduction studies
Treatment of GB syndrome?
IV Immunoglobulin given within first 2 weeks reduces duration and severity of paralysis
General presentation of peripheral neuropathies?
-Depends on type of nerve affected, more than one nerve affected can have combo of symptoms
Presentation of larger motor peripheral neuropathies?
- Weakness, unsteadiness and muscle wasting
- Reduced power
- Absent reflexes
- Normal sensation
Large fibre sensory peripheral neuropathy presentation?
- Numbness, paraesthesia, unsteadiness
- Normal power
- Vibration and proprioception reduced
- Absent reflexes
Presentation of small fibre sensory peripheral neuropathies?
- Pain, dysesthesia
- Normal power
- Pin prick sensation and temp reduced
- Present reflexes
Presentation of peripheral neuropathies with autonomic fibres?
- Dizziness (postural hypotension), impotence, N&V
- Normal power
- Normal sensation
- Present reflexes
