Podcast
Questions and Answers
What is the most common manifestation of Peripheral Neuropathy?
What is the most common manifestation of Peripheral Neuropathy?
Which of the following is NOT a type of Peripheral Neuropathy?
Which of the following is NOT a type of Peripheral Neuropathy?
What is the term for compression or stretching of a nerve at a point where it passes through a narrow space?
What is the term for compression or stretching of a nerve at a point where it passes through a narrow space?
Which symptom is NOT typically associated with Peripheral Neuropathy?
Which symptom is NOT typically associated with Peripheral Neuropathy?
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What is the term for inflammation of one nerve in multiple places?
What is the term for inflammation of one nerve in multiple places?
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What is the term for pain originating from the nerve root?
What is the term for pain originating from the nerve root?
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What is the typical characteristic of polyneuropathy?
What is the typical characteristic of polyneuropathy?
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What is the term for 'pain due to a stimulus that does not normally provoke pain'?
What is the term for 'pain due to a stimulus that does not normally provoke pain'?
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What is the treatment for peripheral nerve tumors?
What is the treatment for peripheral nerve tumors?
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What is the term for the simultaneous malfunction of two or more peripheral nerves in separate areas of the body?
What is the term for the simultaneous malfunction of two or more peripheral nerves in separate areas of the body?
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What is the timeline for acute neuropathy?
What is the timeline for acute neuropathy?
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What is the characteristic of chronic compressive or entrapment neuropathies?
What is the characteristic of chronic compressive or entrapment neuropathies?
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What is the term for 'a painful syndrome characterized by an abnormally painful reaction to a stimulus, as well as an increased threshold'?
What is the term for 'a painful syndrome characterized by an abnormally painful reaction to a stimulus, as well as an increased threshold'?
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What is the course of most neuropathies?
What is the course of most neuropathies?
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What is the primary indication for nerve biopsies in the evaluation of peripheral neuropathy?
What is the primary indication for nerve biopsies in the evaluation of peripheral neuropathy?
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What is the most common cause of the pattern of hyperreflexia, spasticity, and Babinski sign?
What is the most common cause of the pattern of hyperreflexia, spasticity, and Babinski sign?
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What is the purpose of electrodiagnostic studies in the diagnosis of peripheral neuropathy?
What is the purpose of electrodiagnostic studies in the diagnosis of peripheral neuropathy?
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What is the characteristic of Carpal Tunnel Syndrome?
What is the characteristic of Carpal Tunnel Syndrome?
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What is the treatment for Guillain-Barre syndrome?
What is the treatment for Guillain-Barre syndrome?
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What is the characteristic of Complex Regional Pain Syndrome?
What is the characteristic of Complex Regional Pain Syndrome?
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What is the typical feature of Charcot-Marie-Tooth (CMT) disease?
What is the typical feature of Charcot-Marie-Tooth (CMT) disease?
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What is the most common cause of peripheral neuropathy in the context of systemic and metabolic disorders?
What is the most common cause of peripheral neuropathy in the context of systemic and metabolic disorders?
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What is the primary goal of treatment for Carpal Tunnel Syndrome?
What is the primary goal of treatment for Carpal Tunnel Syndrome?
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What is the primary indication for referral to a specialist in the management of Carpal Tunnel Syndrome?
What is the primary indication for referral to a specialist in the management of Carpal Tunnel Syndrome?
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What is the primary system affected by autonomic neuropathy?
What is the primary system affected by autonomic neuropathy?
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Which of the following symptoms is NOT associated with autonomic neuropathy?
Which of the following symptoms is NOT associated with autonomic neuropathy?
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What is the key clinical sign of autonomic neuropathy?
What is the key clinical sign of autonomic neuropathy?
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Which system is responsible for regulating involuntary physiologic processes?
Which system is responsible for regulating involuntary physiologic processes?
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What is the primary focus of treatment for autonomic neuropathy?
What is the primary focus of treatment for autonomic neuropathy?
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Which of the following is a common complication of diabetes mellitus?
Which of the following is a common complication of diabetes mellitus?
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What is the term for the simultaneous malfunction of two or more peripheral nerves in separate areas of the body?
What is the term for the simultaneous malfunction of two or more peripheral nerves in separate areas of the body?
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What is the term for the component of the peripheral nervous system that regulates involuntary physiologic processes?
What is the term for the component of the peripheral nervous system that regulates involuntary physiologic processes?
