Flashcards in Neuropathic Disease Deck (41):
What are the CT layers of a spinal nerve?
The perineurium covers what part of a nerve?
(epi= whole nerve, endo= individual fiber)
Term for "disease of peripheral nerves"
#1 inherited neuropathy
(but note that all inherited neuropathies are rare)
What are the three types of CMT?
-AD, PMP22 gene (peripheral myelin protein)
Appearance of nerves in CMT 1
Large, demyelinated --> remyelinated multiple times
CMT clinical presentation
-distal muscle (leg) weakness + wasting
-numbness, but patients don't complain of it
CMT2 clinical presenation
-CMT 1 but slower progression, less likely to need wheelchair
CMT3 clinical presenation
severe, delayed motor milestones
-Nerve conduction studies to determine axonal vs demyelinating pattern
-+/- genetic testing
In addition to CMT, what are two other hereditary neuropathies?
What are 5 autoimmune/ inflammatory neuropathies?
4) Rheumatoid arthritis
Must Save Some Rose Vases
What are two infectious neuropathies?
2) Lyme (bilateral bells)
What are vitamin related causes of neuropathy?
What are four industrial exposures that may cause neuropathy?
What are six drugs that are assc with neuropathies?
Colchicine Hydralazine Metronidazole Nitrous Oxide Paclitaxel Vincristine
Cheetas Headbutted Martinis. Nevertheless, Oprah Preached Vigilantly.
In addition to checking serum B12, if B vitamin deficiency is expected, what other lab should be drawn?
-methylmalonic acid, if elevated may ~ B12 deficiency
What are the 3 clinical symptoms of B12 deficiency
2) gait disturbance
3) neuropathic pain
+/- posterior column myelopathy
In carpal tunnel, what muscles are weak ?
1) abductor pollicis brevis
2) opponens pollicis
Where is the majority of sensory loss in diabetic neuropathy?
sock and glove distribution (hands and feet)
In addition to sensory loss, what are the symptoms of diabetic neuropathy
1) burning pain
2) weakness in late stage
What are the treatments for pain control in diabetic neuropathy?
1) gabapentin/ pregabalin
5) topical capscaisin
Is Guillain Barre an axonal or demyelinating neuropathy?
-primarily demyelinating, may see secondary axonal loss
In addition to Campylobacter, what infections are assc with Guillian Barre?
Classic guillain barre presentation
rapidly ascending weakness
loss of DTRs
autonomic instability, respiratory failure
How long does GBS typically last?
What is the mortality rate for GBS?
Dx for GBS
1) cytoalbumic dissociation in CSF
2) slowed nerve conduction studies
Treatment for GBS
(one or the other not both)
Miller Fisher Variant of GBS:
Ab assc with Miller Fisher GBS
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP): pathogenesis
-macs + T cells destroy endoneurium - segmental demyelination
CIDP is the peripheral equivalent of _____.
MS, just effects peripheral instead of central nerves
-CSF: elevated protein
-Biopsy (onion bulbing)
Treatment for CIDP
-immunosuppression (Azathioprine, mycophenolate, Cytoxan)
-only 5-10% of cases
-upper AND lower motor neuron signs
#1 COD + life expectancy
-3 years after onset of focal weakness