Neuropathy Flashcards by Thomas Eraifej

Definition of mononeuropathy

Lesions of individual nerve

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Causes of mononeuropathies

Local trauma

Entrapment eg. tumour

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Mononeuritis multiplex definition

2 or more peripheral nerves affected

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Mononeuritis multiplex general cause

Tends to be systemic

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Specific causes of mononeuritis multiplex

WARDS PLC

Wegener’s

Aids / Amyloid

Rheumatoid

Sarcoidosis

Polyateritis nodosa

Leprosy

Carcinomatosis

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Median nerve muscle innervation

LOAF

2 Lumbricals

Opponens pollicis

Abductor pollicis brevis

Flexor pollicis brevis

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Median nerve roots

C6-T1

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Ulnar nerve roots

C7-T1

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Sx of ulnar nerve neuropathy

Weakness / wasting of:

medial wrist flexors
interossei
hypothenar eminence

Sensory loss over medial 1.5 fingers

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Rx of ulnar nerve neuropathy

Rest

Night time soft elbow splint

Surgery

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Most common cause of ulnar nerve palsy

Cubital tunnel syndrome

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Most common cause of median nerve palsy

Carpal tunnel syndrome

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Sx of carpal tunnel syndrome

Pain in hand worse at night

Numbess in thumb and lateral 2.5 fingers

Phalen’s test

Tinel’s test

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Rx of carpal tunnel syndrome

Splinting

Local steroid injection

Decompressive surgery

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Radial nerve roots

C5-T1

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Sx of radial nerve neuropathy

Wrist drop

Numbness over anatomical snuffbox

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Muscles innervated by radial nerve

BEST

Brachioradialis

Extensors

Supinator

Triceps

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Presentation of upper brachial plexus injury

Erb’s palsy

(Waiter’s tip)

Can’t abduct arm

Can’t flex elbow

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Presentation of lower brachial plexus injury

Klumpke’s palsy

(Claw hand)

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Phrenic nerve roots

C3, 4, 5

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Sciatic nerve roots

L4-S3

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Lateral cutaneous nerve of the thigh roots

L2-L3

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Lateral cutaneous nerve of the thigh neuropathy presentation

Lateral burning thigh pain

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Site of Lateral cutaneous nerve of the thigh entrapment

Inguinal ligament

Common peroneal nerve roots

L4-S1

Common causes of common peroneal nerve neuropathy

Trauma to fibular head Sitting cross legged

Common peroneal nerve palsy presentation

Foot drop Sensory loss over dorsum of foot

Tibial nerve roots

L4-S3

Presentation of tibial nerve neuropathy

Can't plantar flex Can't flex toes Sensory loss over sole of foot

Polyneuropathy definition

Symmetrical, widespread disorder of nerves

Metabolic causes of polyneuropathy

DM Renal failure Hypothyroidism

Malignancy causes of polyneuropathy

Paraneoplastic syndromes Polycythaemia rubra vera

Inflammatory causes of polyneuropathy

Guillain Barre syndrome Sarcoidosis

Inherited causes of polyneuropathy

Charcot-Marie-Tooth syndrome

Infective causes of polyneuropathy

Leprosy HIV Syphillis Lyme disease

Toxin causes of polyneuropathy

Lead poisoning Arsenic poisoning

Drug causes of polyneuropathy

Alcohol Isoniazid Phenytoin

Nutritional causes of polyneuropathy

Low B1 Low B12 Low folate

DM polyneuropathy

Mostly sensory Glove and stocking

Another name for Charcot-Marie-Tooth syndrome

Peroneal muscular atrophy

Genetics of Charcot-Marie-Tooth syndrome

Autosomal dominant Ch 17

Presentation of Charcot-Marie-Tooth syndrome

Starts in puberty Weak legs + foot drop

Sx of Charcot-Marie-Tooth syndrome

Peroneal muscle atrophy Hand and arm muscle atrophy Weak legs Foot drop Variable sensory loss

Classical appearance of peroneal muscle atrophy

Inverted champagne bottle appearance

Other name for Guillain Barre syndrome

Acute inflammatory demyelinating polyneuropathy

Presentation of Guillain Barre syndrome

Few weeks post infection Symmetrical ascending muscle weakness Progresses days-4wks Then recovery begins

Triggers for Guillain Barre syndrome

Campylobacter jejuni CMV Mycoplasma VZV HIV

Pathology of Guillain Barre syndrome

Infection triggers antibodies which attack nerves

Sx of Guillain Barre syndrome

Ascending muscle weakness Sweating Tachycardia Arrhythmias

Worry with Guillain Barre syndrome

Respiratory muscle involvement

Features required for diagnosis of Guillain Barre syndrome

Progressive weakness in all 4 limbs Areflexia

Mx of Guillain Barre syndrome

IV immunoglobulin 5 days Plasma exchange No Steroids

Prognosis of Guillain Barre syndrome

85% make near complete recovery Complete paralysis still compatible with recovery

General Mx of polyneuropathies

Rx cause Foot care Splint joints IV immunoglobulin for GBS Rx neuropathic pain

Rx of neuropathic pain

Amitriptyline Gabapentin Pregabalin

Types of autonomic neuropathy

Isolated sympathetic Isolated parasympathetic Part of generalised sensorimotor peripheral neuropathy

Sx of autonomic neuropathy

Postural hypotension Erectile dysfunction Sweating Constipation Horner's syndrome

Causes of primary autonomic failure

Parkinson's disease Lewy body dementia

Causes of secondary autonomic failure

DM Amyloidosis