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Flashcards in Peripheral Neuropathies Deck (62)
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1

Examples of pain/temp small fiber pathologies

DM
Leprosy
amyloidosis

2

Examples of proprioception/vibration fiber pathologies

Vit B12 deficiency
DM
Hereditable

3

Examples of motor fiber pathologies

Immune-related (Guillan-Barre)
Lead toxicity
Acute intermittent porphyria
Inherited disorders

4

Examples of autonomic fiber pathologies

Amyloid
DM
Sjogren's
Botulism
Amiodarone

5

Sx and PE of pain/temp fiber damage

pain, burning, shock-like, stabbing, dysesthesias, allodynia, paresthesias

PE: decreased response to painful stimuli (pin prick), decreased temp sensation (light touch)

6

Sx and PE of proprioception/vibration fiber damage

numbness, pins & needles, poor balance

PE: decreased proprioception and vibration (joint position sense); diminished DTRs

7

Sx and PE of motor fiber damage

cramps, weak grip, foot drop, fasciculations

PE: weakness, diminished DTRs

8

Autonomic nerve damage sx and PE

lightheaded, dry eyes/mouth, abnormal sweating, erectile dysfxn

PE: orthostasis, anisocoria (unequal pupils)

9

Location of peripheral neuropathies

outside brain and spinal cord

10

Which cranial nerves are involved in peripheral neuropathy?

all cranial nerves except I and II

11

Most common causes in U.S.? worldwide?

US: DM and alcohol
worldwide: leprosy

12

Most common presentation of peripheral neuropathy?

distal symmetric sensorimotor dysfxn

13

How are PN categorized by pattern of involvement?

- mononeuropathy = single nerve and its innervation
- Multiple mononeuropathy = multiple indiv peripheral nerves
- Polyneuropathy = widespread distribution

symmetric vs asymmetric, distal vs proximal

14

Likely cause of mononeuropathy

compression, trauma, vascular cause

15

common distribution of polyneuropathies

"stocking-glove distribution"

16

How are PN categorized by time course?

acute: toxic or inflamm
subacute: chemo, lead
chronic: DM, Charcott-Marie-Tooth
recurrent: Guillan-Barre, HIV

17

How are PN categorized?

Location
Time course
Fiber type
Axonal or Demyelinating

18

Common example of demyelinating disease

MS

19

axonal neuropathy

neuropathy with axonal and myelin sheath degeneration DISTAL to injury (Wallerian degeneration)

20

Common mononeuropathies

median neuritis, radial neuritis, ulnar neuritis, peroneal neuritis

21

Hypothesis for why so many diabetics get neuropathy?

direct axonal loss and demyelination secondary to hyperglycemia OR insufficient blood flow in vaso nervorium

22

Most common diabetic neuropathy

diabetic sensorimotor polyneuropathy (DSPN)

23

Complications of diabetic neuropathy

foot ulcers, Charcot joint

24

Where nerve fibers affected in DSPN?

mixed with small and large fibers, sensory, motor, and autonomic

sensory and autonomic >> motor

25

symptoms of DSPN

initially distal: numbness/tingling, burning of toes/feet
progresses to proximal: up leg and to hands ("stocking-glove")
later: gait disturbances, distal motor weakness

26

PE of diabetic neuropathy

Distal sensory loss of pain, temp, touch, vibration

Reduced DTRs at ankle

27

What are signs of autonomic fiber involvement?

impotence, nocturnal diarrhea, difficulty voiding, abnormal sweating, orthostatic hypotension

28

Asymmetric Diabetic Neuropathy

- occurs in older puts who already have DSPN
- involves CN VI, III, and sometimes IV (abrupt onset d/t acute ischemia)
- radiculopathies, limb mononeuropathies

29

CN VI palsy affects on vision

painless double vision (diplopia)

30

Tx of diabetic neuropathy

- Strict glycemic control
- Tricyclics or gabapentin for pain
- Most recover over months