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Peripheral Neuro Dz

Neurology

QuestionAnswer
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
Created by: Abarnard