Polyneuropathies & Mononeuritis Multiplex Flashcards
Peripheral Diabetic Neuropathy
pathophys
- due to late stage DM
- damage to axons (worse at long nerves)
- causes motor and sensory loss
Peripheral Diabetic Neuropathy
complication
vascular problems
Peripheral Diabetic Neuropathy
signs/sx
2
- sensory: diminished sensation to pain, vibration, temp
- stocking glove pattern
Peripheral Diabetic Neuropathy
PE findings
3
- Semmes-Weinstein filament test
- may have toe clawing
- calluses and ulcerations on plantar skin over MT heads
Peripheral Diabetic Neuropathy
when does Semmes-Weinstein filament test indicate significant risk for injury?
- cannot feel 5.07 size
Peripheral Diabetic Neuropathy
Dx
3 components
- X-rays: show joint subluxation, subtle fractures, bone desctruction
- monitor glucose
- consider EMG/NCV to determine tarsal tunnel syndrome/diabetic neuropathy
Peripheral Diabetic Neuropathy
when does charcot arthropathy occur
occurs w/ prolonged neuropathy
Peripheral Diabetic Neuropathy
signs/sx of charcot arthropathy
4
- collapse of arch
- destabilization of midfoot joints
- pt ends up with “rocker bottom foot” deformity
- leads to ulcers on bottom of foot
Peripheral Diabetic Neuropathy
tx (non meds)
- improve glucose control
- shoe adjustments
- wound care for ulcers
- refer to podiatry for prevention
Peripheral Diabetic Neuropathy
medical tx
4
- Nortriptyline and amitriptyline (tx pain & cause drowsiness)
- gabapentin or pregabalin (tx pain but have abuse potential)
- SSRIs may help
- topical steroids may help (capsaicin or lidocaine)
Autonomic Diabetic Neuropathy
pathophys
- damage to autonomic nerves by long term high blood glucose
- can change BP, pulse, GI activity, bladder function, ED
Autonomic Diabetic Neuropathy
signs /sx
3 groups
- GI: n/v/d, constipation, gastroparesis, reflux, feel full
- GU: incomplete emptying of bladder, ED
- Circulatory: orthostatic hypotension
Autonomic Diabetic Neuropathy
tx
- same as peripheral diabetic neuropathy
Carcot-Marie Tooth Disease
pathophys
- inherited motor and sensory losses
Carcot-Marie Tooth Disease
differentiate type 1 vs type 2
- mutations in myeline protein genes
- axonal loss