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Flashcards in Peripheral neuropathies Deck (14)
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Classify the different types of peripheral neuropathies

Radiculopathy: nerve roots
Distal neuropathy: distinct peripheral nerves
-Mono: nerve injury or compression
-Multi: leprosy
-Poly (symmetrical): diabetes, alcohol, hereditary


Describe the features of acute axonal interruption peripheral neuropathy

Acute axonal interruption: occurs after nerve division
-immediate complete sensory and motor loss
-distal segments (crushed/severed) will degenerate
-muscle fibres degenerate if nerve conduction not recovered within 2 years


What are the clinical features of peripheral neuropathies

Numbness or restless legs
Weakness or loss of balance when walking

Progressive deformity: motor neuropathies
Trophic skin changes
Charcot joints


Describe the clinical features of diabetic neuropathy

Early symmetrical numbness and paraesthesia in glove and stocking distribution
Motor loss: claw-toes and high arches -> plantar ulcers
Charcot joints: most commonly affects the midtarsal joints, MTP, and ankle joints


Name the 4 components of diabetic foot

Peripheral vascular disease: ulceration, gangrene
Peripheral neuropathy: ulceration, charcot joint
Infection after minor trauma
Osteoporosis: insufficiency fractures, charcot joint


Describe the features of chronic axonal degeneration peripheral neuropathy

Chronic axonal degeneration: non-traumatic
-slow and progressive sensory and motor loss
-some conditions may predominantly be sensory (diabetes), whilst others motor
-glove and stocking distribution
-altered reflexes and ataxia, muscle weakness/wasting


Describe the features of demyelination peripheral neuropathy

Demyelination: nerve entrapment and blunt soft tissue trauma
-slowing of conduction +/- complete nerve block
-sensory and motor dysfunction distal to lesion
-potentially reversible within 6 weeks
-Demyelinating polyneuropathies rare, except Guillain-Barre syndrome


What is the speed of axonal regeneration?

Axonal regeneration is slow (1 mm/day) and often incomplete.


Outline the prophylactic management of ulceration in diabetic foot

Specialist diabetic foot clinic with MDT
Regular foot inspection
Wide-fitting footwear
Nail care with chiropody
Debridement of calluses
Keep foot cool
Avoid walking barefoot


Define acute brachial neuritis

Unusual cause of severe shoulder girdle pain and weakness due to parainfectious disorder of one or more of the cervical nerve roots and brachial plexus.

History of viral infection or antiviral inoculation.


How does acute brachial neuritis present?

Severe shoulder girdle pain and weakness
Sudden onset, constant
May extend into neck and hand
Usually lasts 2-3 weeks

Paraesthesia: arm or hand
Weakness: shoulder, forearm, hand
-winging of scapula and wrist drop may occur


Define Guillain-Barre syndrome

Acute demyelinating motor and sensory polyneuropathy, usually 2-3 weeks after an URTI or Gi infection.


Define Leprosy

Mycobacterium leprae inection causing a diffuse inflammatory disorder of skin, mucous membranes, and peripheral nerves.


How can leprosy present?

Tuberculoid leprosy causes the most severe lesions. Anaesthetic skin patches develop over extensor surfaces. Loss of motor function -> weakness and deformity of hands and feet.