Peripheral Neuropathy Flashcards
What are the symptoms of large motor fibre injury?
Weakness, Unsteadiness, Wasting
What are the symptoms of large sensory fibre injury?
Numbness, paraesthesia, unsteadiness
What are the symptoms of small fibre injury?
Pain
Dyesthesia
What are the symptoms of autonomic fibre injury?
Dizziness (postural hypotension)
Impotence
Nausea and vomitting (gastroparesis)
Describe power in large motor fibre injury?
Reduced
Describe power in large sensory fibre injury?
Normal
Describe power in small fibre injury?
Normal
Describe power in autonomic fibre injury?
Normal
Describe sensation in large motor fibre injury?
Normal
Describe sensation in large sensory fibre injury?
Vibration and JPS reduced
Describe sensation in small fibre injury?
Pin prick and temperature reduced
Describe sensation in autonomic fibre injury?
Normal
Describe reflexes in large motor fibre injury
Absent
Describe reflexes in large sensory fibre injury
Absent
Describe reflexes in small fibre injury
Present
Describe reflexes in autonomic fibre injury
Present
What is pseudoathetosis
Abnormal writhing movement, usually of the fibres caused by failure of proprioception- indicates disruption of the proprioceptive pathway from nerve to parietal cortex
What is bilateral foot drop?
High stepping gait
May mean peroneal nerve injury
What are the different types of nerve injury?
Radiculopathy
Plexopathy
Peripheral neuropathy (length dependant)
What are is the pattern of loss in length dependant neuropathy?
Weakness or sensory loss in glove and stocking pattern
What is mononeuritis multiplex?
Mononeuritis multiplex (MNM) is a term used to describe a distinctive clinical presentation of progressive motor and sensory deficits in the distribution of specific peripheral nerves.
What is radiculopathy?
Compression of nerve at rootlets or root
Will affect everything in that nerve zone
What causes plexopathy
Traction
GBS causes _____ demyelinating neuropathy lasting ____ to _____.
GBS causes acute demyelinating neuropathy lasting days to weeks.
CIPD (_____ _______ ________ ________) and hereditary sensory motor neuropathy known as ______ _______ _____ disease cause chronic demyelinating neuropathy- lasting _____ to _____
CIPD (chronic inflammatory demyelinating polyradiculopathy) and hereditary sensory motor neuropathy known as charcot-marie-tooth disease cause chronic demyelinating neuropathy- lasting months to years
Guillan-barre sensory symptoms _______ weakness
Guillan-barre sensory symptoms proceed weakness
When do the symptoms of GBS peak?
10-14 days after infection
What is the treatment for GBS?
Tx immunoglobulin infusion and or plasma exchange
What is the commonest symptoms of GBS?
Pain
Describe the genetics of hereditary neuropathy?
AD, AR, X-linked - hundreds of mutations
Genetic testing is available for the most common mutations (CMT1a)
Describe the variants of hereditary neuropathy?
Pure motor, sensory, sensorimotor, small fibre (congenital insensitivity to pain syndrome) and autonomic variants.
Demyelinating and axonal varieties.
What is HMSN type 1?
Atrophy in lower legs in adolescence
Weakness in hands
Large arch of feet
What are the causes of axonal neuropathies?
- idiopathic
- vasculitic
- paraneoplastic
- infections
- drugs/toxins
- metabolic
What are the vasculitic causes of axonal neuropathies:?
Often cause mono neuritis multiplex.
- ANCA +ve
- Rheumatoid arthritis/Sjogrens syndrome (ANA/ENA +ve)
What are the paraneoplastic causes of axonal neuropathy?
Myeloma Antibody mediated (breast cancer/SCLC Anti hu/yo)
What are the infectious causes of axonal neuropathy?
HIV
Syphillis
Lyme
Hepatitis B/C cryoglobulin mediated
Which drugs/toxins cause axonal neuropathy?
Alcohol
Amiodarone
Phenytoin
Chemotherapy (cisplatin/vincristine)
Which metabolic conditions cause axonal neuropathy?
Diabetes B12/folate deficiencies Hypothyroidism Chronic uraemia Prophyria
What can cause chronic autonomic neuropathy?
Diabetes (gastroparesis)
Amyloidosis
Hereditary
What can cause acute autonomic neuropathy?
GBS
Porphyria
How can we treat axonal neuropathy
Treat cause (clear hepatitis C) Symptompatic treatment- physiotherapy, orthotics, neuropathic pain relief
How can we treat axonal (vasculitic) neuropathy
Pulsed IV methylprednisolone + cyclophosphamide
How can we treat demyelinating inflammatory neuropathy
IVIg (pooled immunoglobulin from donors)
Steroids
Azathioprine, mycophendlate, Cyclophosphamide
A 70 week old right handed carpenter has a 6 week history of pins and needles on the inner aspect of his right hand. Associated difficulty with holding cutlery. He has no pain. His power is 4; FDI, ADM. Reflexes are normal and he has reduced pin prick and temphretura and vibration sense in medial 1 1/2 digits.
