peripheral neuropathy

Question 1

Causes of peripheral neuropathy

Answer 1

DM2

B12 deficiency

HIV infection

Alcohol use

drugs/medications

lyme disease

idiopathic

multiple myeloma

monoclonal gammopathy of unknown significance

acromegaly

Thyroid issues -hypothyroid

porphyria

Question 2

most common cause of peripheral neuropathy in adults:

Answer 2

diabetic neuropathy

Question 3

presentation of diabetic neuropathy

Answer 3

numbness, parathesias, burning of feet and insidious spreading in a stocking glove distribution. may have pain and temperature and vibration proprioception be impaired

Question 4

longstanding hypothyroidism can cause:

Answer 4

distal symmetric sensory neuropathy

Question 5

heavy metal causing peripheral neuropathy presentation

Answer 5

exposure hx and see extensor weakness (wrist drop and ankle drop) and rarely the sole symptom (see abdominal pain, myaglias, cognitive difficulties noted in lead poisoning)

Question 6

bilateral progressive distal sensory loss, ankle reflexia, high stepping ataxic gait positive Romberg sign (loss of proprioceptive function loss)

Answer 6

seen with peripheral neuropathy

Question 7

most common causes of peripheral neuropathy

Answer 7

DM2 and ETOH

Question 8

initial work up for peripheral neuropathy:

Answer 8

B12, TSH, ANA, RPR, HgbA1c, and ESR and CBC with serum protein electrophoresis. get blood glucose too

Question 9

paraproteinemia should be suspected as a cause of peripheral neuropathy when you see these lab findings?

Answer 9

anemia (normocytic) and hypercalcemia think MM

Question 10

What does romberg test evaluate?

Answer 10

Assess proprioceptive ability which _can be periphera_l and it does NOT assess cerebellar function.

can cause high steppage gait due to loss of proprioception

This being abnormal doesn’t mean that you have cerebellar issues.

Question 11

How to tell if someone has cerebellar ataxia?

Answer 11

ataxia that occurs with open eyes.

If it’s peripheral then they will have ataxia with closed eyes (Romberg sign)

Question 12

what test can assess cerebellar function?

Answer 12

Pronator drift

Question 13

porphyria can present as peripheral neuropathy but it also presents with

Answer 13

abdominal pain, psychiatric symptoms, autonomic dysfunction and chronic photosensitive rash.

Question 14

peripheral neuropathy signs, and abdominal pain, psychiatric symptoms, autonomic dysfunction and chronic photosensitive rash.

Answer 14

think porphyria for cause of peripheral neuropathy

Question 15

preferred medication to treat diabetic neuropathy

Answer 15

duloxetine

good for people who have concurrent major depression

Duloxetine is also helpful for diabetic neuropathy, fibromyaglia, and chronic lower back pain, and osteoarthritis.

can use SNRI or also TCas

Question 16

mononeuritis multiplex is

Answer 16

painful asymmetrical sensory and motor peripheral neuropathy that is seen with two or more nerves in different parts of the body

seen win vasculitis, connective tissue disorders, systemic disorders like DM2

see multiple long nerves: sciatic, peroneal, tibial and radial in random areas of the body affected. As dx progresses can become more confluent and symmetric.

Question 17

pts complain of pain, numbness dysesthesias, loss of reflexes and foot drop and steppage, foot slapping gait and wrist drop)

Answer 17

presentation of mononeuritis multiplex

clinical diagnosis and physcial exam are enough

Tx is controlling the primary disease process and those who remain symptomatic despite primary dx OTC drugs and TCAs and gabapentin are helpful.

Question 18

Foot drop is from?

Answer 18

anterior tibialis muscle weakness and this could be due to common peroneal nerve injury or L5 radiculopathy.

Common peroneal nerve compression: weakness of foot dorsiflexion, eersion, and toe extension. pain is uncommon

L5 radiculopathy- more extensive weakness involving hte foot dorsiflexion, eversion, and inversion, toe extension and possible weakness of leg abduction. Back pain is common.

sesnsation could be decreased along lateral leg and dorsum of foot in both disorders and reflexes are normal.

Question 19

what can cause foot drop or common peroneal nerve compression or L5 radiculopathy?

Answer 19

could be due to herniated disc

elderly people could be due to osteophyte formation and foraminal stenosis or degnerative changes from intervertebral discs and facet joints.

Need to get MRI to show compression of nerve root. Not necessary for most patients who have acute uncomplicated radiculopathy but with elderly pt with significant neurological deficits and falls need to get one.

Question 21

if there’s a new foot drop what test to be done first?

MRI or EMG

Answer 21

MRI should be done first as EMG will tell you peroneal neuropathy as cause of foot drop but if findings suggest radiculopathy need MRI done.