Peripheral neuropathies

Question 1

What are the different types of polyneuropathies?

Answer 1

1. mononeuropathy- carpal tunnel syndrome
2. polyneuropathy-diabetic neuropathy(symmetrical involvement of peripheral nerves)
3. Mononeuropathy multiplex- multiple peripheral nerves simultaneously

Question 2

What is the prevalence of peripheral neuropathy in patients above 55 years?

Answer 2

> 8%

Question 3

What is the classification of polyneuropathies?

Answer 3

1. acute <4 weeks
2. subacute 4 weeks to 12 weeks
3. chronic polyneuropathies: >12 weeks and often not reversible

Question 4

What are the causes of acute polyneuropathies?

Answer 4

1. Guillain Barre syndrome
2. pophyria
3. Thiamine deficiency neuropathy

Question 5

What are the causes of suabacute neuropathies?

Answer 5

1. Thiamine deficiency neuropathy

Question 6

What are chronic neuopathies causes?

Answer 6

1. Diabetic polyneuropathy
2. Hiv
3. Nutritional deficencies
4. Inflammatory- paraproteinemic

Question 7

What are the clinical features of chronic polyeneuropathy?

Answer 7

symptoms:
1. numbness, paraesthesia, pain, decreased temperature or pain sensation, weakness, incoordination
2 signs: distal weakness, distal sensory loss, distal reflex loss

Question 8

What is Guillain Barre syndrome?

Answer 8

Usually occurs after 3 days to 6 weeks post infection of the respiratory tract or GIT

• Occurs in any age
• mechanism is molecular mimicry

Question 9

What is AIDP?

Answer 9

acute inflammatory demyelinating polyneuropathy

This is an inflamatroy attack of the myelin sheath and is the commonest form of GBS

Question 10

What is the least common type of Guillain Barre Syndrome?

Answer 10

• Axonal forms(AMAN and AMSAN) which stands for antibody mediated attack at nodes of ranvier
• 10% of cases

Question 11

What are the clinical features of GBS?

Answer 11

1. Ascending paralysis usually proximal and sital weakness with absent reflexes
2. usually no sphicter dysfunction
3. facial weakness bilaterally

Question 12

When do the patients present with the peak weakness?

Answer 12

50% will reach within 2 weeks and others within 4 weeks

Question 13

How do we diagnose GBS?

Answer 13

1. csf-albumincytological studies

2. nerve conduction studies

Question 14

How do we treat GBS?

Answer 14

1. SUPPORTIVE
   - respiratory ventilation or intubation as needed
   - bulbar function(risk of aspiration)
   - rehabilitation
   - venous thromboembolitic prevention-heparin
   - ulcer prevention(turn patient often)
2. SPECIFIC
   - plasma exchange
   - IV immunoglobulin

Question 15

What is the mortality rate of GBS?

Answer 15

2-8% mostly killed by sepsis, pulmonary embolism

Question 16

What will we find on CSF for patients with GBS nd HIV?

Answer 16

higher amount of lymphocytes- about 100 lymphocytes

Question 17

What is porphyria?

Answer 17

Group of inherited disorders(autosomal dominant) of haem synthesis

Question 18

What is the clinical presentation of porphyria?

Answer 18

1. Abdominal pain
2. skin lesions
3. seizures and delirium
4. Polyneuropathy with global weakness
   - acute intermittent porphyria

Question 19

Who typically gets Porphyria?

Answer 19

young women who experienceacute attacks

Question 20

What are the 4 p’s?

Answer 20

1. painful abdomen
2. polyneuropathy
3. psychological disturbances
4. port wine coloured urine

Question 21

How do we treat porphyria?

Answer 21

glucose and heme

Question 22

What is paraneoplastic neuropathy?

Answer 22

This can present before the cancer and can help us have early detection and cure
-predominantly sensory symptoms

Question 23

What complications do pts with diabetes present with?

Answer 23

1. polyneuorpathy
2. nephropathy
3. retinopathy

Question 24

What are the clinical features of diabetic neuropathy?

Answer 24

1. slow progression over the years
2. insidious onset of numbness, paraesthesia, burning pain
3. starts distally and moves proximally
4. often associated with carpal tunnel syndrome

Question 25

What complications can the sensory loss due to DM polyneuropathy cause?

Answer 25

1. diabetic foot because of sensory loss 2. impaction of foreign objects 3. foot ulcers 4. Charcot joint

Question 26

What is the treatment of DM polyneuropathy?

Answer 26

1.Control of glucose 2. foot care 3. pain management Even though we can control glucose the damage is often irreversible

Question 27

What is alcohol related polyneuropathy?

Answer 27

- slow and progressive over weeks and months - affects the lower limbs more than the upper limbs - usually sensory features like numbness, paraesthesia, 40% experience pain

Question 28

What causes the polyneuropathy in alcohol users?

Answer 28

1. toxic effects of the alcohol | 2. vitamin deficiencies

Question 29

What is the culprit protein that causes alcohol related polyneuropathy?

Answer 29

1. acetyldehyde

Question 30

What are the 2 types of alcohol polyneuropathy are there?

Answer 30

1. alcohol polyneuropathy - more sensory than motor - poor response to treatment with thiamine - slowly progressive 2. thiamine deficiency polyneuropathy - presents with more motor symptoms - good response to thiamine - acute or subacute

Question 31

What is neuropathy of chronic renal failure?

Answer 31

- insiduous and slow onset - weakness, reduced reflexes, paraesthesia, atrophy - develops at GFR <12ml/min - only occurs in end stage kidney disease

Question 32

What is the treatment of chronic renal disease polyneuropathy?

Answer 32

Does not respond to dialysis so renal transplant is necessary

Question 33

What is toxic neuropathy?

Answer 33

caused by medication - chemotherapy - ARV'S - Antibiotics like quinolones

Question 34

What are the 3 conditions associated with HIV polyneuorpathy?

Answer 34

1. distal sensory polyneuropathy(most common)-disabling pain, paraesthesia 2. demyelinating polyneuropathy-GBS 3. diffuse infiltrative lymphocytosis syndrome-RARE

Question 35

How does B12 deficiency present?

Answer 35

90% or more presen with myeloneuropathy

Question 36

What are the clinical features of B12 NEUROPATHY?

Answer 36

1. Polyneuropathy - loss of weakness - atrophy of distal muscles - loss of reflexes 2. Subacute combined degeneration of the cord: - UMN bladder symptoms - brisk reflexes - loss of proprioception 3. beefy red tongue

Question 37

What is important about vit B12 deficiency?

Answer 37

We must always investigate the cause and check it is not caused by pernicious anaemia, atrophic gastritis which is problems with absorption

Question 38

How do we treat Vit B12?

Answer 38

We can inject intramuscular B12 for life

Question 39

What is CIDP?

Answer 39

It is chronic inflammatroy demyelinating polyneuropathy - inflammatory demyelination of peripheral nerves and roots - responds to steroid treatment and IV immunoglobulins

Question 40

What are the clinical features of chronic inflammatory demyelnating polyneuropahy?

Answer 40

1. proximal and distal weakness 2. sensory loss and paraesthesia in feet and hands 3. global arreflexia 4. there's already atrophy of hand muscles

Question 41

What are the causes of mononeuropathy multiplex?

Answer 41

1. vasculitis | 2. diabetes