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Neurology > Peripheral Neuropathy > Flashcards

Peripheral Neuropathy Flashcards

1
Q

What are the symptoms of large motor fibre injury?

A

Weakness, Unsteadiness, Wasting

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2
Q

What are the symptoms of large sensory fibre injury?

A

Numbness, paraesthesia, unsteadiness

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3
Q

What are the symptoms of small fibre injury?

A

Pain

Dyesthesia

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4
Q

What are the symptoms of autonomic fibre injury?

A

Dizziness (postural hypotension)
Impotence
Nausea and vomitting (gastroparesis)

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5
Q

Describe power in large motor fibre injury?

A

Reduced

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6
Q

Describe power in large sensory fibre injury?

A

Normal

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7
Q

Describe power in small fibre injury?

A

Normal

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8
Q

Describe power in autonomic fibre injury?

A

Normal

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9
Q

Describe sensation in large motor fibre injury?

A

Normal

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10
Q

Describe sensation in large sensory fibre injury?

A

Vibration and JPS reduced

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11
Q

Describe sensation in small fibre injury?

A

Pin prick and temperature reduced

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12
Q

Describe sensation in autonomic fibre injury?

A

Normal

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13
Q

Describe reflexes in large motor fibre injury

A

Absent

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14
Q

Describe reflexes in large sensory fibre injury

A

Absent

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15
Q

Describe reflexes in small fibre injury

A

Present

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16
Q

Describe reflexes in autonomic fibre injury

A

Present

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17
Q

What is pseudoathetosis

A

Abnormal writhing movement, usually of the fibres caused by failure of proprioception- indicates disruption of the proprioceptive pathway from nerve to parietal cortex

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18
Q

What is bilateral foot drop?

A

High stepping gait

May mean peroneal nerve injury

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19
Q

What are the different types of nerve injury?

A

Radiculopathy
Plexopathy
Peripheral neuropathy (length dependant)

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20
Q

What are is the pattern of loss in length dependant neuropathy?

A

Weakness or sensory loss in glove and stocking pattern

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21
Q

What is mononeuritis multiplex?

A

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.

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22
Q

What is radiculopathy?

A

Compression of nerve at rootlets or root

Will affect everything in that nerve zone

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23
Q

What causes plexopathy

A

Traction

24
Q

GBS causes _____ demyelinating neuropathy lasting ____ to _____.

A

GBS causes acute demyelinating neuropathy lasting days to weeks.

25
Q

CIPD (_____ _______ ________ ________) and hereditary sensory motor neuropathy known as ______ _______ _____ disease cause chronic demyelinating neuropathy- lasting _____ to _____

A

CIPD (chronic inflammatory demyelinating polyradiculopathy) and hereditary sensory motor neuropathy known as charcot-marie-tooth disease cause chronic demyelinating neuropathy- lasting months to years

26
Q

Guillan-barre sensory symptoms _______ weakness

A

Guillan-barre sensory symptoms proceed weakness

27
Q

When do the symptoms of GBS peak?

A

10-14 days after infection

28
Q

What is the treatment for GBS?

A

Tx immunoglobulin infusion and or plasma exchange

29
Q

What is the commonest symptoms of GBS?

A

Pain

30
Q

Describe the genetics of hereditary neuropathy?

A

AD, AR, X-linked - hundreds of mutations

Genetic testing is available for the most common mutations (CMT1a)

31
Q

Describe the variants of hereditary neuropathy?

A

Pure motor, sensory, sensorimotor, small fibre (congenital insensitivity to pain syndrome) and autonomic variants.
Demyelinating and axonal varieties.

32
Q

What is HMSN type 1?

A

Atrophy in lower legs in adolescence

Weakness in hands

Large arch of feet

33
Q

What are the causes of axonal neuropathies?

A
  • idiopathic
  • vasculitic
  • paraneoplastic
  • infections
  • drugs/toxins
  • metabolic
34
Q

What are the vasculitic causes of axonal neuropathies:?

A

Often cause mono neuritis multiplex.

  • ANCA +ve
  • Rheumatoid arthritis/Sjogrens syndrome (ANA/ENA +ve)
35
Q

What are the paraneoplastic causes of axonal neuropathy?

A 
Myeloma
Antibody mediated (breast cancer/SCLC Anti hu/yo)
36
Q

What are the infectious causes of axonal neuropathy?

A

HIV
Syphillis
Lyme
Hepatitis B/C cryoglobulin mediated

37
Q

Which drugs/toxins cause axonal neuropathy?

A

Alcohol
Amiodarone
Phenytoin
Chemotherapy (cisplatin/vincristine)

38
Q

Which metabolic conditions cause axonal neuropathy?

A 
Diabetes
B12/folate deficiencies
Hypothyroidism
Chronic uraemia
Prophyria
39
Q

What can cause chronic autonomic neuropathy?

A

Diabetes (gastroparesis)
Amyloidosis
Hereditary

40
Q

What can cause acute autonomic neuropathy?

A

GBS

Porphyria

41
Q

How can we treat axonal neuropathy

A 
Treat cause (clear hepatitis C)
Symptompatic treatment- physiotherapy, orthotics, neuropathic pain relief
42
Q

How can we treat axonal (vasculitic) neuropathy

A

Pulsed IV methylprednisolone + cyclophosphamide

43
Q

How can we treat demyelinating inflammatory neuropathy

A

IVIg (pooled immunoglobulin from donors)
Steroids
Azathioprine, mycophendlate, Cyclophosphamide

44
Q

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

A

Large and small motor and sensory

45
Q

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?

A

Ulnar territory

46
Q

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?

A

NCS demonstrate axonal picture

47
Q

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?

A

Compression in guyons canal

48
Q

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?

A

Liability to pressure palsy- occupational diabetes

49
Q

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?

A

Large and small fibre motor and sensory

50
Q

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?

A

Median right, common peroneal left

51
Q

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?

A

NCS demonstrate axonal picture- mononeuritis multiplex

52
Q

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?

A

ANCA +ve

53
Q

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?

A

Pulsed steroids +/- cyclophosphamide

54
Q

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

A

Mainly large fibre motor and sensory

55
Q

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?

A

Length dependant manner

56
Q

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?

A

NCS demonstrate axonal picture

57
Q

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?

A

Acute porphyria

Neurology (41 decks)

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