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Peripheral Neuropathies Flashcards

1
Q

Name 5 mechanisms that can cause nerve malfunction?

Give an example of each!

A

Demyelination: MS

Axonal degeneration: due to a toxin

Compression: disc prolapse

Infarction: stroke

Infiltration by inflammatory cells: sarcoidosis

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2
Q

What is an axon?

A

The long, slender projection of the neuron (nerve cell)

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3
Q

What is mononeuropathy?

A

When there is a problem with one single nerve

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4
Q

What is multiple mononeuropathy?

A

Only a few nerves are affected, often in different parts of the body

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5
Q

What is polyneuropathy?

A

Many nerves are affected in about the same areas on each side of the body

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6
Q

What usually causes mononeuropathies?

A

Acute compression on the nerve(s)

  • in anatomically exposed nerves
  • in nerves that pass through tight cavities (entrapment)

Trauma or surgery

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7
Q

Give two examples of when mononeuropathy occurs in an anatomically exposed nerve?

A

The common peroneal nerve is exposed at the head of the fibula

The radial nerve is exposed to pressure from the humerus

The ulnar nerve is exposed to pressure at the elbow: cubital tunnel

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8
Q

Where is the fibula?

A

In the leg

It is the more lateral leg bone, next to the tibia

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9
Q

Give an example of when mononeuropathy occurs in a nerve that passes through a tight cavity?

A

The median nerve passing through the carpal tunnel

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10
Q

What is a nerve entrapment?

A

When a nerve that travels through a tight cavity gets compressed

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11
Q

What is carpal tunnel syndrome?

A

When the carpal tunnel starts to cause compression on the median nerve as it travels through

Flexor retinaculum compressed nerve

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12
Q

What causes carpal tunnel syndrome?

A

Often idiopathic

Can be associated with

  • hypothyroidism
  • diabetes
  • pregnancy
  • obesity
  • RA
  • work related
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13
Q

Clinical features of carpal tunnel syndrome?

A

Pain and paraesthesia of the hand

Particularly the index, middle finger, lateral half of ring finger (these are supplied by median nerve)

Worse at night

Wasting of thenar muscles

Tinnel’s sign: pain occurs when you tap the carpal tunnel

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14
Q

What travels through the carpal tunnel?

A

Nine flexor tendons:

  • flexor digitorum profundus
  • flexor digitorum superficialis
  • flexor pollicus longus
  • flexor carpi radialis

The median nerve

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15
Q

What is Tinnel’s sign?

A

Tapping the carpal tunnel area causes pain in people with carpal tunnel syndrome

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16
Q

Which part of the hand does the median nerve supply?

A

Thumb
Index, middle and lateral part of ring finger

And more lateral palm region

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17
Q

Management of carpal tunnel syndrome?

A

Nocturnal splint
Local steroid injections

Surgical decompression if the condition does not resolve

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18
Q

What is mononeuritis multiplex?

A

Loss of sensory and motor function in individual nerves, the pattern of nerve involvement is asymmetrical

Caused by a systemic disorder

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19
Q

What causes mononeuritis multiplex?

A 
Diabetes
Vasculitis
Immune disorders: RA, SLE
Infections
Sarcoidosis
Amyloidosis
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20
Q

Clinical features of mononeuritis multiplex?

A

Motor and sensory loss in some nerves

Deep, aching pain

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21
Q

Does polyneuropathy affect autonomic nerves as well as sensory and motor nerves?

A

Yes!

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22
Q

Describe the symptoms caused by damage to:

  • sensory
  • motor
  • autonomic nerves?
A

Sensory: tingling, numbness, pins & needles, pain

Motor: weakness

Autonomic: postural hypotension, urinary retention, erectile dysfunction, diarrhoea, many more

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23
Q

In which polyneuropathies are autonomic nerves the most affected?

A

Guillain-Barre syndrome
Diabetes mellitus
Amyloidosis

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24
Q

Investigations of a patient with polyneuropathy?

A

Blood:

