Peripheral Neuropathy

Question 1

What are peripheral nerve diseases?

Answer 1

All the diseases involving the peripheral sensory and motor nerves.spinal nerves as well as CNs can get involved.
2 types
-focal neuropathy (mono neuropathy,mononeuritis multiplex)
-polyneuropathy (perpheral neuropathy)

Question 2

Classification of polymeuropathy?

Answer 2

Photo

Question 3

Features of axonal peripheral neuropathies?

Answer 3

4
BL
Symmetrical
Distal > proximal weakness
Glove and stocking numbness

Question 4

Chronic axonal neuropathies?
Mixed pathology (demyelination+axonal degeneration)

Answer 4

DM
Alchohol
Vit def (B1,B12,B6)
Toxic delayed organophosphate
Drugs- INAH,cisplastin,taxole,vincristine
Malignancy
HIV/AIDS
Familial
Heavy metal- lead,arsenic

DM
Uremia (RF)
Hypothyroidism

Question 5

Symptoms and signs of peripheral neuropathy?

Answer 5

Motor-
Muscle weakness and wasting (distribution depends on the type)
Cramps
Diminished or absent deep tendon reflex

Sensory-
Pins and needles feeling
Impairment of sensation
Hyperanesthesia
Burning and shooting pain

Question 6

Ix of peripheral neuropathy?

Answer 6

1.NCT
-confirms diagnosis
-determine the pathology
-locate the site
-assess the extent (focal or generalized)
-Assess the severity
2.nerve biopsy
Confirms pathology- particularly demyelination,vasculitis,leprosy ,amyloid
3.FBS
4.blood urea
5.FBC n blood picture
6.vit B12 levels
7.ESR
8.serum protein electrophoresis (due to myeloma monoclonal bands will present)
9.chest radiography (lung ca)

Question 7

Principals of mx?

Answer 7

5
Reverse etiology
Specific tx of the cause
Prevent further decline of the funtion
Symptomatic mx
Prevention

Question 8

Features of chronic inflammatory demyelinating polyneuropathy (CIDP)?

Answer 8

7
Will progress >8 weeks
Most common acquired demyelinating neuropathy
Polyradiculoneuropathy
Relapsing remitting or chronic progressive course
Insidious onset and slow progression over 8 w
Can mimic GBS
No clear antecedent infection

Question 9

Clinical features of CIDP?

Answer 9

BL symmetrical
Primarily motor neuropathy,affecting both proximal and distal muscles of lower and upper extremities (proximal >= distal)
Sensory is not significant,occasionally present with predominantly sensory symptoms
CN involvement is almost never
Deep tendon reflexes often absent

Question 10

Dx and tx of CIPD?

Answer 10

Dxx-
Clinical
NCS (Confirms the diagnosis and identify the pathology as demyelination)
CSF Ex (^ proteins, N cell count)

Tx-
Steroid
Plasma exchange
Ig
Cytotoxics -cyclophosphamide
Supportive care

Question 11

Features of peripheral neuropathy in diabetes?

Answer 11

Distal symmetrical sensory motor polyneuropathy
Diabetic amyotrophy
Small fiber
Autonomic neuropathy (postural dizziness,nocturnal diarrhea,erectile dysfunction,gustatory sweating)
Mono neuropathy (CN 3,6,CTS,ulnar N,common peroneal N)
Insidious onset
Slow progress
Sensory impairment prominent
Nocturnal cramps
Associated with poor control

Dx-clinical,NCS,threshold testing
Tx- good glycemic control