peripheral neuropathy Flashcards
symptoms?
• Sensory: numbness, tingling, “pins and
needles”, pain, cramps
• Motor: weakness, wasting, difficulty
walking, unsteady
Symptoms tend to start in the feet
signs?
- Tone: normal
- Power: distal weakness +/- wasting
• Reflexes: depressed or absent
(AJ before KJ)
- Sensation: “sock +/- glove” distribution
- Gait: normal/ataxic/foot drop
common causes
• Diabetes mellitus
• Alcohol/drugs
• Inflammation
• Inherited
• Others: cancer, infection (leprosy, HIV,
Lyme disease)
investigations?
• Glucose
• FBC, ESR, U&E, LFTs, thyroid function,
B12, autoimmune screen,
serum protein electrophoresis
• Nerve conduction studies:
Normal : 50-60 m/s
Axonal: 37-40 m/s
Demyelinating: 5-36 m/s
case 1.
• 49y/o man
• Diabetic for 15 years. Modest control
• 12 months of tingling and numbness in his feet
6 months of burning and shooting
pains in his feet – worse at night, causing
insomnia and depression
Examination: normal strength
absent ankle jerks
impaired vibration/PP/LT to mid shin
• Sensory; axonal
• Commonest symptoms:
pains, pins and needles, numbness
• Signs:
absent ankle jerks
“sock” pattern of sensory loss
case 1 treatment
- Maintain good blood glucose control
- Foot care
- Pain relief
examination of someone with guillian barre syndrome?
Examination
• Mild bilateral facial weakness
• Global arm and leg weakness dist>prox
• Absent reflexes
• Mild glove and stocking sensory loss
• Could just stand/walk with support
patology of guillian barre?
• Motor; demyelinating
• Incidence: 2 in100,000 population
• Develops after an infection (eg campylobacter)
• Progresses over 4 weeks to
(i) limb paralysis
(ii) cranial nerve problem
(iii) respiratory muscle weakness
(iv) autonomic dysfunction
treamtne of GB syndrome?
• Ascending paralysis can lead to weakness
of the diaphragm and chest wall muscles
• Cardiac arrhythmias
Treatment: intravenous immunoglobulin
plasma exchange
ventilatory support
cardiac monitor
history of charcot marie tooth syndrome patient?
24y/o man referred because of problems
walking going back 6 months
• Problems running as a child
• Always had funny shaped feet
• His sister had odd feet as did his mother
foot drop also called?
pes cavus
CMT may posses?
small hands
claw hands (fingers drawn inwords)
pathology of CMT?
• Sensori-motor; axonal or demyelinating
• Autosomal dominant inheritance
• Begins early in life and so associated with
foot deformities (pes cavus), clawed toes
difficulties walking/running
• Affects 1 in 2500
peripheral myelin protein 22?
• Chromosome 17 – short arm is duplicated
• Gene for Peripheral Myelin Protein 22Kd
(PMP 22) is on short arm
• Test +ve in 70% of cases
CMT 1: demyelinating, PMP22 duplication
CMT 2: axonal. No gene marker to date
