Peripheral Neuropathy - Kesserwani Flashcards
A high arch and hammer toes are characteristic of what neuropathic disease processes?
Hereditary (such as Charcot-Marie-Tooth) neuropathy - characterized by muscle atrophy and plasticity resulting in changes
Is diabetic neuropathy more of a vascular problem or a simple loss of neurons?
Primarily loss of neurons, but vascular issues play a role.
Why do neuropathies in the foot leading to amputations and infections tend to be worse in men than women?
Hygiene! Men are not as hygienic as women.
A neurologist asks the Pt. to roll back and stand on their heels. The Pt. cannot do this. What does this indicate most likely?
Weakness of dorsiflexion is probably a peripheral nerve problem (common fibular aka penoneal nerve is affected or the sacral plexus, etc.)
A neurologist asks a Pt. to roll forward and stand on their toes. The Pt. cannot do this. What does this indicate most likely? Why?
Weakness of plantar flexion usually implies spinal cord compression (think somatotopically - the farthest reaching motor fibers are located on the outside of the cord, laterally and are compressed before those innervating the more proximal muscles)
A patient presents 1 week post upper respiratory infection w/ complaints of weakness in the legs up to the knees and now the hands. Reflexes in the lower extremities are severely diminnished. LP reveals high protein content w/ a normal WBC. Progression continues and reaches its peak at about 2 weeks. The Pt. is hospitalized and placed on a ventilator, but then improves and is taken off the ventilator. What is the likely diagnosis?
Guillian-Barre Syndrome
Is weakness in the lower a typical sign of developing diabetic neuropathy?
No. Probably another disease process is occurring.
Your long-term patient has pain, numbness, and tingling moving up the from the toes to the shin and knees. Pt. has an Hx. of cubital tunnel syndrome and diabetes. Autonomic problems and cranial neuropathies including CN3, 4, and 6 are also in his Hx. The patient notes that he has had poor control of his “sugars” lately and these symptoms have progressed over several months. Pain and muscle atrophy and signs of vasculitis in the lumbosacral area is reported as the CC of today’s visit. You suspect a plexopathy. Follow-up visits reveal improvement in the lumbosacral pain/symptoms over the next several weeks to months. What neuropathic process is occurring and what pathologic process is occurring in the lumbosacral area? What sign should not be present in this disease process?
Diabetic neuropathy with a developing plexopathy are likely causing these symptoms, but weakness is an unusual feature of plexopathy. Also, plexopathy is monophasic, which means it can occur and go away with improvement of sugar control.
Cerebellar atrophy due to alcohol can result in what symptom?
Truncal ataxia
Excess vitamin B6 can result in damage of what component of the spinal root? What is the presentation?
Dorsal root ganglion - proprioception and sensation issues
What is a monophasic neuropathy?
One in which the disease the disease peaks and then it gets better.
Bladder retention, erectile dysfunction, diarrhea/constipation, incontinence, dry eyes and mouth, lightheadedness, and anhidrosis are all signs of what specific category of neuropathy?
Autonomic neuropathy
Autonomic neuropathy is caused by what kind of disease processes?
Commonly diabetic neuropathy, post-virus (guillian-barre), and paraneoplastic disease
