Week 4- Peripheral neuropathy

Question 1

What force most commonly damages nerves?

Answer 1

Generally compression.

Question 2

How should you approach a peripheral neuropathy patient (5 questions to answer)

Answer 2

Which nerves are damaged?
Where are they damaged?
How are the nerves damaged?
Why are the nerves damaged?
Can we stop the nerves from being damaged?

Question 3

Why can it be hard to differentiate between a peripheral neuropathy and a radiculopathy?

Answer 3

Some peripheral nerves can be damaged at the proximal and distal aspects making it difficult to differentiate.

Question 4

Reflexes are decreased in peripheral nerve problems. True or false?

Answer 4

True- if you damage the afferent or efferent pathway, the reflexes will be affected and hence decrease.

Question 5

The autonomic nervous system can be involved in peripheral neuropathys. True or false?

Answer 5

True- patients can present with gastroperesis (lack of innervation of the gut), postural hypotension etc etc.

Question 6

What will occur to the power, sensation and reflexes in a large motor peripheral neuropathy?

Answer 6

Power will be reduced
Sensation will remain
Reflexes will be dampened

Question 7

What will occur to the power, sensation and reflexes in a large sensory peripheral neuropathy?

Answer 7

Power will be normal
Sensation will be abnormal/reduced
Reflexes will be dampened

Question 8

Which fibres can suffer from peripheral neuropathy but have the reflexes remain unaffected?

Answer 8

Autonomic fibres

And small fibres conducting pain.

Question 9

What is a mono neuropathy?

Answer 9

When one singular nerve branch is damaged e.g. carpal tunnel.

Question 10

What is mono neuritis multiplex?

Answer 10

A vasculitis that essentially takes out whole nerves. Happens quite randomly around the body e.g. one nerve in the foot and another nerve in the arms ill affected.
Subacute onset.

Question 11

What is length dependent peripheral neuropathy?

Answer 11

Presents in a glove and stocking distribution. Peripheral nerves tend to die off from the feet up to the waist.

Question 12

What is a radiculopathy?

Answer 12

Signs which show a specific nerve root compression e.g. pain, numbness.

Question 13

What is the most important demyelinating disorder?

Answer 13

Guillian Barre syndrome.

Question 14

How would you test for peripheral neuropathy?

Answer 14

Nerve conduction studies.

Question 15

Name some chronic demyelinating conditions?

Answer 15

chronic inflammatory demyelinating polyradiculopathy

Hereditary sensory motor neuropathy.

Question 16

How does Guillian Barre syndrome present?

Answer 16

Progressive paraplegia (complete paralysis in lower limbs). Associated sensory symptoms (e.g. pain) proceed weakness.

Question 17

How may someone with the early stages of Guillian Barre be on examination?

Answer 17

They may be completely normal initially.

Question 18

Treatment for Guillian Barre syndrome?

Answer 18

IV immunoglobulins and/or plasma exchange.

Question 19

You can get hereditary neuropathies. What signs may these present with on examination of someone with HMSN Type 1?

Answer 19

Champagne bottle deformity- looks like the gap between their calves is champagne bottle shaped.
Deformity of the hand and foot- very high arched foot.

Question 20

What can cause autonomic neuropathy?

Answer 20

Acute-
Guillain Barre syndrome
Porphyria- patient presents with madness, unexplained abdominal pain and peripheral neuropathy.

Chronic
Diabetes
Amyloidosis- depositation of protein (often secondary to other illness e.g. RA) around the body.
Hereditary

Question 21

How would you treat peripheral neuropathy?

Answer 21

Treat the cause e.g. hepatitis eradication

Symptomatic treatment- physiotherapy, orthotics, neuropathic pain relief.

Question 22

How would you treat a peripheral neuropathy caused by vasculitis?

Answer 22

Pulsed IV methylprednisolone and cyclophosphamide