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59 Cards in this Set
- Front
- Back
Describe the difference in the muscles affected by peripheral neuropathies and NMJ diseases/myopathies.
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Peripheral neuropathis --> DISTAL muscles
NMJ diseases/myopathies --> PROXIMAL muscles |
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What kind of patterns of nerve involvement are seen in peripheral neuropathies?
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1. Stocking and glove patterns
2. Shield and mask patterns |
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Do peripheral neuropathies affect small or large fibers?
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BOTH
Small fibers (touch, pinprick, temperature) Large fibers (vibratory, proprioception) |
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What is the most common cause of distal, symmetric polyneuropathy?
What are some other causes? |
Diabetes mellitus
1. Hypothyroidism 2. Toxic (alcohol, chemo, Vit. B6 overdose) 3. Vitamin deficiencies (B12, B1, B6) 4. Infections (Hep C, HIV, leprosy) |
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List 4 examples of entrapment neuropathies.
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(mononeuropathies)
1. Median neuropathy at wrist (Carpal tunnel syndrome) 2. Ulnar neuropathy at the elbow 3. Peroneal neuropathy at the fibular neck 4. Meralgial paresthica (lateral femoral cutaneous nerve) |
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Thenar muscle atrophy is a result of which mononeuropathy?
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Median neuropathy at the wrist
(Carpal tunnel syndrome) |
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List 3 common causes of multiple mononeuropathies.
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1. SLE
2. Wegener's granulomatosis 3. Polyarteritis nodosa *Caused by nerve infarction/ inflammation |
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What type of neuropathy may cause a right or left foot drop (asymmetrical)?
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Multiple mononeuropathy
(SLE or vasculitis) |
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List 2 common causes of autonomic neuropathies
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1. Amyloidosis
2. Diabetic neuropathy |
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List some signs/symptoms associated with autonomic neuropathy
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1. Postural hypotension (abnormal heart rate variability)
2. GI dysmotility 3. Erectile dysfunction 4. Urinary retention |
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What type of assessment may help confirm diagnosis of a small fiber sensory neuropathy?
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Epidermal nerve fiber density assessment
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What kind of EMG/NCS test results will small fiber sensory neuropathies show?
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Normal EMG/NCS results
(these tests are for large nerve fibers only) |
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Numbness, parasthesias, burning/ electric-like pain are symptoms associated with what type of neuropathy?
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Small fiber sensory neuropathy
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What part of the body are initially affected by small fiber sensory neuropathies?
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Feet and hands
(length-dependent) |
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List some causes of peripheral neuropathy. What is the most common cause?
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"DANG THE RAPIST"
1. Diabetes (MOST COMMON) 2. Alcohol 3. Nutritional 4. GBS 5. Trauma 6. Hereditary 7. Environmental 8. Rheumatologic 9. Paraneoplastic 10. Infectious 11. Systemic disease 12. Tumor |
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What is the most common inherited neurological disorder?
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Charcot-Marie-Tooth disease
(aka: Hereditary motor and sensory neuropathy) |
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What is the most common pattern of inheritance of Charcot-Marie-Tooth disease?
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Autosomal dominant
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What is the most common cause of Charcot-Marie-Tooth disease?
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PMP22 gene duplication
(results in CMT1A-- demyelinating division of CMT) |
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Does Charcot-Marie-Tooth disease usually affect distal or proximal muscles?
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Distal
(weakness, atrophy, and numbness) |
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What are the different variants of Charcot-Marie Tooth disease?
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1. Demyelinating variants (CMT1A)
2. Axonal variants (CMT2) 3. X-linked forms (CMTX) |
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A severe infantile form of Charcot-Marie-Tooth disease is known as..?
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Dejerine-Sottas disease
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List 3 general neuronal injuries that result in peripheral neuropathies
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1. Neuronal (cell body) damage
2. Axonal injury (Wallerian degeneration) 3. Demyelinating injury |
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List 2 peripheral demyelinating diseases
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1. Guillain-Barre syndrome
2. CIDP |
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Guillain-Barre syndrome is often preceded by what kind of events?
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1. Infection
2. Trauma 3. Vaccination |
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What is the clinical presentation of Guillain-Barre syndrome?
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1. Ascending weakness of the lower and upper limbs, <4 weeks
2. Arreflexia 3. Can follow infection, trauma, or vaccination |
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What would you expect to find in the CSF of a patient with Guillain-Barre syndrome?
