Flashcards in Neuropathies Deck (11):
Lower back pain
Although common, take full Hx and O/E
What are the tendon reflex nerve roots?
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.
Metabolic- B12/folate def, diabetes, uraemia
Inflammatory- Guillan Barre(GBS) , chronic inflammatory demyelinating polyneuropathy( CIDP)
Toxic- alcohol, lead, mercury
Drugs- phenytoin, Vincristine, vinblastine
Inherited- Charcot-Marie-Tooth, Friedricks ataxia
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.
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.
What cases give mainly a sensory neuropathy?
What causes give main,y motor neuropathies?
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
Refer pt urgently if these apparent.
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
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.
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