Neuro shelf - PNS

after injury to axons and myelin, a distal disintegration of axon and myelin occurs

after damage to cell body of the neuron, distal dying of the axon and subsequent loss of myelin

neuropathing pain (aching, shooting, throbbing, burning), temperature sensations, autonomic dysfunction (cardiac arrhythmias, orthostatic hypotension, impotence, incontinence, and constipation

loss of vibration and joint position sense, weakness, fasciculations, loss of DTRs

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)

DANG RAPIST

• diabetes
• alcohol
• nutritional
• guillain-barre
• trauma
• hereditary
• environmental (toxins/drugs)
• rheumatic (vascular)
• amyloid
• paraneoplastic
• infectious
• systemic disease
• tumors

symmetric involvement of peripheral nerves, usually logs more than arms, distal more than proximal

involvement of only a single nerve (ex. carpal tunnel)

involvement of individual nerves in multifocal distribution

involvement of nerve roots

guillain-barree, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)

drug-induced, metabolic neuropathies, hereditary neuropathies, amyloidosis

multiple nerves - vasculitis, HNPP, infections (leprosy, lyme), sarcoidosis, HIV

single nerve - compressive mononeuropathy and radiculopathy

motor neuron disease, multifocal motor neuropathy

polyradiculopathy, meningeal carcinomatosis or lymphomatosis, HNPP, hereditary neuropathies

cryptogenic sensory polyneuropathys, metabolic, drug induced, leprosy

sensory neuronopathies (ganglionopathies), paraneoplastic, sjorgen syndrome, B6 toxicity, HIV sensory neuronopathies, cis-platinum toxicity

diabetes, amyloidosis, GBS, vincristine, porphyria, HIV-related autonomic neuropathy

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)

gain ataxia, areflexia, and external opthalmoplegia, usually w/o limb weakness

chromic GBS

improves with steroids

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)

symmetric, distally predominant sensorimotor axonal polyneuropathy. foot drop and leg weakness are major manifestations

sensorimotor axonal polyneuropathy manifested by parasthesias and dysesthesias of extremities (sometimes mimicking GBS), with areflexia and abdominal pain

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

associated with CMV infection in HIV pts

rapidly progressice flaccid paraparesis with sphincter dysfunction, perineal sensory loss, and lower limb areflexia

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

orthostatic hypotension, diarrhea, constipation, early satiety, tachycardia, blurred vision, urinary retention, erectile dysfunction

often follows viral infection, ANS affected.

Postural orthostatic tachycardia syndrome most commonly in women, with light-headedness and near-syncopal episodes

burning sensation and variable loss of sensation over anterolateral thigh, no motor involvement.

entrapment of lateral femoral cutaneous nerve near the inguinal ligament

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

presents with foot-drop with minimal sensory complaints

entrapment of peroneal nerve btwn neck of fibula and insertion of peroneus lungus muscle

pain in lateral shoulder, sensory loss over deltoid

paresis of deltoid, supraspinatus, and biceps

impairment of biceps reflex

sensation radial side of arm to thumb

paresis of biceps and brachioradialis

impairment of biceps reflex

sensation btwn second and 4th finger

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

impairment or loss of triceps reflex

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

sensation medial leg below knee to medial malleolus

quadriceps and anterior tibial muscles

decreased knee jerk reflex

sensation dorsum of foot to great toe

paralysis of extensor hallicis longus, extensor digitorum longus, inversion and eversion of foot

sensation lateral border of foot

loss of plantar and toe flexion

decreased or absent ankle jerk

lead toxicity, leprocy, sarcoidosis, porphyria, entrapments, diabetes, vasculitic neuropathy, Tangier disease

diphtheria, sarcoidosis, DM, GBS, sjorgren syndrome, polyarteritis nodosa, lyme disease, porphyria, syphilis, arsenic

amyloidosis, leprosy, acromegaly, neurofibromatosis, charcot-marie-tooth