Neuropathy W4

Question 1

what is neuropathy

Answer 1

disease of peripheral nerves

Question 2

mononeuropathy?

Answer 2

individual nerve affected

Question 3

polyneuropathy?

Answer 3

many nerves involved
typically longest nerves damaged first
(glove and stocking distribution)

Question 4

mononeuritis multiplex?

Answer 4

multiple mononeuropathies

Question 5

neuropathy classification by modalities affected?

Answer 5

sensory
motor
autonomic/visceral
(can affect one/some/all modalities!)

Question 6

sensory neuropathy types and features?

Answer 6

large fibre - crude touch, vibration, proprioception
small fibre - pain, temperature

Question 7

autonomic/visceral neuropathy features?

Answer 7

affects digestion, heart rate and BP regulation, sweat, bladder/bowel and sexual functions

Question 8

neuropathy classification by pattern of damage?

Answer 8

demyelinating - damage to myelin sheath
axonal - damage to axon

could be both!

Question 9

how to work out if neuropathy is demyelinating or axonal?

Answer 9

nerve conduction studies

Question 10

clinical features of neuropathy?

Answer 10

sensory disturbance
pain
weakness
secondary features

Question 11

sensory disturbance in neuropathy features?

Answer 11

pain (pinprick), temperature, touch, proprioception and/or vibration

Question 12

pain in neuropathy features?

Answer 12

sometimes present, typically neuropathic (burning, stabbing, tingling)

Question 13

weakness in neuropathy features?

Answer 13

accompanied by wasting, loss of reflexes

Question 14

secondary features in neuropathy?

Answer 14

wounds/ulcers
fractures (inc. chronic, poorly healed fractures eg Charcot joints)

Question 15

charcot joints?

Answer 15

occurs in patients who aren’t aware they’ve had a fracture due to loss of pain sensation. put weight on it and healed in abnormal fashion.

Question 16

mononeuropathy features

Answer 16

sensory loss and paraesthesia
and/or motor weakness in select muscle groups

Question 17

paraesthesia?

Answer 17

burning/prickling sensation usually felt in hands, arms, legs, feet
can occur in other parts of body

Question 18

common peroneal (fibular) mononeuropathy - area affected?

Answer 18

lateral aspects of leg, dorsal side of foot

Question 19

lateral cutaneous mononeuropathy - area affected? what’s this associated with?

Answer 19

anterior thigh
overweight

Question 20

mononeuropathy - median nerve vulnerable site?

Answer 20

carpal tunnel

Question 21

mononeuropathy - ulnar nerve vulnerable site?

Answer 21

Guyon’s canal (wrist)
cubital tunnel (elbow)

Question 22

mononeuropathy - radial nerve vulnerable site?

Answer 22

axilla, spiral groove of humerus

Question 23

mononeuropathy - lateral cutaneous nerve vulnerable site?

Answer 23

inguinal ligament

Question 24

mononeuropathy - common peroneal nerve vulnerable site?

Answer 24

fibular neck

Question 25

commonest mononeuropathy?

Answer 25

carpal tunnel syndrome

Question 26

carpal tunnel syndrome features?

Answer 26

pain and paraesthesia
loss of function in important hand movements

Question 27

features of carpal tunnel syndrome pain and paraesthesia?

Answer 27

typically at night
patients ‘wake and shake’

Question 28

associations of carpal tunnel syndrome?

Answer 28

pregnancy
hypothyroidism
rheumatoid arthritis
diabetes

Question 29

treatment of carpal tunnel syndrome?

Answer 29

splints
surgical release

Question 30

common causes of polyneuropathy?

Answer 30

diabetes
alcohol
medications
B12 deficiency
immune
hereditary

Question 31

examples of immune causes of polyneuropathy?

Answer 31

acute - Guillain-Barre syndrome
chronic - CIDP

Question 32

example of hereditary cause of polyneuropathy?

Answer 32

Charcot-Marie-Tooth disease

Question 33

what is Guillain-Barre syndrome?

Answer 33

acute inflammatory disorder - autoimmune polyneuropathy
Neurological emergency!!!!!!!!!!!!! (patients require hospitilization)

Question 34

Guillain-Barre syndrome trigger?

Answer 34

infectious trigger in prior weeks
classically C. jejuni

Question 35

Guillain-Barre syndrome pathophysiology?

Answer 35

antibodies generated against infections then attack similar antigens in peripheral nerves
attack on myelin and sometimes axons

Question 36

Guillain-Barre syndrome clinical features?

Answer 36

ascending weakness pattern (length-dependant)

Question 37

treatment of Guillain-Barre syndrome?

Answer 37

supportive measures (weakness may affect diaphragm, may require ventilation in ICU)
IVIg or plasma exchange

Question 38

clinical features seen in neuropathy on examination?

Answer 38

muscle weakness and wasting (length dependant distal fashion)
tendon reflexes lost (length dependant distal fashion)
sensory loss
coordination affected (if there is sensory ataxia - loss of proprioception)

Question 39

diabetic neuropathy?

Answer 39

chronic slowly progressive
microvascular damage to nerves, particularly small fibre nerves (pain/temperature)
risk to foot health (patients don’t perceive painful stimuli)

Question 40

what does diabetic neuropathy often arise with

Answer 40

retinal and renal disease

Question 41

management of diabetic neuropathy

Answer 41

prevention
podiatry
sometimes amputations

Question 42

inherited neuropathy features?

Answer 42

gradually progressive issues with walking/running, foot sensation

Question 43

exam of inherited neuropathy may show what?

Answer 43

wasting, high arched feet, hammer toes, ulcers, reduced reflexes, weakness (bilateral foot drop)