Peripheral neuropathy Flashcards

1
Q

Describe the characteristics of the following types of nerve damage in terms of symptoms, power, sensation and reflexes:

  • large motor fibre
  • large sensory fibre
  • Small fibre
  • Autonomic
A

-weakness, unsteadiness, wasting
reduced
normal
absent

-numbness, parasthesia, unsteadiness
normal
vibration and JPS reduced
absent

-pain, Dysesthesia
normal
pin prick and temp reduced
present

-dizzines (postural hypotension), impotence, nausea and vomiting (gastroparesis)
normal
normal
present

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2
Q

Name the different points at which nerve damage can occur?

A

Order is from spinal cord proximity outwards:
radiculopathy
Plexopathy
peripheral neuropathy (mononeuropathy, mononeuritis multiplex, length dependent)

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3
Q

Describer the features of the types of peripheral neuropathy:
mononeuropathy
mononeuritis multiplex
length dependent

A
  • effects a single nerve e.g. carpal tunnel
  • multiple whole nerves taken out, asymmetrical, assoc with vasculitis
  • symmetrical, effects the longest nerves from hands and feet up
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4
Q

Describe the possible patterns of loss that occur with:

  • length dependant?
  • Mononeuritis/ Mononeuropathy?
  • what investigation should be done?
A

-glove and stocking, mild-severe

-might get muscle wasting in thenar eminence
on neuritis: wrist and foot drop

-nerve conduction study

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5
Q

What are the 2 ways in which nerves can be damaged?

-what would investigation show?

A

-Axonal loss
Peripheral nerve demyelination

-demyelinating= bizarre and jittery,

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6
Q

demyelinating neuropathy

-types? (2) and causes of each types? (1,2)

A

-Acute
GBS(Guillaine Barre syndrome or AIDP)

Chronic
CIDP (chronic inflammatory demyelinating polyradiculopathy)
Hereditary sensory motor neuropathy

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7
Q

Guillan-Barre syndrome

  • what is it?
  • presentation?
  • cause?
  • treatment?
A

-progressive paraplegia over days up to 4 weeks
sensory symptoms proceed weakness

  • acute, ascending and progressive neuropathy, characterised by weakness, paraesthesiae and hyporeflexia
  • might be post infection e.g. campylobacter
  • immunoglobulin infusion or plasma exchanges
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8
Q

Hereditary neuropathy

  • types? (6)
  • inv?
  • signs in type 1?
A
  • motor, sensory, sensorimotor, small fibre, autonomic variants , congenital insensitivity to pain syndrome
  • genetic testing for common mutations e.g. CMT1a

-foot deformity
champagne bottle wasting (of tibial muscle)

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9
Q

Causes of axonal neuropathies?

  • vasculitic? (2)
  • paraneoplastic? (2)
  • infections? (4)
  • drug/toxin? (4)
  • Metabolic? (5)
A

Idiopathic!!

  • ANCA +ve, RA, sjogrens
  • Myeloma, antibody mediated
  • HIV, syphilis, Lyme, hepatitis
  • Alcohol, amioderone, phenytoin, chemo
  • DM, B12/folate def, Hypothyroidism, chronic uremia, pophyria
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10
Q

Autonomic neuropathy:

-give the two types and their causes?

A

-Chronic
DM, Amyloidosis, hereditary

Acute
GBS, Porphyria

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11
Q

Treatment of peripheral neuropathy:

  • Axonal? (3)
  • demyelinating? (3)
A

-Treat cause (i.e. clear hepatitis)
Symptomatic treatment (physio, orthotics, neuropathic pain relief)
Vasculitic- IV methylprednisolone + cyclophosphamide

-IVIg
steroids
azathioprine, mycophenalate, cyclophosphamide

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