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1. Elevated CSF protein
2. Normal cell count |
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What will the EMG/NCS test results show in a patient with Guillain-Barre syndrome?
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Results will be NORMAL early on
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What is the treatment for Guillain-Barre syndrome?
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1. IVIg
2. Plasma exchange *Do NOT give steroids |
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CIDP may occur over a period of how many weeks?
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8 weeks
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What will be found in the CSF of a patient with CIDP?
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Elevated CSF protein
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What will be the EMG/NCS test results in a patient with CIDP?
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1. Conduction block
2. Temporal dispersion *Acquired demyelinating features |
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What are the treatment options for CIDP?
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1. IVIg
2. Plasma exchange 3. Steroids *Remember, steroids should NOT be given to patients with Guillain-Barre syndrome |
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Pain and LMN syndrome is associated with what kind of neuropathy?
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Brachial or lumbosacral plexopathies
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List 5 causes of brachial plexopathies
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1. Tumor invasion
2. Post-radiation therapy (many years later) 3. Stretch injury 4. Inflammatory 5. Hereditary |
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What are some signs associated with Lumbosacral plexopathies?
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1. Pain
2. LMN syndrome 3. Bowel/bladder/sexual dysfunction |
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Acute onset of arm pain associated with patchy weakness and numbness may be associated with which disease?
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Parsonage-Turner syndrome
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Parsonage-Turner syndrome is also known as...?
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1. Brachial plexus neuritis
2. Amyotrophic neuralgia |
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Parsonage-Turner syndrome is often associated with which disease?
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Diabetes mellitus
(Also associated w/ lupus and vasculitis) |
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Which nerve is commonly involved in Parsonage-Turner Syndrome?
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Anterior interosseous nerve
(patients cannot form a circle w/ the tips of the thumb and index finger) |
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If patients cannot form a circle w/ the tips of the thumb and index finger, what disease may be present?
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Parsonage-Turner Syndrome
(involvement of Anterior interosseous nerve) |
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What kind of symptoms are associates with sensory root dysfunction?
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Radiating pattern of local pain, appearing in a dermatomal fashion
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What sign/symptoms are associated with motor root dysfunction?
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1. LMN syndrome (weakness, atrophy, reduced reflexes, fasciculation, cramps)
2. Myotomal fashion of distribution |
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Cervical radiculopathies are usually caused by what?
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Disc disease
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What are the typical symptoms of thoracic radiculopathis?
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Pain > numbness > bladder dysfunction
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Which nerve roots are commonly involved in cervical radiculopathy?
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C6R (C5-C6V)
C7R (C6-C7V) C8R (C7-T1V) |
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Which nerve roots are commonly involved in lumbosacral radiculopathies?
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L4R (L4-L5V)
L5R (L5-S1V) |
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Which peripheral nerve is involved in the Biceps reflex?
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Musculocutaneous N
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Which peripheral nerve is involved in the Brachioradialis reflex?
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Radial N
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Which peripheral nerve is involved in the Triceps reflex?
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Radial N
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Which peripheral nerve is involved in the patellar reflexx?
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Femoral nerve
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Which peripheral nerve is involved in the ankle reflex?
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Tibial N
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Prolonged or repetitive grip/finger or wrist flexion can cause what kind of mononeuropathy?
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Median neuropathy
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In a patient with median neuropathy, numbness, tingling, and/or pain may be felt in which fingers?
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Thumb, index, middle +/- ring fingers
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In a patient with ulnar neuropathy, numbness, tingling, and/or pain may be felt in which fingers?
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Ring and little fingers
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Hypothenar muscular atrophy may be seen in which type of peripheral neuropathy?
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Ulnar neuropathy at the elbow
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Foot drop with numbness/ paresthesias can be a sign of which peripheral neuropathy?
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Peroneal neuropathy at the fibular neck
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Numbness, tingling, burning, and pain over the thigh, may be a sign of which peripheral neuropathy?
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Meralgia paresthetic
(often seen in people who suddenly gain or lose weight) |
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Nerve infarctions can present as what type of peripheral neuropathy?
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Multiple mononeuropathies
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What is the most common cause of thoracic radiculopathy?
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Post-herpatic neuralgia
(VZV, shingles) |