PERIPHERAL NEUROPATHY Flashcards by Deependra Singh

Tinel sign

Tingling and pain on tapping flexor aspect of wrist
Seen in CARPAL TUNNEL SYNDROME

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Phalens test

Increased pain and tingling on passive maximal flexion of wrist

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Clinical features of. carpal tunnel syndrome

Nocturnal pain
Parasthesia and tingling on palmar aspect of hand or wrist

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Causes of Carpal tunnel syndrome/ ENTRAPMENT NEUROPATHY

Hypothyroidism
Diabetes mellitus
Amyloidosis
Systemic sclerosis
Rheumatoid arthiritis
SLE
Acromegaly
3 Rd trimester of pregnancy

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Causes of Mononueritis multiplex 🌟 WA²RDS P²LC³

Wegener’s Granulomatosis
Amyloidosis
AIDS
RA
DM
SARCOIDOSIS
PAN
Paraneoplastic syndrome
Leprosy (most common cause)
Cancer
Churg Strauss
Hepatitis C

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Causes of mononeuroparhy

Acute ; sustained pressure , torniquet
Chronic : entrapment syndrome

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Nerve involved in carpal tunnel syndrome

Median nerve

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Nerve involved in cubital tunnel syndrome

Ulnar nerve

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Nerve involved in spiral groove of humerus

Radial nerve

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Nerve involved in inguinal ligament

Lateral cutaneous nerve of thigh
MERALGIA PARASTHETICA

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Nerve involved in neck of fibula

Common peroneal nerve

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Nerve involved in Tarsal tunnel syndrome / flexor retinaculum

Posterior tibial nerve

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Causes of polyneuropathy 🌟 VITS OMG

Vitamin deficiency
Infection
Inflammation
Therapeutic drugs
Toxins
Systemic
Other
Malignancy
Genetics

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Causes of polyneuropathy: Vitamin deficiency

Vitamin B 12
Thiamine
Pyridoxine
Vitamin E

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Causes of polyneuropathy: therapeutic drugs

Amiodarone
Antibiotics - isoniazid , ethambutol, metronidazole, dapsone
Phenytoin
Chemotherapy - Cisplatin , vincristine , thalidomide

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Causes of polyneuropathy: TOXINS

Alcohol
Nitrous oxide

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Causes of polyneuropathy: Inflammation

GBS
VASCULITIS ( PAN, SLE )
PARANEOPLASTIC SYNDROME

Causes of polyneuropathy: systemic

Diabetes
Renal failure

Causes of polyneuropathy: malignancy

Infiltration

Causes of polyneuropathy: genetic dis

CMTD ( charcot Marie tooth disease)
Familial amyloid polyneuropathy
Hereditary neuralgic amyotrophy

Causes of polyneuropathy: others

Paraproteinemia
Amyloid

Drugs causing peripheral neuropathy 🌟 MANIC PVC

Metronidazole
Amiodarone
Nitrofurantoin
Isoniazid
Cis platin
Phenytoin
Vinca alkaloids
Ciprofloxacin

Causes of Demyelinating polyneuropathy

CIDP
PADP
CMTD X
MND

Chronic inflammatory Demyelinating polyneuropathy
Paraprotein associated Demyelinating polyneuropathy
Charcot Marie tooth disease type x
Motor neuron disease

Causes of axonal polyneuropathy

Diabetes
Hypothyroidism
Rheumatoid arthiritis
SLE
Systemic sclerosis
SJOGRENS
Alcohol
Uremia
Cirrhosis
PARANEOPLASTIC
Deficiency - B1, B6, B12 , vit e
Genetic - CMTD type 2
Idiopathic
Hereditary
Drugs and toxins

Causes of Peripheral Nerve thickening 🌟 LANDS CAR

Leprosy - most common cause Amyloidosis Neurofibromatosis DM SARCOIDOSIS CIDP CMTD Acromegaly ReFSUM disease Relapsing GBS

Acute onset polyneuropathy

MCC - viral infectious ( influenza , cmv , hep B , EBV GBS- campylobacter jejunii AIP PORPHYRIA ARSENIC / THALLIUM TOXICITY DM

Sub acute onset polyneuropathy

Toxins medication Nutritional def Metabolic PARANEOPLASTIC

Chronic polyneuropathy

CIDP CLD HMSN ( hereditary motor and sensory NEUROPATHY)

Causes of Relapsing / remitting polyneuropathy

GBS Aids Prophyria CIDP

Causes of Pure motor neuropathy 🌟 PHD is A TALL degree

Poliomyelitis Hereditary spinal muscular atrophy Dapsone intoxication Adult form of hexosaminidase deficiency Tick bite paralysis AIP Lead intoxication Lambert Eaton syndrome Lmn form of ALS Brachial neuritis Diptheria MND

Neuropathy involving small muscles of hand

CIDP MND LEAD intoxication THALLIUM TOXICITY Polio late stages Leprosy

In early stages peripheral neuropathy is - Distal / proximal

Ans - Distal Exception - CIDP is characterised by Proximal muscle weakness in early stages ( Demyelinating polyneuropathy) Also AIP

Motor symptoms +/-

Postive - cramps Fasciculation Spasm Tremor Negative - weakness Wasting Loss of dexterity ( handedness)

Sensory symptoms

Positive - Tingling Burning Pain Needles Band like Stumbling Negative - numbness , loss of sensation

Allodynia

Highly painful sensation to non noxious stimuli

Cause of small fibre neuropathy

Diabetes Amyloidosis Hypothyroidism Fabrys disease Hiv SJOGRENS syndrome Cis platin Amiodarone THALLIUM TOXICITY ARSENIC toxicity

Causes of Large fibre neuropathy

SJOGRENS Vit b12 Cisplatin DM Amyloid Lead intoxication Friedrichs ataxia B6 toxicity Hiv

Peripheral NEUROPATHY ass with pain

Cyptogrnic sensorimotor NEUROPATHY DM ARSENIC THALLIUM TOXICITY GBS VASCULITIS HIV FABRYS

Signs and symptoms ass with ANS NEUROPATHY

Bradycardia Tachycardia Perspiration Urine retention Postural hypotension Psvt BP Bowel bladder sexual dysfunction

NEUROPATHY ass with autonomic signs

Acute - botulism PORPHYRIA GBS Amiodarone Vincristine Chronic - DM SJOGRENS CHAGAS AMYLOID PNS

Approach to a patient with neuropathy 🌟 6 Ds

Duration Distribution Deficit Disease pathology Developmental / inherited Drug / toxins exposure