Peripheral Neuropathies Flashcards Preview

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Flashcards in Peripheral Neuropathies Deck (59):
1

What is peripheral neuropathy?

outside of the brain and spinal cord

2

Peripheral neuropathy - cx: US and WW?

US: diabetes
WW: leprosy

3

What is mononeuropathy?

affecting only one nerve

4

Mononeuropathy - cx?

compression
trauma

5

Mononeuropathy - ex?

carpal tunnel
winging of scapula

6

Multiple mononeuropathy?

more than one nerve- NOT symmetrical

7

Multiple mononeuropathy - ex?

wake up and hand falls asleep: ulnar and median n.

8

Polyneuropathy?

more than one nerve - SYMMETRICAL

9

Polyneuropathy - classic sx?

stocking-glove

10

Polyneuropathy - cx?

diabetes
SLE

11

Diabetic peripheral neuropathy- cx?

very common
microvascular prob: not enough blood to the nerves

12

Diabetic peripheral neuropathy categories?

Diabetic sensorimotor polyneuropathy
Asymmetric diabetic neuropathy

13

Diabetic sensorimotor polyneuropathy?

mixed neuropathy: sensory, motor, autonomic
axon

14

Diabetic sensorimotor polyneuropathy - sx?

stocking globe sx
symmetric
chronic
usually starts from the feet then makes its way up to the hands (length dependent neuropathy)

15

Diabetic sensorimotor polyneuropathy - PE?

decreased DTR

16

Asymmetric diabetic neuropathy - sx?

asymmetric
acute
6th CN - abducens (painless double vision-diplopia)

17

Asymmetric diabetic neuropathy -hx?

LONG STANDING DIABETES

18

Diabetic sensorimotor polyneuropathy and asymmetric diabetic neuropathy - tx?

TCA
opioids - avoid
gabapentin
SNRI
pregabalin

19

Chronic renal failure associated neuropathies - uremic neuropathy-sx?

polyneuropathy
stocking glove
demylination

20

Uremic neuropathy - tx?

dialysis - stabilize neuropathy
renal transplant - resolves neuropathy

21

Metabolic neuropathy?

diabetic peripheral neuropathy
uremic neuropathy

22

Axonal vs demyelination?

axonal-not treatable (permanent damage); length dependent
demyelination - treatable; myelin sheath (axon is spared)

23

Infection related neuropathies?

Bell's palsy
Lyme dz
Herpes Zoster
Cytomegalic Virus (HIV/AIDs)

24

Bell's palsy?

paresis of CN VII (facial n)
acute
mononeuropathy

25

Bell's palsy -sx?

drooping of one side of face
diff from stroke: able to frow brow
unilateral loss of taste
ear pain
hyperacusis (hearing sensitivity)

26

Bell's palsy - cx?

HSV

27

Bell's palsy - PE?

sensory is intact
motor prob

28

Bell's palsy- tx?

acyclovir
self-limiting

29

Ramsay Hunt syndrome?

reactivation of herpes zoster
DO NOT MISS -NERVE IS DYING!!

30

Ramsay Hunt syndrome - sx?

vesicular outbreak in auditory canal/pharynx

31

Acoustic neuroma?

can have sx of Bell's palsy but this is insidious, Bell's palsy is acute

32

Lyme dz?

borrelia burgdoferi infxn

33

Lyme dz - tx?

marcolide
tetracycline

34

Lyme dz - sx?

bullseye

35

Postherpetic neuralgia -sx?

pain after shingles (NOT only CN VII- throughout body)

36

Postherpetic neuralgia - tx?

gabapentin

37

Toxic neuropathies?

chronic - d/t repeated exposure to toxic (ie. lead poisoning)
can be: motor (lead), sensory (ethambutol), autonomic (vincristine), or all
pts who are going undergoing chemo

38

Toxic neuropathies - tx?

pyridoxine to prevent and treat isoniazid

39

Nutritional neuropathies?

lack of thiamine B1, pyridoxine B6, vit B 12

40

What can B12 deficiency cx?

pernicious anemia --> sensory neuropathy d/t lack of intrinsic factor from the gut

41

Nutritional neuropathies - cx?

poor nutrition (eating disorders)
malabsoprtion syndrome (celiac dz, no gut - trauma)

42

Nutritional neuropathies -sx?

distal
symmetric
polyneuropathy

43

Inherited neuropaties?

Charcot marie-tooth

44

Charcot marie tooth?

most common inherited dz

45

Charcot marie tooth - sx?

chronic
distal
SENSORY AND MOTOR neuropathy
gait diffculuties
no until late years - physical deformities of foot start to show

46

Charcot marie tooth - PE?

hammer toes
high arch
wasting of distal leg muscles - can lead to arm and hands

47

Guillian - Barree syndrome?

autoimmune neuropathy

48

Guillian baree syndrome?

autoimmune neuropathy

49

Guillian baree sx - sx?

acute
inflammatory demylineation
polyneuropathy
motor paralysis
ascending paralysis over hours to days
rubbery legs
may have autonomic instability -> ventilator support
NO FEVER

50

Guillian baree sx- PE?

dec DTR

51

Guillian baree sx - labs?

LP
-increase protein
-norm glucose
-norm cell ct
-clear/turbid

52

Guillian baree sx - cx?

1-3wks after infection - Campylobacter jejuni

53

Guillian baree sx - prognosis?

good; all recover w/in months-yr

54

Guillian baree sx- tx?

plasmapheresis
HD IV immune globulin
BEGIN EARLY

55

Trigeminal Neuralgia?

tic couloureux

56

Trigeminal neurlagia - sx?

shock like lasts 1-2 sec --> wincing

57

Trigeminal neurlagia - PE?

able to find trigger zone

58

Trigeminal neurlagia - tx?

Carbamazepine
+/-surgery

59

Diabetic sensorimotor polyneuropathy - tx? first line fails?

1) gabapentin
#1 fail? --> TCA