Lecture 8: Peripheral Neuropathies Flashcards Preview

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Flashcards in Lecture 8: Peripheral Neuropathies Deck (21):
1

Peripheral Neuropathies: features

-axonal degeneration, paranodal or segmental demyelination
-mainly categorized by the basis of structure being affected

2

Axonal neuropathies

-conduction velocity can be normal or slightly reduced
-see denervation at affected muscle

3

demyelinating neuropathies

-conduction may be slowed considerably or completely blocked
-see no signs of denervation

4

polyneuropathies

-lead to symmetric sensory, motor or mixed deficit; most marked distally
-involvement of motor fibers = flaccid weakness
-involvement of sensory fibers = impaired sensory perception
-tendon reflexes depressed

5

Classification of Peripheral Nerve Dz's

-spatial
-temporal
-etiology based

6

polyneuropathy

-distal axonopathy; largest and longest axons first
-parasthesias, numbness in Feet first
-early motor deficit in feet
-"Glove stocking"
-early loss of ankle reflex

7

Mononeuropathy

-single anatomically defined nerves in sequence
examples = sciatic, ulnar, median nerves

8

ganglionpathy

asymmetric, pure sensory,
-hand > feet
-areflexia and ataxia

9

Polyneuropathy: etiology classifications

-Metabolic dz
-toxic
-nutritional deficiency
-immune mediated
-paraneoplastic
-infectious
-genetic

10

Diabetic neuropathy

-distal, symmetric, sensorimotor
-can affect autonomic system: BP, HR, GI, bladder fx, ED
-diabetic neuropathic cachexia
-large fiber ataxxia
-neuropathy with glucose intolerance
- diabetic amyotrophy
-diabetic truncal/cranial neuropathy

11

Diabetic neuropathic cachexia

-symmetrical peripheral neuropathy with profound wt. loss and painful dysesthesias, affecting proximal lower limbs, hands and lower trunk

12

diabetic amyotrophy

-affects thighs, hips, butt and legs
-pain affecting one side of body and can have sudden onset
-followed by intense weakness of proximal muscles in LE

13

Diabetic neuropathy tx

-tight glycemic control
-experimental therapies: aldose reductase inhibs, PKCB inhibss, Alpha lipoicacid, gamma linoleic acid
-FLudrocortisone: for ortho hypotension
-pain: duloxene, tramadol, gabapentin

14

Inherited polyneuropathies : types

-common cause of slowy progressive polyneuropathies
-variable clinical severity
-Charcot-Marie Tooth syndrome
-HnPP
-Familial amyloid neuropathy

15

Chronic Inflammatory Demyelinating Neuropathy

-precipitating events: infxns, vaccines, surg, pregnancy, HIV,
-motor > sensory deficits
-mean onset = 47 y/o
-Features: weakness, areflexia, facial/eom palsy, sensory deficits
-CSF: high protein
-nerve conduction: slow
-Tx: steroids, IVIg, PE

16

Carpal tunnel syndrome: features

-middle aged, women
-compression of median nerve
-tingling, numbness, swollen

17

Ulnar Nerve lesions

-occurs in elbow region
-sensory changes in medial 1.5 digits and along medial border of hand

18

Meralgia Parasthetica

-lateral femoral cutaneous nerve is stretched/compressed due to obese, diabetic or pregnancy
-hyperextension of hip or increased lumbar lordosis cane lead to neve compression of inguinal ligament
-pain, parathesia, numbness at outer aspect of thigh
-commonly settle spontaneously

19

Trigeminal Nerve palsy

-adult: > 60
-disabling, lancinating, or electrical facial pain
-along V2, V3
-sudden
-paroxysmal, unilateral, not during sleep, provocable,
-tx: anticonvulsants, glycerol injection

20

Facial Nerve Palsy (aka Bells palsy)

-idiopathic paresis of LMN type attributed to an inflame rxn involving CN VII
-sudden onset/abrupt
-face feels stiff, and pulled to one side
-hyperacusis or impaired taste
-difficulty holding saliva, food or fluids
-Tx: corticosteroids, symptomatic management and antivirals

21

Complex Regional Pain syndrome

= chronic pain cndtn in which high levels of nerve impulses are sent to an affected site
-most common in ages 20-35, affecting women more
-sx's: continuous intense pain that is worse over time; burning pain; swelling/stiffness of joints; muscle spasms; skin changes
-tx; relieve painful sx's