peripheral neuropathy

Question 1

Most common causes of peripheral neuropathies

Answer 1

VITAMINS

vitamin deficiency/vasculitis
infections (TB, leprosy)
toxic (amiodarone, lead, vincristine)
amyloid
metabolic (alcohol, diabetes, porphyria, hyperthyroid, liver/renal failures)
idiopathic/inherited
neoplasm
systemic (SLE, PAN, MM)

Question 2

Guillain-barre syndrome (AIDP)

Answer 2

Autoimmune disease with ganglioside targets (anti-GM1)
Path: C jejuni or other respiratory infection or CMV/EBV
Sx: rapidly evolving ascending areflexic motor paralysis
- blubar weakness and respiratory muscle weakness can occur
- autonomic dysfunction may be present
- tendon reflexes disappear
Dx: CSF analysis, increased protein
- measurement of FVC important for questionable intubation
Tx: IVIg or plasmapheresis

Question 3

Miller-fisher variant

Answer 3

Of GBS

gait ataxia, areflexia, external ophthalmoplegia, no limb weakness

Question 4

Chronic inflammatory demyelinating polyneuropathy (CIDP)

Answer 4

Sx: slowly evolving weakness beginning in the legs with widespread areflexia and loss of vibratory sense, weakness of neck floxor, painful paresthesias
Dx: CSF, nerve conduction studies
Tx: IVIG therapy

Question 5

Multifocal motor neuropathy

Answer 5

pure motor multiple mononeuropathy
Sx: slowly progressive asymmetric distal limb weakness beginning in the arms
Dx: high IgM anti GM1
Tx: IVIg, rituximab, cyclophosphamide

Question 6

Charcot-Marie-Tooth disease

Answer 6

Adolescence with symmetric slowly progressive distal muscular atrophy of legs and feet, eventually involves the hands