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Peripheral Neuro Dz
Neurology
| Question | Answer |
|---|---|
| Ulnar neuropathy | stretch / compress ulnar n.; cubital tunnel or Guyon canal (FCU mx may be spared); d/t pressure, bone spurs, cysts; sensory precede motor sx |
| Ulnar neuropathy: provoking factors | Elbow Flexion (Cubital), Wrist Extension (Guyon’s); Nighttime |
| Ulnar neuropathy: Dx | Hx; EMG/NCS can help find site of lesion |
| Ulnar neuropathy: Tx | modify activity; extensor splint at night; NSAIDs; surgery (nerve transposition or ligament release); No C’steroids |
| Radial neuropathy: etiology | axilla (crutches); Saturday night palsy; handcuffs; humerus fx |
| Radial neuropathy: Dx | Motor>sensory; weakness in extension & arm ext rotation; forearm atrophy; xray shoulder/humerus |
| Meralgia paresthetica: patho | stretch/compress lat fem cutaneous n. |
| Meralgia paresthetica: RF | obesity; DM; PG; hip hyperextension; lumbar lordosis |
| Meralgia paresthetica: Dx | pain, paresthesia, numb; outer thigh; usu unilateral (relieved by sitting); no motor sx |
| Meralgia paresthetica: Tx | often self-ltg; hydrocortisone injxn; nerve transposition |
| Fem neuropathy: RF | lithotomy posn (inguinal lig); DM; retroperitoneal neoplasm/hematoma; pelvic fx; fem art cath (n. trauma) |
| Fem neuropathy: Dx | Quads atrophy/weakness; sensory impairment anteromedian thigh; decreased patellar DTR; EMG/NCS; CT/MRI |
| Fem neuropathy: Tx | Tx etiology; splints/braces; PT |
| Sciatic n. palsy: Dx | weakness w/ leg flexion, dorsiflexion & foot eversion (drop foot); hamstring & ankle DTR dec/absent; sensory loss posterior thigh/leg/foot; tingling/burning/lanceting pain (worse w/standing, cough) |
| Sciatic n. palsy: Dx tests | EMG/NCS (distinguish from peroneal neuropathy); xray |
| Sciatic n. palsy: Tx | Tx etiology; behave change; anti-inflam; PT; surg |
| Peroneal n. palsy: Dx | weak dorsiflexion (foot drop) & eversion; sensory loss/ paresthesia: anterolateral calf & foot dorsum; EMG/NCS? Tx sim to sciatic n. palsy |
| CN VII palsy (Bell): etiology | idio; HIV, sarcoid, Lyme, tumor; HSV infxn? RF = PG, DM |
| CN VII palsy: Dx | abrupt; facial paralysis (some upper sparing); drooping corner of mouth; ptosis/ forehead smooths out; ear pain; dysgeusia; hyperacusis |
| CN VII palsy: to distinguish btw peripheral & central lesion: | peripheral: complete paralysis forehead mx; central: partial sparing forehead mx |
| CN VII palsy: prognosis | 60% spont resolve; 10% perm disfigurement/dysfn; best indicator of severity = progress first 2-3 days; worst: complete palsy at onset, advanced age, hyperacusis, severe initial pain |
| CN VII palsy: Tx | prednisone; artificial tears/eye patch; No Surg |
| CMT: genetics | usually auto dom |
| CMT: patho | Type I: demyelinating; II: axonal; Motor>Sensory; Lower > Upper; childhood/young; slow progression |
| CMT I vs CMT II: Dx | CMT II: less mx wasting/ secondary weakness; less common postural tremor/arm involvement; NO peripheral n. hypertrophy |
| CMT Dx: | H&P; DNA testing; Nerve/mx bx (confirmatory); EMG/NCS |
| CMT: EMG/NCS | CMT I: segmental demyelination; reduced motor & sensory conduction velocity; CMT II: axonal loss; normal/sl dec motor conduction, dec SNAPs; chronic partial denervation in affected mx |
| Dejerine-Sottas Dz (CMT III): patho | phytanic acid disturbance; prog demyelinating neuropathy; infancy/kids |
| Dejerine-Sottas Dz: Dx | weakness, ataxia; sensory loss; DTR: global hyporeflexia; high CSF pro; EMG/NCS: dec motor velocity, sensory conduction |
| Dejerine-Sottas Dz: Tx | Supportive; plasmapheresis; dietary restriction |
