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Neuro Module > Peripheral Neuropathies > Flashcards

Peripheral Neuropathies Flashcards

1
Q

Examples of pain/temp small fiber pathologies

A

DM
Leprosy
amyloidosis

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2
Q

Examples of proprioception/vibration fiber pathologies

A

Vit B12 deficiency
DM
Hereditable

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3
Q

Examples of motor fiber pathologies

A

Immune-related (Guillan-Barre)
Lead toxicity
Acute intermittent porphyria
Inherited disorders

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4
Q

Examples of autonomic fiber pathologies

A 
Amyloid
DM
Sjogren's
Botulism
Amiodarone
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5
Q

Sx and PE of pain/temp fiber damage

A

pain, burning, shock-like, stabbing, dysesthesias, allodynia, paresthesias

PE: decreased response to painful stimuli (pin prick), decreased temp sensation (light touch)

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6
Q

Sx and PE of proprioception/vibration fiber damage

A

numbness, pins & needles, poor balance

PE: decreased proprioception and vibration (joint position sense); diminished DTRs

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7
Q

Sx and PE of motor fiber damage

A

cramps, weak grip, foot drop, fasciculations

PE: weakness, diminished DTRs

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8
Q

Autonomic nerve damage sx and PE

A

lightheaded, dry eyes/mouth, abnormal sweating, erectile dysfxn

PE: orthostasis, anisocoria (unequal pupils)

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9
Q

Location of peripheral neuropathies

A

outside brain and spinal cord

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10
Q

Which cranial nerves are involved in peripheral neuropathy?

A

all cranial nerves except I and II

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11
Q

Most common causes in U.S.? worldwide?

A

US: DM and alcohol
worldwide: leprosy

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12
Q

Most common presentation of peripheral neuropathy?

A

distal symmetric sensorimotor dysfxn

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13
Q

How are PN categorized by pattern of involvement?

A
  • mononeuropathy = single nerve and its innervation
  • Multiple mononeuropathy = multiple indiv peripheral nerves
  • Polyneuropathy = widespread distribution

symmetric vs asymmetric, distal vs proximal

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14
Q

Likely cause of mononeuropathy

A

compression, trauma, vascular cause

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15
Q

common distribution of polyneuropathies

A

“stocking-glove distribution”

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16
Q

How are PN categorized by time course?

A

acute: toxic or inflamm
subacute: chemo, lead
chronic: DM, Charcott-Marie-Tooth
recurrent: Guillan-Barre, HIV

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17
Q

How are PN categorized?

A

Location
Time course
Fiber type
Axonal or Demyelinating

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18
Q

Common example of demyelinating disease

A

MS

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19
Q

axonal neuropathy

A

neuropathy with axonal and myelin sheath degeneration DISTAL to injury (Wallerian degeneration)

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20
Q

Common mononeuropathies

A

median neuritis, radial neuritis, ulnar neuritis, peroneal neuritis

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21
Q

Hypothesis for why so many diabetics get neuropathy?

A

direct axonal loss and demyelination secondary to hyperglycemia OR insufficient blood flow in vaso nervorium

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22
Q

Most common diabetic neuropathy

A

diabetic sensorimotor polyneuropathy (DSPN)

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23
Q

Complications of diabetic neuropathy

A

foot ulcers, Charcot joint

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24
Q

Where nerve fibers affected in DSPN?

A

mixed with small and large fibers, sensory, motor, and autonomic

sensory and autonomic&raquo_space; motor

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25
Q

symptoms of DSPN

A

initially distal: numbness/tingling, burning of toes/feet
progresses to proximal: up leg and to hands (“stocking-glove”)
later: gait disturbances, distal motor weakness

26
Q

PE of diabetic neuropathy

A

Distal sensory loss of pain, temp, touch, vibration

Reduced DTRs at ankle

27
Q

What are signs of autonomic fiber involvement?

A

impotence, nocturnal diarrhea, difficulty voiding, abnormal sweating, orthostatic hypotension

28
Q

Asymmetric Diabetic Neuropathy

A
  • occurs in older puts who already have DSPN
  • involves CN VI, III, and sometimes IV (abrupt onset d/t acute ischemia)
  • radiculopathies, limb mononeuropathies
29
Q

CN VI palsy affects on vision

A

painless double vision (diplopia)

30
Q

Tx of diabetic neuropathy

A
  • Strict glycemic control
  • Tricyclics or gabapentin for pain
  • Most recover over months
31
Q

“length dependent” neuropathy

A

longest nerves affected first

32
Q

How is asymmetric diabetic neuropathy different from typical DSPN?

