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Neurology > Polyneuropathy > Flashcards

Polyneuropathy Flashcards

1
Q

What are polyneuropathies?

A

Motor and or sensory disorder of multiple peripheral or cranial nerves
Usually symmetrical, widespread and often worse distally (‘glove and stocking’)

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2
Q

How can polyneuropathies be classified?

A

Chronicity
Function (sensory, motor, autonomic or mild)
Pathology (demyelination, axonal degeneration or both)

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3
Q

What should you ask about in polyneuropathy?

A 
Time course
Nature of symptoms
Preceding or associated events (e.g. D/V before Guillan Barre, weight loss in cancer)
Travel
Alcohol/drug use
Sexual infections
Family history
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4
Q

What is the function of nerve conduction stidies?

A

Distinguish demyleinating from axonal causes

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5
Q

what investigations in polyneuropathy?

A 
FBC
ESR
Gluose
U/E
LFT
TSH
B12
Electophoresis
ANA
ANCA
CXR
Urinalysis
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6
Q

What are causes of predominantly sensory neuropathy?

A 
Diabtes
Uraemia (
CKD
Leprosy
Alcoholism
B12 deficiency
Amyloidosis
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7
Q

Describe sensory neuropathy.

A 
Numbness
Pins and needles
Paraesthesiae
Glove and stocking distribution
Difficulty handling small objects
Signs of trump (finger burns or joint deformation)

DM and alcohol are painful

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8
Q

What are causes of motor neuropathies?

A

Guillain Barre syndrome
Porphyria
Lead poisoning
Hereditary sensorimotor neuropathies - Charcot-Marie-Tooth
Chronic infelammatory demylinating polyneuropathy
Diphtheria

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9
Q

Describe motor neuropathy

A

Progressive
Weak or clumsy hands
Difficulty in walking - falls
Difficulty in breathing (reduced vital capacity)
LMN lesion
Wasting and weakness most in distal muscles o hands and feet
Hyporeflexia

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10
Q

What do you get in cranial nerve neuropathies?

A

Swallowing/speaking difficulty

Diplopia

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11
Q

What causes alcoholic neuropathy?

A

Toxic effects and reduced absorption of B vitamins

Sensory symptoms present prior to motor

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12
Q

What can B12 deficiency cause?

A

Subacute combined degeneration of the spinal cord

Dorsal column affected first (joint position and vibration) prior to distal paraesthesia

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13
Q

What is Guillain Barre syndrome? Features?

A

Immune mediaed demyelination of the peripheral nerves often triggered by infection - Campylobacter jejuni

Peripheral neuropathy (motor) preceded by D/V

Progressive weakness of all four limbs
Weakness is classically ascending - LL first - however proximal muscles earlier than distal
Sensory symptoms mild

Can be:
Areflexia
Cranial nerve involvement
Autonomic involvement 
Anti-GM1 antibodies
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14
Q

What is Miller Fisher syndrome?

A 
Guillain Barre variant, associated with:
Ophthalmoplegia
Areflexia
Ataxia
Eye muscles are affected first
Descending paralysis
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15
Q

What is HSMN?

A

Hereditary sensorimotor neuropathy - Charcot-Marie- Tooth
Peroneal msucular atrophy

Type 1 - demyelinating

  • autosomal dominany
  • Start at puberty
  • Motor symptoms predominante
  • distal muscle wasting, clawed toes, foot drop, leg weakness

Type 2 - axonal

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16
Q

How do you manage polyneuropathy?

A

Treat the cause
PT/OT
Foot care and shoe choice in sensory neuropathies
Splinting joints help prevents contracture

In Guillar Barre and chronic inflammatory demyelinating polyneuropathy, IV immunoglobulins help
Steroids /immunosuppressants for vasculitic causes

Treat neuropathic pain with amitriptyline, gabapentin, pregabalin

17
Q

What is chronic inflammatory demyelinating polyneuropathy

A

Antibody mediated inflammation results in segmental demyelination of peripheral nerves
Males>females
Motor features predominant
More insidious onset that GBS
High protein in CSF
Treat with IV IG, steroids and immunosuppressants

18
Q

What can cause autonomic neuropathies?

A

DM, amyloidosis, GBS, Sjogren’s HIV, Leprosy, SLE, genetic, paraneoplastic, Lambert Eaton, Syphillis

19
Q

What are signs of autonomic neuropathy?

A

Sympathetic:
Postural hypotension, Reduced sweating, ejacualtory failure, Horner’s

Parasympathetic:
Constipation
Urine retention
Erectile dysfunction
Holmes-Adie pupil
20
Q

What are tests of autonomic function?

A

BP - postural drop of >20/10 is abnormal

ECG - variation of <10bpm with respiration is abnormal

Cystometry - bladder pressure studies

Pupils - instil 0.1% adrenaline
- Dilates if post-ganglionic sympathetic denervation, not if normal
Instil 2.5% cocaine
- Dilates if normal, not if sympathetic denervation

Paraneoplastic antibodies

21
Q

What is first line treatment for neuropathic pain?

A

Amitriptyline
Duloxetine
Gabapentin
Pregabalin

Tamadol may be used as rescue therapy
Topical capsaicin for localised neuropathic pain

However, carbamazepine for first line trig menial neuralgia

Neurology (22 decks)

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