peripheral neuropathy;bennett

Question 1

which neuropathy have loss of individual myelin internode. demyelination in axons can regenerate, but does not have same integrity

Answer 1

Segmental demyelination

Question 2

occurs after transection of axon: no regeneration

Answer 2

wallerian

Question 3

what are the Toxic causes to neropathy? which one causes permanent impairement?

Answer 3

drug intox.

heavy metals (permanent impairement)

organic compounds

Question 4

Degenerated but still has some integrity so dysfunction can be halted and nerve able to have full recovery

Answer 4

Axonal degeneration

Question 5

what is the main infection for neuropathy

Answer 5

VIRUS!!! Leprosy, HIV, CMV , Dherpes, hepatitis, etc

Question 6

Classification of neuropathy

Answer 6

Diabetic
Alcoholic
Nutritional
Gullain-Barre

Toxic, hereditary, recurrent, anyloidosis, porphyria, infectious, systemic, tumor

Question 7

Motor paralysis

Answer 7

this will be seen in later finding to developt.

muscles of feet and legs affected first and most severely and slowly progress up to leg and thigh

Question 8

pattern 1 vs pattern 2 sensory loss

Answer 8

pattern 1: loss of touch pressure, vibratory, 2 points discrimnation, as disease worsen it progresses proximally and includes loss of pain and temp sensation (larger fibers–>smaller fibers)

pattern 2:primary loss of pain and temp with lesser impariment of pressure and vibratoy and position

Question 9

where is paresthesia and dysestheisa prominent

Answer 9

hands and feet

Question 10

what are the most two frequent manifestion for PN and where does it usaully occur in?

Answer 10

anhyrdosis and orthostatic hypertension which occurs in small fiber poly neuropathy

Question 11

Acute axonal polyneuropathy Cause? duration? key components?

Answer 11

evolves over several day;

cause: porphyric neuropathic massive intoxication

present with renal and liver failure : KEY

Question 12

what neuropathy can be seen in parkinsons? what is its characteristics? sensory or motor deficit?

Answer 12

subacute axonal polyneuropathy

evolves in weeks, tends to be chronic overtime

sensory vs motor deficit dependent of toxic agent

Question 13

chronic axonal polyneuropathy

Answer 13

progress 6 months-60 yrs

NO systemic disorder *******

MOTOR deficit

genetically determined neropathy: autosomal dominant

Question 14

acute demyelinating polyneuorpathy cause? characteristic? what are the only manifestions?

Answer 14

virus precedes to neuropathy

KEY: areflexic motor paralysis, mild sensory disturburance: only manifestion****

acute rise of total protein in CSP in 1st week

Question 15

which neuropathy tend to be relapsing and remitting neuropathy? cause?

Answer 15

subacute demyelinating polyneuropathy

diphtheria toxin

Question 16

chronic demyelinating polyneuropathy

Answer 16

wide variety of disorder
motor and sensory prob: mixed

no specific characteristic

Question 17

Charcot vs Roussy-levy

Answer 17

charco:
- storkleg appearance (MAIN difference)
- thenar and hypothenar wasting
- pes cavus(high arch), hammertoes
- motor and sensory loss

Roussy-levy:

• static tremor
• sensory loss only
• pes cavus, claw foot

Question 18

Guillan-Barre syndrome
cause?
characteristics? PE?

Lab studies?

Answer 18

virus triggering syndrome

acute ascending motor paraylsis: demyelinating disease
Most common: weakness

initial: leg pain, tingling, numbness

reflexes become absent
***respiratory failure

CSF: protein is increased without PLEOCYTOSIS

Question 19

Neuropathy with inflammation

what test do you use?

Answer 19

elevated csf protein, low grade inflammatory,

similar to GBS except chronic

muscle weakness

Sed rate: specific to inflammatory process
-it is senstive but no specific

Question 20

tx for guillian barre syndrome

Answer 20

plasmapharesis immunoglobulin

Question 21

which neuropathy is consistent with axonal degeneration

Answer 21

neuropathy with disproteinemia

Question 22

usually sensorimotor caused by axonal degneration (pain and paresthesias)

which loss occurs first?

Answer 22

alcohol neuropathy

mainly sensory occurs first for a long period of time.

Question 23

drug induced neuropathy cause

Answer 23

renal or hepatic dysfunction

Question 24

what causes diabetic neuropathy

Answer 24

long standing hyperglycemia

Question 25

what is the most common form of diabetic neuropathy? what loss is presented first?

Answer 25

distal symmetric polyneuropathy; sensory present first, and motor present much later

stocking-glove distribution

1st pattern sensory loss

Question 26

Autonomic neuropathy is associated with what neuropathy?

Answer 26

somatic polyneuropathy

atrophy of skin, loss of nails: predisposing factor to someone to develop charcot

-advanced neuropathy: muscle weakness–> muscle concracure—> crowing of toes, metatarsal heads, etc

Question 27

nerve biopsy: what will it reveal

Answer 27

demyelination or axonal damage

may confirm vasculitis (detect if vessels are closed off to cause nerve damage?)

fibrosis within a nerve

biopsy always done on SENSORY NERVE

Question 28

medication tx of painful diabetic neuroapthy

Answer 28

TCA and gabapentin*
TCA: first line of tx

use gabapentin before lyrica

Question 29

if there is a vascular component of painful diabetic neuropathy, what drug do you use?

Answer 29

pentoxifyline—alters viscosity and blood flow: changes shape of RBC: so it takes awhile to be effective

Question 30

if pt has superficial pain, what is the good medication to use?

Answer 30

capsaicin

Question 31

Transcutaneous electric stimulation (TENS) usage

Answer 31

neuro-physiological and chemical effect

utilized for pain management

Question 32

Accupuncture usage

Answer 32

the points coincide with myoneural junctions. endorphins which promote analgesia

enkephalins which block incoming pain signal

Question 33

Amitriptyline combo with what cause systematic relief and will prolong benefit of therapy

Answer 33

electrotherapy

Question 34

Magnetic bio-stimulation in diabetic peripheral neuropathy

Answer 34

pathophysiology: closure produces excess of charged K_ on the inner side on nerve membrane leading to depolarization

magnetic selectively induces hyperpolararization or repolarziation, which will allow a retun to baseline axonal potential