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Y3 - Neuro > Peripheral Neuropathy > Flashcards

Peripheral Neuropathy Flashcards

1
Q

What is peripheral neuropathy?

A

Dysfunction of peripheral nerves due to local damage, compression or peripheral disease

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2
Q

What is radiculopathy?

A

Compression of spinal nerve roots

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3
Q

What are the symptoms of radiculopathy?

A

Sensory disturbance and weakness in nerve root dysfunction

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4
Q

What is plexopathy?

A

Nerve dysfunction at the level of a nerve plexus

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5
Q

What are the symptoms of plexopathy?

A

Sudden onset of neuopathic pain with associated numbness, tingling and weakness

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6
Q

What is the presentation of motor nerve peripheral neuropathy (symptoms, power, sensation, reflexes)?

A

Weakness, gait disturbance, wasting
Reduced power
Normal sensation
Absent reflexes

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7
Q

What is the presentation of large sensory nerve peripheral neuropathy (symptoms, power, sensation, reflexes)?

A

Numbness, paraesthesia, ataxia
Normal power
Vibration and proprioception sensation decreased
Absent reflexes

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8
Q

What is the presentation of small sensory nerve peripheral neuropathy (symptoms, power, sensation, reflexes)?

A

Pain, dysesthesia (abnormal sensation)
Normal power
Pin prick and temperature sensation decreased
Reflexes present

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9
Q

What is the presentation of autonomic nerve peripheral neuropathy (symptoms, power, sensation, reflexes)?

A

Dizziness, impotente, bladder disturbance, nausea/vomiting
Normal power
Normal sensation
Reflexes present

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10
Q

What is mononeuropathy?

A

Peripheral neuropathy in which a single nerve is affected

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11
Q

What is mononeuropathy caused by?

A

Peripheral nerve compression and entrapment

Focal demyelination occurs at compression site and some axonal degeneration happens

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12
Q

What is axonal degeneration?

A

Damage to axons
Nerve fibre dies back from the periphery
Conduction velocity initially normal as continuity is maintained in surviving fibres
Length dependent neuropathy

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13
Q

What does length dependent neuropathy mean?

A

Longest, most vulnerable axons (to the toes) damaged first

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14
Q

What investigation is done for mononeuropathies?

A

Nerve conduction studies

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15
Q

What is the main example of a mononeuropathy?

A

Median nerve (carpal tunnel syndrome)

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16
Q

What are the symptoms of carpal tunnel syndrome?

A

Aching pain in hand at night
Loss of sensation over thumb, index, middle and lateral half of third finger
Thenar wasting and weakness in grip strength

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17
Q

What conditions are associated with carpal tunnel syndrome?

A

Diabetes
Rheumatoid
Overuse
Pregnancy

18
Q

What is the management for carpal tunnel syndrome?

A

Splinting
Steroid injections
Decompression surgery

19
Q

What are the symptoms of ulnar nerve neuropathy?

A

Sensory loss over medial 1.5 fingers
Development of ulnar claw
Hypothenar muscle wasting
Weakness in wrist flexion and flexion of 4th/5th DIP

20
Q

What is the management of ulnar nerve neuropathy?

A

Surgical decompression

21
Q

What are the symptoms of radial nerve neuropathy?

A

Wrist drop
Weakness of brachioradialis and finger extension
Loss of sensation in dorsal first web space

22
Q

What is the management of radial nerve neuropathy?

A

Supportive - usually recovers within 1-3 months

23
Q

What are the symptoms of lateral cutaneous nerve of the thigh nerve neuropathy?

A

Burning thigh pain

24
Q

What are the symptoms of common fibular nerve neuropathy?

A

Foot drop

Loss of sensation laterally below the knee and over the dorm of the foot

25
Q

What are the symptoms of tibial nerve neuropathy?

A

Sensory loss over sole of foot
Weakness in plantar flexion (unable to stand on tiptoes)
Weakness in inversion of the foot and flexion of the big toes

26
Q

What is mononeuritis multiplex?

A

When 2 mononeuropathies in distinct locations develop at the same time

27
Q

What are causes of mono neuritis multiplex?

A 
Diabetes
Rheumatoid
Carcinomatosis
Vasculitis: Wegener's, PAN
Infection: HIV, leprosy
28
Q

What are the general features of presentation of polyneuropathy?

A

Usually symmetrical and widespread
Sensory symptoms - in glove and stocking distribution with subsequent proximal spread
Motor symptoms - progressive weakness with associated respiratory difficulties
Can be autonomic, cranial nerve symptoms

29
Q

What are the types of damage in polyneuropathy?

A

Axonal damage

Demyelination

30
Q

What are the causes of axonal damage causing polyneuropathies?

A

Metabolic: diabetes, renal failure, hypothyroidism
Nutritional: B12, copper, zinc
Vasculitic: Wegener’s, PAN, rheumatoid
Infections: HIV, syphilis, Lyme
Drug/toxins: alcohol, cisplatin, vincristine, isoniazid
Malignancy: paraneoplastic

31
Q

What is the mechanism of damage in demyelination?

A

Schwann cell damage leads to myelin sheath disruption

This causes marked slowing of conduction

32
Q

What are causes of demyelination causing polyneuropathies?

A

Guillian-Barre syndrome
CIDP - chronic inflammatory demyelinating polyneuropathy
Charcot-Marie Tooth Disease

33
Q

What is Guillian-Barre syndrome?

A

Acute, autoimmune inflammatory demyelinating peripheral neuropathy

34
Q

What is the presentation of Guillian-Barre syndrome?

A

Usually few weeks after infection (upper resp, GI)
Ascending muscle weakness starting in the lower limbs and spreading, usually over a four week period leading to paralysis
Associated pain, sensory loss, autonomic dysfunction, cranial nerve symptoms
Loss of reflexes

35
Q

What is the clinical course of of Guillian-Barre syndrome?

A

Typically worsening of paralysis for up to four weeks and then recovery phase starts - full recovery is seen in the majority of patients

36
Q

What investigations are done in Guillian-Barre syndrome?

A

Neve conduction studies - slowed conduction

Lumbar puncture - increased protein with normal white cells

37
Q

What is the management of Guillian-Barre syndrome?

A

IV immunoglobins
Plasmapheresis
+/- ventilatory support

38
Q

What is CIDP (chronic inflammatory demyelinating polyneuropathy)?

A

Variant of Guillian-Barre syndrome associated with slower onset of symptoms and a much slower recovery (months – years)

39
Q

What is Charcot-Marie Tooth Disease?

A

Heredity sensory motor neuropathy

40
Q

What is the presentation of Charcot-Marie Tooth Disease?

A

Begins around puberty
Progressive distal muscle wasting in the legs giving rise to champagne shaped legs
Associated lower limb weakness
Foot drop and high stepping gait
+/- sensory disturbance and loss of reflexes

41
Q

What is the management of Charcot-Marie Tooth Disease?

A

Physiotherapy

42
Q

What investigations are done for peripheral neuropathies?

A 
Bloods
Urinalysis
Chest x ray
Lumbar puncture
Nerve conduction studies

Y3 - Neuro (14 decks)

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