Peripheral Neuropathies and ALS Flashcards Preview

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Flashcards in Peripheral Neuropathies and ALS Deck (50)
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1

Mononeuropathy

Focal involvement of a single nerve

2

Examples of mononeuropathy

Median: Carpal tunnel
Ulnar: cubital tunnel
Radial: wristdrop
Peroneal: foot drop
(compression, trauma or entrapment)

3

Mononeuropathy multiplex

Damage to one or more peripheral nerves (at random and noncontigous)
Pattern early on is asymmetric

4

Polyneuropathy

Several peripheral nerves affected at same time
Presents as distal and symmetric deficit

5

How to classify the problem

(based on structure affected)
Axon (axonal or neuronal)
Myelin (demyelinating)

6

Most common neuropathy

Diabetic polyneuropathy

7

Neuropathy

Axon is target
May see motor and sensory deficits but SENSORY usually precedes motor

8

Neuronal neuropathy

Affects nerve cell bodies in anterior horn of spinal cord or dorsal root ganglion

9

Examples of neuronal neuropathy

Type 2 Charcot Marie tooth hereditary
Vitamin B6 toxicity

10

Demyelinating neuropathies

Involve myelin sheath surrounding axon
Often autoimmune or inherited (Guillain Barre, chronic inflammatory demyelinating polyneuropathy or charcot marie tooth)

11

What is Guillain Barre Syndrome?

Idiopathic inflammatory neuropathy
Demyelinating

12

When do you see Guillain Barre more

After infection (campylobacter jejuni!!)

13

Presentation of Guillain Barre Syndrome

Ascending weakness (symmetric) usually beginning in legs
Sensory usually
Absent DTRs frequently
Maybe autonomic dysfunction

14

What is chronic inflammatory demyelinating polyneuropathy?

Idiopathic inflammatory neuropathy (slowly progressive or relapsing)

15

Presentation of CIDP

Diffuse hyporeflexia or areflexia
Diffuse weakness
Generalized sensory loss

16

What is Charcot-Marie-Tooth?

Hereditary motor and sensory neuropathies (genetically heterogenous group of disorders with similar clinical phenotype)

17

Presentation of Charcot Marie Tooth

Weakness
Wasting of distal muscles in limbs (with or without sensory loss)
Pes cavus
Reduced or absent DTRs

18

Timing types

Acute (days to 4 wks)
Subacute (4-8 wks)
Chronic (>8 wks)

19

Cause of acute mononeuropathy

Probably traumatic or ischemia

20

Cause of chronic mononeuropathy

-More common
Entrapment or recurrent minor trauma

21

Cause of acute polyneuropathy

Think inflammatory process (Guillain-Barre, neoplasms, infection, toxins)

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Cause of chronic polyneuropathy

Hereditary or metabolic, CIDP (gradual evolution over yrs)

23

Peripheral vs motor vs sensory nerves

Peripheral: sensory, motor and autonomic elements
Motor: large myelinated fibers
Sensory: large for proprioception and small for pain and temp

24

Sxs associated with motor nerve problems

Weakness
Fatigue
Cramps
Muscle twitches

25

Signs of motor nerve problems

Weakness
Muscle wasting
Fasciculations

26

Sxs associated with sensory nerve probs

Numbness or loss of sensation
Altered sensation
Neuropathic pain (burning, dull, poorly localized or sharp)
Loss of coordination/imbalance

27

Signs of sensory nerve probs

Sensory loss (sharp/dull, light touch, temp, vibration etc)
Loss of proprioception

28

First thing to be lost in pts with polyneuropathies

Ankle reflexes

29

Autonomic sxs

Postural hypotension
Tachycardia
Cold extremities
Impaired thermoregulatory sweating
Bowel and bladder dysfunction
Impotence

30

Example of chronic axonal polyneuropathy

Diabetes