Peripheral Neuropathy-Louie Flashcards
If someone goes into Dr. Louie’s clinic & might have peripheral neuropathy…what types of symptoms might they describe?
numbness tingling pain imbalance weakness **mainly in feet & legs, sometimes glove (hands)
Why do the feet experience peripheral neuropathy first?
b/c they have the longest nerves–more affected.
Hands are more rare, but still an issue of longer nerves
How might a patient describe numbness?
Feels like I’m walking on logs.
Feels like my sock is always bundled up in my shoe.
How might a pt describe tingling?
pins & needles feeling
How might a pt describe pain?
burning, shooting, electric pain
often patients experience allodynia (non-painful things are excruciating)
What might a patient complain of that tips you off that they have imbalance?
they may say that they feel dizzy & disoriented
you can ask-problem in head or feet. They’ll say feet.
Imbalance. They may have multiple falls & an unsteadiness of gait.
If someone complains of imbalance & you do the Romberg test…what might happen? What are you testing?
once they close their eyes & block their vision, their unsteadiness will probably get worse & they may fall.
not due to cerebellum problem, but proprioception.
What patterns will you see in patients who complain of weakness?
you will see the weakness more distally than proximally
they may have trouble gripping, doing fine motor things, opening jars
foot drop or tripping over feet (shoes worn out at toe)
problems writing
If someone has bulbar or cranial nerve problems…what will be some of their symptoms?
diplopia (problem w/ extraocular muscles)
ptosis
dysarthria/dysphagia
What are some of the possible sensory problems of a peripheral neuropathy patient?
loss of pinprick sensation in distal extremities
loss of temp in distribution
hypersensitivity
loss of proprioception
Describe Charcot foot.
this is seen in atrophy of muscles
high arch
contracted, curled hammer toes
atrophied calf muscle
What does muscle atrophy look like in a hand?
thenar compartment may look wasted away. There should be bulk b/w thumb & 2nd finger dorsally…from interosseus muscle. If this isn’t there–problem.
What is a fasciculation?
a small involuntary muscle contraction & relaxation
What are some of the motor features of peripheral neuropathy?
distal atrophy possible fasciculations weakness distally tremor absent or diminished deep tendon reflexes foot drop
Describe the pes cavus foot deformity.
high arch
fixed plantar flexion of the foot
What are the facial features that are sometimes seen with peripheral neuropathy?
diplopia dysconjugate gaze ptosis facial asymmetry tongue weakness pupillary abnormalities (autonomic involvement)
What are 2 of the main components of an EMG exam?
nerve conduction study
needle electorde exam
Review: what is the fcn of nodes of Ranvier? What creates these?
saltatory conduction
myelinaton creates these (faster conduction)
What are some ways to measure action potentials?
oscilloscope
reading electrode
reference electrode
T/F The more strength a muscle needs, the more motor units it recruits.
True.
What are the different components of the spikes you see in an EMG? In diseased muscle, what do you see?
see phase (below baseline)
turns (near peak)
diseased muscle: polyphasic (lots of turns)
muscle disease also includes lower amplitudes
SO…you have a patient whose peak ms is lower for the median nerve than the ulnar nerve. They also have a lower peak ms for their median nerve @ the wrist than from the elbow-wrist. What condition does this patient have?
this patient has carpal tunnel syndrome most likely
Decreased sensory or motor amplitudes may suggest what on a nerve conduction study?
axonal damage
Delayed or slowed distal latencies or slowed conduction velocities in a nerve conduction study may be suggestive of what?
a demyelinating disease
