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Flashcards in Peripheral Nerve Diseases Deck (22):
1

What happens in Guillain-Berre Syndrome?


1. flu-like illness, usually a virus

2. T-cells cross-react with myelin and macrophages destroy it

3. you get acute ascending paralysis

4. usually resolves with time

2

The acute demyelination occurs thorughout the PNS, but where is it most intense?


spinal and cranial nerve motor roots and adjacent nerves

3

What sort of immune cells will proliferate around nerves and venules in Guillain Barre?


mononuclear immune cells - lymphocyes, macrophages, and plasma cells (so basically everything but neutrophils)

4

What are some physical exam and lab signs of Guillain Barre?


rapid onset weakness, loss of DTRs

some loss of sensation

elevated CSF protein, but no lymphocytes

5

Demyelination occurs _____ in GUillarin-Barre.


segmentally - it won't just be the whole thing disappearing right away

6


What bacteria causes leprosy (Hansen Disease)?


Mycobacterium leprae

7

How is Mycobacterium leprae transmitted?


probably through responratory droplets - usualy an't even find the bug in the skin lesions

8

What makes mycobacterium leprae special?


they have a waxy coat so it can't stain with gram stain - have to use acid-fast

only grow intracellularly, so hard to grow in culture

hard to kill by normal immune response

9

How does the immune system (hopefully) respond to mycobacterium leprae?


forms granulomas around it to wall off and destroy

10

What are the two forms of leprosy an which is less severe?


Tuberculoid Leprosy is less severe

Lepromatous Leprosy is the bad one

11

What are the symptoms of tuberculoid leprosy and why is it less severe?


Dry scaly skin lesions and some nerve degeneration

Not as severe because they have the appropriate T cell response to the bug with granuloma formation

12


What are the symptoms of lepromatous leprosy and why is it more severe?


Affects skin, nerves, eye, mouth, testes, hands and feet (grows bet at 91 degrees - so stays at periphery)

- leonine facies (skin lesions form big dysfiguring nodules on the face)

- Autoamputation

 

WOrse because they don't form granulomas

13

Instead of granulomas, what would you see on histology in lepromatous leprosy?


foamy histiocytes

14

Where does varicell zoster remain dormant after chicken pox?


the sensory ganglia of the spinal cord and brain stem

15

What will you see on histology in varicella zoster?


neuronal destruction and multinucleated giant cells (in shingles)

16

What is another name for Hereditary Motor and Sensory Neuropathy Type 1?


Charcot-Marie-Tooth Disease

17

What happens in CMT?


repetitive demyelination and remyelination leading ot muscle and sensation loss (pain intact)

usually lower extremities more affected - high arches, hammer toes, muscle atrophy

 

18

What will nerves of CMT patients look like on histology?


they'll have onion bulb formation - this is the remyelination

19

What is the most common manifestation of peripheral neuropathy in diabetes?


symmetric sensory and motor neuopathy involving distal nerves - hands and feet in sock and glove distribution

- decreased pain sensation

20

What is the most common cause of a mononeuropathy?


malignancies that press on nerves - brachila plexopathy from lung neoplasms, obturator palsy from pelvis neoplasms and cranial nerve palsies from brain tumors

21


How does a polyneuropathy occur with malignancy?


it occurs as a paraneoplastic effect related to some cytokine released from the tumor

especially common with small cell lung cancer and plasma cell malignancies

22