Peripheral Neuropathies Flashcards
if there was a LARGE MOTOR fibre problem, what would be the symptoms, power, sensation and reflexes change
Sx - weakness, unsteadiness, wasting
Power - reduced
Sensation - normal
Reflexes - absent
if there was a LARGE SENSORY fibre problem, what would be the symptoms, power, sensation and reflexes change
Sx - numbness, unsteadiness, paraesthesia
Power - normal
Sensation - vibration and proprioception reduced
Reflexes - absent
if there was a SMALL fibre problem, what would be the symptoms, power, sensation and reflexes change
Sx - pain, dyesthesia
Power - normal
Sensation - pin prick and temperature reduced
Reflexes - present
if there was a AUTONOMIC fibre problem, what would be the symptoms, power, sensation and reflexes change
Sx - dizziness (postural hypotension), impotence, nausea and vomiting (gastroparesis)
Power - normal
Sensation - normal
Reflexes - present
what are the large fibres mainly
A-alpha
Beta
what are the small fibres mainly
A-gamma
C
if you have a bilateral foot drop what type of gait would you expect to see
high stepping gait
what is pseudoathetosis
movement disorder caused by peripheral demyelination neuropathy
what is seen in pseudoathetosis
- slow, involuntary, writing movements present at rest usually seen in the fingers
- severe loss of proprioception
what does pseudoathetosis indicate
disruption of the proprioceptive pathway from nerve to parietal cortex
what is meant by radiculopathy
compression or irritation of a nerve as it exits the spinal column.
what is a mononeuropathy
just one nerve affected e.g. foot drop/fibular nerve
what is mono neuritis multiplex
malfunction of two or more peripheral nerves in separate areas of the body
what are the patterns of peripheral neuropathy
“glove and stocking”
mild
moderate
severe
what are the 2 types of pathology causing peripheral neuropathy
demyelinating pathology
Axonal pathology
what are acute (days to weeks) demyelinating neuropathies
Guliian Barre Syndrome
what are chronic (months to years) chronic neuropathies
CIDP
Hereditary sensory motor neuropathy (formerly known as Charcot-Marie-Tooth disease)
what is guillain barre syndrome
acute inflammatory demyelinating polyneuropathy that occurs post infection
what are the triggers of gillian barre syndrome
campylobacter jejuni CMV mycoplasma zoster HIV EBV
Sx of GBS
- progressive paraplegia
- pain (v common)
- sensory symptoms
- weakness
what are the Ix done and GBS and what results would be seen
NCS - slow conduction
CSF - increased protein, normal WCC
what is the Tx for GBS
1st - IV immunoglobulin
2nd - plasma exchange
what is HSMN
group of neuropathies, Type I and II are most common and forms of Charcot-Marie-Tooth disease
what are the genetic features of Type I HSMN
autosomal dominant; more common
due to defect in PMP-22 gene on ch. 17 (peripheral myelin protein) which codes for myelin
How does HSMN I present and what does NCS show
demyelinating pathology
features often start at puberty
NCS shows greatly decreased conduction
what Sx of HSMN are often seen FIRST
weak legs + foot drop
what are the rest of Sx of HSMN
distal muscle wasting atrophy of hands and arm muscles pes cavus (high arched foot) clawed toes “champagne bottle legs deformity” variable loss of sensation and reflexes
what is champagne bottle legs deformity
hypertrophy of the proximal muscles, with marked perennial muscle atrophy with tapering of the distal extremities
what are the pathological features of HSMN type II
autosomal dominant; but affects a different gene not known
axonal pathology
what are the Sx of HSMN type II
same as type I but not as severe
tends to affect lower extremities rather than upper
what is the NCS like in HSMN type II
NORMAL
in type I is is DECREASED
what are examples of chronic and acute autonomic neuropathy
Chronic
- Diabetes (ie gastroparesis)
- Amyloidosis
- Hereditary
Acute
- GBS
- Porphyria
Sx in a case of neuropathy that would make you think of porphyria as a cause
- peripheral neuropathy (pins and needles, unsteadiness, absent reflexes, sensory loss, weakness)
- abdo pain
- psychosis
Sx of peripheral neuropathy
sensory neuropathy
- pins and needles, numbness, burning/sharp pain, ataxia
motor neuropathy
- twitching, muscle cramps, wasting, weakness, paralysis
autonomic neuropathy
- constipation/diarrhoea, N+V, tachycardia, impotence
what are causes of axonal pathology peripheral neuropathies
Alcohol DM Vasculitis (ANCA +) Vit B12 deficiency, hypothyroidism HSMN II Myeloma Idiopathic (age related) HIV, syphilis, lyme disease, Hep B/C
what are causes of demyelinating pathology peripheral neuropathies
Guillian-Barre Syndrome CIPD Amiodarone HSMN I paraprotein neuropathy
what are the Tx options for axonal pathologies
treat cause (e.g. hep C)
symptomatic treatment = physio, orthotics, neuropathic pain relief
what is the Tx for vasculitis causing neuropathy
IV methylprednisolone + cyclophosphamide
what are the treatment options for demyelinating pathologies
- IV Immunoglobulins
- Steroids
- Immunosuppression:
Azathioprine, myocphenalate, cyclophosphamide
what is meant by mono neuritis multiplex
used when 2 or more peripheral nerves are affected
causes tend to be systemic
what are the causes of mono neuritis multiplex
WARDS PLC
Wegners Aids/Amyloid Rheumatoid Diabetes Sarcoidosis Pan Leprosy Carcinoma
what type of neuropathy does alcohol abuse lead to
chronic, initially sensory then mixed, axonal neuropathy
drugs causing peripheral neuropathy
antibiotics = nitrofurantoin, metronidazole
Amiodarone
TCAs
