Peripheral Neuropathies Flashcards Preview

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Flashcards in Peripheral Neuropathies Deck (47):
1

What is a good approach to PNS problems?

Which nerves are damaged?
Where are they damaged?
How are they damaged (myelin or axonal)?
Why are they damaged?
Can we stop it?

2

What are symptoms of large alpha/beta fibre motor problems?

Weakness, unsteadiness, wasting of muscles

3

Will power be reduced in pathologies of large alpha/beta motor fibres of the PNS?

Yes

4

Will sensation be intact in pathologies of large alpha/beta motor fibres of the PNS?

Yes

5

Will reflexes be normal in pathologies of large alpha/beta motor fibres of the PNS?

No - absent

6

What will the symptoms be in pathologies of large alpha/beta sensory fibres of the PNS?

Numbness, paraesthesia, unsteadiness

7

Will power be preserved in pathologies of large alpha/beta sensory fibres of the PNS?

Yes, normal power

8

Will reflexes be normal in pathologies of large alpha/beta sensory fibres of the PNS?

Yes

9

Will sensation be preserved in pathologies of large alpha/beta sensory fibres of the PNS?

No; vibration and proprioception reduced

10

Will reflexes be normal in pathologies of large alpha/beta sensory fibres of the PNS?

No - absent

11

What symptoms will occur with pathologies of the small delta and C fibres of the PNS?

Pain, dysethesia

12

Will power be preserved with pathologies of the small delta and C fibres of the PNS?

Yes, normal

13

Will sensation be preserved with pathologies of the small delta and C fibres of the PNS?

No; pin-prick and temperature perception reduced

14

Will reflexes be normal with pathologies of the small delta and C fibres of the PNS?

Yes

15

What symptoms will occur with pathologies of delta and C fibres the ANS?

Dizziness (postural hypotension)
Impotence
N+V (gastroparesis)

16

Will power be preserved with pathologies of delta and C fibres the ANS?

Yes

17

Will sensation be preserved with pathologies of delta and C fibres the ANS?

Yes

18

Will reflexes be normal with pathologies of delta and C fibres the ANS?

Yes

19

What is a high stepping gait?

Foot drop due to weakness of ankle dorsiflexion

20

What are DDx of a high stepping gait?

Common fibular nerve palsy
L5 palsy
Motor neuropathies; bilateral due to alcohol or diabetes

21

Where is the nerve damaged in a radiculopathy?

Nerve root; commonly due to a prolapsed disc

22

What is a mononeuropathy?

Single nerve problem for example a wrist drop due to radial nerve palsy or carpal/ cubital syndrome

23

What is mononeuritis multiplex?

Vasculitis affecting the blood supply to nerves

24

What is a length dependent peripheral neuropathy?

Neuropathy due to underlying systemic condition such as diabetes or alcoholism

25

What distribution of sensory loss will length dependent peripheral neuropathy show?

Glove and stocking
Symmetrical

26

Are plexopathies painful?

YES

27

What is the difference between guillan barre syndrome and MS?

Guillain barre = demyelinating disorder of PNS
MS = demyelinating disorder of CNS

28

What are the acute and chornic demyelinating neuropathies of the PNS?

Acute (days to week): GBS
Chronic (months to years): CIDP, charcot-marie-tooth disease

29

What are the symptoms of GBS?

Progressive paraplegia over days up to 4 weeks
Assoc sensory symptoms proceed weakness
PAIN very common

30

When are the peak symptoms of GBS?

10-14 days into onset of illness

31

What commonly precedes GBS?

Campylobacter
Resp infections

32

What % of people with GBS will require ventilation?

25%

33

What will cause the majority of deaths in GBS?

Autonomic failure; cardiac arrhythmias
It will strip the ANS of its myelin

34

What is the treatment for GBS?

IVIg and/or plasma exchange
Minimal role for steroids

35

What is charcot marie tooth disease?

Pure motor, sensory, sensorimotor, small fibre and autonomic variants
Demyelinating and axonal variation
Genetic

36

What is typically seen in CMT?

Wasting of tibial muscles
Deforming arthropathy of hands
Pes cavus

37

What are the different types of axonal neuropathies?

Vasculitis
Paraneoplastic
Infections
Drugs/ toxins
Metabolic

38

What causes vasculitis axonal neuropathies?

ANCA +ve
RA
Sjogren's

39

What causes paraneoplastic axonal neuropathies?

Myeloma
Antibody mediated (breast cancer, small cell lung cancer)

40

What causes infectious axonal neuropathies/

HIV
Syphilis
Lyme disease
Hep B/C (cryoglobulin mediated)

41

What drugs/toxins cause axonal neuropathies?

ALCOHOL
Amiodarone
Phenytoin
Chemo; cisplatin/ vincristine

42

What metabolic disorders cause axonal neuropathies?

Diabetes
B12/ folate deficiency
Chronic uraemia
Porphyria - acute intermittent porphyria

43

What causes chronic autonomic neuropathies?

Diabetes; gastroparesis
Amyloidosis
Hereditary

44

What will cause acute autonomic neuropathies?

GBC
Porphyria

45

What is the treatment for axonal neuropathies in general?

Treat cause
Symptomatic; physio, orthotics, neuropathic pain relief

46

What is the treatment for vasculitis related axonal neuropathies?

Pulsed IV methylprednisolone + cyclophosphamide

47

What is the treatment for demyelinating neuropathies?

IVIg
Steroids
Azathioprine
Mycophenolate
Cyclophosphamide