Peripheral Neuropathies Flashcards
There is involvement with the CNS (brain and spinal cord). True or false?
False
- no involvement with CNS
Where does the PNS start?
Spinal nerve root
Large motor fibre neuropathy - symptoms
Power - increased/normal/reduced
Sensation - normal/abnormal
Reflexes - present/absent
Symptoms: weakness, unsteadiness, wasting, lack of muscle control
Power: Reduced
Sensation: Normal
Reflexes: Absent
Large sensory fibre neuropathy - symptoms
Power - increased/normal/reduced
Sensation - normal/abnormal
Reflexes - present/absent
Symptoms: Numbness, paraesthesia
Power - Normal
Sensation: Vibration and JPS reduced
Reflexes: Absent
Small fibre neuropathy - symptoms Power - increased/normal/reduced Sensation - normal/abnormal Reflexes - present/absent
Symptoms: pain, dyesthesia
Power: Normal
Sensation: pin prick and temperature reduced
Reflexes: Present
The term “radiculopathy” is used if the damage is where?
Nerve root is damaged
The term “plexopathy” is used if the damage is where?
Nerve plexus is damaged
Plexopathy - presentation
Unilaterally paralysed but often recover
There term “peripheral neuropathy” is used if the damage is where?
Peripheral nerve is damaged
What are the 3 main types of peripheral neuropathy
Mononeuropathy
Mononeuritis multiplex
Length dependent peripheral neuropathy
Carpal tunnel syndrome is an example of:
Mononeuropathy
Mononeuritis multiplex
Length dependent peripheral neuropathy
Mononeuropathy
Mononeuritis multiplex - clinical features
Asymmetrical
painful
Isolated damage to at least 2 separate nerve areas
Wrist drop + foot drop is an example of:
Mononeuropathy
Mononeuritis multiplex
Length dependent peripheral neuropathy
Mononeuritis multiplex
- as there is isolated damage to at least 2 separate nerve areas
Length dependent peripheral neuropathy may have which type of distribution?
Glove and stocking distribution
Mononeuritis multiplex is asymetrical/symetrical?
Asymmetrical
Length dependent peripheral neuropathy has symmetrical/asymmatrical distribution?
Symmetrical
Name 2 ways in which peripheral nerves can be damaged?
Axonal loss
Demyelination
Nerve damage: axonal loss is treatable. True or false?
False
- untreatable
Nerve damage: demyelination. name 2 acute demyelination disorders
Guillaine Barre Syndrome
Acute inflammatory demyelinating polyradiculopathy
Management of demyelinating neuropathies
IV Ig
Steroids
Immunosuppressants
Patient presents with rapidly progressive paraplegia, pain, weakness, unsteadiness, paraesthesia and dysphagia. What is the likely diagnosis?
Guylaine barre syndrome (GBS)
GBS - is the most common form of neuromuscular paralysis. True or false?
True
GBS - definition
There is acute demyelination of the PNS
GBS - who gets it
Young adults mainly
GBS - examination findings
Findings may be normal in the initial phase
Reduced reflexes -> absent
Reduced tone
GBS - management
IV Ig
Plasma exchange
Steroids
Physiotherapy
What was “hereditary neuropathy” formerly known as?
Charcot marie tooth
Patient presents with clawed hands, high arched for and champagne bottle deformity of the calves. What is the likely diagnosis?
Hereditary neuropathy
Pseudoathetosis - definition
Abnormal writing movements of the fingers caused by loss of proprioception
GBS - clinical features
Acute onset ascending weakness of all 4 limbs
Loss of reflexes
Sensory symptoms
A 50yo man presents complaining of pain in both his feet. He describes the pain as burning. O/E he has 5/5 power in both legs and feet however has reduced sensation up to his mid shins. What is the likely diagnosis?
Diabetic neuropathy
- Glove and stocking sensory disturbance with no motor involvement is indicative of diabetic neuropahty. Check for ulcers
Foot drop is caused by a mononeuropathy affecting which nerve? Obturator nerve Common fibulae nerve Tibial nerve Sciatic nerve Femoral nerve
Common fibulae nerve
Wrist drop is caused by a mononeuropathy affecting which nerve? Radial Axillary Ulnar Median Musculocutaneous
Radial nerve
Which of the following (multiple) would be caused by a mononeuropathy affecting 5e sciatic nerve? Weakness of knee extension Weakness of knee flexion Weakness of ankle Doris/plantar flexion Weakness of hip flexion Loss of ankle jerk reflex
Weakness of ankle Dorsi/plantar flexion
Loss of ankle jerk reflex
Weakness of knee flexion
Which of the following would be caused by a mononeuropathy affecting the femoral nerve? Weakness of knee flexion Weakness of knee extension Loss of ankle jerk reflex Loss of patellar reflex Weakness of hip flexion
Loss of patellar reflex
Weakness of hip flexion
Weakness of knee extension
