Peripheral Neuropathies
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Questions and Answers

What is the primary pathophysiologic mechanism contributing to diabetic neuropathy?

  • Vitamin B12 deficiency
  • Increased peripheral nerve blood flow
  • Hyperglycemia-induced metabolic changes (correct)
  • Decreased oxidative stress

Which factor is NOT typically associated with vitamin B12 deficiency neuropathy?

  • Hyperthyroidism (correct)
  • Pernicious anemia
  • Impaired absorption
  • Dietary deficiencies

Which type of neuropathy is predominantly induced by chemotherapy?

  • Diabetic neuropathy
  • Hypothyroid neuropathy
  • Vitamin B12 deficiency neuropathy
  • Chemotherapy-induced peripheral neuropathy (correct)

What hormonal imbalance is primarily linked to peripheral neuropathy in hypothyroidism?

<p>Decreased thyroid hormone levels (C)</p> Signup and view all the answers

Which microbial infection is NOT associated with the pathophysiology of peripheral neuropathy?

<p>Hepatitis A (C)</p> Signup and view all the answers

How does alcoholism contribute to the pathophysiology of peripheral neuropathy?

<p>Causes oxidative stress and nutrient deficiencies (D)</p> Signup and view all the answers

Which of the following structures is NOT part of the Peripheral Nervous System (PNS)?

<p>Spinal cord (A)</p> Signup and view all the answers

What major deficit is typically observed with motor nerve impairment?

<p>Diminished reflex responses (D)</p> Signup and view all the answers

Which statement accurately describes neuronopathy?

<p>Ganglion cells are predominantly affected leading to widespread sensory deficits. (B)</p> Signup and view all the answers

Which symptom is associated with impairment of larger sensory fibers?

<p>Reduced ability to feel touch (C)</p> Signup and view all the answers

What can result from autonomic nerve impairment?

<p>Loss of control over bowel and bladder functions (A)</p> Signup and view all the answers

What is the primary function of the perineurium at the subarachnoid angle?

<p>To provide a protective barrier and encase nerve roots (C)</p> Signup and view all the answers

Which of the following is NOT a symptom of peripheral neuropathy?

<p>Severe neurological pain (B)</p> Signup and view all the answers

Which layers become continuous with the pia mater at the junction with the spinal cord?

<p>Outer layers of the root sheath (B)</p> Signup and view all the answers

Which condition might lead to reduced ability to feel touch and decreased overall sensation?

<p>Sensory Neuronopathy (C)</p> Signup and view all the answers

What is a key indicator of both motor and sensory nerve impairment?

<p>Muscular weakness or spasticity (B)</p> Signup and view all the answers

What characteristic of the endoneurium is particularly significant for nerve health?

<p>It contains blood vessels supplying nutrients to nerve fibers. (C)</p> Signup and view all the answers

Impairment of small fibers primarily affects which types of sensations?

<p>Pain and temperature (B)</p> Signup and view all the answers

What anatomical feature enhances the vulnerability of nerves to compression?

<p>Narrow spaces such as foramina and tunnels (A)</p> Signup and view all the answers

Which symptom is specifically linked to autonomic nerve impairment?

<p>Heat intolerance (C)</p> Signup and view all the answers

Which specific nerves are highlighted as being at risk of entrapment in constricted areas?

<p>Median and ulnar nerves (C)</p> Signup and view all the answers

Which condition is most likely to affect the blood vessels within the endoneurium?

<p>Diseases that lead to vascular susceptibility (A)</p> Signup and view all the answers

What is a common characteristic of peripheral neuropathy symptoms?

<p>Widespread sensory and proprioceptive deficits that do not follow a dermatome pattern (C)</p> Signup and view all the answers

Where does the arachnoid become continuous with the outer layers during its passage?

<p>At the subarachnoid angle (A)</p> Signup and view all the answers

What is a significant challenge for nerve fibers as they travel?

<p>Transiting narrow anatomical spaces (C)</p> Signup and view all the answers

What does the reflection of the arachnoid contribute to at the subarachnoid angle?

<p>It continues into the outer layers of the root sheath. (C)</p> Signup and view all the answers

What is a significant risk factor for the reactivation of the varicella-zoster virus (VZV) leading to shingles?

<p>Impaired cell-mediated immunity (A)</p> Signup and view all the answers

Which statement accurately describes the clinical manifestations associated with Lyme disease?

<p>Facial palsy is a common manifestation. (B)</p> Signup and view all the answers

Which mechanism is proposed to lead to peripheral neuropathies in patients with chronic hepatitis C virus (HCV) infection?

<p>Cryoglobulin deposition in vasa nervorum (B)</p> Signup and view all the answers

During the disseminated phase of Lyme disease, which triad of symptoms can be expected?

<p>Cranial nerve palsies, radiculitis, and aseptic meningitis (C)</p> Signup and view all the answers

What is a proposed immune-mediated mechanism related to the neuropathies seen in hepatitis B and C infections?

<p>Production of antibodies and immune complexes attacking peripheral nerves (A)</p> Signup and view all the answers

What is a common clinical feature of diabetic neuropathy?

<p>Stocking-and-glove pattern of sensory loss (D)</p> Signup and view all the answers

Which condition is primarily associated with the production of antibodies leading to vitamin B12 deficiency?

<p>Pernicious anemia (C)</p> Signup and view all the answers

What role does vitamin B12 play in nerve function?

<p>It acts as a coenzyme for methionine synthesis. (C)</p> Signup and view all the answers

Which of the following conditions can result in vitamin B12 deficiency due to dietary restrictions?

<p>Vegetarianism (D)</p> Signup and view all the answers

What effect does vitamin B12 deficiency have on homocysteine levels?