A

Asymmetric
Acute
Cranial nerves affected

33
Q

Cause of asymmetric diabetic neuropathy

A

acute ischemia

34
Q

signs/sx and tx of uremic neuropathy

A
  • Distal symmetric sensoriomotor polyneuropathy
  • stocking-glove distributions, distal motor weakness, restless leg syndrome
  • tx: dialysis, renal transplant
35
Q

Examples of infection related neuropathies

A 
Bell's Palsy
Lyme Disease
Herpes Zoster (shingles)
Cytomegalic Virus (CMV) in HIV
Symmetric Distal Polyneuropathy associated with AIDS
36
Q

Bell’s Palsy is paresis of _____ nerve and associated with _____ infection.

A 
CN VII (facial)
herpes simplex virus
37
Q

How would Bell’s Palsy be classified?

A

acute mononeuropathy

38
Q

How do you differentiate Bell’s Palsy from stroke?

A

Stroke patient can still wrinkle forehead, only lower face affected

Bell’s Palsy affects upper and lower face

39
Q

Signs/Sx of Bell’s Palsy

A

UNILATERAL paresis

corner of mouth droops, no nasolabial fold, forehead unfurrowed, can’t close eyelids

SENSORY INTACT

40
Q

Bell’s Palsy management

A

80% recover within weeks to months w/ or w/o treatment

May give steroids or Acyclovir

41
Q

Ramsay Hunt Syndrome

A

may present as Bell’s Palsy; so must rule Ramsay out!!!

shingles of CN VII with vesicular rash in external canal/pharynx

42
Q

shingles caused by what virus?

A

Herpes Zoster in adults

43
Q

signs of shingles?

A

vesicular painful rash in dermatomal distribution

44
Q

Postherpetic neuralgia

A

persistent pain following shingles that can last years

45
Q

Shingles treatment

A

Tricyclics
Gabapentin
Pain meds

46
Q

Lyme disease caused by what organism?

A

Borrelia burgdoferi in ticks

47
Q

CMV infections often associated with ______.

A

HIV/AIDS

48
Q

All dying from AIDS with have what neuropathy?

A

symmetric distal polyneuropathy

49
Q

Different causes of toxic neuropathies

A

drugs (chemo), heavy metals (lead), industrial compounds, alcohol

50
Q

Chelation therapy

A

used to treat heavy metal toxic neuropathy

51
Q

______ to prevent and treat isoniazid (INH) neurotoxicity.

A

pyridoxine (B6)

52
Q

Vitamin deficiencies that result in neuropathies?

A

Thiamine B1, Pyridoxine B6, Vit B12, Vit E

53
Q

Most common inherited neuromuscular disease that is also an inherited neuropathy

A

Charcot Marie-Tooth

54
Q

Categorization of Charcot Marie-Tooth

A

Chronic distal sensory and motor neuropathy which develops over years

55
Q

Signs/Sx of Charcot Marie-Tooth

A

long standing gait difficulties, h/o being “unathletic” child; mostly LE but progresses hands

PE: wasted leg muscles, weakness, hammer toes, distal sensory loss and loss of DTRs

56
Q

Autoimmune acute inflammatory demyelinating polyneuropathy

A

Guillan-Barre Syndrome

57
Q

Clinical signs of Guillan-Barre Syndrome

A
  • Rapidly evolving motor paralysis with areflexia
  • Ascending paralysis over hrs to days
  • C/O “rubbery legs”
  • DTRs disappear in days
  • Autonomic instability
58
Q

CSF findings of Guillan-Barre Syndrome

A

typically normal at disease presentation; after 7-14 days- elevated protein, normal glucose, no pleocytosis

59
Q

Guillan-Barre Syndrome management

A

85% achieve full recovery within several months to a year; treat ASAP

tx: plasmapheresis or IV immune globulins
supportive: 30% need intubation, trach, or mechanical ventilation

60
Q

Symptoms of trigeminal neuralgia

A
  • episodes of electric (lancinating) shock pain in CN V innervation
  • pain so intense they wince (“tic”)
  • single jabs or cluster of pain in “trigger zone”
  • no sensory loss
61
Q

Who is most likely to be affected by trigeminal neuralgia?

A

F > M

middle aged/elderly

62
Q

Trigeminal neuralgia treatment

A

Carbamazepine or phenytoin

Surgery if fail med therapy

Neuro Module (13 decks)

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