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Study Notes
Peripheral Neuropathy: Clinical Presentation
- Distal sensory loss, burning, stinging, and "pins and needles" sensation
- Symptoms: ulcers or slow healing wounds, sensitivity to touch, lack of sensation, increased falls, and tingling or numb feet
- Sensory changes are the most common manifestation
Classifications of Peripheral Neuropathies
- Mononeuropathy: involves one nerve
- Polyneuropathy: involves multiple nerves
- Mononeuropathy Multiplex: involves one nerve in multiple places
Mononeuropathies
- May occur due to injury, compression, angulation, or stretching of a nerve
- Entrapment neuropathy: compression of a nerve by neighboring anatomic structures
- Examples: carpal tunnel syndrome, compression/entrapment nerve, ischemia, leg crossing, high boots
- Acute compression neuropathy: no treatment is necessary, complete recovery generally occurs within 2 months
- Chronic compressive or entrapment neuropathies: avoidance of aggravating factors and correction of underlying systemic conditions are important
Polyneuropathies
- Typically symmetric and distal
- Associated with Diabetes Mellitus (DM); also known as "stocking-glove" neuropathy
Mononeuropathy Multiplex
- Simultaneous malfunction of two or more peripheral nerves in separate areas of the body
- Can be caused by infection (e.g., HIV)
- Neuropathic pain: burning, dull, and poorly localized
- Allodynia: pain due to a stimulus that does not normally provoke pain
- Hyperpathia: a painful syndrome characterized by an abnormally painful reaction to a stimulus
Timeline
- Acute: days to 4 weeks
- Subacute: 4-8 weeks
- Chronic: >8 weeks
- Course: monophasic, progressive, or relapsing
Upper Motor/sensory Neuron Involvement
- Hyperreflexia, spasticity, Babinski sign
- Most common cause: vitamin B12 deficiency
- Other considerations: copper deficiency, HIV
Physical Examination
- Sharp/Dull
- Deep ankle reflex
- Foot evaluation for ulceration
Diagnostic Workup
- Electrodiagnostic Studies (EDx): nerve conduction studies (NCS) and needle electromyography (EMG)
- Nerve Conduction Studies (NCS)
- Needle Electromyography (EMG)
- Nerve Biopsies (NBx): less widely performed, primary indication is suspicion for amyloid neuropathy or vasculitis
Treatment
- Protect anesthetic extremities from injury
- Patient education: daily foot inspection, use of a mirror if needed, and proper shoe fitting
- Physical therapy: prevents contractures, and maintains a weak extremity in a position of useful function
- Pain management: simple analgesics (e.g., aspirin, NSAIDS), gabapentin, or pregabalin
Carpal Tunnel Syndrome
- Mononeuropathy: affects only the median nerve
- Causes: repetitive wrist activities, pregnancy, diabetes mellitus, rheumatoid arthritis
- H&P: initial symptoms, subtle disparity between affected-opposite sides, Tinel sign, Phalen sign, and carpal compression test
- Diagnostic studies: US, EDx, and NCS
- Treatment: relieve pressure on median nerve, splinting, oral corticosteroids, NSAIDs, methylprednisolone injections, and surgery
Guillain-Barré Syndrome
- Rapidly progressive weakness or paralysis
- Associated with mild respiratory or intestinal infection, swine flu immunizations
- Common in 20-50 years old
- Treatment: plasmapheresis and/or IVIG
Complex Regional Pain Syndrome (CRPS)
- Rare disorder characterized by autonomic and vasomotor instability
- Cardinal symptoms and signs: pain, swelling, disturbances of color and temperature, dystrophic changes, and limited range of motion
- Most cases preceded by surgery or direct physical trauma
- Syndrome phases: pain, swelling, skin color/temperature changes, and dystrophy
- Treatment: NSAIDs, prednisone, invasive therapies, and early mobilization after injury or surgery
Charcot-Marie-Tooth (CMT)
- Inherited neuropathies
- Clinical presentation: foot deformities or gait disturbances in childhood or early adult life
- Slow progression leads to typical features of polyneuropathy
- No medical treatment, but physical and occupational therapy are key
Neuropathies Associated with Systemic & Metabolic Disorders
- Diabetes Mellitus
- Chronic alcohol overuse
- Nutrition deficiencies
- Pregnancy
Neuropathies Associated with Infection & Inflammatory Disorders
- HIV/AIDS
- Sarcoidosis
- Rheumatoid Arthritis
Neuropathies Associated with Toxin Exposure
- Chronic alcohol overuse
- Chemotherapy
- Heavy metals exposure (e.g., lead, arsenic)
- Environmental (e.g., vibration-induced nerve damage, loud sounds, prolonged cold exposure, hypoxemia)
Autonomic Neuropathies
- Resulting from diseases of the peripheral autonomic nervous system, a significant complication of diabetes mellitus
- Characterized by changes in:
- Skin and hair texture
- Itching
- Edema
- Loss of nails
- Sweating abnormalities
- Dryness of mouth and eyes
- Excessive salivation
Cardiovascular Impacts
- Cardiac arrhythmias
- Orthostatic hypotension
- Sleep apnea
Gastrointestinal Impacts
- Dysphagia
- Constipation
- Gastroparesis
Genitourinary and Neuroendocrine Impacts
- Urinary retention or incontinence
- Bladder urgency
- Sexual dysfunction
Key Clinical Sign
- Orthostatic fall in blood pressure without an appropriate increase in heart rate
- Measured through orthostatic hypotension test
Important to Know
- Autonomic nervous system regulates involuntary physiologic processes, including heart rate, blood pressure, respiration, digestion, and sexual arousal
- Autonomic nervous system disorders can occur on their own or as a result of progression of other peripheral nervous system disorders
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Description
This quiz covers the clinical presentation of peripheral neuropathy, including symptoms, signs, and classifications of peripheral neuropathies. Learn about the common manifestations of peripheral neuropathy, such as distal sensory loss, burning sensations, and impaired vibratory sensation.
