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Internal Med > Peripheral neuropathies > Flashcards

Peripheral neuropathies Flashcards

1
Q

What are the different types of polyneuropathies?

A
  1. mononeuropathy- carpal tunnel syndrome
  2. polyneuropathy-diabetic neuropathy(symmetrical involvement of peripheral nerves)
  3. Mononeuropathy multiplex- multiple peripheral nerves simultaneously
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2
Q

What is the prevalence of peripheral neuropathy in patients above 55 years?

A

> 8%

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3
Q

What is the classification of polyneuropathies?

A
  1. acute <4 weeks
  2. subacute 4 weeks to 12 weeks
  3. chronic polyneuropathies: >12 weeks and often not reversible
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4
Q

What are the causes of acute polyneuropathies?

A
  1. Guillain Barre syndrome
  2. pophyria
  3. Thiamine deficiency neuropathy
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5
Q

What are the causes of suabacute neuropathies?

A
  1. Thiamine deficiency neuropathy
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6
Q

What are chronic neuopathies causes?

A
  1. Diabetic polyneuropathy
  2. Hiv
  3. Nutritional deficencies
  4. Inflammatory- paraproteinemic
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7
Q

What are the clinical features of chronic polyeneuropathy?

A

symptoms:
1. numbness, paraesthesia, pain, decreased temperature or pain sensation, weakness, incoordination
2 signs: distal weakness, distal sensory loss, distal reflex loss

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8
Q

What is Guillain Barre syndrome?

A

Usually occurs after 3 days to 6 weeks post infection of the respiratory tract or GIT

  • Occurs in any age
  • mechanism is molecular mimicry
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9
Q

What is AIDP?

A

acute inflammatory demyelinating polyneuropathy

This is an inflamatroy attack of the myelin sheath and is the commonest form of GBS

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10
Q

What is the least common type of Guillain Barre Syndrome?

A
  • Axonal forms(AMAN and AMSAN) which stands for antibody mediated attack at nodes of ranvier
  • 10% of cases
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11
Q

What are the clinical features of GBS?

A
  1. Ascending paralysis usually proximal and sital weakness with absent reflexes
  2. usually no sphicter dysfunction
  3. facial weakness bilaterally
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12
Q

When do the patients present with the peak weakness?

A

50% will reach within 2 weeks and others within 4 weeks

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13
Q

How do we diagnose GBS?

A
  1. csf-albumincytological studies

2. nerve conduction studies

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14
Q

How do we treat GBS?

A
  1. SUPPORTIVE
    - respiratory ventilation or intubation as needed
    - bulbar function(risk of aspiration)
    - rehabilitation
    - venous thromboembolitic prevention-heparin
    - ulcer prevention(turn patient often)
  2. SPECIFIC
    - plasma exchange
    - IV immunoglobulin
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15
Q

What is the mortality rate of GBS?

A

2-8% mostly killed by sepsis, pulmonary embolism

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16
Q

What will we find on CSF for patients with GBS nd HIV?

A

higher amount of lymphocytes- about 100 lymphocytes

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17
Q

What is porphyria?

A

Group of inherited disorders(autosomal dominant) of haem synthesis

18
Q

What is the clinical presentation of porphyria?

A
  1. Abdominal pain
  2. skin lesions
  3. seizures and delirium
  4. Polyneuropathy with global weakness
    - acute intermittent porphyria
19
Q

Who typically gets Porphyria?

A

young women who experienceacute attacks

20
Q

What are the 4 p’s?

A
  1. painful abdomen
  2. polyneuropathy
  3. psychological disturbances
  4. port wine coloured urine
21
Q

How do we treat porphyria?

A

glucose and heme

22
Q

What is paraneoplastic neuropathy?

A

This can present before the cancer and can help us have early detection and cure
-predominantly sensory symptoms

23
Q

What complications do pts with diabetes present with?

A
  1. polyneuorpathy
  2. nephropathy
  3. retinopathy
24
Q

What are the clinical features of diabetic neuropathy?

A
  1. slow progression over the years
  2. insidious onset of numbness, paraesthesia, burning pain
  3. starts distally and moves proximally
  4. often associated with carpal tunnel syndrome
25
Q

What complications can the sensory loss due to DM polyneuropathy cause?

A
  1. diabetic foot because of sensory loss
  2. impaction of foreign objects
  3. foot ulcers
  4. Charcot joint
26
Q

What is the treatment of DM polyneuropathy?

A

1.Control of glucose
2. foot care
3. pain management
Even though we can control glucose the damage is often irreversible

27
Q

What is alcohol related polyneuropathy?

A
  • slow and progressive over weeks and months
  • affects the lower limbs more than the upper limbs
  • usually sensory features like numbness, paraesthesia, 40% experience pain
28
Q

What causes the polyneuropathy in alcohol users?

A
  1. toxic effects of the alcohol

2. vitamin deficiencies

29
Q

What is the culprit protein that causes alcohol related polyneuropathy?

A
  1. acetyldehyde
30
Q

What are the 2 types of alcohol polyneuropathy are there?

A
  1. alcohol polyneuropathy
    - more sensory than motor
    - poor response to treatment with thiamine
    - slowly progressive
  2. thiamine deficiency polyneuropathy
    - presents with more motor symptoms
    - good response to thiamine
    - acute or subacute
31
Q

What is neuropathy of chronic renal failure?

A
  • insiduous and slow onset
  • weakness, reduced reflexes, paraesthesia, atrophy
  • develops at GFR <12ml/min
  • only occurs in end stage kidney disease
32
Q

What is the treatment of chronic renal disease polyneuropathy?

A

Does not respond to dialysis so renal transplant is necessary

33
Q

What is toxic neuropathy?

A

caused by medication

  • chemotherapy
  • ARV’S
  • Antibiotics like quinolones
34
Q

What are the 3 conditions associated with HIV polyneuorpathy?

A
  1. distal sensory polyneuropathy(most common)-disabling pain, paraesthesia
  2. demyelinating polyneuropathy-GBS
  3. diffuse infiltrative lymphocytosis syndrome-RARE
35
Q

How does B12 deficiency present?

A

90% or more presen with myeloneuropathy

36
Q

What are the clinical features of B12 NEUROPATHY?

A
  1. Polyneuropathy
    - loss of weakness
    - atrophy of distal muscles
    - loss of reflexes
  2. Subacute combined degeneration of the cord:
    - UMN bladder symptoms
    - brisk reflexes
    - loss of proprioception
  3. beefy red tongue
37
Q

What is important about vit B12 deficiency?

A

We must always investigate the cause and check it is not caused by pernicious anaemia, atrophic gastritis which is problems with absorption

38
Q

How do we treat Vit B12?

A

We can inject intramuscular B12 for life

39
Q

What is CIDP?

A

It is chronic inflammatroy demyelinating polyneuropathy

  • inflammatory demyelination of peripheral nerves and roots
  • responds to steroid treatment and IV immunoglobulins
40
Q

What are the clinical features of chronic inflammatory demyelnating polyneuropahy?

A
  1. proximal and distal weakness
  2. sensory loss and paraesthesia in feet and hands
  3. global arreflexia
  4. there’s already atrophy of hand muscles
41
Q

What are the causes of mononeuropathy multiplex?

A
  1. vasculitis

2. diabetes

Internal Med (15 decks)

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