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Y3 NEUROLOGY > Peripheral Neuropathy > Flashcards

Peripheral Neuropathy Flashcards

1
Q

What is the most common site of damage in the PNS?

A

Peripheral nerve

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2
Q

How is the integrity of the PNS tested?

A

By eliciting reflexes (reduced reflex = reduced PNS function)

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3
Q

What clinical signs and symptoms would we expect from a lesion to a large motor fibre?

A

Weakness (reduced power)
Unsteadiness
Muscle wasting
Absent reflexes

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4
Q

What clinical signs and symptoms would we expect from a lesion to a large sensory fibre?

A 
Numbness
Paraesthesia
Unsteadiness
Reduced vibration and proprioceptive sense
Absent reflexes
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5
Q

What clinical signs and symptoms would we expect from a lesion to a small fibre?

A

Pain
Dyaesthesia (unpleasant sensation when touched)
Pin-prick and temperature sense reduced

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6
Q

What clinical signs and symptoms would we expect from a lesion to an autonomic fibre?

A

Dizziness (postural hypotension)
Impotence
Nausea/Vomiting (gastroparesis)

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7
Q

Small fibres are important for reflexes. True/ False?

A

False

Large fibres are the most important

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8
Q

What is ‘pseudoathetosis’?

A

Rare condition which involves loss of proprioception causing writhing movements

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9
Q

List the three classes of nerve damage, and what site in the PNS is damaged in each

A

Radiculopathy (root damage)
Plexopathy (plexus damage)
Peripheral neuropathy (peripheral nerve)

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10
Q

List the signs of C6 radiculopathy

A

Pain and/or weakness along the length of the arm, including the biceps (the muscles in front of the upper arms), wrist extensors, and the thumb and index finger.
Reduced biceps reflex

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11
Q

List the signs of C7 radiculopathy

A

Pain and/or weakness from the neck to the hand and can include the triceps (the muscles on the back of the upper arms), wrist flexors, finger extensors and the middle finger.
Reduced triceps reflex

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12
Q

What clinical symptom would suggest plexopathy?

A

Lots of pain and weakness in one area of the body

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13
Q

List the types of peripheral neuropathy

A

Length-dependant peripheral neuropathy
Mononeuropathy
Mononeuritis multiplex

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14
Q

What are the 4 main types of length-dependant peripheral neuropathy?

A 
WEAKNESS AND/OR SENSORY LOSS
Mild
Moderate
Severe
Glove and stocking
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15
Q

Mononeuritis multiplex typically has a symmetrical/ asymmetrical pattern

A

Asymmetrical

Mononeuropathy is typically symmetrical

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16
Q

What is the most common cause of peripheral neuropathy?

A

Carpal tunnel syndrome

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17
Q

Longer nerves are more likely to be damaged in length-dependant peripheral neuropathy. True/ False?

A

True

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18
Q

What is the main diagnostic technique used to differentiate between axon loss and demyelination?

A

Nerve conduction studies

19
Q

What result would we expect from a nerve conduction study of a patient with GBS?

A

Conduction block

20
Q

What are the two main types of demyelinating mononeuropathy? Give an example for each

A

Acute (days-weeks) e.g. GBS

Chronic (months - years) e.g. heridatory sensory mononeuropathy, CIDP

21
Q

Define Guillian Barre syndrome

A

Progressive paraplegia of up to 4 weeks (peak 10-14 days into onset)

22
Q

What are the classical clinical features of GBS?

A

ASCENDING SENSORI-MOTOR WEAKNESS
Sensory symptoms (typically proceed weakness)
ALMOST ALWAYS PAIN
Areflexia

23
Q

Guillian Barre syndrome is typically caused by…

A

An infectious illness e.g. lung or stomach infection

24
Q

Which gut bacteria is commonly associated with GBS?

A

Camplyobacter

25
Q

Outline the management for GBS

A

Immunoglobulin infusion

Plasma exchange

26
Q

The 10% mortality rate of GBS is linked to…

A

Autonomic failure e.g. cardiac arrhythmias

27
Q

What are the 5 main types of heridatory neuropathy?

A 
Pure motor
Pure sensory
Sensorimotor
Small fibre
Autonomic
28
Q

Congenital insensitivity to pain is associated with a lesion to what type of heridatory neuropathy?

A

Small fibre

29
Q

List the two varieties of heridatory neuropathy

A

Demyelinating

Axonal

30
Q

What is the main diagnostic technique for heridatory neuropathy?

A

Genetic testing

31
Q

A mutation in which gene will cause ‘champagne bottle ‘legs in heridatory neuropathy?

A

HMSN1

32
Q

List the aetiology of axonal neuropathies

A

Idiopathic (age-related)
Vasculitis (RA/ Sjogrens)
Paraneoplastic (myeloma, Ig mediated breast cancer SCLC)
Infections (HIV, sypillus ,lyme, Hep B/C)
Drugs/ toxins (Alcohol, amiodarone, phentoin, chemo)
Metabolic (DM, B12/ folate def., hypothyroidism, chronic uraemia, poprhyria)

33
Q

List the aetiology of autonomic neuropathy

A 
Acute illness (GBS, porphyria)
Chronic illness (DM e.g. gastroparesis, amyloidosis, heridatory)
34
Q

Mononeuritis multiplex is commonly caused by…

A

Vasculitis

35
Q

Outline the management of axonal peripheral neuropathy

A 
SYMPTOM CONTROL
Physio
Orthotics
Neuronal pain relief
Treat cause e.g. Hep C
36
Q

Outline the management of VASCULITIC axonal peripheral neuropathy

A

Pulsatile IV methyprednisolone and cyclophosphamide

37
Q

Outline the management of demyelinating inflammatory peripheral neuropathy

A 
IV immunoglobulin
Steroids
Azathioprine
Myclophenolate
Cyclophosphamide
38
Q

What two mechanisms lead to the damage of peripheral nerves?

A

Axon loss

Demyelination

39
Q

GBS is common in…

A

Young adults

40
Q

Which condition is the most common form of neuromuscular paralysis?

A

Guillian Barre Syndrome

41
Q

Mononeuropathy occurs as a result of…

A

Nerve compression (Carpal/ cubital tunnel syndrome, ulnar/ radial neuropathy

42
Q

Mononeuritis multiplex occurs as a result of…

A

Diabetes

Vasculitis

43
Q

List investigations used to diagnose GBS

A

Neurophysiology (NCS, EMG)

CSF (high protein)

Y3 NEUROLOGY (22 decks)

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