Peripheral Neuropathies Flashcards by Samantha Camuso

Examples of pain/temp small fiber pathologies

DM
Leprosy
amyloidosis

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Examples of proprioception/vibration fiber pathologies

Vit B12 deficiency
DM
Hereditable

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Examples of motor fiber pathologies

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

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Examples of autonomic fiber pathologies

Amyloid
DM
Sjogren's
Botulism
Amiodarone

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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)

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Sx and PE of proprioception/vibration fiber damage

numbness, pins & needles, poor balance

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

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Sx and PE of motor fiber damage

cramps, weak grip, foot drop, fasciculations

PE: weakness, diminished DTRs

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Autonomic nerve damage sx and PE

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

PE: orthostasis, anisocoria (unequal pupils)

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Location of peripheral neuropathies

outside brain and spinal cord

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Which cranial nerves are involved in peripheral neuropathy?

all cranial nerves except I and II

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Most common causes in U.S.? worldwide?

US: DM and alcohol
worldwide: leprosy

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Most common presentation of peripheral neuropathy?

distal symmetric sensorimotor dysfxn

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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

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Likely cause of mononeuropathy

compression, trauma, vascular cause

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common distribution of polyneuropathies

“stocking-glove distribution”

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How are PN categorized by time course?

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

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How are PN categorized?

Location
Time course
Fiber type
Axonal or Demyelinating

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Common example of demyelinating disease

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axonal neuropathy

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

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Common mononeuropathies

median neuritis, radial neuritis, ulnar neuritis, peroneal neuritis

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Hypothesis for why so many diabetics get neuropathy?

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

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Most common diabetic neuropathy

diabetic sensorimotor polyneuropathy (DSPN)

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Complications of diabetic neuropathy

foot ulcers, Charcot joint

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Where nerve fibers affected in DSPN?

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

sensory and autonomic&raquo_space; motor

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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

PE of diabetic neuropathy

Distal sensory loss of pain, temp, touch, vibration Reduced DTRs at ankle

What are signs of autonomic fiber involvement?

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

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

CN VI palsy affects on vision

painless double vision (diplopia)

Tx of diabetic neuropathy

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

"length dependent" neuropathy

longest nerves affected first

How is asymmetric diabetic neuropathy different from typical DSPN?

Asymmetric Acute Cranial nerves affected

Cause of asymmetric diabetic neuropathy

acute ischemia

signs/sx and tx of uremic neuropathy

- Distal symmetric sensoriomotor polyneuropathy - stocking-glove distributions, distal motor weakness, restless leg syndrome - tx: dialysis, renal transplant

Examples of infection related neuropathies

``` Bell's Palsy Lyme Disease Herpes Zoster (shingles) Cytomegalic Virus (CMV) in HIV Symmetric Distal Polyneuropathy associated with AIDS ```

Bell's Palsy is paresis of _____ nerve and associated with _____ infection.

``` CN VII (facial) herpes simplex virus ```

How would Bell's Palsy be classified?

acute mononeuropathy

How do you differentiate Bell's Palsy from stroke?

Stroke patient can still wrinkle forehead, only lower face affected Bell's Palsy affects upper and lower face

Signs/Sx of Bell's Palsy

UNILATERAL paresis corner of mouth droops, no nasolabial fold, forehead unfurrowed, can't close eyelids SENSORY INTACT

Bell's Palsy management

80% recover within weeks to months w/ or w/o treatment May give steroids or Acyclovir

Ramsay Hunt Syndrome

may present as Bell's Palsy; so must rule Ramsay out!!! shingles of CN VII with vesicular rash in external canal/pharynx

shingles caused by what virus?

Herpes Zoster in adults

signs of shingles?

vesicular painful rash in dermatomal distribution

Postherpetic neuralgia

persistent pain following shingles that can last years

Shingles treatment

Tricyclics Gabapentin Pain meds

Lyme disease caused by what organism?

Borrelia burgdoferi in ticks

CMV infections often associated with ______.

HIV/AIDS

All dying from AIDS with have what neuropathy?

symmetric distal polyneuropathy

Different causes of toxic neuropathies

drugs (chemo), heavy metals (lead), industrial compounds, alcohol

Chelation therapy

used to treat heavy metal toxic neuropathy

______ to prevent and treat isoniazid (INH) neurotoxicity.

pyridoxine (B6)

Vitamin deficiencies that result in neuropathies?

Thiamine B1, Pyridoxine B6, Vit B12, Vit E

Most common inherited neuromuscular disease that is also an inherited neuropathy

Charcot Marie-Tooth

Categorization of Charcot Marie-Tooth

Chronic distal sensory and motor neuropathy which develops over years

Signs/Sx of Charcot Marie-Tooth

long standing gait difficulties, h/o being "unathletic" child; mostly LE but progresses hands PE: wasted leg muscles, weakness, hammer toes, distal sensory loss and loss of DTRs

Autoimmune acute inflammatory demyelinating polyneuropathy

Guillan-Barre Syndrome

Clinical signs of Guillan-Barre Syndrome

* Rapidly evolving motor paralysis with areflexia * Ascending paralysis over hrs to days * C/O "rubbery legs" * DTRs disappear in days * Autonomic instability

CSF findings of Guillan-Barre Syndrome

typically normal at disease presentation; after 7-14 days- elevated protein, normal glucose, no pleocytosis

Guillan-Barre Syndrome management

85% achieve full recovery within several months to a year; treat ASAP tx: plasmapheresis or IV immune globulins supportive: 30% need intubation, trach, or mechanical ventilation

Symptoms of trigeminal neuralgia

- episodes of electric (lancinating) shock pain in CN V innervation - pain so intense they wince ("tic") - single jabs or cluster of pain in "trigger zone" - no sensory loss

Who is most likely to be affected by trigeminal neuralgia?

F > M | middle aged/elderly

Trigeminal neuralgia treatment

Carbamazepine or phenytoin Surgery if fail med therapy

Peripheral Neuropathies Flashcards

(62 cards)