  • FBC
  • ESR
  • vitamin B12
  • serum glucose
  • U&E

Nerve conduction tests

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25
List some causes of polyneuropathy?
``` Guillain-Barre syndrome Diabetes Mellitus Amyloidosis Vitamin deficiency Drugs Idiopathic sensorimotor neuropathy Many many more! ```
26
What is Guillain-Barre syndrome?
A polyneuropathy causing inflammatory demyelination It is often triggered by an infection
27
What infections cause Guillain-Barre syndrome? And how long after the infection does GBS occur?
Camplylobacter jejuni Epstein-Barr virus Cytomegalovirus 2-4 weeks post infection
28
Pathogenesis of GBS?
The infectious organism antigens share epitopes with the antigens of the peripheral nerve cells So antibodies that were created to fight the pathogen start to attack the nerve cells, damaging the nerves
29
Clinical features of GBS?
Progressive onset symmetrical limb weakness Loss of reflexes Sensory symptoms: paraesthesia In some cases the facial and respiratory muscles are involved Autonomic features: - bladder problems - cardiac arrhythmias Respiratory involvement can cause death
30
Investigations of GBS?
Lumbar puncture: - raised protein in CSF - normal white count Nerve conduction tests: slowed
31
Treatment of GBS?
At first signs of resp involvement, intubate and refer to ITU IV immunoglobulins Don't use corticosteroids, they don't help
32
Which vitamin deficiencies can cause polyneuropathies?
Thiamin (B1) Pyridoxine (E6) B12
33
What causes thiamin deficiency?
Reduced food intake: - alcoholism - starvation
34
Clinical features of thiamin deficiency?
Polyneuropathy Wernicke-Korsakoff syndrome
35
How does Wernicke-Korsakoff syndrome present?
Ocular disturbances (ophthalmoplegia) Changes in mental state (dementia) Unsteady stance and gait (ataxia)
36
Treatment of polyneuropathy caused by thiamin deficiency?
Thiamin supplement, IV for 3 days
37
Clinical features of pyridoxine deficiency?
Sensory polyneuropathy
38
What causes pyridoxine deficiency?
Some people taking isoniazid therapy for TB get this as a side effect
39
Treatment of pyridoxine deficiency?
More prevention People taking isoniazid are given prophylactic pyridoxine
40
Clinical features of B12 deficiency (in terms of nervous system)?
Polyneuropathy Subacute combined degeneration of the spinal cord Distal sensory loss Absent ankle jerks Evidence of cord disease
41
Treatment of B12 deficiency?
IM injection of B12
42
What is hereditary sensorimotor neuropathy?
An umbrella term for a number of inherited conditions that cause polyneuropathy The most common being Charcot Marie Tooth syndrome
43
What is Charcot Marie Tooth syndrome?
Progressive loss of muscle tissue and touch sensation in the distal limbs, as well as weakness
44
What is the inheritance pattern of Charcot Marie Tooth syndrome?
Autosomal dominant
45
Clinical features of Charcot Marie Tooth syndrome?
Distal limb muscle wasting and weakness Mostly affects the legs Loss of sensation and reflexes Legs look like inverted champagne bottles High arched feet and hammer toes
46
Management of Charcot Marie Tooth syndrome?
Incurable Physical therapy, moderate exercise Braces and splints Specially modified shoes or surgery for foot deformities
47
Name CN I. How would a lesion of CN I present? What causes CN I lesions?
Olfactory nerve Loss of sense of smell and taste Tumours, trauma, infection
48
Name CN II. How would a lesion of CN II present? What causes CN II lesions?
Optic nerve Visual field defects Visual acuity Blindness: mono or bi Hemianopia: homo or bi Pupillary abnormalities: - size - shape Causes: MS, occlusion of retinal artery, trauma, anaemia, drugs
49
Name CN III. How would a lesion of CN III present? What causes CN III lesions?
Oculomotor Fixed dilated pupil Ptosis DOWN + OUT deviation of eye Causes: Diabetes M, temporal arteritis, syphilis
50
Name CN IV. How would a lesion of CN IV present? What causes CN IV lesions?
Trochlear Diplopia: double vision Eyes move down and in Head tilt down and to side opposite side of lesion Causes: trauma, diabetes
51
Name CN V. How would a lesion of CN V present? What causes CN V lesions?
Trigeminal Reduced sensation in areas supplied by trigeminal Weakness of jaw clenching Jaw deviates to side of lesion when mouth opens Causes: trigeminal neuralgia, herpes zoster, more
52
Name CN VI. How would a lesion of CN VI present? What causes CN VI lesions?
Abducens Inability to look laterally in one eye INWARD deviation of eye Horizontal diplopia Causes: MS, pontine stroke
53
Name CN VII. How would a lesion of CN VII present? What causes CN VII lesions?
Facial nerve If UMN: - Facial weakness, find it hard to puff out cheeks, show teeth If LMN: - The above + paralysed forehead Causes: - UMN: stroke, tumour - LMN: polio, bell's palsy
54
Name CN VIII. How would a lesion of CN VIII present? What causes CN VIII lesions?
Vestibulocochlear Unilateral deafness Tinnitus Causes: loud noise, herpes zoster, brainstem CVA
55
Name CN IX. How would a lesion of CN IX present? What causes CN IX lesions?
Glossopharyngeal Impaired gag reflex: IX controls the afferent arm of the reflex Causes: trauma, brainstem lesions, polio
56
Name CN X. How would a lesion of CN X present? What causes CN X lesions?
Vagus Weakness of palate: nasal voice, nasal regurgitation of food Impaired gag reflex: X controls the efferent arm of the reflex Causes: trauma, brainstem lesions, tumours
57
Name CN XI. How would a lesion of CN XI present? What causes CN XI lesions?
Accessory Weakness and wasting of sternocleidomastoid and trapezius Causes: trauma, brainstem lesions, tumours
58
Name CN XII. How would a lesion of CN XII present? What causes CN XII lesions?
Hypoglossal Wasting of ipsilateral side of tongue with fasciculation Tongue deviates to side of lesion Causes: polio
59
What does palsy mean?
Paralysis
60
Which cranial nerve(s) control(s) the gag reflex?
IX controls afferent arm | X controls efferent arm
61
What is Bell's palsy?
Inability to control facial muscles on one side of the face, due to a facial nerve problem on that side

Neurology (23 decks)

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