Nsp Week 2: Peripheral Nerve And Nerve Root Disorders (Desousa)

Front 1

Describe the difference in the muscles affected by peripheral neuropathies and NMJ diseases/myopathies.

Back 1

Peripheral neuropathis --> DISTAL muscles
NMJ diseases/myopathies --> PROXIMAL muscles

Front 2

What kind of patterns of nerve involvement are seen in peripheral neuropathies?

Back 2

1. Stocking and glove patterns
2. Shield and mask patterns

Front 3

Do peripheral neuropathies affect small or large fibers?

Back 3

BOTH
Small fibers (touch, pinprick, temperature)
Large fibers (vibratory, proprioception)

Front 4

What is the most common cause of distal, symmetric polyneuropathy?
What are some other causes?

Back 4

Diabetes mellitus

1. Hypothyroidism
2. Toxic (alcohol, chemo, Vit. B6 overdose)
3. Vitamin deficiencies (B12, B1, B6)
4. Infections (Hep C, HIV, leprosy)

Front 5

List 4 examples of entrapment neuropathies.

Back 5

(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)

Front 6

Thenar muscle atrophy is a result of which mononeuropathy?

Back 6

Median neuropathy at the wrist
(Carpal tunnel syndrome)

Front 7

List 3 common causes of multiple mononeuropathies.

Back 7

1. SLE
2. Wegener's granulomatosis
3. Polyarteritis nodosa

*Caused by nerve infarction/ inflammation

Front 8

What type of neuropathy may cause a right or left foot drop (asymmetrical)?

Back 8

Multiple mononeuropathy
(SLE or vasculitis)

Front 9

List 2 common causes of autonomic neuropathies

Back 9

1. Amyloidosis
2. Diabetic neuropathy

Front 10

List some signs/symptoms associated with autonomic neuropathy

Back 10

1. Postural hypotension (abnormal heart rate variability)
2. GI dysmotility
3. Erectile dysfunction
4. Urinary retention

Front 11

What type of assessment may help confirm diagnosis of a small fiber sensory neuropathy?

Back 11

Epidermal nerve fiber density assessment

Front 12

What kind of EMG/NCS test results will small fiber sensory neuropathies show?

Back 12

Normal EMG/NCS results
(these tests are for large nerve fibers only)

Front 13

Numbness, parasthesias, burning/ electric-like pain are symptoms associated with what type of neuropathy?

Back 13

Small fiber sensory neuropathy

Front 14

What part of the body are initially affected by small fiber sensory neuropathies?

Back 14

Feet and hands
(length-dependent)

Front 15

List some causes of peripheral neuropathy. What is the most common cause?

Back 15

"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

Front 16

What is the most common inherited neurological disorder?

Back 16

Charcot-Marie-Tooth disease
(aka: Hereditary motor and sensory neuropathy)

Front 17

What is the most common pattern of inheritance of Charcot-Marie-Tooth disease?

Back 17

Autosomal dominant

Front 18

What is the most common cause of Charcot-Marie-Tooth disease?

Back 18

PMP22 gene duplication
(results in CMT1A-- demyelinating division of CMT)

Front 19

Does Charcot-Marie-Tooth disease usually affect distal or proximal muscles?

Back 19

Distal
(weakness, atrophy, and numbness)

Front 20

What are the different variants of Charcot-Marie Tooth disease?

Back 20

1. Demyelinating variants (CMT1A)
2. Axonal variants (CMT2)
3. X-linked forms (CMTX)

Front 21

A severe infantile form of Charcot-Marie-Tooth disease is known as..?

Back 21

Dejerine-Sottas disease

Front 22

List 3 general neuronal injuries that result in peripheral neuropathies

Back 22

1. Neuronal (cell body) damage
2. Axonal injury (Wallerian degeneration)
3. Demyelinating injury

Front 23

List 2 peripheral demyelinating diseases

Back 23

1. Guillain-Barre syndrome
2. CIDP

Front 24

Guillain-Barre syndrome is often preceded by what kind of events?

Back 24

1. Infection
2. Trauma
3. Vaccination

Front 25

What is the clinical presentation of Guillain-Barre syndrome?

Back 25

1. Ascending weakness of the lower and upper limbs, <4 weeks
2. Arreflexia
3. Can follow infection, trauma, or vaccination

Front 26

What would you expect to find in the CSF of a patient with Guillain-Barre syndrome?

Back 26

1. Elevated CSF protein
2. Normal cell count

Front 27

What will the EMG/NCS test results show in a patient with Guillain-Barre syndrome?

Back 27

Results will be NORMAL early on

Front 28

What is the treatment for Guillain-Barre syndrome?

