CC1: Peripheral Neuropathies

Question 1

What classification of nerve injury is neuropraxia?

Answer 1

Class 1

Question 2

What is the cause of neuropraxia?

Answer 2

Compression or acute ischemia

Question 3

What does neuropraxia do to the nerve?

Answer 3

Conduction block, no axon changes (MILD)

Question 4

What classification of nerve injury is axonotmesis?

Answer 4

Class II

Question 5

What is the cause of axonotmesis?

Answer 5

A crash injury to a limb causing axonal disruption

Question 6

What does axonotmesis do to the nerve?

Answer 6

• Axonal damage results in loss of continuity
• Wallerian degeneration distally

Question 7

How long is axonotmesis recovery?

Answer 7

Depends on nerve regeneration 1-3 mm/d (slow)

Question 8

What classification of nervy injury is neuronotmesis?

Answer 8

Class III

Question 9

What causes neuronotmesis?

Answer 9

Connective tissue elements severance, injuries that separate entire nerve

Question 10

What does neuronotmesis do to the nerve?

Answer 10

Separates entire nerve from tissue - endoneuro and schwann cell tube

Question 11

Can axonal regeneration occur in neuronotmesis?

Answer 11

Is very limited, little hope of functional recovery without surgery

Question 12

What can ocurr in neuronotmesis malformation?

Answer 12

Neuroma formation and aberrant regeneration

Question 13

Peripheral neuropathies can be subdivided into two major categories:

Answer 13

Primary axonopathies
Primary myelinopathies

Question 14

What are neuropathic disorders?

Answer 14

Diseases of the neuron cell body and their peripheral processes

Question 15

Large myelinated axons project:

Answer 15

Motor and sensory axons responsible for proprioception, vibration, and light touch

Question 16

Thinly myelinated axons project:

Answer 16

Sensory fibers responsible for light touch, pain, temperature, and preganglionic autonomic functions

Question 17

Small unmyelinated fibers project:

Answer 17

Pain, temperature, and postganglionic autonomic functions.

Question 18

What type of spacial distribution does a mononeuropathy have?
Ex. Entrapment neuropathies as in carpal tunnel or local trauma

Answer 18

Focal spatial distribution - one nerve affected

Question 19

What type of spacial distribution does a multiple mononeuropathy have?
Ex. Vasculitis

Answer 19

Multifocal - usually asymmetric

Question 20

What type of spacial distribution does a polyradiculopathy have?
Ex. Sensory/motor diabetic neuropathy

Answer 20

Diffuse - symmetric

Question 21

Which fiber is involved with :
LMN weakness
Muscle loss atrophy
Loss of tendon reflex
Impaired proprioception
Abnormal Romberg test

Answer 21

Large fiber type neuropathy

Question 22

Which fiber is involved with :
Contact hyperalgesia
Burning, aching, stabbing pain
(non specific)
Mild distal disturbance in sharp- dull discrimination
Normal DTR’s
Orthostatic hypotension

Answer 22

Small fiber neuropathies

Question 23

Which type of neuropathy involves axonal atrophy, impaired transport, chromatolysis, dying back?

Answer 23

Axonal neuropathy

Question 24

Which type of neuropathy has a gradual insidious of tingling and prickling onset found in lower extremities?

Answer 24

Axonal neuropathy

Question 25

Which type of neuropathy has a normal CSF protein level?

Answer 25

Axonal neuropathy

Question 26

Which type of neuropathy has a decreased ankle reflex?

Answer 26

Axonal neuropathy

Question 27

Which type of neuropathy has toxins, B vitamins, diabetes, hypothyroid, HIV?

Answer 27

Peripheral Sensory Motor Axonal Polyneuropathy

Question 28

Which type of neuropathy has autoimmune diseases?

Answer 28

Demyelinating neuropathies

Question 29

Where does destruction of myelin sheath often begin at in demyelination?

