Lecture 2-neuropathies/ALS

Question 1

Nerve causing foot drop

Answer 1

Perineal nerve

Question 2

Nerve causing weakness of hand muscles

Answer 2

Ulnar nerve

Question 3

Nerve causing wrist drop

Answer 3

Radial nerve

Question 4

Mononeuropathy multiplex examples

Answer 4

DM(combo of individual nerves usu in stocking glove distribution) and thoracic neuropathy(ex of brachial plexus)

Question 5

Poly neuropathic commonly seen in what nerve distribution?

Answer 5

Distal nerve distributions

Question 6

Damage to the axons but NO nerve damage

Answer 6

Neuropraxia (ex: Saturday night palsy)

Question 7

Causes of mechanical pathology

Answer 7

Direct trauma, neuropraxia, or entrapment

Question 8

Ischemia of nerves

Answer 8

Vascular neuropathies

Question 9

Examples of vascular neuropathies

Answer 9

DM, poly arthritis nodosa, and RA

Question 10

Vascular neuropathies will be in ____(multiple or single) nerve distributions

Answer 10

Multiple

Question 11

Most common atonal polyneuropathy

Answer 11

DM

Question 12

Both motor and sensory deficits but SENSORY dominates

Answer 12

Axonal polyneuropathies

Question 13

Diabetic polyneuropathy

Answer 13

• symmetric distal sensory loss in feet
• loss of thermal and vibratory sense first
• may complain of pain
• may see mononeuropathy a/w DM

Question 14

Most common mononeuropathy a/w diabetes

Answer 14

3rd nerve palsy

Question 15

Neuronal polyneuropathy

Answer 15

• ABSENCE of sensory involvement (Looks like pure motor)
• involves proximal and distal muscles
• fasciculations

Question 16

Most common neuronal polyneuropathy

Answer 16

Amyotrophic lateral sclerosis (ALS)

Question 17

Acute demyelination polyneuropathy

Answer 17

GBS

Question 18

Chronic demyelinating polyneuropathy

Answer 18

Charcot-Marie-tooth

Question 19

What will you see in CSF with all demyelinating polyneuropathies

Answer 19

Elevated protein in CSF

Question 20

Most common mono neuropathy

Answer 20

Median nerve causing carpal tunnel syndrome

Question 21

Guillian-barre pathology starts with

Answer 21

pins and needles in feet progression to weakness in legs and moves proximally; DTRs lost early in lower extremities

Question 22

Guillian-barre can happen after infection 60% of the time with these etiologic agents

Answer 22

URI, campylobacter, mono, CMV, herpes

Question 23

demyelinating disease seen in 2nd and 4th decade

Answer 23

charcot-marie-tooth (inherited)

Question 24

see slowly evolving footdrop, on exam shows distal wasting of intrinsic muscles of feet; may have hx of ankle sprains

Answer 24

Charcot marie tooth

Question 25

acute

Answer 25

onset in a few days; think trauma with compression

Question 26

subacute

Answer 26

onset within 2-4wks

Question 27

chronic

Answer 27

onset >1 month prior; think DM

Question 28

most causes of peripheral neuropathy affect

Answer 28

BOTH MOTOR AND SENSORY

Question 29

Motor symptoms

Answer 29

weakness, fatigue, cramps, muscle twitches

Question 30

Sensory symptoms

Answer 30

numbness, pain (sharp, burning, stabbing, shooting), alteration in sensation, loss of coordination (sensory ataxia)

Question 31

most UNCOMMON complaint in sensory symptoms

Answer 31

sensory ataxia

Question 32

Motor signs we observe

Answer 32

weakness (usually focal; classify strength/compare sides), fatigue (myasthenia), cramps (must work muscles to see), fasciculations (easier to see in thin pts and more prominent in gastrocnemius)

Question 33

Sensory signs we observe

Answer 33

sensory loss (loss of sharp/dull, light touch), sensory ataxia (may look cerebellar), hyporeflexia (loss of sensory feedback from muscles)

Question 34

In polyneuropathies the deficit of sensory lost is seen in

Answer 34

distal areas (stocking glove)

Question 35

Myopathy definition

Answer 35

inflammation or degeneration of skeletal muscles

Question 36

Differences of myopathy and neuropathy:

Answer 36

myopathy has PROXIMAL motor weakness | neuropathies have DISTAL motor weakness if ANY sensory loss and or loss of reflexes think NEUROPATHY

Question 37

Motor neuron disease findings

Answer 37

typically produce symptoms of upper and or lower motor neuron dysfunction WITHOUT sensory symptoms

Question 38

B-12 Deficiency findings

Answer 38

symmetrical distal sensory involvement and symmetrical proximal motor involvement

Question 39

two CLASSIC studies for neuropathies

Answer 39

EMG and nerve conduction studies

Question 40

findings of slowing of nerve conduction velocity suggest

Answer 40

DEMYELINATING neuropathy (GB, CMT)

Question 41

findings of denervation changes on EMG

Answer 41

AXONAL neuropathy

Question 42

findings of segment of one nerve

Answer 42

MONONEUROPATHY

Question 43

findings of slowing of nerve conduction velocity on multiple nerves

Answer 43

POLYNEUROPATHY

Question 44

Nerve biopsy indication

Answer 44

if you think inflammatory

Question 45

Muscle biopsy indication

Answer 45

if you think myopathy

Question 46

Imaging indication

Answer 46

if you think TUMOR

Question 47

DM Tx

Answer 47

control glucose; maybe try TCAs for neuropathic pain

Question 48

Guillian-Barre Tx

Answer 48

supportive care, steroids DONT help

Question 49

Carpul tunnel tx

Answer 49

cock-up splint or surgery

Question 50

ALS tx

Answer 50

anticonvulsants for fasciculations

Question 51

B-12 Tx

Answer 51

replace B-12 (duh)

Question 52

Non-pharmacologic tx

Answer 52

PT, TENS, Magnets, relaxation techniques

Question 53

idiopathic disease affecting both upper and lower motor neurons with NO ALTERATION in sensation

Answer 53

ALS

Question 54

ALS accounts for what % of acquires motor neuron disease

Answer 54

80%

Question 55

ALS weakness usually starts where

Answer 55

hands and arms and goes to legs later

Question 56

commonly seen with ALS

Answer 56

muscle twitching and cramps

Question 57

Signs and symptoms of ALS

Answer 57

PAINLESS progressive weakness of intrinsic muscles of the hand, may even see wasting of the msucles

Question 58

Hallmark of ALS

Answer 58

presence of both upper and lower motor neuron signs in the same limb (spastic tone, hyperreflexia, fasciculations, wasting)

Question 59

tongue fasciculations with limb weakness and upper motor neuron signs highly suggest:

Answer 59

ALS

Question 60

How is ALS diagnosed?

Answer 60

clinically!!!; NCS normal, EMG shows widespread involvement of proximal and distal muscles, imaging is normal

Question 61

ALS prognosis

Answer 61

mean duration of time between symptoms and death is 27-43months