Back 28

1. IVIg
2. Plasma exchange

*Do NOT give steroids

Front 29

CIDP may occur over a period of how many weeks?

Back 29

8 weeks

Front 30

What will be found in the CSF of a patient with CIDP?

Back 30

Elevated CSF protein

Front 31

What will be the EMG/NCS test results in a patient with CIDP?

Back 31

1. Conduction block
2. Temporal dispersion
*Acquired demyelinating features

Front 32

What are the treatment options for CIDP?

Back 32

1. IVIg
2. Plasma exchange
3. Steroids

*Remember, steroids should NOT be given to patients with Guillain-Barre syndrome

Front 33

Pain and LMN syndrome is associated with what kind of neuropathy?

Back 33

Brachial or lumbosacral plexopathies

Front 34

List 5 causes of brachial plexopathies

Back 34

1. Tumor invasion
2. Post-radiation therapy (many years later)
3. Stretch injury
4. Inflammatory
5. Hereditary

Front 35

What are some signs associated with Lumbosacral plexopathies?

Back 35

1. Pain
2. LMN syndrome
3. Bowel/bladder/sexual dysfunction

Front 36

Acute onset of arm pain associated with patchy weakness and numbness may be associated with which disease?

Back 36

Parsonage-Turner syndrome

Front 37

Parsonage-Turner syndrome is also known as...?

Back 37

1. Brachial plexus neuritis
2. Amyotrophic neuralgia

Front 38

Parsonage-Turner syndrome is often associated with which disease?

Back 38

Diabetes mellitus

(Also associated w/ lupus and vasculitis)

Front 39

Which nerve is commonly involved in Parsonage-Turner Syndrome?

Back 39

Anterior interosseous nerve
(patients cannot form a circle w/ the tips of the thumb and index finger)

Front 40

If patients cannot form a circle w/ the tips of the thumb and index finger, what disease may be present?

Back 40

Parsonage-Turner Syndrome
(involvement of Anterior interosseous nerve)

Front 41

What kind of symptoms are associates with sensory root dysfunction?

Back 41

Radiating pattern of local pain, appearing in a dermatomal fashion

Front 42

What sign/symptoms are associated with motor root dysfunction?

Back 42

1. LMN syndrome (weakness, atrophy, reduced reflexes, fasciculation, cramps)
2. Myotomal fashion of distribution

Front 43

Cervical radiculopathies are usually caused by what?

Back 43

Disc disease

Front 44

What are the typical symptoms of thoracic radiculopathis?

Back 44

Pain > numbness > bladder dysfunction

Front 45

Which nerve roots are commonly involved in cervical radiculopathy?

Back 45

C6R (C5-C6V)
C7R (C6-C7V)
C8R (C7-T1V)

Front 46

Which nerve roots are commonly involved in lumbosacral radiculopathies?

Back 46

L4R (L4-L5V)
L5R (L5-S1V)

Front 47

Which peripheral nerve is involved in the Biceps reflex?

Back 47

Musculocutaneous N

Front 48

Which peripheral nerve is involved in the Brachioradialis reflex?

Back 48

Radial N

Front 49

Which peripheral nerve is involved in the Triceps reflex?

Back 49

Radial N

Front 50

Which peripheral nerve is involved in the patellar reflexx?

Back 50

Femoral nerve

Front 51

Which peripheral nerve is involved in the ankle reflex?

Back 51

Tibial N

Front 52

Prolonged or repetitive grip/finger or wrist flexion can cause what kind of mononeuropathy?

Back 52

Median neuropathy

Front 53

In a patient with median neuropathy, numbness, tingling, and/or pain may be felt in which fingers?

Back 53

Thumb, index, middle +/- ring fingers

Front 54

In a patient with ulnar neuropathy, numbness, tingling, and/or pain may be felt in which fingers?

Back 54

Ring and little fingers

Front 55

Hypothenar muscular atrophy may be seen in which type of peripheral neuropathy?

Back 55

Ulnar neuropathy at the elbow

Front 56

Foot drop with numbness/ paresthesias can be a sign of which peripheral neuropathy?

Back 56

Peroneal neuropathy at the fibular neck

Front 57

Numbness, tingling, burning, and pain over the thigh, may be a sign of which peripheral neuropathy?

Back 57

Meralgia paresthetic
(often seen in people who suddenly gain or lose weight)

Front 58

Nerve infarctions can present as what type of peripheral neuropathy?

Back 58

Multiple mononeuropathies

Front 59

What is the most common cause of thoracic radiculopathy?

Back 59

Post-herpatic neuralgia
(VZV, shingles)