Syncope and peripheral neuropathy

Question 1

Syncope with significant stress or fear

Answer 1

Vasovagal (tilt table)

Question 2

Syncope with the patient on Coumadin.

Answer 2

Cardiac: arrhythmia (ECG)

Question 3

Syncope with a prior TIA

Answer 3

Vascular (carotid US)

Question 4

Syncope with progressively worsening headache

Answer 4

Neurologic: intracranial lesion (CT/MRI)

Question 5

Syncope with urinary incontinence

Answer 5

Neurologic: seizure (CT/MRI, EEG)

Question 6

Cause of syncope for a diabetic

Answer 6

Endocrine: hypoglycemia (give glucose)

Question 7

What are the common categorical etiologies of peripheral neuropathy?

Answer 7

1. Nutritional: deficiency in vitamins B1 (thiamine), B6 (history of isoniazid), B12, and E
2. Metabolic: diabetes, uremia, hypothyroidism
3. Toxins: lead (wrist or food drop) and other heavy metals
4. Medications: isoniazid, aminoglycosides, ethambutol, vincristine
5. Infectious: Lyme disease, HIV, diphtheria
6. Autoimmune: Guillain-Barre, lupus, scleroderma, sarcoidosis, amyloidosis, polyarteritis nodosa
7. Anatomical/trauma: carpal tunnel syndrome (secondary to repetitive activity, acromegally, or hypothyroidism), radial nerve palsy (pressure paralysis), fractures