| Refsum dz: patho | Progressive Demyelinating Neuropathy; Early Childhood |
| Refsum dz: Dx | weakness, ataxia; sensory loss; DTR: global hyporeflexia; retinitis pigmentosa; CSF protein normal; nerve bx; EMG/NCS: dec motor velocity, sensory conduction; Tx supportive |
| Systemic-metabolic neuropathies include: | DM; uremia; alcoholic & nutrition def; paraproteinemias |
| DM neuropathy | sensory precedes motor; lower ext precedes upper; Hx: autonomic sx?; NCS nml / mildly slow |
| Charcot Arthropathy is a complication of: | DM peripheral neuropathy |
| Charcot Arthropathy | d/t Joint Subluxation, Periarticular fx; rocker bottom foot; pain, swelling, ulceration |
| Uremia: Dx | Symmetric sensory-motor; lower ext > upper; distal > proximal; severity correlates with degree of renal insufficiency |
| EtOH/Nutritional deficiency | cobalamin (B12) def; axonal > myelin; slow progression |
| EtOH/Nutritional deficiency: Dx | Distal symmetric Polyneuropathy; sensory precedes motor; Lower ext precedes upper; cramps, painful paresthesias, tenderness; CNS Sx often precede PNS; mental status change; myelopathy; optic neuropathy |
| Acute Idiopathic Polyneuritis (AIDP aka GBS): pathophysiology | Progressive demyelinating polyradiculoneuropathy; probably immune-mediated; Axonal Degeneration Subtypes (AMAN; AMSAN) |
| AIDP (GBS): Dx studies | H&P; high CSF pro (2-3 wks post onset); EMG/NCS: demyelination with delayed conduction (3-4 wks) |
| AIDP (GBS): Dx: MOTOR findings | Weakness; Symmetric; Proximal before Distal; Lower ext before Upper; Advanced: Resp mx Compromise, CN Involvement |
| AIDP (GBS): Dx: SENSORY findings | Paresthesias; Loss of Sensation; Distal before Proximal; DTR: Global hyporeflexia or areflexia; ANS: tachycardia, cardiac irreg; BP changes, pulmonary dysfn, loss of rectal tone; possibly neuropathic pain |
| AIDP (GBS): Tx | Anti-inflammatories (Prednisone is CI); plasmapheresis; IVIg; mechanical ventilation (monitor FVC) |
| Leprosy: 2 Types: | tuberculoid (multifocal) & lepromatous (symmetrical) |
| CRPS (complex regional pain syndrome) mgmt | Neurontin, topical capsaicin, prednisone (40mg daily & taper); 1500-2000mg of vitamin C daily may reduce likelihood of CRPS after fx |
| AIDP (GBS): Etiology | may follow vax / surgery / recent illness; may be assoc with C jejuni. |
| Miller Fisher syndrome = | subtype of AIDP (GBS), characterized by ataxia, areflexia, opthalmoplegia |
| Unilateral facial weakness w/ inability to close eye | Bell palsy (self-limiting) |
| Ascending paralysis | GBS |
| Paralysis after Campylobacter enteritis | GBS |
| Ulnar neuropathy | stretch / compress ulnar n.; cubital tunnel or Guyon canal; d/t pressure, bone spurs, cysts; sensory precede motor sx |
| Ulnar neuropathy: provoking factors | Elbow Flexion (Cubital), Wrist Extension (Guyon); Nighttime |
| Radial neuropathy: S/S | Motor>sensory; weakness in extension & arm ext rotation; forearm atrophy; xray shoulder/humerus |
| Meralgia paresthetica: S/S | pain, paresthesia, numb; outer thigh; usu unilateral (relieved by sitting); no motor sx |
| Fem neuropathy: RF | lithotomy posn (inguinal lig); DM; retroperitoneal neoplasm/hematoma; pelvic fx; fem art cath (n. trauma) |
| Fem neuropathy: S/S | Quads atrophy/weakness; sensory impairment anteromedian thigh; decreased patellar DTR; EMG/NCS; CT/MRI |
| Charcot-Marie-Tooth: pathology | Type I: demyelinating; II: axonal; Motor>Sensory; Lower > Upper; childhood/young; slow progression |
| Charcot-Marie-Tooth: CMT I vs CMT II: S/S | CMT II: less mx wasting/ secondary weakness; less common postural tremor/arm involvement; NO peripheral n. hypertrophy |
