Peripheral neuropathy Flashcards
1
Q
What is the definition of peripheral neuropathy?
A
Damage/disease of nerves supplying the extremities of the body
2
Q
How common is peripheral neuropathy?
A
Around 1 in 10 people aged 55 and over are affected
3
Q
What is the pathology of peripheral neuropathy?
A
- Nerves outside the CNS
- Functions of sensation, motor and autonomic nerves are affected
- Longest nerves affected first e.g. feet
4
Q
What are the risk factors/aetiology of peripheral neuropathy?
A
- Diabetes
- Shingles
- HIV
- B12 deficiency
- Hypothyroidism
- Chronic liver and kidney disease
- Cancers e.g. lymphoma, multiple myeloma
- Charcot-Marie-Tooth disease – hereditary
- Guillain-Barre syndrome
- RA/lupus/Sjogren’s syndrome
- Drugs e.g. amiodarone, chemotherapy, metronidazole, nitrofurantoin, phenytoin
- Inhaling solvents
- ↑ alcohol
- Smoking
- Trauma
- Entrapment of nerve e.g. sciatica, carpal tunnel syndrome
5
Q
What are the signs/symptoms of peripheral neuropathy?
A
- Depends of which nerves are damaged
- Sensory
- Numbness and tingling of hands/feet
- Burning, stabbing or shooting pain
- Loss of balance and co-ordination
- Motor
- Muscle weakness – especially in the feet
- Muscle atrophy
- Twitching/muscle cramps
- Footdrop
- Ulcers/cuts on feet that take a long time to heal
- Autonomic
- Constipation/diarrhoea/incontinence
- Nausea/bloating/belching
- Postural/Orthostatic hypotension
- Tachycardic
- Change in sweating
- Erectile dysfunction
- Difficulty emptying bladder
- Mononeuropathy
- Double vision
- Bell’s palsy
- Carpal tunnel syndrome
6
Q
What investigations are carried out when peripheral neuropathy is suspected?
A
- HbA1c
- Urine dipstick
- B12/folate
- Nerve conduction test
- Electromyography
- X-ray
- CT
- MRI
- LP
- Nerve biopsy - rare
7
Q
What are the surgical treatments for peripheral neuropathy?
A
- Amputation of limb – severe
* Pacemaker - rare
8
Q
What are the pharmacological treatments for peripheral neuropathy?
A
- Anti-diabetic medication
- Neuopathic pain killers e.g. amitriptyline, gabapentin
- Tramadol
- B12 injections
- Corticosteroids
- Immunosuppressants
- Immunoglobulin injections
- Capsaicin cream – if pain is localised
- Lidocaine plaster – if pain is localised
- Botox injections – for hyperhidrosis
9
Q
What are the pharmacological treatments for peripheral neuropathy?
A
- Smoking cessation
- ↓ alcohol intake
- Better control of blood glucose – diet, exercising regularly, healthy weight etc.
- Physiotherapy
- Walking aids
- Acupuncture
