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Y4: Neurology > Peripheral neuropathy > Flashcards

Peripheral neuropathy Flashcards

1
Q

What are the different types of neuropathy?

A
  • Mononeuropathy (single nerve affected)
  • Multiple mononeuropathies (mononeuritis multiplex)
  • Symmetrical polyneuropathy
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2
Q

Name some genetic causes of polyneuropathy?

A
  • Charcot-Marie-Tooth (CMT) disease
  • Familial amyloid polyneuropathy
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3
Q

What drugs can cause a polyneuropathy?

A
  • Amiodarone
  • Antibiotics (dapsone, isoniazid, metronidazole, ethambutol)
  • Chemotherapy (cisplatin, vincristine, thalidomide)
  • Phenytoin
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4
Q

What toxins can cause a polyneuropathy?

A
  • Alcohol
  • Recreational use of nitrous oxide
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5
Q

What vitamin deficiencies can cause a polyneuropathy?

A
  • Thiamine
  • Pyridoxine
  • Vitamin E
  • Vitamin B12
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6
Q

What infections can cause a polyneuropathy?

A
  • HIV
  • Leprosy
  • Brucellosis
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7
Q

Name some inflammatory causes of polyneuropathy?

A
  • Vasculitis
  • Guillain-Barre syndrome
  • Chronic inflammatory demyelinating polyradiculoneuropathy
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8
Q

Systemical medical conditions which can cause a polyneuropathy?

A
  • Diabetes
  • Renal failure
  • Sarcoidosis
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9
Q

What are the types of polyneuropathy and why is it important to make a distinction?

A
  • Axonal
    • Damage to the nerve cell body
  • Demyelinating
    • Damage to the myelin sheath
  • * Only demyelinating neuropathies are susceptible to treatment
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10
Q

What does motor nerve involvement in neuropathies result in?

A

LMN lesions

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11
Q

What does autonomic nerve involvement in neuropathies result in?

A
  • Usually complications other neuropathies
    • Postural hypotension
    • Disturbance of sweating
    • GI, bladder and sexual dysfunction
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12
Q

Describe some investigations into peripheral neuropathy?

A
  • Glucose (fasting)
  • ESR, CRP, FBC, U&Es, LFTs
  • Serum protein electrophoresis
  • Vitamin B12, folate
  • ANA, ANCA
  • HIV testing
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13
Q

Describe entrapment neuropathies?

A
  • Usually the cause of a mononeuropathy
  • Predisposing factors: DM, excess alcohol, genetic syndromes
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14
Q

\Describe an entrapment neuropathy of the median nerve?

A
  • At wrist, carpal tunnel syndrome
  • Pain/paraesthesia on palmar aspect of hands and fingers
  • Waking patient from sleep. Pain may extend to arm and shoulder.
  • Motor loss:
    • Abductor pollicis brevis
  • Sensory loss:
    • Lateral palm and thumb, index, middle and lateral half of fourth finger
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15
Q

Describe an entrapment neuropathy of the ulnar nerve?

A
  • Entrapment at elbow
  • Paraesthesia on medial border of hand, wasting and weakness of hand muscles
  • Motor involvement:
    • All small hand muscles, except abductor pollicis brevis
  • Sensory involvement:
    • Medial palm and little finger, and medial half fourth finger
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16
Q

Describe an entrapment neuropathy of the radial nerve?

A
  • Weaknesss of extension of wrist and fingers, often precipitated by sleeping in abnormal posture eg arm over back of chair
  • Motor involvement:
    • Wrist and finger extensors, supinator
  • Sensory involvement:
    • Dorsum of thumb
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17
Q

Describe an entrapment neuropathy of the common peroneal nerve?

A
  • Foot drop, trauma to head of fibula
  • Motor involvement:
    • Dorsiflexion and eversion of foot
  • Sensory involvement:
    • Nil or dorsum of foot
18
Q

Describe an entrapment neuropathy of the lateral cutaneous nerve of the thigh?

A
  • Meralgia paraesthetica
  • Tingling and dysasthesia on lateral border of thigh
  • Motor involvement:
    • Nil
  • Sensory involvement:
    • Lateral border of thigh
19
Q

Name some causes of Axonal multifocal mononeuropathy?

