Peripheral Neuropathies & ALS (Exam #4) Flashcards
How can you differentiate Radiculopathy from Peripheral Neuropathy?
Radiculopathy = nerve root lesion/compression NOT peripheral (involve segmental pattern/dermatomes)
How can you differentiate Myopathy from Peripheral Neuropathy?
Myopathy = proximal motor weakness with NO sensory
- Peripheral Neuropathy = distal motor weakness; ANY sensory
What is the most common nerve affected with Mononeuropathy Peripheral Neuropathy, and what condition does this result in?
Median n.
- Carpal Tunnel Syndrome (CTS)
What population is most affected by Polyneuropathy Peripheral Neuropathy?
DM patients
What are the five pathologies of Peripheral Neuropathy?
- Mechanical
- Vascular
- Axonal
- Neuronal
- Demyelinating
What two causes can lead to Mechanical pathology of Peripheral Neuropathy?
- Compression
- Entrapment
What two causes can lead to Vascular pathology of Peripheral Neuropathy?
- Venous disease
- Arterial occlusion
How can you differentiate Vascular Peripheral Neuropathy from conditions like Polyarteritis Nodosa or RA?
- Polyarteritis Nodosa or RA = widespread (MULTIPLE nerve distributions)
What does Axonal pathology of Peripheral Neuropathy likely indicate?
DM problems
What pathology of Peripheral Neuropathy involves symmetric with sensory loss in feet? Which two types of sensory are lost first?
Axonal = DM problems
- Thermal and vibratory lost first
Which pathology of Peripheral Neuropathy has SENSORY deficits dominating? Which has MOTOR deficits dominating?
- Axonal = SENSORY
- Neuronal = MOTOR
What condition is the most common Neuronal Peripheral Neuropathy?
ALS
Which pathology of Peripheral Neuropathy involves involvement of distal AND proximal muscles + fasciculations?
Neuronal
Which pathology of Peripheral Neuropathy is immune-mediated?
Demyelinating
What is seen in CSF of ALL Demyelinating Polyneuropathies?
Elevated proteins in CSF
What two conditions are associated with Demyelinating Peripheral Neuropathy? What is the course of each?
- Guillain-Barre = ACUTE
- Charcot-Marie-Tooth = CHRONIC
What pathology of Peripheral Neuropathy is Guillain-Barre associated with?
Demyelinating
What condition involves pins and needles in feet that progresses to weakness in legs moving proximally?
Guillain-Barre
- Acute Demyelinating Peripheral Neuropathy
What condition involves slowly evolving foot drop, distal wasting of intrinsic feet muscles?
Charcot-Marie-Tooth
- Chronic Demyelinating Peripheral Neuropathy
What pathology of Peripheral Neuropathy is Charcot-Marie-Tooth associated with?
Demyelinating
How does Polyneuropathy Peripheral Neuropathy sensory loss often present?
Distally as a “stocking glove” distribution
What condition involves symmetric/generalized distal sensory and proximal motor sxs?
B-12 Deficiency
What is the dx test of choice for Peripheral Neuropathies?
EMG/NCS
Which pathology of Peripheral Neuropathy presents with denervation changes on EMG?
Axonal
Which pathology of Peripheral Neuropathy presents with slowing on NCS?
Demyelinating
What is seen on NCS with Mononeuropathy Peripheral Neuropathies?
Slowing in ONE nerve
What is seen on NCS with Polyneuropathy Peripheral Neuropathies?
Slowing in MULTIPLE nerves
What two meds/class of meds are considered for tx of Peripheral Neuropathies?
- NSAIDs
- Gabapentin/Pregabalin
What class of meds may be considered for tx of Peripheral Neuropathies if DM too?
TCAs (Amitriptyline)
What is the recommended tx for Guillain-Barre? What meds do NOT help?
Supportive care
- Steroids do NOT help)
What condition involves both upper AND lower motor neurons with NO sensory sxs?
Amyotrophic Lateral Sclerosis (ALS)
What condition involves weakness in hands/arms moving distally?
Amyotrophic Lateral Sclerosis (ALS)
How can you differentiate Amyotrophic Lateral Sclerosis (ALS) from Guillain-Barre?
- ALS = weakness moves DISTALLY
- Guillain-Barre = weakness moves PROXIMALLY
What condition involves both upper AND motor neuron signs in SAME limb?
Amyotrophic Lateral Sclerosis (ALS)
What is the hallmark sign of Amyotrophic Lateral Sclerosis (ALS)?
Both upper AND lower motor neuron signs in SAME limb
Fasciculations in what body part are often associated with Amyotrophic Lateral Sclerosis (ALS)?
TONGUE
that is a tongue → ‘U’
What are three examples of UMN signs?
- Increased tone
- Hyperreflexia
- Spastic
What are three examples of LMN signs?
- Wasting/atrophy
- Hyporeflexia
- Fasciculations
What is the dx of Amyotrophic Lateral Sclerosis (ALS)?
Clinical
What class of meds may be considered for tx of Amyotrophic Lateral Sclerosis (ALS), and what sxs do they specifically treat?
Anticonvulsants
- Tx fasciculations
