Peripheral Neuropathy Lecture Powerpoint Flashcards
The only cranial nerve covered in dura mater and technically part of the CNS opposed to the PNS
CN II (optic nerve)
Are spinal nerves part of the PNS?
uhhh
T4 dermatome corresponds to…. T10 corresponds to…
Nipple line, umbilicus line
know the dermatome man
df
Peripheral neuropathy definition
Pathology or abnormality affecting the nerves of the PNS specifically including mono (focal involvement of single nerve) or poyneuropathies (affecting many peripheral nerves and often symmetric)
Carpal tunnel syndrome is an example of a ___ neuropathy
Mono
Diabetic neuropathy is an example of a ___ neuropathy
Poly
Mononeuropathy multipex
Simultaneous or sequential non-symmetrical involvement of varying nerves and is not progression of a single neuropathy (for example peroneal nerve and median nerve compression occurring at the same time) sometimes due to same underlying cause other times randomly co-occurring
Peripheral neuropathy predisposing factors (8)
- Diabetes
- peripheral arterial disease
- HTN
- hypercholesterolemia
- tobacco/alcohol use
- Genetic conditions
- nutritional deficit
- iatrogenic (such as surgery positioning)
Peripheral neuropathy epidemiology
Males equal to females, risk increases with age
PNS disorders symptoms (3)
- weakness
- parasthesia/dysesthesia (burning, numbness, pins and needles)
- autonomic dysfunction
Typical presentation of a patient with chronic peripheral neuropathy description
-my feet are asleep especially at night (brain has nothing else to focus on) and sometimes have shooting tingling pain coming up the legs that has been going on a while in both legs over past few months (subacute)
Cranial neuropathies signs and symptoms are specific to…
….the sensation and motor function (remember pneumonic to know which CN’s do which) of that specific nerve
Some say money matters…
Sensory I Sensory II Motor III Motor IV Sensory V1 Sensory V2 Both V3 Motor VI Both VII Sensory VIII Both IX Both X Motor XI Motor XII
Degenerative disk disease definition
Tear of intervertebral disk that rips the annulus fibrosis allowing the nucleus pulposis to protrude out most often laterally and potentially compress spinal nerve roots that also exit laterally either from sharp trauma or extended deterioration over time
Degenerative disk disease presentation (4)
- Low back pain
- sensory disturbance
- weakness
- unilateral specific location
Neoplastic disease is a common etiology of peripheral neuropathy (T/F)
FALSE
Diabetic amyotrophy definition
Subacute onset, very painful, dermatomal sensory deficit with a protracted course over 2 to 3 months that resembles a disk herniation but imaging is unremarkable typically occurring in prolonged hyperglycemic states
Diabetic amyotrophy treatment (1)
Steroids to decrease inflammation and monitoring blood glucose
Herpes zoster infection (REMEMBER the name of the causative agent)
Shingles, caused by varicella zoster virus that resides in nerve roots and erupts sporadically and is triggered by stress or immunocompromise appearing with dermatomal vesicular rash with severe pain
Post herpetic neuralgia
Pain lingering from herpes zoster infection that lasts for months or years after
Herpes zoster treatment (2)
Antiviral medication and chronic pain management
Brachial plexopathy in infant
Occurs during childbirth when a shoulder gets caught on the pubic symphisis of the mother while the baby’s head is pulled
Cervical or brachial plexopathy etiologies (3)
- trauma
- malignancies
- idiopathic
Brachial/lumbar plexitis
A subacute, severe pain sensory disturbance and weakness with a many month course of the brachial/lumbar plexus impacting multiple nerves downstream from where these nerves move
Electromyography and nerve conduction velocity tests can confirm…
These tests are typically second to what studies?
….multiple nerve root involvement indicating plexitis being the cause of a peripheral neuropathy
-Negative imaging studies
Brachial/lumbar plexitis treatment (3)
- steroids
- pain management
- surgery
Upper motor neurons tend to be ___ to the lower motor neuron preventing ____ (seen if destroyed).
If a lower motor neuron is destroyed then tend to see ____
inhibitory, spasticity, flaccid paralysis or fasciculations (but no strong contractions)
Median nerve neuropathy/carpal tunnel syndrome
Typically an overuse syndrome from swelling associated with tendonitis seeing dysethesias, parasthesias, and weakness in digits I through radial aspect of digit IV and and palm
Ulnar nerve neuropathy
Usually an overuse syndrome most noticable with repetitive flexion/extension of the arm, due to stretch or compression in cubital tunnel or from compression due to resting on a surface, sensory deficits tend to affect digit V and ulnar aspect of digit IV, as well as ulnar claw hand
Median neuropathy/carpal tunnel syndrome treatment (3)
- activity modification
- splint
- surgery
Ulnar nerve neuropathy treatment (1)
-surgical decompression
Peroneal nerve compression
Usually from compression or ischemia of the nerve typically in pt’s who habitually cross legs or have knee/leg trauma, symptoms include foot drop (lack of dorsiflexion) and sensory loss in lateral aspect of foot and shin
Lateral femoral cutaneous nerve compression/meralgia paresthetica
Compression of lateral femoral cutaneous nerve at the waist (inguinal canal) common in obese, weightlifters, post partum, or hip surgery patients, often idiopathic, sees parasthesias/hyperesthesia’s in anterior lateral thigh
Lateral femoral cutaneous nerve compression/meralgia paresthetica has sensory involvement but…
…NO MOTOR involvement
Posterior tibial nerve compression/tarsal tunnel syndrome
Least common among compressive mononeuropathies, causes pain and sensory disturbance at the medial aspect of foot and angle due to compression at the tarsal tunnel (medial ankle)
Polyneuropathies
Slow onset, progressive, begining in lower distal extremities and spreading proximally eventually to upper extremities type of neuropathy that can involve combos of sensory, motor, and autonomic fibers and have symptoms in all 3
Guillain barre syndrome/acute inflammatory demyelinating polyradiculoneuropathy definition and how is it diagnosed
Often occurring few weeks post viral illness, is a rapidly progressing ascending sensory loss and motor weakness, also involves autonomic involvement (heart, temp, pupils), diagnosed clinically but confirmed by CSF analysis and slow nerve conduction studies
Guillain barre syndrome pathophysiology
Theorized to be antibody mediated attack of the myelin on nerve roots and peripheral axons resulting in radicular symptoms
Diagnostic studies for guillain barre syndrome (3)
- CSF analysis (lumbar puncture
- EKG
- breathing capacity
Guillain barre syndrome treatment (4)
- IV IG
- Plasmapheresis (plasma replacement)
- Respiratory support
- DVT prophylaxis
Chronic inflammatory demyelinating polyradiculoneuropathy
Chronic form of guillan barre syndrome that presents as either a relapse or one that does slowly progresses regardless of treatment
Charcot marie tooth disease/hereditary sensory motor neuropathy
Genetic sensory motor neuropathy disease usually beginning at early age characterized by high arched foot, hammer toes, intrinsic hand and foot muscle atrophy, and sensory loss
