Neuropathies Flashcards Preview

Neurology Year 3- K > Neuropathies > Flashcards

Flashcards in Neuropathies Deck (11):
1

Lower back pain

Although common, take full Hx and O/E

2

What are the tendon reflex nerve roots?

Biceps- C5/6
Suprinator- C6
Triceps- C7
Fingers- C8

Knee L3/4
Ankle- S1/2

3

Peripheral neuropathy

O/E
Inspection- thenar + hypothenar eminences
Pes cavus? Muscle wasting or fasciculations?
Neuropathic ulcers or deformed joints? Charcots joints

Tone- normal or ⬇️
Power- if motor or sensorimotor- weakness distal usually
Reflexes- ⬇️ or absent
Sensation- pin prick, vibration, proprioception check.

Inv- 1.Bloods-> FBC( macrocytosis), U+Es, ESR, B12, folate, glucoses, VDRL, ANCA, ANA, ENA, Rheumatoid factor, plasma electrophoresis.
2. Nerve conduction studies- demyelination or axonal?
3. LP to look for ⬆️ protein(GBS) (CIDP)
4. Possible nerve biopsy if vasculitis suspected or diff dx.

DDx
Metabolic- B12/folate def, diabetes, uraemia
Inflammatory- Guillan Barre(GBS) , chronic inflammatory demyelinating polyneuropathy( CIDP)
Toxic- alcohol, lead, mercury
Vascular- vasculitis
Drugs- phenytoin, Vincristine, vinblastine
Inherited- Charcot-Marie-Tooth, Friedricks ataxia
Neoplastic-paraprotein asssc
Infective- syphillis
Idiopathic

4

What are demyelinating neuropathies?

Slowing velocities on nerve conduction- due to myelin loss
If onset acute/subacute-GBS common
CIDP- is a chronic form of GBS- treatable w/ steroids + IV immuniglobulin.

5

What are axial neuropathies?

Show loss of amplitude on nerve conduction studies- preserved velocities because of loss of axons.

B12 def + vasculitis are aquired axonal neuropathies.
Because axons do not regrow, unlike myelin sheaths, they do not improve w/ tx.

6

What cases give mainly a sensory neuropathy?

Diabetes
B12
Alcohol

7

What causes give main,y motor neuropathies?

Lead
Inflammatory neuropathies

8

What are the red flags for cauda equina syndrome?

Bilateral or unilateral sciatica
Bladder or bowel dysfx
Saddle anaesthesia or paresthesia in perianal region/ buttocks
Gait disturbance
Sexyal dysfx

Refer pt urgently if these apparent.

9

Whats Horners syndrome?

Caused by damage to sympathetic NS (oculosympathetic palsy)

Obsereve: ptosis, acuity + fields normal.
Pupils small (miosis) but reacts to light and accomodation

Movements: nystagmus if brainstem disease
Fundi- normal
Extras: Eyes- heterochromia of iris- less pigmented affected eye
Neck: lymphadenopathy, carotid aneurysm, scars, ipsilateral carotid bruit (dissection)
Lungs: Apical Pancoasy tumour- T1 muscle wasting + sensory loss

Brainstem: CVA, MS, syringomyelia, look for nystagmus, bulbar palsy, sensory loss.

Idiopathic in young women.

10

What are the anatomical courses of the sympathetic supply to the pupil?

Midbrain->Medulla-> T1 cord-> T1 root-> thoracic DRG-> ascending preganglionic fibers-> carotid plexus-> long ciliary nerve-> short ciliary nerve-> radial pupillodikator muscle/ Muller m

11

What is the classical triad for Horners syndrome?

Ptosis, Miosis, Anhidrosis.

The little Jack Horner for a small pupil with a sunken eye.