Answer 29

Nodes of Ranvier

Question 30

Which type of neuropathy has elevated CSF protein?

Answer 30

Demyelinating neuropathy

Question 31

Which type of neuropathy has fast progressive weakness?

Answer 31

Demyelinating neuropathy

Question 32

Which type of neuropathy has cranial nerve involvement?

Answer 32

Demyelinating neuropathy

Question 33

Which type of neuropathy has mild sensory loss?

Answer 33

Demyelinating neuropathy

Question 34

Which type of neuropathy has multifocal hereditary adquision?

Answer 34

Demyelinating neuropathy

Question 35

Which type of neuropathy has absent Deep tendon Reflexes?

Answer 35

Demyelinating neuropathy

Question 36

What type of studies are done in laboratories for peripheral neuropathies?

Answer 36

EMG and nerve conduction studies

Question 37

The most common cause of neuropathy worldwide:

Answer 37

Clinical Diabetic Neuropathy

Question 38

What type of neuropathy is Clinical Diabetic?

Answer 38

Distal axonopathy, focal and multifocal, sensory snd autonomic manifestations

Question 39

Unilateral oculomotor nerve palsies occur in what type of neuropathy? CN III

Answer 39

Cranial neuropathy

Question 40

Burning type of pain in thigh and pain with sensory loss with unilateral proximal muscle weakness and atrophy occurs in what type of neuropathy?

Answer 40

Proximal Diabetic Neuropathy of the Lower Limbs

Question 41

What accumulates in the nerve creating a hypertonic condition and water accumulation?

Answer 41

Sorbitol

Question 42

Chronic hyperglycemia increases ______ of proteins producing accumulation in tissues and endothelial cell membranes (causing microvascular disease)

Answer 42

glycosylation

Question 43

Alteration in polyol metabolism

Answer 43

Glucose → Sorbitol → Fructose

Question 44

Vascular pathogenesis of diabetics involves:

Answer 44

- hypoxia or ischemia of microvasculature of the nerve - mitochondria in DRG - oxidative stress

Question 45

Guillain Barre syndrome is what type of neuropathy?

Answer 45

Acute Inflammatory Demyelinating Polyneuropathy

Question 46

2/3 of the patients have a predisposing factor such as respiratory infection or gastroenteritis:

Answer 46

Guillain Barre

Question 47

In Guillain Barre CSF protein is _____

Answer 47

Elevated

Question 48

Pathogenesis is immune mediated: “molecular mimicry"

Answer 48

Guillain Barre

Question 49

What are the 2 groups of vessels involved in vaculitic neuropathies?

Answer 49

- nerve large arteriole vasculitis - nerve microvasculitis

Question 50

A diverse group of disorders characterized by the acute-to-subacute onset of painful sensory and motor deficits that result from inflammatory destruction of nerve blood vessels and subsequent ischemic injury:

Answer 50

Vaculitic neuropathies

Question 51

The two main pathways that lead to ischemic vasculitic nerve damage are:

Answer 51

- Immune complex deposition - Cell-mediated immunity

Question 52

Ooccurs when antigen-presenting cells present relevant antigens to circulating T cells producing proinflammatory cytokines and other inflammatory mediators that cause

Answer 52

Cell mediated immunity

Question 53

What type of ischemic pathways is within the vessel walls with complement deposition and release of proinflammatory cytokines.

Answer 53

Immune mediated complex deposition

Question 54

The most common is the median nerve entrapment in the wrist

Answer 54

Carpal tunnel syndrome

Question 55

Weakness in ankle dorsiflex and eversion - compression in the knee is what type of neuropathy?

Answer 55

Peroneal

Question 56

Tibial nerve compression in the region of the ankles as the nerve passes under the transverse tarsal (laciniate) ligament

Answer 56

Tarsal tunnel syndrome

Question 57

Impingement of the Lateral Femoral Cutaneous Nerve under the inguinal ligament

Answer 57

Meralgia paresthetica