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114 Cards in this Set

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Are cranial nerves part of central or periph nervous system?
PERIPH
Name for:

injure AXON/MYELIN--> DISTAL degen of axon/myelin
Wallerian Degeneration

(PNS)

Contrast neuronal degen: inj body --> die
Name for:

Damage periph neuron body --> distal dying of axon
Neuronal/axonal degeneration

(contrast Wallerian: just lose distal axon)
Difference b/w:

Wallerian degen & neuronal degen
Wallerian: inj axon --> distal dying of axon

Neuronal: inj BODY --> distal die axon
Small or large fiber:

Neuropathic pain
Small
Small or large fiber:

Aching/throbbing/burning
Small
Small or large fiber:

Temperature
Small
Small or large fiber:

Cardiac arryth
Small
Small or large fiber:

Orthostatic hypoT
Small
Small or large fiber:

Constipation
Small
Small or large fiber:

Loss of vibration
Large
Small or large fiber:

Lose of position sense
Large
Small or large fiber:

Weakness
Large
Small or large fiber:

Denervation --> fasciculations
Large
Small or large fiber:

Lose DTRs
Large
Acute, subacute or chronic peripheral neuropathy:

Guillan-Barre
Acute
Acute, subacute or chronic peripheral neuropathy:

Porphyria
ACUTE
Acute, subacute or chronic peripheral neuropathy:

Diphtheria
ACUTE
Acute, subacute or chronic peripheral neuropathy:

Polio
Acute
Acute, subacute or chronic peripheral neuropathy:

Thallium
Acute
Acute, subacute or chronic peripheral neuropathy:

-Lead
-Arsenic
Both ACUTE
Acute, subacute or chronic peripheral neuropathy:

Uremia
Acute
Acute, subacute or chronic peripheral neuropathy:

Vasculitis
Acute
Acute, subacute or chronic peripheral neuropathy:

B1, B12 def
Subacute
Acute, subacute or chronic peripheral neuropathy:

Sarcoidosis
Subacute
Name for:

Stocking-glove pattern
Polyneuropathy
Polyneuropathy: symm?
YES

(stocking-glove)
Name for pattern:

involvement of individ nerves in a multifocal distrib
Mononeuropathy multiplex
Name for pattern:

Involvement of nerve roots
Radiculopathy
Peripheral neuropathy:

#1 risk factor
DM

(EtOH is #2)
Guillain-Barre:

-symm?
-weak? prox or distal?
-sens loss?
Sym
Prox AND distal weak
Sens loss
Chronic inflamm demyelinating polyneuro:

-symm?
-weak? prox or distal?
-sens loss?
SAME AS GBS:

Symm
Prox & distal weak
Sens loss
Amyloidosis:

-symm?
-weak? prox or distal?
-sens loss?
Symm
DISTAL WEAK (not prox; contrast GBS)
Sens loss
Lyme disease neuropathy:

-symm?
-weak? prox or distal?
-sens loss?
ASYMM

Distal weak

Sens loss
Sarcoidosis neuropathy:

-symm?
-weak? prox or distal?
-sens loss?
ASYMM (contrast amyloidosis)

Distal weak

Sens loss
HIV:

-symm?
-weak? prox or distal?
-sens loss?
ASYMM

Distal weak

Sens loss
Hereditary neuropathy with liability to pressure palsy (HNPP):

-symm?
-weak? prox or distal?
-sens loss?
ASYMM

Prox & Distal weak

Sens loss
Another name for:

Acute Inflammatory Demyelinating Polyneuropathy
Guillain Barre
Another name for:

Guillan Barre
Acute Inflammatory Demyelinating Polyneuropathy
Guillain Barre:

-M or F?
-adults or children?
-what % die? what % excellent recovery?
M=F
Adults > child
5% die, 85% recover
Guillain Barre:

What % pts preceded by acute infxn? what type of infxn (SPECIFIC)?
75% pts with resp or GI infxn

25% CAMPYLOBACTER JEJUNI

25% CMV or EBV
What periph neuropathy:

s/p Camplyobacter jejuni
Guillain Barre
What periph neuropathy:

autoimmune against GANGLIOSIDES
Guillain Barre
What dz:

anti-GM1, antiGD1a, antiGQ1b
Guillain Barre
Guillain Barre:

Abs against what neuron component?
Gangliosides
Guillain Barre:

most common Ab detected
Anti-GM1

(m for most common)
What dz:

rapid, ascending areflexic motor paralysis +/- sensory loss
GBS
Guillain Barre:

Weakness starts what body part? Reaches worst in how many days?
Feet --> LBP

Worst within 30d (usu 14d)
Guillain Barre:

See bulbar weakness? resp muscle weak?
YES
Guillain Barre:

DTRs increase or decrease? W/in how many days?
Disappear after 3d
Guillain Barre:

-Pain common?
-Autonomic s/sx?
Pain common

ANS inv: ortho hypo, transient HTN, arrryth
What dz:

Miller-Fischer variant
Guillain Barre

(Gait ataxia, areflexia, external ophthalmoplegia; no limb weakness)
Guillain Barre: what syndrome?

Gait ataxia, areflexia, external ophthalmoplegia; no limb weakness
Miller-fisher variant
Miller-Fisher variant of GBS:

-how appear nerve conduction studies
-see which Abs?
NORMAL NCS

anti-GQ1b Abs
What dz:

CSF: albumino-cytologic dissociation (high protein, no cells)
GBS
Guillain Barre:

-what is an early EMG change?
Decrease motor unit recruitment
If suspect GBS --> order which labs?
1. CBC
2. ESR
3. HIV
4. LFTs
GBS: req hosp? when transfer to ICU?
YES

monitor FVC, negative insp pressure

FVC <15 --> ICU & likely intubate
GBS: what med txs?
IVIg & plasmapheresis (equally effective)

NOT STEROIDS
GBS: give steroids to tx?
No proven benefit
Which ROOT SYNDROME:

Pain lateral shoulder; deltoid sens loss; paralyzed deltoid, supraspinatus, biceps
C5
C5 root syndrome:

-where is pain?
-which muscles paralyzed?
Pain: lateral shoulder

Paralyzed biceps, supraspinatus, deltoid
Which ROOT SYNDROME:

Impaired biceps reflex
C5 or C6
Which ROOT SYNDROME:

Pain radial side of arm (to thumb); paralyzed biceps & brachioradialis
C6
C6 root synd:

-where is pain?
-which muscles paralyzed?
-lose what reflex?
Pain: radial arm to thumb
Paralyzed biceps & brachiorad

Lose biceps (same as C5)
Which ROOT SYNDROME:

Pain b/w 2nd & 4th fingers; paralyzed triceps, extensors, flexors, pec major
C7
C7 root synd:

-where is pain?
-what muscles paralyzed?
-lose what reflex?
Pain 2nd-4th fingers
Paralyzed triceps, extensors & flexors and pec major

Lose Triceps
Which ROOT SYNDROME:

Lose triceps reflex
C7
Which ROOT SYNDROME:

Lose knee jerk
L3 or L4
Which ROOT SYNDROME:

Lose adductor thigh reflex
L3

(also lose knee jerk()
Which ROOT SYNDROME:

No sens loss; paralyzed quadriceps & ant tibial muscles
L3

(contrast L4: medial leg sens loss)
Which ROOT SYNDROME:

Lose sensation medial leg (below knee) to medial malleolus
L4
Which ROOT SYNDROME:

Invert foot
L4
Which ROOT SYNDROME:

Lose sensation dorsum of foot to great toe; paralyzed extensor hallucis longus
L5
L5 root synd: lose what reflex?
Trick - none
Which ROOT SYNDROME:

Lose ankle jerk
S1
Which ROOT SYNDROME:

Lose sens lateral border of foot; evert foot
S1
Another name for:

Chronic GBS
Chronic Inflammatory Demyelinating Polyneuropathy
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP):

-what ages?
-preceding events?
40-60yo

NO KNOWN ANTECEDENTS (contrast GBS - C jejuni)
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP):

-slow or rapid onset?
-painful?
-how affect reflexes?
SLOW, PAINLESS weakness beginning in legs

