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Neurology SB > Peripheral Neuropathies > Flashcards

Peripheral Neuropathies Flashcards

1
Q

if there was a LARGE MOTOR fibre problem, what would be the symptoms, power, sensation and reflexes change

A

Sx - weakness, unsteadiness, wasting

Power - reduced

Sensation - normal

Reflexes - absent

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2
Q

if there was a LARGE SENSORY fibre problem, what would be the symptoms, power, sensation and reflexes change

A

Sx - numbness, unsteadiness, paraesthesia

Power - normal

Sensation - vibration and proprioception reduced

Reflexes - absent

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3
Q

if there was a SMALL fibre problem, what would be the symptoms, power, sensation and reflexes change

A

Sx - pain, dyesthesia

Power - normal

Sensation - pin prick and temperature reduced

Reflexes - present

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4
Q

if there was a AUTONOMIC fibre problem, what would be the symptoms, power, sensation and reflexes change

A

Sx - dizziness (postural hypotension), impotence, nausea and vomiting (gastroparesis)

Power - normal

Sensation - normal

Reflexes - present

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5
Q

what are the large fibres mainly

A

A-alpha

Beta

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6
Q

what are the small fibres mainly

A

A-gamma

C

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7
Q

if you have a bilateral foot drop what type of gait would you expect to see

A

high stepping gait

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8
Q

what is pseudoathetosis

A

movement disorder caused by peripheral demyelination neuropathy

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9
Q

what is seen in pseudoathetosis

A
  • slow, involuntary, writing movements present at rest usually seen in the fingers
  • severe loss of proprioception
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10
Q

what does pseudoathetosis indicate

A

disruption of the proprioceptive pathway from nerve to parietal cortex

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11
Q

what is meant by radiculopathy

A

compression or irritation of a nerve as it exits the spinal column.

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12
Q

what is a mononeuropathy

A

just one nerve affected e.g. foot drop/fibular nerve

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13
Q

what is mono neuritis multiplex

A

malfunction of two or more peripheral nerves in separate areas of the body

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14
Q

what are the patterns of peripheral neuropathy

A

“glove and stocking”
mild
moderate
severe

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15
Q

what are the 2 types of pathology causing peripheral neuropathy

A

demyelinating pathology

Axonal pathology

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16
Q

what are acute (days to weeks) demyelinating neuropathies

A

Guliian Barre Syndrome

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17
Q

what are chronic (months to years) chronic neuropathies

A

CIDP

Hereditary sensory motor neuropathy (formerly known as Charcot-Marie-Tooth disease)

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18
Q

what is guillain barre syndrome

A

acute inflammatory demyelinating polyneuropathy that occurs post infection

19
Q

what are the triggers of gillian barre syndrome

A 
campylobacter jejuni
CMV
mycoplasma
zoster
HIV
EBV
20
Q

Sx of GBS

A
  • progressive paraplegia
  • pain (v common)
  • sensory symptoms
  • weakness
21
Q

what are the Ix done and GBS and what results would be seen

A

NCS - slow conduction

CSF - increased protein, normal WCC

22
Q

what is the Tx for GBS

A

1st - IV immunoglobulin

2nd - plasma exchange

23
Q

what is HSMN

A

group of neuropathies, Type I and II are most common and forms of Charcot-Marie-Tooth disease

24
Q

what are the genetic features of Type I HSMN

A

autosomal dominant; more common

due to defect in PMP-22 gene on ch. 17 (peripheral myelin protein) which codes for myelin

25
Q

How does HSMN I present and what does NCS show

A

demyelinating pathology
features often start at puberty

NCS shows greatly decreased conduction

26
Q

what Sx of HSMN are often seen FIRST

A

weak legs + foot drop

27
Q

what are the rest of Sx of HSMN

A 
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
28
Q

what is champagne bottle legs deformity

A

hypertrophy of the proximal muscles, with marked perennial muscle atrophy with tapering of the distal extremities

29
Q

what are the pathological features of HSMN type II

A

autosomal dominant; but affects a different gene not known

axonal pathology

30
Q

what are the Sx of HSMN type II

A

same as type I but not as severe

tends to affect lower extremities rather than upper

31
Q

what is the NCS like in HSMN type II

A

NORMAL

in type I is is DECREASED

32
Q

what are examples of chronic and acute autonomic neuropathy

A

Chronic

  • Diabetes (ie gastroparesis)
  • Amyloidosis
  • Hereditary

Acute

  • GBS
  • Porphyria
33
Q

Sx in a case of neuropathy that would make you think of porphyria as a cause

A
  • peripheral neuropathy (pins and needles, unsteadiness, absent reflexes, sensory loss, weakness)
  • abdo pain
  • psychosis
34
Q

Sx of peripheral neuropathy

A

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

35
Q

what are causes of axonal pathology peripheral neuropathies

A 
Alcohol
DM
Vasculitis (ANCA +) 
Vit B12 deficiency, hypothyroidism 
HSMN II
Myeloma 
Idiopathic (age related)
HIV, syphilis, lyme disease, Hep B/C
36
Q

what are causes of demyelinating pathology peripheral neuropathies

A 
Guillian-Barre Syndrome
CIPD
Amiodarone
HSMN I
paraprotein neuropathy
37
Q

what are the Tx options for axonal pathologies

A

treat cause (e.g. hep C)

symptomatic treatment = physio, orthotics, neuropathic pain relief

38
Q

what is the Tx for vasculitis causing neuropathy

A

IV methylprednisolone + cyclophosphamide

39
Q

what are the treatment options for demyelinating pathologies

A
  • IV Immunoglobulins
  • Steroids
  • Immunosuppression:
    Azathioprine, myocphenalate, cyclophosphamide
40
Q

what is meant by mono neuritis multiplex

A

used when 2 or more peripheral nerves are affected

causes tend to be systemic

41
Q

what are the causes of mono neuritis multiplex

A

WARDS PLC

Wegners
Aids/Amyloid
Rheumatoid 
Diabetes
Sarcoidosis 
Pan
Leprosy 
Carcinoma
42
Q

what type of neuropathy does alcohol abuse lead to

A

chronic, initially sensory then mixed, axonal neuropathy

43
Q

drugs causing peripheral neuropathy

A

antibiotics = nitrofurantoin, metronidazole

Amiodarone

TCAs

Neurology SB (23 decks)

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