Which nerves are damaged
Large and small motor and sensory
A 70 week old right handed carpenter has a 6 week history of pins and needles on the inner aspect of his right hand. Associated difficulty with holding cutlery. He has no pain. His power is 4; FDI, ADM. Reflexes are normal and he has reduced pin prick and temperature and vibration sense in medial 1 1/2 digits.
Where are the nerves damaged?
Ulnar territory
A 70 week old right handed carpenter has a 6 week history of pins and needles on the inner aspect of his right hand. Associated difficulty with holding cutlery. He has no pain. His power is 4; FDI, ADM. Reflexes are normal and he has reduced pin prick and temperature and vibration sense in medial 1 1/2 digits.
how are the nerves damaged?
NCS demonstrate axonal picture
A 70 week old right handed carpenter has a 6 week history of pins and needles on the inner aspect of his right hand. Associated difficulty with holding cutlery. He has no pain. His power is 4; FDI, ADM. Reflexes are normal and he has reduced pin prick and temperature and vibration sense in medial 1 1/2 digits.
Why are the nerves damaged?
Compression in guyons canal
A 70 week old right handed carpenter has a 6 week history of pins and needles on the inner aspect of his right hand. Associated difficulty with holding cutlery. He has no pain. His power is 4; FDI, ADM. Reflexes are normal and he has reduced pin prick and temperature and vibration sense in medial 1 1/2 digits.
Can we stop the nerves being damaged?
Liability to pressure palsy- occupational diabetes
62 year old retired journalist with painful paraesthesia and “burning” sensation in lower limbs for 4/52.
Grip strength reduced in right hand.
O/E left 4/5 abductor pollicis, Dorsiflexion on left leg 4/5 reduced sensation to pinprick over L5.
absent L ankle reflex.
Which nerves are damaged?
Large and small fibre motor and sensory
62 year old retired journalist
Painful paraesthesia and “burning” sensation in lower limbs for 4/52. Grip strength reduced in right hand.
O/E left 4/5 abductor pollicis, Dorsiflexion on left leg 4/5 reduced sensation to pinprick over L5. absent L ankle reflex.
Where are the nerves damaged?
Median right, common peroneal left
62 year old retired journalist
Painful paraesthesia and “burning” sensation in lower limbs for 4/52. Grip strength reduced in right hand.
O/E left 4/5 abductor pollicis, Dorsiflexion on left leg 4/5 reduced sensation to pinprick over L5. absent L ankle reflex.
How are the nerves damaged?
NCS demonstrate axonal picture- mononeuritis multiplex
62 year old retired journalist
Painful paraesthesia and “burning” sensation in lower limbs for 4/52. Grip strength reduced in right hand.
O/E left 4/5 abductor pollicis, Dorsiflexion on left leg 4/5 reduced sensation to pinprick over L5. absent L ankle reflex.
Why are the nerves damaged?
ANCA +ve
62 year old retired journalist
Painful paraesthesia and “burning” sensation in lower limbs for 4/52. Grip strength reduced in right hand.
O/E left 4/5 abductor pollicis, Dorsiflexion on left leg 4/5 reduced sensation to pinprick over L5. absent L ankle reflex.
Can we stop the nerves from being damaged?
Pulsed steroids +/- cyclophosphamide
24 year old female
7/7 Admitted with abdominal pain under surgeons (normal laparoscopic examination)
4/7 history pins and needles in all four limbs with unsteadiness – requiring assistance of 2 to walk.
PMH: Admitted to Carseview aged 19 with acute psychosis
O/E ataxic gait, absent reflexes throughout.
4/5 in flexors, sensory loss – patchy pin-prick and temperature, absent VS and reduce JPS.
BP: Significant Postural drop.
Which nerves are damaged
Mainly large fibre motor and sensory
24 year old female
7/7 Admitted with abdominal pain under surgeons (normal laparoscopic examination)
4/7 history pins and needles in all four limbs with unsteadiness – requiring assistance of 2 to walk.
PMH: Admitted to Carseview aged 19 with acute psychosis
O/E ataxic gait, absent reflexes throughout.
4/5 in flexors, sensory loss – patchy pin-prick and temperature, absent VS and reduce JPS.
BP: Significant Postural drop.
Where are the nerves damaged?
Length dependant manner
24 year old female
7/7 Admitted with abdominal pain under surgeons (normal laparoscopic examination)
4/7 history pins and needles in all four limbs with unsteadiness – requiring assistance of 2 to walk.
PMH: Admitted to Carseview aged 19 with acute psychosis
O/E ataxic gait, absent reflexes throughout.
4/5 in flexors, sensory loss – patchy pin-prick and temperature, absent VS and reduce JPS.
BP: Significant Postural drop.
How are the nerves damaged?
NCS demonstrate axonal picture
24 year old female
7/7 Admitted with abdominal pain under surgeons (normal laparoscopic examination)
4/7 history pins and needles in all four limbs with unsteadiness – requiring assistance of 2 to walk.
PMH: Admitted to Carseview aged 19 with acute psychosis
O/E ataxic gait, absent reflexes throughout.
4/5 in flexors, sensory loss – patchy pin-prick and temperature, absent VS and reduce JPS.
BP: Significant Postural drop.
Why are the nerves damaged?
Acute porphyria
