Disorders of the PNS I (Classification, CMT & Diabetic Neuropathy) Flashcards
(46 cards)
Which category of peripheral neuropathy is associated with motor and sensory loss in dermatomal distribution?
- Radiculopathy
- Often associated with disc & vertebral bone disease
RehabilitationConsiderations for diabetic neuropathies:
- Thorough assessment of sensory and motor systems
- Screen for autonomic neuropathy: specially cardiovascular AN: Squatting test: test for hydrostatic hypotension
- Safety assessment: at higher risk for falls
- Pain magament
Which category of peripheral neuropathy includes damaged to multiple peripheral nerves and is common in diabetes?
mononeuropathy multiplex
What is Acute Sensory Neuropathy?
- A type of diabetic neuropathy
- Rapid onset of severe burning pain, sharp “electric shock” hypersensitivity of feet
- Sympstons worsen at night
- Mild symmetric or no sensory loss but with allodynia
- Recovery possible within 1 year if stable blood glucose maintained
Prognosis of peripheral neuropathies:
- Depending on type of neuropathy recovery is usually slow.
- May have full recovery
- May have residual deficits
- With severe neuropathy, can develop chronic muscular atrophy, contractures, deformities
Motor & sensory changes resulting from PNS disease occur in:
- distribution of nerve roots
- plexi or peripheral nn themselves.
- Look at peripheral nerve distribution.
Which peripheral nerve disease involves mainly the peroneal nerve, affecting muscles in foot & lower leg but can progress to nereves of forearms & hands.
Charco Marie Tooth Disease AKA Hereditary Motor and Sensory Disease AKA peroneal muscular atrophy
The PNS includes motor, sensory and autonomic nerves:
- Cranial nn
- Spinal nn
- Spinal nerve roots
- Peripheral nn
- Autonomic system
Which category of peripheral neuropathy includes damage to spinal roots?
- radiculopathy
- dermatomal distribution
In which type of diabetic neuropathy the patient shows a rapid onset of: severe burning pain, deep aching pain, sudden sharp “electric shock” sensation, and hypersensitivity of feet?
Acute Sensory Neuropathy
AUTONOMIC Signs & Symptoms of Neuropathic Dysfunction include:
- Vasomotor disturbances (orthostatic hypotension)
- Alterations in sweating
- Trophic changes of skin & nails
Medical Management of diabetic neuropathies:
- Good metabolic control: control of blood sugar levels
- Symptomatic management
- Medication for painful sensory neuropathies
- Prevention of complications
MOTOR Signs & Symptoms of Neuropathic Dysfunction include:
- Weakness (usually distal weakness first)
- Decreased DTRs
- Atrophy
- Cramping with fatigue
- Hypotonicity or flaccidity
Etiology of Charcot Marie-Tooth Disease:
- Inherited as autosomal dominant, autosomal recessive or X-linked pattern
- Various types: CMT1 most common autosomal dominant pattern.
which type of diabetic neuropathy presents with the characterictic “stocking - glove” sensory loss?
chronic sensorimotor neuropathy or diabetic polyneuropathy
Etiology/Pathogenesis of Diabetic Neuropathy:
- Metabolic impairments related to hyperglycemia
- Vascular changes
- Reduced nerve growth factor (NGF)
categories of peripheral neuropathy:
1. Symmetric polyneuropathy: stocking and glove
2. Mononeuropathy: mononeuropathy multiplex is common in diabetes
3. Plexopathy: injury to brachial, lumbar, or sacral plexus.
4. Radiculopathy: injury to spinal roots, dermatomal distribution
Diagnosis of CMT:
- History,
- Clinical exam,
- genetic studies,
- electrophysiologic studies (NCV/EMG),
- nerve biopsy
Pathology and two types of Charcot Marie-Tooth Diseas:
Gene mutations result in abnormal structure &/or function of the peripheral nerves
- CMT1: Segmental demyelination of fibular (peroneal) nerve
- CMT2: Associated with axonal degeneration -Onset varies between 2nd and 7th decades
What is the incidence of Charcot-Marie-Tooth Disease?
Onset?
- 1 in 2500 persons in the USA
- Onset in childhood or adulthood: Most often in adolescence or early adulthood
what is chronic sensorymotor neuropathy?
- AKA diabetic polyneuropathy
- Most common
- loss of position sense & vibration: large fibers
- loss of pain & temp: small finbers
- dull. aching pain in limbs and burning sensations especially at night
Autonomic diabetic neuropathy is manifested where?
In multiple systems:
- Cardiavascular: tachycardia, exercise intolerance, orthostatic hypotension, dizziness.
- GI: esophagus dysfunction, diarrhea, constipation
- Genitourinary: incontinence, erectile dysfunction
- Other: sweating, heat intolerance, dry skin, blurred vision
SENSORY Signs & Symptoms of Neuropathic Dysfunction:
- Anesthesia
- Hipothesia
- Hyperesthesia
- Impaired position sense and vibration: Large fiber problem
- Impaired pinprick & temperature: Small fiber problem
Which is the most common hereditary disorder of peripheral nerves:
Charcot Marie-Tooth Disease AKA hereditary motor and sensory neuropathy (HSMD) or peroneal muscular atrophy
