peripheral neuropathy Flashcards
What is motor nerve damage associated with
muscle weakness
-fasiculations
-muscle atrophy
-painful cramps
What symptoms will you have with sensory nerve damage
Loss of vibratory sense
stocking glove sensation
loss of reflexes
loss of position sense
loss of temp sense
What is another name for autonomic nerve damage
small fiber neuropathies
What symptoms will you have with autonomic nerve damage
excess sweating
heat intolerance
inability to expand
What is neuropathy of several discrete nerves known as
multiple mononeuropathy
What is polyneuropathy
multiple nerves diffusely
What are some acquired sources of neuropathy
trauma (physical injury)
Diabetes
Vascular / blood problems (CAD)
systemic autoimmune diseases (SLE)
triggered autoimmune disease (Guillian-barre)
What is the leading cause of polyneuropathy in the US
Diabetes
Where does Guillian-Barre neuropathy generally present first
trunk
What is the most common cause of single nerve injury
Physical injury
What are some genetic sources of neuropathy
Charcot-Marie-Tooth
What is the most common inherited nerve disorder
Charcot-Marie-Tooth
What is a common infection that can cause neuropathy
HIV
What are the physiologic tests for nerve function
Nerve conduction velocity (NCV)
Electromyography (EMG)
What does NCV measure
signal strength and speed
What does EMG measure
Electrical activity rest/contraction
What are some neuropathology tests for nerve appearance
Nerve bx (usu. from lower leg)
Neurodiagnostic skin bx
What is the gold standard for dx small fiber neuropathies
Neurodiagnostic skin biopsy
What does MRI for neuropathy look for
Compression
mass
soft tissue structures
What does CT for neuropathy look for
Mass
Solid tissue structure (spinal stenosis)
What are some therapies than can help improve some peripheral neuropathies
orthotics
acupuncture
CBT
Behavioral strategies
What are some surgeries that can be done to help peripheral neuropathy
decompress a nerve
severing the nerve and replace w/ stimulation
What is the best treatment for peripheral neuropathy
Prevention
If a patient presents with profound motor weakness with minimal atrophy and reflexia, what dx should you consider
Acquired demyelinating polyneuropathy
If a patient presents with chronic progressive muscle weakness, fasciculation, muscle atrophy, and no sensory deficits, what dx should you consider?
Motor neuron disease
What is an autonomic testing for peripheral neuropathy
QSART testing
What are the symptoms someone with vascular / ischemic neuropathy may present with
Abnormal pain / temperature sensation
Atrophy in proportion to weakness
disproportionate preservation of reflexes
What is complex regional pain syndrome
Chronic pain condition (>6mo) that most often affects one limb.. usually after injury
If someone presents with prolonged or excessive pain and changes in skin color, temperature, and/or swelling in affected area, what might their dx be
CRPS
What are the types of CRPS
CRPS 1
CRPS 2
What is CRPS 1
No confirmed injury
*reflex sympathetic dystrophy syndrome
What is CRPS 2
Associated and confirmed injury
*causalgia
Which gender is more apt to get CRPS
Women (roughy age 40)
Who is CRPS more common in
Patients with other inflammatory disorders
What are the most common triggers for CRPS
Fx, strains, limb immobilization
Soft tissue injury
Surgery
What is the benefit of nerve conduction studies and EMGs
Helps distinguish between demyelinating disorders from axonal disorders
What are some vascular effects that may occur from CRPS
Possible ischemia of deeper tissue, causing muscle and joint pain/damage
may dilate/leak fluid into surrounding tissue causing red/swollen skin
May over constrict causing old, white, bluish skin
What are some immune system effects of CRPS
High levels of cytokines
*redness, swelling, and warmth
What is the key symptom of chronic regional pain syndrome
Prolonged severe pain that may be constant
What is the best treatment for CRPS
Rehab or PT
What is the most common cause of Vitamin B12 deficiency
Lack of intrinsic factor (common in elderly)
*pernicious anemia
What are some reasons a person may develop vitamin B12 neuropathy
Autoimmune
malabsorption
Dietary insufficiency
Which ancestry is most likely to have pernicious anemia
Northern European ancestry
What is the H&P focused on with workup for Vitamin B12 neuropathy
GI and Neuro findings
What signs are consistent with macrocytic anemia
Pallor
fatigue
What blood work will be done to dx Vitamin B12
CBC with peripheral smear
serum B12
Folate
*MMA
*homocysteine
What differentials should be ruled out with vitamin B12 neuropathy
Lead toxicity
Syphillis
MS
What are some complications if Vitamin B12 deficiency goes undiagnosed
Heart failure
Severe neurologic deficits
Increased risk for gastric cancer
Increased risk for autoimmune diseases
What is Guillian-Barre syndrome
Rare neurologic disorder in which the body’s immune system mistakenly attack peripheral nervous system
Who are more frequently effected by Guillian-Barre syndrome
Most common in adults and older people
How can Guillian-Barre be life threatening
Potentially interferes with breathing, BP, and HR
When do most cases of Guillian-Barre present
A few days or weeks following a respiratory or GI viral infection
What virus caused an increase incidence of GBS
ZIKA
How will GBS present
Symmetric weakness is the most characteristic
Symptoms can increase in intensity over a period of hours, days, weeks until certain muscles cannot be used at all
What are the key diagnostic findings with GBS
Recent onset
abnormal sensations
Absent / diminished deep tendon reflex
Recent viral infection / diarrhea
What is the most common type of GBS in the US
Acute inflammatory demyelinating polyneuropathy
What are the 2 types of GBS
Acute inflammatory demyelinating polyneuropathy
Acute motor axonal neuropathy
Millie-Fisher syndrome
Chronic inflammatory demyelinating polyneuropathy
multifocal motor neuropathy
What is the acute treatment of Guillian-Barre
Admit and treat in ICU
-Plasmapheresis
-IVIG
