Neuro shelf - PNS

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  1. wallerian degeneration
    after injury to axons and myelin, a distal disintegration of axon and myelin occurs
  2. neuronal/axonal degeneration
    after damage to cell body of the neuron, distal dying of the axon and subsequent loss of myelin
  3. symptoms associated with involvement of small nerve fibers
    neuropathing pain (aching, shooting, throbbing, burning), temperature sensations, autonomic dysfunction (cardiac arrhythmias, orthostatic hypotension, impotence, incontinence, and constipation
  4. symptoms associated with involvement of large fibers
    loss of vibration and joint position sense, weakness, fasciculations, loss of DTRs
  5. first-line tests when investigating PNS symptoms
    CBC, ESR, rheumatoid profiles (for collagen disase, leukemia, vasculitis), renal and liver function tests, glucose, HbA1C, vitamin B12, folate, thyroid function tests (hypothyroid neuropathy), serum and urine protein electrophoresis (monoclonal gammopathy, lymphoma, amyloidosis)
  6. causes of peripheral neuropaties

    • diabetes
    • alcohol
    • nutritional
    • guillain-barre
    • trauma
    • hereditary
    • environmental (toxins/drugs)
    • rheumatic (vascular)
    • amyloid
    • paraneoplastic
    • infectious
    • systemic disease
    • tumors
  7. polyneuropathy
    symmetric involvement of peripheral nerves, usually logs more than arms, distal more than proximal
  8. mononeuropathy
    involvement of only a single nerve (ex. carpal tunnel)
  9. mononeuropathy multiplex
    involvement of individual nerves in multifocal distribution
  10. radiculopathy
    involvement of nerve roots
  11. Peripheral neuropathies...

    symmetric proximal and distal weakness with sensory loss
    guillain-barree, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
  12. Peripheral neuropathies...

    symmetric distal weakness with sensory loss
    drug-induced, metabolic neuropathies, hereditary neuropathies, amyloidosis
  13. Peripheral neuropathies...

    asymmetric distal weakness with sensory loss
    multiple nerves - vasculitis, HNPP, infections (leprosy, lyme), sarcoidosis, HIV

    single nerve - compressive mononeuropathy and radiculopathy
  14. Peripheral neuropathies...

    asymmetric distal weakness without sensory loss
    motor neuron disease, multifocal motor neuropathy
  15. Peripheral neuropathies...

    asymmetric proximal and distal muscle weakness with sensory loss
    polyradiculopathy, meningeal carcinomatosis or lymphomatosis, HNPP, hereditary neuropathies
  16. Peripheral neuropathies...

    symmetric sensory loss without weakness
    cryptogenic sensory polyneuropathys, metabolic, drug induced, leprosy
  17. Peripheral neuropathies...

    asymmetric proprioceptive sensory loss without weakness
    sensory neuronopathies (ganglionopathies), paraneoplastic, sjorgen syndrome, B6 toxicity, HIV sensory neuronopathies, cis-platinum toxicity
  18. Peripheral neuropathies...

    autonomic symptoms and signs
    diabetes, amyloidosis, GBS, vincristine, porphyria, HIV-related autonomic neuropathy
  19. guillain-barre syndrome
    often preceded by infection with campylobacter jejuni or CMV, EBV (herpes viruses)

    antibodies that target gangliocides

    rapidly evolving, ascending areflexic motor paralysis without w/o sensory symptoms. often starts with tingling, pins-and-needles in the feet, lower back pain, bulbar weakness and respiratory muscle paralysis may occur, automonic dysfunction (orthostatic hypotension, transient hypertension, cardiac arrythmias

    reflexes disappear around day 3, worst at day 14

    dx - albuminocytologic dissociation in the CSF (elevated protein but few or no cells)
  20. miller-fisher variant of guillain-barre
    gain ataxia, areflexia, and external opthalmoplegia, usually w/o limb weakness
  21. chronic inflammatory demyelinating polyneuropathy (CIDP)
    chromic GBS

    improves with steroids
  22. multifocal motor neuropathy
    pure motor multiple mononeuropathy

