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