Diseases of peripheral nerves Flashcards
(38 cards)
Motor nerve damage symptoms
usu. associated with muscle weakness
may also see painful cramps, fasciculations, muscle atrophy
Sensory nerve damage symptoms
various symptom patterns can include loss of vibratory sense, stocking-glove sensation, loss of reflexes, loss of position sense, loss of temperature sensation, pain
Autonomic nerve damage: aka small-fiber neuropathies symptoms
Excess sweating, heat intolerance, inability to expand
and contract small blood vessels regulating blood pressure, gastrointestinal symptoms
What is the most common cause of a single nerve injury?
Trauma
What is the most common cause of polyneuropathy in the US?
Diabetes
What is the most common inherited neurological disorder?
Charcot-Marie-Tooth
Peripheral Neuropathy evaluation
*Medical history (symptoms, triggers, possible causes)
* Physical with full neurological exam
*Blood work (looking for deficiencies, dysfunction, infection, metabolic dx, autoimmunity).
*CSF
*Genetic testing
Physiologic tests of nerve function
- Nerve conducsion velocity (NCV)- Tests signal strength and speed
- Electromyography (EMG)-Tests electrical activity, rest/contraction (differentiates between nerve and muscle issue.
What is the gold standard for small fiber neuropathies
Skin biopsy
What is a QSART?
Used for small fiber neuropathies, test sweat ability, Acetyl-choline
Imaging for peripheral neuropathy evaluation
- MRI (Compression/mass/soft tissue/structural)
- CT (Mass/solid tissue/structural)
conservative treatments for peripheral neuropathy
- Manage potential causes i.e diabetes, smoking habits, drinking habits, diet, exercise
Managing specific symptoms:
Motor-Orthotics, mechanical aids
Autonomic-Accupuncture, massage, CBT/psychotherapy
Sensory-Behavioral strategies
*Transcutaneous electrical nerve stimulation (TENS)
Medication treatments for peripheral neuropathy
- TCA’s
- SSRI’s
- Gabapentin
- Topiramate
- Duloxetine
- Topical/local anesthetics
- Capsaicin
- Implanted spinal cord pumps with lidocaine, bupivicaine
- Opioids
Surgical treatments for peripheral neuropathy
- Remove compression
- Cutting the nerve-replaced with stimulation
Complex Regional Pain Syndrome (CRPS)
Chronic (>6 months) pain condition that usually affects one limb, typically after an injury.
Characterized by prolonged or excessive pain and changes in skin color, temperature, and or swelling.
Type I CRPS
Without a confirmed nerve injury
Type II CRPS
With an associated, confirmed nerve injury.
Who is most commonly affected by CRPS?
- Women
*Peak at age 40 - More common in patients with other inflammatory or autoimmune conditions.
Pathophysiology of CRPS
- Peripheral nerve abnormality involving small, unmyelinated/thinly myelinated sensory nerve axons carrying pain messages. Also affects nerves communicating with blood vessels.
- Vascular effects
*Immune system effects
Presentation of CRPS
- Prolonged severe pain described as “burning”, “pins and needles” sensation, or “squeezing” sensation.
- Pain can spread from area of onset
- Often will see sensitivity to area.
*Skin temp, color, swelling changes - Abnormal movement
- Abnormal sweating pattern
CRPS treatment therapies
- Rehab and PT
*Psychotherapy
*Sympathetic nerve block
*Surgical sympathectomy
*Intrathecal drug pumps
*Spinal cord stimulation
CRPS medicinal treatment
- Bisphosphonates
*Anti-Inflammatory meds (NSAID’s, Corticosteroids) - Neuropathic pain meds (gabapentin, pregabalin)
- Botox
*Opioids (CAUTION)
What is the role of Vitamin B12 in the body?
- Important in cellular metabolism and nervous system maintenance/integrity.
- Important in synthesis of DNA and cell division
What is the most common etiology of vitamin B12 deficiency?
Lack of intrinsic factor (pernicious anemia); a common finding in the elderly.