    slowly progressive, asymmetric, predominantly distal limb weakness beginning in arms, develops in distribution of individual nerves (not myotomes), can be severe in muscles with relatively normal bulk

    dx - conduction block in motor nerves in arease not prone to compression

    tx - IVIg or immunosuppressive drug therapy (cyclophosphamide)
  23. uremic neuropathy
    symmetric, distally predominant sensorimotor axonal polyneuropathy. foot drop and leg weakness are major manifestations
  24. polrphyric neuropathy
    sensorimotor axonal polyneuropathy manifested by parasthesias and dysesthesias of extremities (sometimes mimicking GBS), with areflexia and abdominal pain
  25. Charcot-Marie-Tooth disease
    presents in adolescence with symmetric, slowly progressive distal musclular atrophy of legs and feet, then hands. Hammer toes and pes cavus common

    CMT2 is only axonal motor neuropathy in CMT family, the others are primarily deemyelinating
  26. lumbosacral polyradiculopathy
    associated with CMV infection in HIV pts

    rapidly progressice flaccid paraparesis with sphincter dysfunction, perineal sensory loss, and lower limb areflexia
  27. Neuropathy of leprosy
    sensory and motor involvement. presents as mononeuropathy multiplex or mononeuropathies with predilection for cooler areas such as distal limbs, nose, ears. DTRs preserved. Palpable nerve hypertrophy.

    axonal damage, myelin changes, and nerve fiber loss are cardinal features
  28. symptoms of autonomic neuropathies
    orthostatic hypotension, diarrhea, constipation, early satiety, tachycardia, blurred vision, urinary retention, erectile dysfunction
  29. pandysautonomia
    often follows viral infection, ANS affected.

    Postural orthostatic tachycardia syndrome most commonly in women, with light-headedness and near-syncopal episodes
  30. meralgia paresthetica
    burning sensation and variable loss of sensation over anterolateral thigh, no motor involvement.

    entrapment of lateral femoral cutaneous nerve near the inguinal ligament
  31. femoral neuropathy
    leg weakness on attempting to stand or walk, pain in anterior thigh

    usually due to trauma from surgery, stretch injury (ex during birth), DM, inflammatory processes
  32. Peroneal neuropathy
    presents with foot-drop with minimal sensory complaints

    entrapment of peroneal nerve btwn neck of fibula and insertion of peroneus lungus muscle
  33. root syndromes...

    pain in lateral shoulder, sensory loss over deltoid

    paresis of deltoid, supraspinatus, and biceps

    impairment of biceps reflex
  34. root syndromes...

    sensation radial side of arm to thumb

    paresis of biceps and brachioradialis

    impairment of biceps reflex
  35. root syndromes...

    sensation btwn second and 4th finger

    paralysis/weakness of triceps, wrist extensors and flexors, pectoralis major

    impairment or loss of triceps reflex
  36. root syndromes...

    often no sensory loss, sometimes medial thigh and knee

    paralysis of quadriceps, adductor (differentiates from femoral neuropathy)

    loss of knee jerk, loss or impaired adductor reflex
  37. root syndromes...

    sensation medial leg below knee to medial malleolus

    quadriceps and anterior tibial muscles

    decreased knee jerk reflex
  38. root syndromes...

    sensation dorsum of foot to great toe

    paralysis of extensor hallicis longus, extensor digitorum longus, inversion and eversion of foot
  39. root syndromes...

    sensation lateral border of foot

    loss of plantar and toe flexion

    decreased or absent ankle jerk
  40. neuropathies that may begin in arms rather than legs
    lead toxicity, leprocy, sarcoidosis, porphyria, entrapments, diabetes, vasculitic neuropathy, Tangier disease
  41. neuropathy associated with cranial nerve involvement
    diphtheria, sarcoidosis, DM, GBS, sjorgren syndrome, polyarteritis nodosa, lyme disease, porphyria, syphilis, arsenic
  42. neuropathies associated with palpable peripheral nerves
    amyloidosis, leprosy, acromegaly, neurofibromatosis, charcot-marie-tooth
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Neuro shelf - PNS
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