Skeletal Muscle and Peripheral Nerve Pathology I Flashcards
looking for what in CSF
protein
inflammation
types of peripheral nerve injury
1 - axonal - trauma
2 - demyelinating - MS/GB
3 - neuronopathies - kill nerve body - polio
MBP
myelin basic protein
-role in myelin compaction
mutant forms - charcot marie tooth disease
demyelinating neuropathy - slow conduction
atrophy of leg muscle
polio
acute axonal injury
degeneration of distal axon
reinnervation of myofibers
myelinated by proliferating schwann cells
new internodes shorter and myelin sheath thinner
axonal degeration
loosened myelin layers
lipid droplet vaculoles
what does nerve follow to regenerate
myelin
mononeuropathy
affect single nerve
trauma, entrapment, infection
polyneuropathy
affect multiple nerves
symmetric fashion
stocking and glove distribution
mononeuritis multiplex
disease process damaging several nerves in haphazard fashion
vasculitis common cause
polyradiculoneuropathy
affect nerve root as well as peripheral nerve
-diffuse symmetric sx prox and distal parts of body
acute inflammatory demyelinating polyneuropathy
guillan barre
paralysis and areflexia, DTR gone, nerve conduction slow, CSF protein high, preceding acute flu-like illness
guillan barre
guillan barre infections
campylobacter jejuni CMV EBV mycoplasma pneumonia prior vaccination - no evidence
nerve biopsy
often lymphocytes
chronic guillan barre
2 months or more
doesn’t get better
onion bulb neuropathy
demyelinzation
myelin basic protein
stain for myelin
ulnar deviation
rheumatoid arthritis
systemic autoimmune diseases with neuropathy
rheumatoid arthritis
sjogren
SLE
vasculitis
non-infectious inflammation of blood vessels - can involve and damage peripheral nerves
fibrinoid necrosis of vessels
polyarteritis nodosum
target lesion
lyme
pseudomembrane
diptheria
toxin causes neuropathy
most common cause of stocking glove peripheral neuropathy
diabetes
thin myelinated nerve, thick endometrial vessel, nodular sclerosis of glomerulus
diabetes
numbness, loss of pain sensation, difficulty with balance, paresthesia, dysthesia
distal symmetric diabetic polyneuropathy
leads to foot and ankle fractures, chronic skin ulcers
also - diabetics have autonomic dysfunction
postural hypotension, incomplete bladder emptying, sexual dysfunction
peripheral neuropathy in diabetic
has variable presentation
distal, symmetric neuropathy, asymptomatic or muscle cramp, distal dysesthesias, diminished DTRs
uremic neuropathy
-with chronic renal failure
axonal degeneration is primary event**
recovery after dialysis
compression mononeuropathy with distal symmetric sensory polyneuropathy
thyroid dysfunction - hypothyroid
vit B12 deficiency
pernicious anemia
-subacute combined degeneration with damage to long tracts in SC and peripheral nerves
peripheral neuropathy deficiency
B1 (thiamine) B6 (pyridoxine) folate vit E copper zinc
uremic frost
white froth around mouth
with neuropathies
wernickes encephalopathy
image of brain lesion
-from thiamine deficiency**
toxic neuropathies
alcohol
heavy metals - lead, mercury, arsenic, thallium
medications - vinca alkaloids, taxanes, cisplatin
basophilic stippling on RBC
lead poisoning
can cause neuropathy
dots on hands with neuropathy
arsenic
direct infiltration of tumor to brachial plexus
pancoast tumor
paraneoplastic sensorimotor neuropathy
with small cell lung cancer
waldenstroms
B cell IgM immunoglobulins
-hyperviscosity an demyelinating peripheral neuropathy
periphera nerve injury/entrapment
carpal tunnel
2nd and 3rd toes neuropathy with trauma
-dancer
whartons neuroma
charcot marie tooth disease
sensory AND motor neuropathy
inherited genetic disorder**
distal muscle atrophy, sensory loss, foot deformity
CMT - charcot marie tooth disease
see bruising, cuts, abrasions - no symptoms - no sensation of pain**
pes cavus foot
with CMT 1
high arch and prominent metatarsal heads
painless weakness
with disorders of NMJ
myasthenia gravis
painless weakness**
autoimmune - Abs against AChR
associations with myasthenia gravis
thymoma / thymic hyperplasia
anti-AChR Abs
weakness that worsens with exertion
myasthenia gravis
also see diplopia and ptosis
tx of myasthenia gravis
acetylcholinesterase inhibitors
lambert eaton myasthenic syndrome
autoimmune disorder causing Abs that block ACh release by inhibiting presynaptic Ca channel
gets better with exertion**
myasthenia gravis vs. lambert eaton
MG - postsynaptic
LE - presynaptic
LE - better with exertion
MG - worse with exertion
association with lambert eaton
neuroendocrine carcinoma of lung
-small cell
CD8 T cells
polymyositis
CD4 T cells
dermatomyositis