| Dejerine-Sottas Dz (CMT III): pathophys | phytanic acid disturbance; prog demyelinating neuropathy; infancy/kids |
| Dejerine-Sottas Dz: S/S | weakness, ataxia; sensory loss; DTR: global hyporeflexia |
| Refsum dz: patho | Progressive demyelinating neuropathy; early childhood |
| Refsum dz: S/S | weakness, ataxia; sensory loss; DTR: global hyporeflexia; retinitis pigmentosa; Tx supportive |
| Systemic-metabolic neuropathies include: | DM; uremia; alcoholic & nutrition def; paraproteinemias; CTD, amyloidosis |
| DM neuropathy | sensory precedes motor; lower ext precedes upper; Hx: autonomic sx?; NCS nml / mildly slow |
| Charcot arthropathy | 2/2 Joint Subluxation, Periarticular fx; rocker bottom foot; pain, swelling, ulceration |
| Uremia: S/S | Symmetric sensory-motor; lower ext > upper; distal > proximal; severity correlates with degree of renal insufficiency |
| Neuropathy: EtOH/ Nutritional deficiency | cobalamin (B12) def; axonal > myelin; slow progression |
| EtOH/Nutritional deficiency: S/S | Distal symmetric Polyneuropathy; sensory precedes motor; Lower ext precedes upper; cramps, painful paresthesias, tenderness; CNS Sx often precede PNS; mental status change; myelopathy; optic neuropathy |
| AIDP (GBS): patho | Progressive Demyelinating; prob immune-mediated; Axonal Subtypes (AMAN; AMSAN) |
| AIDP (GBS): Motor S/S | Ascending weakness; Symmetric; Proximal > Distal mx; Lower ext before Upper; Advanced: Resp mx Compromise, CN Involvement |
| AIDP (GBS): Sensory S/S | Pain/paresthesias; Loss of Sensation; Distal before Proximal; DTR: Global hyporeflexia or areflexia; autonomic dysfn: tachycardia, cardiac irreg; BP changes, pulmonary dysfn, loss of rectal tone |
| Leprosy: 2 Types: | tuberculoid (multifocal) & lepromatous (symmetrical) |
| Bell palsy sx | Abrupt onset upper & lower (ipsilateral) facial paresis/ paralysis, mastoid pain, hyperacusis, dry eyes, altered taste; ipsilat ear pain may precede |
| most common type of diabetic polyradiculopathy = | high lumbar radiculopathy of L2, L3, L4 roots, causing diabetic amyotrophy |
| CN III palsy affects which muscles | inferior oblique muscle (medial, inferior, & superior recti). Eye turns down and out |
| CN III palsy S/S | Ptosis. Unable to look up, down, or adduct/turn eye inward. Mydriasis (pupil constrictor muscle): pupil dilated |
| CN III palsy: etiology | Circle of Willis aneurysm (posterior communicating artery); or uncal herniation (increased ICP) |
| CN IV palsy AKA: | superior oblique muscle palsy. Cannot look down & in |
| CN IV palsy will cause: | Torsional diplopia = hypertropia; compensated head tilt (contra to side of palsy); bilateral or congenital |
| CN IV palsy etiology | ischemia, minor head trauma, tumor |
| CN IV palsy S/S | vertical deviation, oblique diplopia, hypertropic eye worse in ipsilateral head tilt & opposite gaze (adduction) |
| CN VI palsy affects this muscle | lateral rectus muscle |
| CN VI palsy: cannot: | adduct eyes |
| CN VI palsy may mimic: | strabismus |
| CN VI palsy etiologies | usually ischemic. possibly due to moderate trauma, increased ICP, tumor, aneurysm, MS |
| Peripheral neuropathy: axonal vs demyelinating | axonal: normal conduction velocity, denervation on EMG; demyelinating: slow velocity, no EMG denervation |
| sudden onset of LMN d/o, asym facial paresis, often hyperacusis & impaired taste | Bell palsy (prev: 30/100K) |
| Bell palsy DDx | Lyme dz, tumor, AIDS, sarcoidosis, herpes zoster in geniculate ganglion |
Created by:
Abarnard
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