Peripheral Neuropathy

Question 1

Large fibre motor 
Symptoms, 
Power, 
Sensation 
\+ Reflexes?

Answer 1

Weakness, wasting
Reduced
Normal
Absent

Question 2

Large Fibre sensory Symptoms,
Power,
Sensation
+ Reflexes?

Answer 2

Numbness, paraesthesia
Normal
Reduced
Absent

Question 3

Small fibre Symptoms,
Power,
Sensation
+ Reflexes?

Answer 3

Pain, Dyesthesia
Normal
Pin prick and temp reduced
Present

Question 4

Autonomic Symptoms,
Power,
Sensation
+ Reflexes?

Answer 4

Dizziness, Nausea and vomiting
Normal
Normal
Present

Question 5

Pseudoathetosis

Answer 5

abnormal writhing movements (typically of fingers/hands) due to failure of joint proprioception, indicating disruption of proprioceptive pathway from nerve to parietal cortex.

Question 6

Radiculopathy

Answer 6

pain, weakness, numbness and difficulty controlling certain muscles. Problem often occurs at root of nerve (shortly after its exit from the spinal cord) can be caused by spine herniation

Question 7

Plexopathy

Answer 7

pain, loss of motor control and sensory deficits. Occur at Brachial and lumbosacral plexus, often due to trauma (e.g. dislocated shoulder).

Question 8

Mononeuropathy

Answer 8

is isolated nerve damage out with CNS e.g. carpal tunnel syndrome. (compression, trauma, ischaemia, inflammation)

Question 9

Mononeuritis Multiplex

Answer 9

multiple nerves involved, asymmetrically. (Diabetes, vasculitis, SLE, Sarcoidosis, Amyloidosis)

Question 10

Polyneuropathy

Answer 10

multiple nerves involved, concurrently and symmetrically ‘Glove and Stocking’ í severe. (Diabetes, Acute Inflammatory Demyelinating Polyneuropathy [GBS], toxic/metabolic, hereditary)

Question 11

Acute demyelinating Neuropathy?

Answer 11

GBS

Question 12

Chronic demyelinating neuropathies?

Answer 12

CIDP

HSMN

Question 13

what is Guillaine Barre syndrome?

Answer 13

progressive Paraplegia over days to weeks. Sensory symptoms proceed to weakness + pain very common!
25% require mechanical ventilation, 10% die from autonomic failure

Question 14

possible cause of GBS?

Answer 14

infection (post campy)

Question 15

Treatment of GBS?

Answer 15

Immunoglobulin infusion and or plasma exchange

Question 16

Hereditary Sensory Motor Neuropathy is also known as …

Answer 16

Charcot Marie Tooth Disease

Question 17

Most common HMSN and how it presents?

Answer 17

HMSN type 1

Weakness in legs in adolescence then weakness in hands

Question 18

what is an axonal neuropathy?

Answer 18

axonal atrophy/degeneration

Question 19

causes of axonal neuropathy?

Answer 19

• Idiopathic
• Vasculitic (ANCA +ve, RA/Sjogrens)
• Paraneoplastic (myeloma, antibody mediated)
• Infections (HIV, syphilis, Hep B/C)
• Drugs/Toxins (Alcohol, Amiodarone, Chemo)
• Metabolic (DM, B12/folate deficiency, hypothyroidism)

Question 20

Autonomic neuropathy causes

Answer 20

• Acute = GBS + Porphyria

- Chronic = Diabetes, Amyloidosis + Hereditary

Question 21

Axonal neuropathy treatment?

Answer 21

• Treat cause (ie clear hepatitis C)

- Symptomatic treatment - physiotherapy, orthotics, neuropathic pain relief.

Question 22

Axonal (vasculitic) treatment?

Answer 22

• Pulsed IV methylprednisolone + cyclophosphamide

Question 23

Demyelinating (inflammtory neuropathy) treatment?

Answer 23

• IVIg (pooled immunoglobulin from donors)
• Steroids
• Azathioprine, mycophenalate, cyclophosphamide