peripheral neuropathy;bennett Flashcards
which neuropathy have loss of individual myelin internode. demyelination in axons can regenerate, but does not have same integrity
Segmental demyelination
occurs after transection of axon: no regeneration
wallerian
what are the Toxic causes to neropathy? which one causes permanent impairement?
drug intox.
heavy metals (permanent impairement)
organic compounds
Degenerated but still has some integrity so dysfunction can be halted and nerve able to have full recovery
Axonal degeneration
what is the main infection for neuropathy
VIRUS!!! Leprosy, HIV, CMV , Dherpes, hepatitis, etc
Classification of neuropathy
Diabetic
Alcoholic
Nutritional
Gullain-Barre
Toxic, hereditary, recurrent, anyloidosis, porphyria, infectious, systemic, tumor
Motor paralysis
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
pattern 1 vs pattern 2 sensory loss
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
where is paresthesia and dysestheisa prominent
hands and feet
what are the most two frequent manifestion for PN and where does it usaully occur in?
anhyrdosis and orthostatic hypertension which occurs in small fiber poly neuropathy
Acute axonal polyneuropathy Cause? duration? key components?
evolves over several day;
cause: porphyric neuropathic massive intoxication
present with renal and liver failure : KEY
what neuropathy can be seen in parkinsons? what is its characteristics? sensory or motor deficit?
subacute axonal polyneuropathy
evolves in weeks, tends to be chronic overtime
sensory vs motor deficit dependent of toxic agent
chronic axonal polyneuropathy
progress 6 months-60 yrs
NO systemic disorder *******
MOTOR deficit
genetically determined neropathy: autosomal dominant
acute demyelinating polyneuorpathy cause? characteristic? what are the only manifestions?
virus precedes to neuropathy
KEY: areflexic motor paralysis, mild sensory disturburance: only manifestion****
acute rise of total protein in CSP in 1st week
which neuropathy tend to be relapsing and remitting neuropathy? cause?
subacute demyelinating polyneuropathy
diphtheria toxin
chronic demyelinating polyneuropathy
wide variety of disorder
motor and sensory prob: mixed
no specific characteristic
Charcot vs Roussy-levy
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
Guillan-Barre syndrome
cause?
characteristics? PE?
Lab studies?
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
Neuropathy with inflammation
what test do you use?
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
tx for guillian barre syndrome
plasmapharesis immunoglobulin
which neuropathy is consistent with axonal degeneration
neuropathy with disproteinemia
usually sensorimotor caused by axonal degneration (pain and paresthesias)
which loss occurs first?
alcohol neuropathy
mainly sensory occurs first for a long period of time.
drug induced neuropathy cause
renal or hepatic dysfunction
what causes diabetic neuropathy
long standing hyperglycemia
what is the most common form of diabetic neuropathy? what loss is presented first?
distal symmetric polyneuropathy; sensory present first, and motor present much later
stocking-glove distribution
1st pattern sensory loss
Autonomic neuropathy is associated with what neuropathy?
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
nerve biopsy: what will it reveal
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
medication tx of painful diabetic neuroapthy
TCA and gabapentin*
TCA: first line of tx
use gabapentin before lyrica
if there is a vascular component of painful diabetic neuropathy, what drug do you use?
pentoxifyline—alters viscosity and blood flow: changes shape of RBC: so it takes awhile to be effective
if pt has superficial pain, what is the good medication to use?
capsaicin
Transcutaneous electric stimulation (TENS) usage
neuro-physiological and chemical effect
utilized for pain management
Accupuncture usage
the points coincide with myoneural junctions. endorphins which promote analgesia
enkephalins which block incoming pain signal
Amitriptyline combo with what cause systematic relief and will prolong benefit of therapy
electrotherapy
Magnetic bio-stimulation in diabetic peripheral neuropathy
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