A
  • Defined on nerve conduction studies
    • DM
    • Vasculitis
    • Sarcoidosis
    • Infec tion (HIV, HCV, Lyme disease, diphtheria)
20
Q

Name some causes of Focal demyelination causes of multifocal mononeuropathy?

A
  • Multifocal motor neropathy
  • Multiple compression neuropathies
  • Lymphoma
21
Q

What is the most common polyneuropathy?

A

Length-dependent pattern

22
Q

Describe Length dependent polyneuropathy?

A
  • Occurs in the longest periphertal nerves first
  • Affects the LLs before the ULs
  • Develop in an ascending glove and stocking distribution
23
Q

Describe Guillain-Barre syndrome?

A
  • Immune mediated conditions
  • Most common variant is an acute inflammatory demyelinated polyneuropathy (AIDP)
  • Can be associated with Campylobacter jejuni
  • Acute paralysis developing over days or weeks with a loss of tendon reflexes
24
Q

What are the clinical features of Guillain-Barre?

A
  • Distal paraesthesia and pain precede muscler weakness
    • Ascends rapidly from lower to upper limbs
  • Facial and bulbar weakness
  • Respiratory weakness requiring ventilatory support in 20%
25
Q

Describe the timing of the clinical features Guilain-Barre?

A
  • Weakness can develop over 4 weeks
  • Respiratory failure can develop within hours
26
Q

Signs of Guillain-Barre on examination?

A
  • Diffuse weakness
  • Loss of reflexes
27
Q

Describe Miller Fisher syndrome?

A
  • Variant of Guillain-Barre Syndrome
    • Involves anti-GQ1b anitbodies
  • Internal and external opthalmoplegia
  • Ataxia
  • Areflexia
28
Q

Describe the investigations into Guillain-Barre?

A
  • Nerve conduction studies
    • Slowing of nerve conduction velocity
  • CSF
    • Elevated protein
  • LFTs
    • Elevated AST/ALT
  • Spirometry
    • Reduced vital capacity
29
Q

Describe the management of Guillain-Barre syndrome?

A
  • Plasma exchange
  • or
  • IV immunoglobulin
  • Supportive treatments
30
Q

What is the most common cause of chronic neuropathy?

A

Diabetes mellitus

31
Q

What is Charcot-Marie-Tooth disease (CMT)?

A

Umbrella term for the inherited neuropathies

32
Q

Most common type of Charcot-Marie-Tooth (CMT) disease?

A
  • Autosomal dominantly inherited CMT type 1
  • Mutation of PMP-22 gene
33
Q

What are the common signs of Charcot-Marie-Tooth disease?

A
  • Distal wasting
    • Inverted champagne bottle legs
  • Pes cavus
  • Predominantly motor involvement
34
Q

Describe Brachial plexopathy?

A

Trauma damage to the upper or lower parts of the brachial plexus

35
Q

Upper brachial plexus damage?

A
  • Erb-Duchenne palsy
  • Affected muscles:
    • Biceps, deltoid, rhomboids, brachioradialis, triceps
  • Sensory loss:
    • Patch over deltoid
36
Q

Describe lower brachial plexus damage?

A
  • Affected muscles
    • All small hand muscles, ‘claw hand’ (ulnar wrist flexors)
  • Sensory loss
    • Ulnar border of hand/forearm
37
Q

Describe the symptoms of thoracic outlet syndrome?

A
  • Affected muscles
    • Small hand muscles, ulnar forearm
  • Sensory loss
    • Ulnar border of hand/forearm/upper arm
38
Q

Describe Neuralgic amyotrophy?

A
  • aka Brachial neuritis
  • Presents as acute brachial plexopathy of inflammatory origin
  • Severe shoulder pain -> patchy upper brachial plexus lesion
  • Autosomal dominant form exists
39
Q

Differential for Neuralgic amyotrophy?

A
  • Motor herpes zoster
    • Appearance of vesicles
40
Q
A

Y4: Neurology (11 decks)

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