Peripheral neuropathy Flashcards
What is Charcot-Marie Tooth disease
A herditary sensorimotor disorder HSMD
chronic demyelinating disorder of the PNS
Presents in 20s
Features of Charcot Marie Tooth
Distal muscle wasting and weakness Champagne bottle appearance pes cavus absent reflexes loss of sensation calf muscle atrophy
What is Guillain Barre syndrome (GBS)
an acute demyelinating disorder of the PNS
Features of GBS
pain very common
acute <4 weeks
symmetrical progressive sensorimotor paralysis
areflexia - lose reflexes
associated with post infectious state eg campylobacter
off legs
What is chronic inflammatory demyelinating polyradiculoneuropathy
acquired demyelinating condition of the PNS
what 5 questions should be asked when it comes to identifying peripheral neuropathy disease
- which nerves are damaged
- where are they damaged
- how are they damaged
- why are they damaged
- how to manage this
PNS includes ANS, true or false
true
modality and function of motor nerves
Aa
muscle control
symptoms of damage to motor nerves
muscle weakness and wasting
unsteadiness
reduced power
are reflexes absent or present with motor neuron damage
absent
is sensation preserved or diminished in motor neuron damage
preserved
modality and function of sensory nerves
Aa / AB
fine touch and proprioception
symptoms of damage to sensory nerves
reduced vibration and proprioception
is power preserved or diminished in sensory neuron damage
preserved
are reflexes absent or present with sensory neuron damage
absent
modality and function of small fibres
A delta / C
pain and temperature sensation
symptoms of small fibre damage
reduced pain and temperature sensation
is power preserved or diminished in small fibre damage
preserved
are reflexes present or absent in small fibre damage
present
modality and function of autonomic nerves
A delta / C
HR, BP, sweating, gut
is power preserved in autonomic nerve damage
yes
is sensation preserved in autonomic nerve damage
yes
are reflexes present in autonomic nerve damage
yes
what is pseudoathetosis
large fibre sensory neuropathy with damaged joint position sense
what is radiculopathy
damage to the nerve roots
what is plexopathy
damage to the plexus
what is peripheral neuropathy
damage to the nerves distal to plexus
what are the types of peripheral neuropathy
mononeuropathy
mononeuritis multiplex
length dependent peripheral neuropathy
give examples of mononeuropathy
carpal tunnel syndrome
cubital tunnel syndrome
common fibular nerve palsy
what is mononeuritis multiplex
painful, patchy distribution
affects more than 2 isolated nerve areas
is mononeuritis multiplex symmetrical
NO
does not have rules of symmetry
in which conditions in mononeuritis multiplex seen
DM
vasculitis
SLE
amyloidosis
describe distribution of length dependent peripheral neuropathy
glove and stocking distribution
symmetrical
weakness +/or sensory loss
how can nerves be damaged
axonal loss
peripheral nerve demyelination
how can peripheral demyelination be classified
acute
chronic
examples of acute peripheral demyelinating disease and what is the timescale
Guillain Barré syndrome
Acute Inflammatory Demyelinating Polyradiculoneuropathy AIDP
days - weeks
examples of chronic peripheral demyelinating disease and what is the timescale
Hereditary Sensory Motor neuropathy HSMN aka Charcot Marie Tooth disease
Chronic Inflammatory Demyelinating Polyradiculoneuropathy CIDP
months - years
management of GBS
IVIG +/or plasma exchange
causes of axonal neuropathies
idiopathic vasculitic paraneoplastic infections drugs/toxins metabolic
causes of autonomic neuropathies
DM amyloidosis hereditary Guillain Barré porphyrias
what is the ABCDEE of peripheral neuropathies
Alcohol B12 / folate deficiency Cancer / CKD Diabetes Every vasculitis Especially ANCA and RA
which drugs can cause peripheral neuropathy
phenytoin
chemotherapy - cisplatin/vincristine
alcohol
amiodarone
