Flashcards in Peripheral Neuropathy Deck (28):
1
What are the symptoms of large fibre damage?
Motor- weakness, unsteadiness, wasting
Sensory- numbness, paraesthesia, unsteadiness
2
What are the symptoms of small fibre damage?
Pain
Dyesthesia
3
What are the symptoms of autonomic fibre damage?
Dizziness (postural hypotension)
Impotence
Nausea and vomiting (gastroparesis)
4
What are the changes in power in nerve damage?
Large motor- Reduced
Large sensory, small and autonomic- Normal
5
What are the changes in sensation in large motor and autonomic nerve damage?
Normal
6
What are the changes in sensation in large sensory and small nerve fibres?
Large sensory- vibration and JPS reduced
Small- pin prick and temperature reduced
7
What are the changes in reflexes in nerve damage?
Large motor/sensory- Absent
Small/Autonomic- Present
8
What are some conditions caused by nerve damage specific to location of damage?
Radiculopathy
Plexopathy
Peripheral neuropathy- mononeuropathy, mononeuritis multiplex, (length dependant) peripheral neuropathy)
9
How can peripheral nerves be damaged?
Axonal Loss
Peripheral nerve demyelination
10
What can be used to assess nerve status in demyelinating neuropathies?
NCS
11
What is an acute demyelinating neuropathy?
Guillaine Barre/AIDP
12
What are some chronic demyelinating neuropathies?
CIDP (chronic inflammatory demyelinating polyradiculopathy)
Hereditary sensory motor neuropathy (formerly Charcot-Marie-Tooth)
13
What occurs in GBS?
Progressive paraplegia over days up to 4 weeks
Associated sensory symptoms proceed illness
Pain common
14
When are the peak symptoms of GBS?
10-14 days after onset
15
What can be a cause of GBS?
Infection eg. campylobacter
16
How is GBS treated?
Ig infusion and/or plasma exchange (minimal role for steroids)
17
Describe hereditary neuropathies
Hundreds of mutations
Pure motor, sensory, sensorimotor, small fibre (congenital insensitivity to pain syndrome) and autonomic variants
Demyelinating and axonal varieties
Genetic testing available for most common
18
What can cause axonal neuropathies?
Idiopathic (age related)
Vasculitic
Paraneoplastic
Infections
Drugs/toxins
Metabolic
19
What are the vasculitic (often mononeuritis multiplex) causes of axonal neuropathies?
ANCA +ve
Rheumatoid arthritis/Sjrogens syndrome (ANA/ENA +ve)
20
What are the paraneoplastic causes of axonal neuropathies?
Myeloma
Antibody mediated (eg breast cancer/SCLC anti hu/yo)
21
What are the infectious causes of axonal neuropathies?
HIV
Syphilis
Lyme
Hep B/C (cryoglobulin mediated)
22
What are the drug/toxin-based causes of axonal neuropathies?
Alcohol
Amiodarone
Phenytoin
Chemotherapy (cisplatin, vincristine)
23
What are the metabolic causes of axonal neuropathies?
Diabetes
B12/folate deficiencies (other)
Hypothyroidism
Chronic uraemia
Porphyria
24
What are some chronic causes of autonomic neuropathy?
DM (i.e. gastroparesis)
Amyloidosis
Hereditary
25
What are some acute causes of autonomic neuropathy?
GBS
Porphyria
26
What is the treatment of axonal peripheral neuropathy?
Treat cause
Symptomatic treatment- physio, orthotics neuropathic pain relief
27
What is the treatment of axonal (vasculitic) peripheral neuropathy?
Pulsed IV methylprednisolone + cyclophosphamide
28