Peripheral Neuropathy Flashcards
Key Questions to ask in Hx
Onset (abrupt/definite date vs gradual, insidious)
Duration (acute vs chronic)
Neuro: predominant which symptoms (motor, sensory or mixed)
List the causes of peripheral neuropathy
Alcohol, AIDP
B12, B6, B1 deficiency
CIDP, Cancer (e.g. paraneoplastic)
Diabetes, Drugs (anti-TB, chemotherapy, cardiac and antibiotics)
Environmental
Familial - HSMN
Others: uremia, infections: e.g. HIV, Hep C (cryo), Lyme
or
Inherited, Metabolic
Immune (vasculitic vs non vasculitic), Infection, Neoplastic
Investigations
NCS:
Confirm nerve damage
Axonal – reduction in amplitude of compound muscle action potentials (CMAP)
Ddx: Alcohol, Diabetes Mellitus, HSMN II, most peripheral neuropathies
Demyelinating – slow nerve conduction velocity
Ddx: GBS / CIDP, Carcinoma (para-neoplastic), HSMN I
Etiology:
- Diabetes – Fasting Glucose / HbA1c
- Alcohol misuse – LFT and GGT
- Serum Vitamin B12
- Uremia – Renal panel
GBS – LP shows raised protein level “Cyto-albumic dissociation”
Management
Principles:
* Multidisciplinary team approach (neurologist, PT, OT)
* Aim of optimizing function, (reducing disability) and preventing handicap
–> Walking-aids, ankle foot orthoses (AFOs)
–> Physiotherapy and rehabilitation
* Treat underlying cause (e.g. stop drugs/alcohol, replace B12, IVIG for GBS)
* Tendon transfers or surgical correction of deformities