<p>Increases homocysteine levels (B)</p> Signup and view all the answers

The accumulation of methylmalonyl-CoA due to vitamin B12 deficiency can result in what kind of neurological damage?

<p>Abnormal myelination (A)</p> Signup and view all the answers

Which of the following can trigger vitamin B12 deficiency aside from dietary causes?

<p>Use of histamine-2 blockers (B)</p> Signup and view all the answers

Which symptom is least likely to be associated with diabetic neuropathy?

<p>Persistent muscle spasms (D)</p> Signup and view all the answers

Nitrous oxide exposure can lead to deficiency in which vitamin recognized for its role in neurological health?

<p>Vitamin B12 (B)</p> Signup and view all the answers

One of the symptoms of vitamin B12 deficiency neuropathy includes which of the following?

<p>Cognitive disturbances (B)</p> Signup and view all the answers

Flashcards

Peripheral Nervous System (PNS)

The part of the nervous system outside the brain and spinal cord, including cranial nerves, spinal nerves, and ganglia.

Diabetic Neuropathy

Neuropathy caused by diabetes, involving metabolic changes, high insulin, microvascular damage, and oxidative stress.

Vitamin B12 Deficiency Neuropathy

Neuropathy caused by inadequate vitamin B12 absorption, often due to dietary deficiency or pernicious anemia.

Chemotherapy-induced PN

Neuropathy as a side effect of cancer treatment (chemotherapy).

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Hypothyroidism and PN

Neuropathy potentially linked to hormonal imbalances and metabolic problems in hypothyroidism.

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Microbial Infections and PN

Certain infections (shingles, Lyme, hepatitis, leprosy, HIV) can potentially lead to peripheral neuropathy.

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Alcoholism and PN

Harmful effects of alcohol abuse on the nerves by both toxic and nutritional deficiency factors.

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Subarachnoid angle (SA)

Where the perineurium passes between dura mater and arachnoid, and some layers go to nerve root.

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Dura mater

A tough outer membrane covering nervous tissue.

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Arachnoid (A)

Middle membrane wrapping around nerve roots; continuous with root sheath.

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Root sheath (RS)

Protective layer around nerve root, continuous with arachnoid.

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Endoneurium

Connective tissue sheath around single nerve fibers, with blood vessels.

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Peripheral Nervous System

Nerves outside the brain and spinal cord.

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Nerve vulnerability

Nerves are vulnerable to compression and entrapment in narrow spaces.

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Intervertebral Foramina

Narrow passages where spinal nerves exit the spine.

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carpal tunnel

Example of narrow passage where nerve is susceptible to compression.

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Shingles Cause

Shingles is caused by a virus that travels along nerve paths to the skin, creating a painful rash.

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Lyme Disease Neuropathy

Lyme disease can cause nerve damage, often affecting facial nerves and other nerves in the neck or lower back.

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Hepatitis C & Neuropathy

Certain types of hepatitis viruses can damage nerves and cause neuropathy, possibly via immune reactions or protein buildup in the blood vessels that supply nerves.

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Immune-Mediated Neuropathy

Some infections can trigger immune reactions that damage or inflame nerves.

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Direct Viral Invasion Neuropathy

Some viruses can directly infect nerve cells and cause nerve damage.

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Peripheral Neuropathy

Damage to the nerves outside the brain and spinal cord, affecting motor, sensory, and autonomic functions.

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Motor Nerve Impairment

Weakness, spasms, twitching, wasting of muscles, and reduced reflexes are symptoms.

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Sensory Nerve Impairment (Large Fibers)

Reduced touch sensation, decreased overall sensation, loss of reflexes, reduced limb position sense.

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Sensory Nerve Impairment (Small Fibers)

Impaired pain and temperature sensation, especially from injuries.

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Autonomic Nerve Impairment

Problems with involuntary functions like sweating, bowel/bladder control, blood pressure regulation, and digestion.

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Neuronopathy

A problem with the nerve cells themselves (ganglia), leading to diverse sensory problems.

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Sensory Distribution

Sensory deficits may not follow specific dermatome patterns in neuronopathy.

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Multi-system effects

Peripheral neuropathy affects multiple nerve systems (motor, sensory, autonomic) in a wider distribution than spinal nerve/root involvement.

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Causes of Neuropathy

Peripheral neuropathy can result from autoimmune conditions, toxic substances, and various other factors.

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Diagnosis of Neuropathy

Diagnosis focuses on patterns of sensory, motor and reflex deficits; Understanding nerve innervation is crucial.

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Diabetic Neuropathy

Neuropathy caused by diabetes, often leading to sensory loss, pain, and weakness in the lower limbs.

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Vitamin B12 Deficiency

A condition where insufficient B12 leads to nerve damage and neurological problems, including neuropathy.

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Pernicious Anemia

An autoimmune condition causing B12 deficiency due to antibodies attacking intrinsic factor.

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Peripheral Neuropathy Symptoms

Sensory loss, abnormal sensations (dysesthesias), painful paresthesias, muscle weakness, balance problems.

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One-carbon cycle

Metabolic pathway requiring vitamin B12 for functions related to DNA and RNA.

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Homocysteine Accumulation

A buildup of homocysteine, a byproduct of B12 deficiency, which contributes to nerve damage.

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Myelin Synthesis

B12 is essential in converting methylmalonyl-CoA to succinyl CoA, crucial for proper nerve covering.

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Nitrous Oxide use

Exposure leading to acute cobalamin deficiency and nerve damage.

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Subacute Combined Degeneration

A serious neurological condition; nerve damage caused by B12 deficiency.

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Vitamin B12 and Nerve Function

Vitamin B12 plays a central role in maintaining neurological health through its functions in the one-carbon cycle and myelin synthesis.

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