Peripheral Neuropathies Flashcards
What is the definition of wallergian degeneration?
Nerve fiber is cut or crushed and everything distal degenerates
Define dermatome, myotome, and sclerotome?
Area of skin supplied by a single spinal nerve
Muscle group supplied by a single spinal nerve
Area of bone supplied by a single spinal nerve
Two most common nerve root levels involved in radiculopathy in the cervical spine and 2 in the lumbar?
C5-c6, which is c6 compression
C6-c7, which is c7 compression
L4-l5, which is l5 compression
L5-s1, which is s1 compression
Where is the pain, sensory, weakness and DTR loss in the following nerve roots being compressed?
C5, C6, C7, and C8?
5: scapula, shoulder. Lateral arm. Shoulder abduction. Biceps.
6: scapula, shoulder, proximal arm. Lateral arm and 1,2 fingers. Shoulder abduction and elbow flexion. Biceps and maybe BR.
7: scapula, shoulder/arm, elbow/forearm. 3 digit. Elbow ext. wrist ext. and finger ext. Triceps.
8: scapula, shoulder/arm, and medial forearm. 4 and 5 finger. Finger flexion and abduction. Finger flexors.
Where is the pain, sensory, weakness and DTR loss in the following nerve roots being compressed?
L4, L5, S1?
4: Anterior lateral thigh, knee, medial calf. Medial calf. Hip flexion and knee extension. Patella.
5: posterior thigh and lateral calf. Lateral calf and top of foot. Hamstrings, foot dorsiflexion, eversion, inversion. None.
S1. Post thigh and posterior calf. Posterior lat calf lateral foot. Hamstrings and ankle plantar flexion. Achilles.
What part of the body has sensory provided by the following spinal levels?
C6,c7,c8,t1,t4,t10,l1,l4,l5, s1?
Thumb and index Middle finger 4th and 5th finger Medial forearm Nipple line Umbilicus Inguinal Medial calf Lateral calf Posterior calf and lateral foot.
What 2 conditions can compress the medial cord of brachial?
What condition did he say can affect the upper trunk and lateral cord?
What condition can cause ischemia to the lumbar spine?
Breast or lung cancer
Radiation injury
Diabetes
4 things are impaired in peripheral nerve disease of large myelinated sensory fibers?
2 things impaired in peripheral nerve disease of small unmyelinated sensory fibers?
Light touch, 2 point, vibration and joint position.
Temp and pain
5 signs of peripheral nerve disease of motor neurons?
Atrophy, weakness, reduced or absent DTR, fasciculations, cramps
How do characterize median mononeuropathy?
What is another name for it and why?
What is the numbness pattern?
What is the syndrome we check for with what test and what 3 muscles are abnormal on EMG?
Gradual dull ache pain of the proximal forearm. People don’t wake up because of pain.
Pronator syndrome because pronation makes the pain worse
2 and 3 fingers
Anterior interosseous syndrome by OK sign test
FPL, FDP, and PQ
4 areas most commonly compressing the ulnar nerve?
Axilla, elbow, cubital tunnel and wrist
What sign from a special test suggests ulnar neuropathy?
Froment sign where you try to take a piece of paper from their thumb and finger and they flex their thumb to hold onto it
4 most common places for the radial nerve to be compressed and which one is most common?
Axilla, spiral grove in humerus (most common Saturday night palsy ), supinator, and wrist
What is the hallmark sign of radial neuropathy and why?
Wrist drop because weakness in extensors of wrist, finger and thumb
3 clinical features of radial neuropathy at the spiral groove or Saturday night palsy?
Weakness of wrist and finger extension but elbow extension is spared
With peroneal mononeurpathy at the fibular head, what 3 muscles are abnormal, what 3 actions are weak, where is sensory loss?
Tib ant, EHL and EDB
Dorsiflexion, eversion and toe extension
Top of foot, maybe lateral calf
What is the term for the distribution of symptoms in peripheral neuropathy and why?
Stocking glove.
Peripheral neuropathies can be motor, sensory, autonomic or all of the above.
They are usually symmetric and more severe in distal limbs, hence stocking glove or hand feet.
What is the maneuver to test for proprioception in peripheral neuropathy?
Rhomberg
What is the most common identifiable cause of neuropathy in the US?
Diabetes
What is deficiency state to remember that causes peripheral neuropathy?
B12
What is the most common hereditary motor sensory neuropathy and which type is most common?
Charcot Marie tooth, HMSN1 most common and it is a demyelinating.
Inheritance of CMT and 4 clinical signs?
AD
Young people
Problems walking or running first
Distal symmetric atrophy of arms and legs
Skeletal abnormalities like hammer toes and scoliosis
What is two differences of type 2 CMT?
1 big difference of type 3?
Onset in adulthood and axonal loss so conduction loss is pretty normal in motor neurons.
Very severe demyelinating neuropathy of childhood.
What is the viral syndrome that can precede guillain barre?
Two other conditions that have associations with it?
Epstein Barr, mycoplasma and camp jejuni.
HIV
Hodgkin
2 key CSF lab findings for guillain barre?
3 findings on nerve conduction velocity study?
Protein up, cell count/glucose count normal.
Slow conduction, focal conduction block, prolonged f waves
How do we characterize miller fisher syndrome and what is it?
4 signs?
Variant of GBS.
Eye muscle paralysis, ataxia, areflexia and facial weakness.
Antibodies that identify the three variants of GBS?
Miller fisher
AMAN
AMSAN
GQ1b and GT1a
GM1, GM1b, and GD1a
GM1, GM1b, and GM1a
How do we characterize multifocal motor neuropathy? 4 signs.
Two things that are absent?
What is the antibody?
Adult, more commonly male, distribution of a single nerve then slowly progresses to distal weakness of hands and feet.
No sensory or UMN sign
Gm1
What CD4 count do we see HIV neuropathies?
What are the 3 types?
Distal symmetrical poly
Acute inflammatory demyelinating poly
Chronic inflammatory demyelinating poly
The following antibodies indicate specific neuropathies, what are they? AANCA Anti mag Anti gm1 Anti gq1b Hu antibody
Systemic vasculitis MGUS associated neuropathy Multifocal motor neuropathy Miller fisher Carcinomatous sensory neuropathy
4 additional tests we can do to help with diagnosis?
EMG, CSF, nerve biopsy, skin biopsy
What 3 conditions can be diagnosed solely off of a nerve conduction study?
GBS, CMT1, MMN
