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Neurology > Peripheral Neuropathy > Flashcards

Peripheral Neuropathy Flashcards

1
Q

What 5 things should you always find out when trying to diagnose a peripheral neuropathy?

A 
1 - Which nerves are damaged?
2 - Where are they damaged?
3 - How are the nerves damaged? 
4 - Why are the nerves damaged?
5 - Can we stop the nerves from being damaged?
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2
Q

What is radiculopathy usually due to?

A

Intervertebral disc herniation

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3
Q

In peripheral nerve injury, what happens to reflexes?

A

Reflexes are reduced if there is damage to the afferent or efferent pathways

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4
Q

Peripheral neuropathy occurs due to a problem which affect the ________ _____?

A

PERIPHERAL NERVE

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5
Q

When there is damage to a large motor neurone, what symptoms are experienced?

A
  • WEAKNESS
  • Unsteadiness
  • Wasting
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6
Q

When there is damage to a large motor neurone, what happens to the power?

A

REDUCED

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7
Q

When there is damage to a large motor neurone, what happens to the sensation?

A

NORMAL

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8
Q

When there is damage to a large motor neurone, what happens to reflexes?

A

ABSENT

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9
Q

When there is damage to large sensory fibres, what symptoms are experienced?

A
  • NUMBNESS
  • PARAESTHESIA
  • Unsteadiness
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10
Q

When there is damage to large sensory fibres, what happens to the power?

A

NORMAL

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11
Q

When there is damage to large sensory fibres, what happens to the sensation?

A

Vibration and JPS are reduced

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12
Q

When there is damage to large sensory fibres, what happens to reflexes?

A

ABSENT

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13
Q

When there is damage to autonomic fibres, what symptoms are experienced?

A
  • Dizziness (postural hypotension)
  • Impotence
  • Nausea and vomiting (gastroparesis
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14
Q

When there is damage to autonomic fibres, what happens to power?

A

NORMAL

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15
Q

When there is damage to autonomic fibres, what happens to sensation?

A

NORMAL

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16
Q

When there is damage to autonomic fibres, what happens to reflexes?

A

PRESENT

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17
Q

When there is damage to small fibres, what symptoms are experienced?

A
  • Pain

* Dyesthesia

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18
Q

When there is damage to small fibres, what happens to power?

A

NORMAL

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19
Q

When there is damage to small fibres, what happens to reflexes?

A

PRESENT

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20
Q

When there is damage to small fibres, what happens to sensation?

A

Pin prick and temperature sensation are reduced

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21
Q

What is pseudoathetosis?

A

A problem with proprioception - there IS NOT a problem in the basal ganglia, but there is a problem in the peripheral nerve

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22
Q

Bilateral foot drop….

A

High stepping gait
Cant dorsiflex foot
Due to lesion in common perineal nerve

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23
Q

What would cause bilateral foot drop?

A

Lesion in common perineal nerve

24
Q

Describe mononeuritis multiplex.

A

Subacute - occurring over weeks to months

25
Q

What is mono neuritis multiplex usually driven by?

A

A nasty vasculitis

26
Q

What is mono neuritis multiplex dependant on?

A

LENGTH

27
Q

Describe the features of mono neuritis multiplex.

A
  • VERY symmetrical
  • Peripheral nerves die off from feet to wrists
  • Usually caused by metabolic processes e.g diabetes
28
Q

What causes mononeuritis multiplex often?

A

Diabetes

29
Q

What could muscle wasting of the thenar eminence be due to?

A
  • Carpal tunnel syndrome
  • Median nerve compression at the elbow
  • Plexopathy
  • MND
30
Q

Wrist drop

A

Radial nerve

31
Q

Foot drop

A

Common peroneall nerve - unable to dorsiflex

32
Q

What are the 3 major categories of nerve damage?

A
  1. Radiculopathy
  2. Plexopathy
  3. Peripheral neuropathy
33
Q

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

A
  • Axonal loss

* Peripheral nerve demyelination

34
Q

What test is done to find out which way nerves have been damaged?

A

Nerve Conduction Studies

35
Q

Give an example of an acute demyelinating neuropathy which occurs over days to weeks

A

GBS

36
Q

How does GBS often start?

A

TINGLING LIMBS

37
Q

How quick is it before someone with GBS can become quadriplegic?

A

Over the course of 2 weeks

38
Q

Give examples of chronic demyelinating neuropathies which occur over months to years.

A
  • CIDP (chronic inflammatory demyelinating polyradiculopathy)
  • Hereditary sensory motor neuropathy (formerly known as Charcot-Marie-Tooth disease)
39
Q

What is the key feature of GBS?

A

Progressive paraplegia over days, up to 4 weeks

40
Q

What precede the weakness in GBS?

A

Associated sensory symptoms

41
Q

What is very common in GBS?

A

PAIN

42
Q

When do peak symptoms occur in GBS?

A

10-14 days

43
Q

Initially, how can a GBS exam be?

A

NORMAL

44
Q

What does GBS have a possible association with?

A

Infection i.e campylobacter

45
Q

What do 25% of people with GBS require?

A

Mechanical ventilation

46
Q

How do 10% of people with GBS die?

A

From autonomic failure e.g cardiac arrhythmias

47
Q

What is the treatment for GBS?

A

Immunoglobulin infusion OR plasma exchange

48
Q

What are the different variants of hereditary neuropathy?

A

Pure motor, sensory, sensorimotor, small fibre (congenital insensitivity to pain syndrome) and autonomic variants
(also axonal and demyelinating variations)

49
Q

Genetic testing is available for the most common mutation in hereditary neuropathy. What is this mutation?

A

CMT 1a

50
Q

Give examples of CHRONIC causes of autonomic neuropathy.

A
  • Diabetes (via gastroparesis)
  • Amyloidosis
  • Hereditary
51
Q

Give examples of ACUTE causes of autonomic neuropathy.

A
  • GBS

* Porphyria

52
Q

If someone has a triad of:

  • Acute psychosis
  • Unexplained abdominal pain
  • Peripheral neuropathy

What are they liked to have?

A

Autonomic neuropathy caused by PORPHYRIA

53
Q

How are axonal peripheral neuropathies treated?

A
  • Treat cause

* Symptomatic

54
Q

Axonal peripheral neuropathies are REVERSIBLE

A

FALSE - IRREVERSIBLE

55
Q

How are vasculitic axonal peripheral neuropathies treated?

A

With pulsed IV methylprednisolone + cyclophosphamide

56
Q

How are demyelinating (inflammatory) peripheral neuropathies treated?

A

IV Ig (pooled immunoglobulin from donors).
Steroids.
Azathioprine, Mycophenalate, Cyclophosphamide.

Neurology (42 decks)

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