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Neurology > Peripheral Neuropathies > Flashcards

Peripheral Neuropathies Flashcards

1
Q

What is a good approach to PNS problems?

A 
Which nerves are damaged?
Where are they damaged?
How are they damaged (myelin or axonal)?
Why are they damaged?
Can we stop it?
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2
Q

What are symptoms of large alpha/beta fibre motor problems?

A

Weakness, unsteadiness, wasting of muscles

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3
Q

Will power be reduced in pathologies of large alpha/beta motor fibres of the PNS?

A

Yes

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4
Q

Will sensation be intact in pathologies of large alpha/beta motor fibres of the PNS?

A

Yes

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5
Q

Will reflexes be normal in pathologies of large alpha/beta motor fibres of the PNS?

A

No - absent

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6
Q

What will the symptoms be in pathologies of large alpha/beta sensory fibres of the PNS?

A

Numbness, paraesthesia, unsteadiness

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7
Q

Will power be preserved in pathologies of large alpha/beta sensory fibres of the PNS?

A

Yes, normal power

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8
Q

Will reflexes be normal in pathologies of large alpha/beta sensory fibres of the PNS?

A

Yes

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9
Q

Will sensation be preserved in pathologies of large alpha/beta sensory fibres of the PNS?

A

No; vibration and proprioception reduced

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10
Q

Will reflexes be normal in pathologies of large alpha/beta sensory fibres of the PNS?

A

No - absent

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11
Q

What symptoms will occur with pathologies of the small delta and C fibres of the PNS?

A

Pain, dysethesia

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12
Q

Will power be preserved with pathologies of the small delta and C fibres of the PNS?

A

Yes, normal

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13
Q

Will sensation be preserved with pathologies of the small delta and C fibres of the PNS?

A

No; pin-prick and temperature perception reduced

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14
Q

Will reflexes be normal with pathologies of the small delta and C fibres of the PNS?

A

Yes

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15
Q

What symptoms will occur with pathologies of delta and C fibres the ANS?

A

Dizziness (postural hypotension)
Impotence
N+V (gastroparesis)

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16
Q

Will power be preserved with pathologies of delta and C fibres the ANS?

A

Yes

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17
Q

Will sensation be preserved with pathologies of delta and C fibres the ANS?

A

Yes

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18
Q

Will reflexes be normal with pathologies of delta and C fibres the ANS?

A

Yes

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19
Q

What is a high stepping gait?

A

Foot drop due to weakness of ankle dorsiflexion

20
Q

What are DDx of a high stepping gait?

A

Common fibular nerve palsy
L5 palsy
Motor neuropathies; bilateral due to alcohol or diabetes

21
Q

Where is the nerve damaged in a radiculopathy?

A

Nerve root; commonly due to a prolapsed disc

22
Q

What is a mononeuropathy?

A

Single nerve problem for example a wrist drop due to radial nerve palsy or carpal/ cubital syndrome

23
Q

What is mononeuritis multiplex?

A

Vasculitis affecting the blood supply to nerves

24
Q

What is a length dependent peripheral neuropathy?

A

Neuropathy due to underlying systemic condition such as diabetes or alcoholism

25
Q

What distribution of sensory loss will length dependent peripheral neuropathy show?

A

Glove and stocking

Symmetrical

26
Q

Are plexopathies painful?

A

YES

27
Q

What is the difference between guillan barre syndrome and MS?

A

Guillain barre = demyelinating disorder of PNS

MS = demyelinating disorder of CNS

28
Q

What are the acute and chornic demyelinating neuropathies of the PNS?

A

Acute (days to week): GBS

Chronic (months to years): CIDP, charcot-marie-tooth disease

29
Q

What are the symptoms of GBS?

A

Progressive paraplegia over days up to 4 weeks
Assoc sensory symptoms proceed weakness
PAIN very common

30
Q

When are the peak symptoms of GBS?

A

10-14 days into onset of illness

31
Q

What commonly precedes GBS?

A

Campylobacter

Resp infections

32
Q

What % of people with GBS will require ventilation?

A

25%

33
Q

What will cause the majority of deaths in GBS?

A

Autonomic failure; cardiac arrhythmias

It will strip the ANS of its myelin

34
Q

What is the treatment for GBS?

A

IVIg and/or plasma exchange

Minimal role for steroids

35
Q

What is charcot marie tooth disease?

A

Pure motor, sensory, sensorimotor, small fibre and autonomic variants
Demyelinating and axonal variation
Genetic

36
Q

What is typically seen in CMT?

A

Wasting of tibial muscles
Deforming arthropathy of hands
Pes cavus

37
Q

What are the different types of axonal neuropathies?

A 
Vasculitis
Paraneoplastic
Infections
Drugs/ toxins
Metabolic
38
Q

What causes vasculitis axonal neuropathies?

A

ANCA +ve
RA
Sjogren’s

39
Q

What causes paraneoplastic axonal neuropathies?

A 
Myeloma
Antibody mediated (breast cancer, small cell lung cancer)
40
Q

What causes infectious axonal neuropathies/

A

HIV
Syphilis
Lyme disease
Hep B/C (cryoglobulin mediated)

41
Q

What drugs/toxins cause axonal neuropathies?

A

ALCOHOL
Amiodarone
Phenytoin
Chemo; cisplatin/ vincristine

42
Q

What metabolic disorders cause axonal neuropathies?

A

Diabetes
B12/ folate deficiency
Chronic uraemia
Porphyria - acute intermittent porphyria

43
Q

What causes chronic autonomic neuropathies?

A

Diabetes; gastroparesis
Amyloidosis
Hereditary

44
Q

What will cause acute autonomic neuropathies?

A

GBC

Porphyria

45
Q

What is the treatment for axonal neuropathies in general?

A

Treat cause

Symptomatic; physio, orthotics, neuropathic pain relief

46
Q

What is the treatment for vasculitis related axonal neuropathies?

A

Pulsed IV methylprednisolone + cyclophosphamide

47
Q

What is the treatment for demyelinating neuropathies?

A 
IVIg
Steroids
Azathioprine
Mycophenolate
Cyclophosphamide

Neurology (48 decks)

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