Peripheral Neuropathies Flashcards by S B

if there was a LARGE MOTOR fibre problem, what would be the symptoms, power, sensation and reflexes change

Sx - weakness, unsteadiness, wasting

Power - reduced

Sensation - normal

Reflexes - absent

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if there was a LARGE SENSORY fibre problem, what would be the symptoms, power, sensation and reflexes change

Sx - numbness, unsteadiness, paraesthesia

Power - normal

Sensation - vibration and proprioception reduced

Reflexes - absent

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if there was a SMALL fibre problem, what would be the symptoms, power, sensation and reflexes change

Sx - pain, dyesthesia

Power - normal

Sensation - pin prick and temperature reduced

Reflexes - present

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if there was a AUTONOMIC fibre problem, what would be the symptoms, power, sensation and reflexes change

Sx - dizziness (postural hypotension), impotence, nausea and vomiting (gastroparesis)

Power - normal

Sensation - normal

Reflexes - present

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what are the large fibres mainly

A-alpha

Beta

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what are the small fibres mainly

A-gamma

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if you have a bilateral foot drop what type of gait would you expect to see

high stepping gait

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what is pseudoathetosis

movement disorder caused by peripheral demyelination neuropathy

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what is seen in pseudoathetosis

slow, involuntary, writing movements present at rest usually seen in the fingers
severe loss of proprioception

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what does pseudoathetosis indicate

disruption of the proprioceptive pathway from nerve to parietal cortex

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what is meant by radiculopathy

compression or irritation of a nerve as it exits the spinal column.

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what is a mononeuropathy

just one nerve affected e.g. foot drop/fibular nerve

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what is mono neuritis multiplex

malfunction of two or more peripheral nerves in separate areas of the body

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what are the patterns of peripheral neuropathy

“glove and stocking”
mild
moderate
severe

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what are the 2 types of pathology causing peripheral neuropathy

demyelinating pathology

Axonal pathology

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what are acute (days to weeks) demyelinating neuropathies

Guliian Barre Syndrome

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what are chronic (months to years) chronic neuropathies

CIDP

Hereditary sensory motor neuropathy (formerly known as Charcot-Marie-Tooth disease)

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what is guillain barre syndrome

acute inflammatory demyelinating polyneuropathy that occurs post infection

what are the triggers of gillian barre syndrome

campylobacter jejuni
CMV
mycoplasma
zoster
HIV
EBV

Sx of GBS

progressive paraplegia
pain (v common)
sensory symptoms
weakness

what are the Ix done and GBS and what results would be seen

NCS - slow conduction

CSF - increased protein, normal WCC

what is the Tx for GBS

1st - IV immunoglobulin

2nd - plasma exchange

what is HSMN

group of neuropathies, Type I and II are most common and forms of Charcot-Marie-Tooth disease

what are the genetic features of Type I HSMN

autosomal dominant; more common

due to defect in PMP-22 gene on ch. 17 (peripheral myelin protein) which codes for myelin

How does HSMN I present and what does NCS show

demyelinating pathology features often start at puberty NCS shows greatly decreased conduction

what Sx of HSMN are often seen FIRST

weak legs + foot drop

what are the rest of Sx of HSMN

``` distal muscle wasting atrophy of hands and arm muscles pes cavus (high arched foot) clawed toes “champagne bottle legs deformity” variable loss of sensation and reflexes ```

what is champagne bottle legs deformity

hypertrophy of the proximal muscles, with marked perennial muscle atrophy with tapering of the distal extremities

what are the pathological features of HSMN type II

autosomal dominant; but affects a different gene not known axonal pathology

what are the Sx of HSMN type II

same as type I but not as severe tends to affect lower extremities rather than upper

what is the NCS like in HSMN type II

NORMAL | in type I is is DECREASED

what are examples of chronic and acute autonomic neuropathy

Chronic - Diabetes (ie gastroparesis) - Amyloidosis - Hereditary Acute - GBS - Porphyria

Sx in a case of neuropathy that would make you think of porphyria as a cause

- peripheral neuropathy (pins and needles, unsteadiness, absent reflexes, sensory loss, weakness) - abdo pain - psychosis

Sx of peripheral neuropathy

sensory neuropathy - pins and needles, numbness, burning/sharp pain, ataxia motor neuropathy - twitching, muscle cramps, wasting, weakness, paralysis autonomic neuropathy - constipation/diarrhoea, N+V, tachycardia, impotence

what are causes of axonal pathology peripheral neuropathies

``` Alcohol DM Vasculitis (ANCA +) Vit B12 deficiency, hypothyroidism HSMN II Myeloma Idiopathic (age related) HIV, syphilis, lyme disease, Hep B/C ```

what are causes of demyelinating pathology peripheral neuropathies

``` Guillian-Barre Syndrome CIPD Amiodarone HSMN I paraprotein neuropathy ```

what are the Tx options for axonal pathologies

treat cause (e.g. hep C) symptomatic treatment = physio, orthotics, neuropathic pain relief

what is the Tx for vasculitis causing neuropathy

IV methylprednisolone + cyclophosphamide

what are the treatment options for demyelinating pathologies

- IV Immunoglobulins - Steroids - Immunosuppression: Azathioprine, myocphenalate, cyclophosphamide

what is meant by mono neuritis multiplex

used when 2 or more peripheral nerves are affected | causes tend to be systemic

what are the causes of mono neuritis multiplex

WARDS PLC ``` Wegners Aids/Amyloid Rheumatoid Diabetes Sarcoidosis Pan Leprosy Carcinoma ```

what type of neuropathy does alcohol abuse lead to

chronic, initially sensory then mixed, axonal neuropathy

drugs causing peripheral neuropathy

antibiotics = nitrofurantoin, metronidazole Amiodarone TCAs