Peripheral neuropathy

Question 1

Causes of peripheral neuropathy

Answer 1

Metabolic and endocrine- hyothyroidism, liver failure, renal failure, Posinfective po

Question 2

Mechanism of peripheral nerve degeneration

Answer 2

Infarction – DM
Infiltration- leprosy and granulomas
Demyelination- Guillain-Barre Syndromes
Axonal degeneration- toxic neuropathies
Wallerian degemration
Compression- Carpal tunnel syndrome

Question 3

Clinical fetures

Answer 3

Sensory : Paresthesia, burning pain, tingling sensation, numbness, loss proprioception, allodynia, loss of pain and temperature sensation

Motor: Wasting, hypotonia, hyporeflexia, fasciculation, deformity.

Autonomic: Postural hypotension, urinary retention, erectile dysfunction, diarrhea/constipation, diminished sweating, cardiac arrhythmias, gustatory sweating.

Question 4

Diabetic neuropathy
Peripheral damage:

Answer 4

1. Occlusion of th vasa nervorum
2. Sorbitol and fructose accumulation in Schwann cells du

Question 5

Common presentaios of diabetic neuropathy

Answer 5

1. DIstal symmetrical polyneuropathy (stockings and gloves pattern)
2. Acute painful neuropathyy

Question 6

10 gram monofilament

Answer 6

for diabetic patiency

Question 7

Carpal nerve
Median nerve entrapment

Clinical presentation:

Question 8

Guillain-Barre syndrome

Answer 8

AIDP
Triggered by infections.

Question 9

Investigation of peripheral neuropathy:

Answer 9

Urinalyis- glucose, protein
Haemotology- FBC, ESR, vitamin B12, folate
Biochemistry- HBA1c, fastingglucose, E/U/ Cr, LFT, TSH
CSF- protein high normal cell count. in GBS.
Nerve conduction studies
Electromyography (EMG)
Nerve biopsy: e.g. vasculities, sarcordoisis, CIDP, Leprosy,

Question 10

Treatment

Answer 10

TREATMENT OF THE UNDERLYING CAUSE.

Treatment of neuropathic pain.

Question 11

Nerve biopsy is useful in (5)

Answer 11

: most useful in inflammatory disorders such as vasculitis, sarcoidosis, CIDP, infectious diseases such as leprosy, or infiltrative disorders such as amyloidosis or tumour

Question 12

Treatment of neuropathic pain

Answer 12

1. Anticonvulsants- Gabapentin, pregabalin, sodium valproate
2. Antidepressants- Amitriptyline, duloxetine, venlafaxine
3. Opioids- tramadol, morphine, tapentadol
4. Capsaicin cream

Question 13

Anticonvulsants indicated for neuropathic pain.

Answer 13

Gabapentin, pregabalin, sodium valproate