Peripheral Neuropathy Flashcards
Large fibre motor Symptoms, Power, Sensation \+ Reflexes?
Weakness, wasting
Reduced
Normal
Absent
Large Fibre sensory Symptoms,
Power,
Sensation
+ Reflexes?
Numbness, paraesthesia
Normal
Reduced
Absent
Small fibre Symptoms,
Power,
Sensation
+ Reflexes?
Pain, Dyesthesia
Normal
Pin prick and temp reduced
Present
Autonomic Symptoms,
Power,
Sensation
+ Reflexes?
Dizziness, Nausea and vomiting
Normal
Normal
Present
Pseudoathetosis
abnormal writhing movements (typically of fingers/hands) due to failure of joint proprioception, indicating disruption of proprioceptive pathway from nerve to parietal cortex.
Radiculopathy
pain, weakness, numbness and difficulty controlling certain muscles. Problem often occurs at root of nerve (shortly after its exit from the spinal cord) can be caused by spine herniation
Plexopathy
pain, loss of motor control and sensory deficits. Occur at Brachial and lumbosacral plexus, often due to trauma (e.g. dislocated shoulder).
Mononeuropathy
is isolated nerve damage out with CNS e.g. carpal tunnel syndrome. (compression, trauma, ischaemia, inflammation)
Mononeuritis Multiplex
multiple nerves involved, asymmetrically. (Diabetes, vasculitis, SLE, Sarcoidosis, Amyloidosis)
Polyneuropathy
multiple nerves involved, concurrently and symmetrically ‘Glove and Stocking’ í severe. (Diabetes, Acute Inflammatory Demyelinating Polyneuropathy [GBS], toxic/metabolic, hereditary)
Acute demyelinating Neuropathy?
GBS
Chronic demyelinating neuropathies?
CIDP
HSMN
what is Guillaine Barre syndrome?
progressive Paraplegia over days to weeks. Sensory symptoms proceed to weakness + pain very common!
25% require mechanical ventilation, 10% die from autonomic failure
possible cause of GBS?
infection (post campy)
Treatment of GBS?
Immunoglobulin infusion and or plasma exchange
Hereditary Sensory Motor Neuropathy is also known as …
Charcot Marie Tooth Disease
Most common HMSN and how it presents?
HMSN type 1
Weakness in legs in adolescence then weakness in hands
what is an axonal neuropathy?
axonal atrophy/degeneration
causes of axonal neuropathy?
- Idiopathic
- Vasculitic (ANCA +ve, RA/Sjogrens)
- Paraneoplastic (myeloma, antibody mediated)
- Infections (HIV, syphilis, Hep B/C)
- Drugs/Toxins (Alcohol, Amiodarone, Chemo)
- Metabolic (DM, B12/folate deficiency, hypothyroidism)
Autonomic neuropathy causes
- Acute = GBS + Porphyria
- Chronic = Diabetes, Amyloidosis + Hereditary
Axonal neuropathy treatment?
- Treat cause (ie clear hepatitis C)
- Symptomatic treatment - physiotherapy, orthotics, neuropathic pain relief.
Axonal (vasculitic) treatment?
- Pulsed IV methylprednisolone + cyclophosphamide
Demyelinating (inflammtory neuropathy) treatment?
- IVIg (pooled immunoglobulin from donors)
- Steroids
- Azathioprine, mycophenalate, cyclophosphamide
