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Flashcards in peripheral neuropathy Deck (29):
1

what is a neuropathy?

disorder of the nerve

2

what is a mononeuropathy?

problem with one nerve

3

what is polyneuropathy?

problem with many nerves

4

what is mono neuropathy multiplex?

problems with lots of individual nerves. (different from polyneuropathy as nerves are disseminated and damage is not related)

5

what is a common example of a mononeuropathy?

carpal tunnel syndrome

6

what are the defining features of a polyneuropathy/peripheral neuropathy

symmetrical and length dependant

can be:

sensory

motor

sensory and motor

7

what pain feature is often common with polyneuropathy/peripheral neuropathy?

allodynia

oversensitivity to sensory stimuli

pain due to sensory stimulus that would not ordinarily cause pain

8

what are the common features of mononeuropathy multiplex?

asymmetrical

random patchy process

vasculitis

inflammatory process

immune process

9

how can peripheral neuropathies be classified?

according to:

nerves affected

hereditary or acquired

axonal or demyelinating

inflammatory, non-inflammatory

acute or chronic

10

what are the four commonest causes of peripheral neuropathies

diabetes
idiopathic

leprosy
hiv (in other countries)

11

what are some uncommon causes of peripheral neuropathy?

Deficiency states e.g. B12 /Folate

Alcohol/Toxins/Drugs

Hereditary Neuropathies

Paraneoplastic Syndromes

Metabolic abnormalities

12

what investigations can be performed for peripheral neuropathies?

history and examination

+/- neuropathy screen

+/- vasculitis screen

+/- EMG/NCS

+/- CSF study

+/- nerve biopsy

13

what blood tests should be conducted in a neuropathy?

FBC
ESR

UECR, RBS, TFT, CRP
serum electrophoresis

B12 folate

Anti Gliadin

(TPHA, HIV)

tumour markers?

14

what blood tests should be conducted for vasculitis?

FBC, ESR

UECr, CRP

ANA, ENA, ANCA

15

how can you treat a neuropathy

idiopathic- supportive

neuropathic analgesia (gabepentin, amitrptyline)

treat, remove underling cause eg DM/gluten

16

what are the featues of hereditary neuropathy?

tend to be symmetrical

length dependent • i.e. polyneuropathy / peripheral neuropathy

17

name three common causes of hereditary neuropathy

charcot marie tooth disease (CMT)

hereditary motor sensory neuropathy (HMSN)

axonal/demyelinating or mixed

18

what are the clinical signs of CMT

slow over many years

length dependant

motor or sensory

sometimes very little symptoms but signs present

pes cavus

19

what is pes cavus

clawing of the foot

high arch & relatively stiff

20

what are the four main categories of CMT?

CMT1 (demyelinating)

CMT2 (Axonal)

X LINKED

intermediate CMT

21

CMT1 AND 2 are either:

autosomal dominant or autosomal recessive

22

what gene is commonly responsible for AD cmt1a

PMP22

23

what is PMP22

peripheral myelin protein gene on chromosome 22

24

mutations of PMP22 can cause?

CMT1a

25

deletions in PMP22 can cause?

HLPP/ HNPP

hereditary neuropathy with liability to pressure palsies

26

what does PMP do?

makes the protein which forms part of the schwann cells /myelin sheath

27

can can deletion lead to demyelination

overproduction of PMP22 due to duplication leads to interuption in PMP processing and interupts other Schwann cell functions •

without PMP22, myelin is unstable and degenerates - demyelination

28

what is CMT1b

much less common varient of CMT

MPZ mutation

can be classical CMT or more severe and early onset

29

what are the three types of CMT2

CLASSICAL

CMT2 +sensory (especially if pain)

CMT+ upper limb onset