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Peripheral Neuropathy Flashcards

1
Q

What 5 things should you always find out when trying to diagnose a peripheral neuropathy?

A 
1 - Which nerves are damaged?
2 - Where are they damaged?
3 - How are the nerves damaged? 
4 - Why are the nerves damaged?
5 - Can we stop the nerves from being damaged?
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2
Q

What is radiculopathy usually due to?

A

Intervertebral disc herniation

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3
Q

In peripheral nerve injury, what happens to reflexes?

A

Reflexes are reduced if there is damage to the afferent or efferent pathways

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4
Q

Peripheral neuropathy occurs due to a problem which affect the ________ _____?

A

PERIPHERAL NERVE

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5
Q

When there is damage to a large motor neurone, what symptoms are experienced?

A
  • WEAKNESS
  • Unsteadiness
  • Wasting
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6
Q

When there is damage to a large motor neurone, what happens to the power?

A

REDUCED

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7
Q

When there is damage to a large motor neurone, what happens to the sensation?

A

NORMAL

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8
Q

When there is damage to a large motor neurone, what happens to reflexes?

A

ABSENT

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9
Q

When there is damage to large sensory fibres, what symptoms are experienced?

A
  • NUMBNESS
  • PARAESTHESIA
  • Unsteadiness
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10
Q

When there is damage to large sensory fibres, what happens to the power?

A

NORMAL

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11
Q

When there is damage to large sensory fibres, what happens to the sensation?

A

Vibration and JPS are reduced

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12
Q

When there is damage to large sensory fibres, what happens to reflexes?

A

ABSENT

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13
Q

When there is damage to autonomic fibres, what symptoms are experienced?

A
  • Dizziness (postural hypotension)
  • Impotence
  • Nausea and vomiting (gastroparesis
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14
Q

When there is damage to autonomic fibres, what happens to power?

A

NORMAL

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15
Q

When there is damage to autonomic fibres, what happens to sensation?

A

NORMAL

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16
Q

When there is damage to autonomic fibres, what happens to reflexes?

A

PRESENT

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17
Q

When there is damage to small fibres, what symptoms are experienced?

A
  • Pain

* Dyesthesia

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18
Q

When there is damage to small fibres, what happens to power?

A

NORMAL

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19
Q

When there is damage to small fibres, what happens to reflexes?

A

PRESENT

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20
Q

When there is damage to small fibres, what happens to sensation?

A

Pin prick and temperature sensation are reduced

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21
Q

What is pseudoathetosis?

A

A problem with proprioception - there IS NOT a problem in the basal ganglia, but there is a problem in the peripheral nerve

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22
Q

Bilateral foot drop….

A

High stepping gait
Cant dorsiflex foot
Due to lesion in common perineal nerve

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23
Q

What would cause bilateral foot drop?

A

Lesion in common perineal nerve

24
Q

Describe mononeuritis multiplex.

A

Subacute - occurring over weeks to months

25
What is mono neuritis multiplex usually driven by?
A nasty vasculitis
26
What is mono neuritis multiplex dependant on?
LENGTH
27
Describe the features of mono neuritis multiplex.
* VERY symmetrical * Peripheral nerves die off from feet to wrists * Usually caused by metabolic processes e.g diabetes
28
What causes mononeuritis multiplex often?
Diabetes
29
What could muscle wasting of the thenar eminence be due to?
* Carpal tunnel syndrome * Median nerve compression at the elbow * Plexopathy * MND
30
Wrist drop
Radial nerve
31
Foot drop
Common peroneall nerve - unable to dorsiflex
32
What are the 3 major categories of nerve damage?
1. Radiculopathy 2. Plexopathy 3. Peripheral neuropathy
33
What are the 2 main ways in which nerves can be damaged?
* Axonal loss | * Peripheral nerve demyelination
34
What test is done to find out which way nerves have been damaged?
Nerve Conduction Studies
35
Give an example of an acute demyelinating neuropathy which occurs over days to weeks
GBS
36
How does GBS often start?
TINGLING LIMBS
37
How quick is it before someone with GBS can become quadriplegic?
Over the course of 2 weeks
38
Give examples of chronic demyelinating neuropathies which occur over months to years.
* CIDP (chronic inflammatory demyelinating polyradiculopathy) * Hereditary sensory motor neuropathy (formerly known as Charcot-Marie-Tooth disease)
39
What is the key feature of GBS?
Progressive paraplegia over days, up to 4 weeks
40
What precede the weakness in GBS?
Associated sensory symptoms
41
What is very common in GBS?
PAIN
42
When do peak symptoms occur in GBS?
10-14 days
43
Initially, how can a GBS exam be?
NORMAL
44
What does GBS have a possible association with?
Infection i.e campylobacter
45
What do 25% of people with GBS require?
Mechanical ventilation
46
How do 10% of people with GBS die?
From autonomic failure e.g cardiac arrhythmias
47
What is the treatment for GBS?
Immunoglobulin infusion OR plasma exchange
48
What are the different variants of hereditary neuropathy?
Pure motor, sensory, sensorimotor, small fibre (congenital insensitivity to pain syndrome) and autonomic variants (also axonal and demyelinating variations)
49
Genetic testing is available for the most common mutation in hereditary neuropathy. What is this mutation?
CMT 1a
50
Give examples of CHRONIC causes of autonomic neuropathy.
* Diabetes (via gastroparesis) * Amyloidosis * Hereditary
51
Give examples of ACUTE causes of autonomic neuropathy.
* GBS | * Porphyria
52
If someone has a triad of: * Acute psychosis * Unexplained abdominal pain * Peripheral neuropathy What are they liked to have?
Autonomic neuropathy caused by PORPHYRIA
53
How are axonal peripheral neuropathies treated?
* Treat cause | * Symptomatic
54
Axonal peripheral neuropathies are REVERSIBLE
FALSE - IRREVERSIBLE
55
How are vasculitic axonal peripheral neuropathies treated?
With pulsed IV methylprednisolone + cyclophosphamide
56
How are demyelinating (inflammatory) peripheral neuropathies treated?
IV Ig (pooled immunoglobulin from donors). Steroids. Azathioprine, Mycophenalate, Cyclophosphamide.

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