Approach to Peripheral Neuropathies

Question 1

What feeds nerves with nutrients and blood?

Answer 1

Vasa Nervorum

Question 2

If a peripheral nerve is myelinated it has a ____ conduction speed

Answer 2

FAST

Question 3

If a peripheral nerve is unmyelinated, it has a ____ conduction speed

Answer 3

Slow

Question 4

What is a Radiculopathy?

Answer 4

Nerve root dysfunction

Question 5

Skin area supplied by a single spinal root

Answer 5

Dermatome

Question 6

Muscle group supplied by a single spinal root

Answer 6

Myotome

Question 7

Area of bone supplied by a single spinal root

Answer 7

Sclerotome

Question 8

In the Cervical region, what level/nerve root is most commonly compressed?

Answer 8

Level = C6-C7

Nerve root compressed = C7

Question 9

Most common etiology of Brachial Plexopathy?

Answer 9

Compression/stretch with CABG for ex.

Question 10

Parsonage-Turner Syndrome is a Brachial Plexopathy. Where is there pain, weakness and atrophy?

Answer 10

Shoulder area

Question 11

Single nerve affected with specific sensory loss and weakness

Answer 11

Mononeuropathy

Question 12

Stocking/glove sensory loss with distal weakness

Answer 12

Polyneuropathy

Question 13

Focal involvement of 2+ nerves with some systemic disorders like DM/vasculitits

Answer 13

Mononeuritis Multiplex

Question 14

Which motor neurons are affected with Peripheral neuropathies?

Answer 14

LMN

Question 15

DTRs with Peripheral Neuropathies

Answer 15

Hypoactive

Question 16

Distal paresis, atrophic muscles and flaccid tone characterize central or peripheral neuroapthies?

Answer 16

Peripheral neuropathies

Question 17

Carpal Tunnel Syndrome traps which nerve and where will pain/numbness/paresthesias be felt?

Answer 17

Median Nerve

= Thumb and first 2 fingers

Question 18

What is another syndrome besides Carpal Tunnel Syndrome that can trap the Median Nerve?

Answer 18

Pronator Syndrome

Question 19

Where is the pain and when with Pronator Syndrome?

Answer 19

Pain of the proximal forearm and with pronation

Question 20

What movement can the patient not do if they have Anterior Interosseous Syndrome and what nerve is affected?

Answer 20

They cannot make a good circle when trying to make the “OK” sign
– Median Nerve

Question 21

What syndrome affects the Ulnar nerve and where?

Answer 21

Cubital Tunnel Syndrome

– At the elbow

Question 22

What will the patient have an abnormality in if they have an Ulnar Mononeuropathy?

Answer 22

Cannot grasp something well between thumb and first finger

– will have thumb flexion

Question 23

What is a common Radial Mononeuropathy?

Answer 23

Saturday Night Palsy

Question 24

As the Radial Nerve is damaged with Saturday Night Palsy, what will the sign be?

Answer 24

Wrist drop

Question 25

Where is the radial nerve compressed with Saturday Night Palsy?

Answer 25

Spiral groove

Question 26

What is the most common lower limb entrapment Neuropathy?

Answer 26

Peroneal Mononeuropathy

Question 27

Where does Peroneal Mononeuropathy usually occur?

Answer 27

Fibular head entrapment

Question 28

What will be present with Peroneal Mononeuropathy?

Answer 28

Foot drop - loss of dorsiflexion and possible sensory loss on top of foot

Question 29

If large fibers are affected, what senses will be altered?

Answer 29

Position and vibratory

Question 30

If small fibers are affected, what senses will be altered?

Answer 30

Pain and temperature

Question 31

What are the 2 most common causes of Polyneuropathy?

Answer 31

Diabetes | Alcohol

Question 32

What is the most common Hereditary Polyneuroathy?

Answer 32

Charcot-Marie-Tooth

Question 33

Hereditary Motor Sensory Neuropathies (HMSN) like charcot-marie-tooth have many forms. Which forms are demyelinating or axonal?

Answer 33

``` HMSN1 = demyelinating HMSN2 = axonal ```

Question 34

What is a unique finding with HMSN1?

Answer 34

Skeletal deformities | -- pes cavus and hammer toes

Question 35

With HMSN1, what will the EMG show and why?

Answer 35

Slowing of motor nerve conduction | -- demyelinating type

Question 36

HMSN2 has similar symptoms to type 1 without the?

Answer 36

No skeletal abnormalities

Question 37

What will the EMG show with HMSN2 and why?

Answer 37

NORMAL conduction velocities of motor nerve | -- Axonal type

Question 38

Charcot-Marie-Tooth inherited polyneuropathy is also called?

Answer 38

Hereditary Motor Sensory Neuropathies (HMSN)

Question 39

What usually causes Guillain Barre Syndrome?

Answer 39

Campylobacter Jejuni enteritis

Question 40

What will be seen in the CSF with Guillain Barre Syndrome?

Answer 40

Increased protein (albumino-cytologic dissociation) with normal cell count

Question 41

Will the conduction velocity be slowed with Guillain Barre?

Answer 41

Yes

Question 42

What is the treatment options for Guillain Barre?

Answer 42

Plasmapheresis | IVIg

Question 43

A poor prognosis with Guillain Barre is associated with?

Answer 43

Low amplitude motor nerves

Question 44

What is a common variant of Guillan Barre?

Answer 44

Miller-Fisher Syndrome

Question 45

What antibodies are (+) with Miller-Fisher Syndrome?

Answer 45

(+) GQ1b | (+) GT1a

Question 46

What are the symptoms of Miller-Fisher Syndrome and what is it a variant of?

Answer 46

Variant of Guillain Barre | = Ophthalmoplegia, ataxia, arreflexia, facial weakness

Question 47

What antibodies are (+) with Miller-Fisher Syndrome?

Answer 47

(+) GQ1b | (+) GT1a

Question 48

What is similar to Guillain Barre syndrome but is more persistent?

Answer 48

Chronic Inflammatory Demyelinating Polyneuropathy

Question 49

How can you treat Chronic Inflammatory Demyelinating Polyneuropathy that you cannot do with Guillan Barre?

Answer 49

Steroids Immune suppressants -- can still do plasma exchange, IVIg