Flashcards in Peripheral Neuropathy Deck (28)
What are the symptoms of large fibre damage?
Motor- weakness, unsteadiness, wasting
Sensory- numbness, paraesthesia, unsteadiness
What are the symptoms of small fibre damage?
What are the symptoms of autonomic fibre damage?
Dizziness (postural hypotension)
Nausea and vomiting (gastroparesis)
What are the changes in power in nerve damage?
Large motor- Reduced
Large sensory, small and autonomic- Normal
What are the changes in sensation in large motor and autonomic nerve damage?
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
What are the changes in reflexes in nerve damage?
Large motor/sensory- Absent
What are some conditions caused by nerve damage specific to location of damage?
Peripheral neuropathy- mononeuropathy, mononeuritis multiplex, (length dependant) peripheral neuropathy)
How can peripheral nerves be damaged?
Peripheral nerve demyelination
What can be used to assess nerve status in demyelinating neuropathies?
What is an acute demyelinating neuropathy?
What are some chronic demyelinating neuropathies?
CIDP (chronic inflammatory demyelinating polyradiculopathy)
Hereditary sensory motor neuropathy (formerly Charcot-Marie-Tooth)
What occurs in GBS?
Progressive paraplegia over days up to 4 weeks
Associated sensory symptoms proceed illness
When are the peak symptoms of GBS?
10-14 days after onset
What can be a cause of GBS?
Infection eg. campylobacter
How is GBS treated?
Ig infusion and/or plasma exchange (minimal role for steroids)
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
What can cause axonal neuropathies?
Idiopathic (age related)
What are the vasculitic (often mononeuritis multiplex) causes of axonal neuropathies?
Rheumatoid arthritis/Sjrogens syndrome (ANA/ENA +ve)
What are the paraneoplastic causes of axonal neuropathies?
Antibody mediated (eg breast cancer/SCLC anti hu/yo)
What are the infectious causes of axonal neuropathies?
Hep B/C (cryoglobulin mediated)
What are the drug/toxin-based causes of axonal neuropathies?
Chemotherapy (cisplatin, vincristine)
What are the metabolic causes of axonal neuropathies?
B12/folate deficiencies (other)
What are some chronic causes of autonomic neuropathy?
DM (i.e. gastroparesis)
What are some acute causes of autonomic neuropathy?
What is the treatment of axonal peripheral neuropathy?
Symptomatic treatment- physio, orthotics neuropathic pain relief
What is the treatment of axonal (vasculitic) peripheral neuropathy?
Pulsed IV methylprednisolone + cyclophosphamide