Absent reflexes
What dz:

slow-evolving, painless weakness beginning in legs --> widespread areflexia & loss of vibratory sense; weak neck flexors
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP):

-weak neck flexors and/or extensors?
Flexors
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP):

How tx?
STEROIDS x many yrs

(contrast GBS - no role for steroids)

Some pts may respond to IVIg or plasmapharesis
What dz:

Immune-mediated pure motor multiple mononeuropathy
Multifocal Motor Neuropathy
Multifocal Motor Neuropathy:

-pure motor or sens inv?
-what ages?
-M or F?
-underlying mxn?
Pure motor
young adults; M>F (slight)
immune-mediated
Multifocal Motor Neuropathy: begins in which limbs?
ARMS

(contrast CIDP: legs)
What dz:

Young adult with slow-evolving, ASYMM distal limb weakness beginning in arms
Multifocal Motor Neuropathy
Multifocal Motor Neuropathy: distal or proximal weak?
Distal
Multifocal Motor Neuropathy: weakness in muscle with decreased or normal bulk?
Normal bulk
Multifocal Motor Neuropathy: how affect reflexes?
NORMAL REFLEXES

(decreased strength in muscles w/normal bulk)
Multifocal Motor Neuropathy: how affect CSF?
Normal
Multifocal Motor Neuropathy: see what Ab?
IgM anti-GM1

(IgM!!!!)
What dz:

Very high IgM anti-GM1
Multifocal Motor Neuropathy
Multifocal Motor Neuropathy: how tx?
Good response to IVIg or CYCLOPHOSPHAMIDE

(imp to identify this dz)
What % periph neuropathies are assoc w/serum monoclonal gammopathy (M-protein)?
10%!
10% periph neuropathies assoc w/what protein?
M-protein reacting w/myelin-assoc glycoprotein (MAG)
M-protein: reacts w/what myelin protein?
Myelin-assoc glycoprotein (MAG)
Monoclonal gammopathies (M-protein assoc):

-sens? early or late?
-motor? early or late? which limbs?
Sens early --> motor (esp legs) late
Monoclonal gammopathies (M-protein assoc):

Small or large fiber?
LARGE FIBER
Monoclonal gammopathies (M-protein assoc):

Electrodiagnostic findigns?
DEMYELINATION
Monoclonal gammopathies (M-protein assoc):

How tx?
1. Excise & radiate plasmacytoma (if can locate)
2. Plasmapharesis
Most common & important diabetic neuropathy?
Diabetic polyneuropathy
Diabetic neuropathy:

-how many yrs after dz?
-common at presentation?
5-10 yrs

Uncommon at presentation
Diabetic neuropathy:

Is WEAKNESS early or late?
LATE

usu p/w paresthesias first
Diabetic neuropathy:


Small or large fibers?
BOTH
Diabetic neuropathy:

How tx? (classes of drugs)
Glucose control

NSAIDs
TCAs
AEDs: gabapentin, carbamazepine
Diabetic neuropathy:

Neuropathic pain responds to what drug class?
AEDs! Gabapentin & carbamazepine
Diabetic AMYOTROPHY:

-another name
-TM1 or 2?
-how present?
Diabetic proximal motor neuropathy

TM2 (older pts)

thigh & LBP --> thigh weak w/atrophy
Name for:

T2DM with severe thigh & back pain --> thigh muscle weakness w/atrophy
Diabetic amyotrophy (aka diabetic prox motor neuropathy)
T/F DM pts more susceptible to compression neuropathies
T
Uremic neuropathy:

-a/symm?
-distal or prox?
-motor or sens?
-CLASSIC FEATURES?
Symm, distal, motor&sens

Foot drop, leg weak
Porphyric neuropathy:

-assoc which disease?
-sens or motor?
-how affect reflexes?
ACUTE intermitt porph

Acute sens loss --> rapid weakness & paralysis --> areflexia, abd pain
What dz:

Abdominal pain + leg paresthesias --> leg paralysis --> asc
AIP --> porphyric neuropathy
Critical care neuropathies: develop after how long in ICU?
2 weeks