Term
| What cranial nerve isn't part of the PNS? |
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Definition
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Term
| Sxs of PN in small fibers |
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Definition
-pain
-burning
-sweating abnormalities
-disturbances of temp sensation |
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Term
| Mononeuropathy of the median nerve in the wrist is called... |
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Definition
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Term
| Classic sensory loss sign of polyneuropathy |
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Definition
| stocking-glove distribution (starts at toe tips and moves up to knee then to hands - symmetrical) |
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Term
| Stocking-glove polyneuropathy (PN) is commonly seen in what dx? |
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Definition
DM - a chronic mixed sensory, motor & autonomic PN that presents 5-10 years from onset of diagnosis
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Term
| What inflammatory PN is secondary to viral illness, acute in presentation and attacks the ganglioside of neurons? |
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Definition
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Term
| PN of lrg nerve fibers affects what three things? |
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Definition
1. position of sense
2. vibratory perception
3. tendon reflexes |
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Term
| Peripheral nerves respond to injury by what 3 reactions? |
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Definition
1. Wallerian degeneration
2. Axonal degeneration
3. Sedmental demyelination |
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Term
| Patho of Wallerian degeneration |
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Definition
| Crushing, compression or ischemic injury of peripheral axon leading to loss of continuity with immediate paralysis of the muscle or loss of sensation in area supplied by axon and disintergration of internal cellular structures of the myelin and axon due to accumulation of granular debris. Muscle atrophy is final outcome. |
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Term
| Peripheral nerves can regenerate. What factors increase this event? |
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Definition
1. presence of myelin sheath
2. short distance between sites for sprouts to travel |
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Term
| What three dx states are most common with axonal degeneration? |
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Definition
1. DM
2. alcoholism
3. AIDS
Leprosy is the most common cause worldwide |
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Term
| Patho of axonal degeneration |
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Definition
| The neuronal cell body is unable to provide nutrients that maintain the long axon in the periphery. Becasue the longest axons are the most susceptible to dx and neurotoxins sxs occur first distally then progress centrally. |
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Term
| What vitamin deficiency can cause PN? |
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Definition
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Term
| What are the most common complaints of pts with PN? |
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Definition
- signs = numbness, decreased sensation
+ signs = tripping, new pain, paresthesia, dysesthesia
other sxs: difficulty walking in the dark, loss of balance. |
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Term
| Classic presentation of PN |
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Definition
- decreased sensation/motor abnormalities in a "stocking-glove" distribution
- slow, progressive sxs
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Term
| T/F - knee and ankle muscle stretch reflexes will hyper sensitive in PN? |
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Definition
| F - the reflexes will be diminished |
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Term
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Definition
| inability to coordinate muscle activity during voluntary movements so that smooth movements occur |
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Term
| Ataxia most often occurs d/t to disorders o what two CNS locations? |
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Definition
1. Cerebellum
2. Posterior columns of the spinal cord |
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Term
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Definition
| W/pt standing & eyes closed if swaying is present it is either a proprioceptive or cerebellar issue. If swaying stops when eyes are open then the issue is proprioceptive; if it doesn't stop then the issue is cerebellar loss. |
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Term
| What does an EMG measure? |
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Definition
| Denervation caused by loss of motor units with determination of site, extent & severity of lesion. It can also determine if the problem is sensory or motor, demyelinative or axonal and acute or chronic. |
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Term
| An EMG showing a lesion in the neuromuscular junction results in what dx? |
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Definition
| Myasthenia Gravis - resultant decrease in AcH |
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Term
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Definition
1. Weakness, atrophy & decreased reflexes - nerve root disorders
2. Foot/leg pain - muscle strain, DJD, Lumbar disc dx, spinal stenosis, arterial/venous insufficiency, thrombophelbitis
3. ALS
4. MS
5. polymyositis |
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Term
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Definition
- Txt underlying cause: w/drawl offending meds, remove toxic exposure, correct vitamin/nutritional deficiencies, address alcoholism, control DM
- PT:stretching, strengthening, resistance, weight-bearing exercises, balance & gait training, use of assisting devices.
- Orthoses:
1. braces/splints to prevent/correct contractures (spastic PN = UMN)
2. ankle-foot orhtoses (AFOs) prevent footdrop
- Surgical correction of acquired deformities as last resort
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Term
| What is the goal of PN txt |
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Definition
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Term
| Standard med txt of neruogenic pain |
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Definition
| Anti-epileptics (phenothiazine aka prolixin) and TCAs (amytriptyline) |
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Term
| What can the pt use for small areas of neurogenic pain? |
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Definition
| lidocaine patches or capsaicin ointment |
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Term
| Pts with neurogenic pain should be given narcotics - t/f? |
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Definition
| F - you will create an addict |
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Term
| What meds are available to txt neurogenic pain? |
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Definition
1. Phenothiazine (Proloxin)
2. Amytriptyline (Elavil): 90 - 150mg/qd
3. Pregabalin (Lyrica): 50mg/tid
4. Gabapentin (Neurotin): 3600mg/qd req'd for pain control
5. Tramadol
6. NSAIDs - adjunct therapy only
Although opiods should be avoided oxycodone (37mg/qd) has been shown to moderately decrease pain. |
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Term
| Non-pharmaceutical txts of neurogenic pain |
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Definition
heat, cold, massage, vibration, acupuncture, electricity (TENS),
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Term
| What is the #1 pt safety complication of PN? |
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Definition
#1 - Fall risk
- Tell pts to not walk in the dark or on irregular surfaces (throw rugs).
- Make sure they have regular eye exams
- Men should use a urinal at night
- wear low heels w/firm soles (increases prioreceptive input)
- unclutter pathways in the home
- use height-adjustable beds, chairs & toilets
- install handrails, grab bars & non-slips in bathtubs & on stairs
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Term
| General S/E profile of meds used to control neurogenic pain: |
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Definition
| orthostatic hypotension, sedation, drowsiness |
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Term
| Typical presentation of pt w/PN: |
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Definition
1. increasing numbness & tingling in feet for last 9-12mths
2. P/E: mild orthostatic hypotension (autonomic neuropathy sxs); decreased sharp & vibratory distal LE (LMN issue); absence of ankle reflexes; excessive sway on Romberg tests (prioreceptive issue) & difficulty w/tandem gait. |
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Term
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Definition
1. h/o numbness, tingling, burning, "pins & needles", clumsiness
2. P/E: sensory loss, areflexia, hypotonia, ataxia |
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Term
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Definition
1. h/o weakness, clumsiness, cramps, muscle twitches
2. P/E: weakness, atrophy, fasciculations, areflexia, hypotonia, deformities (kyphoscoliosis) |
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Term
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Definition
1. h/o: lightheadedness, fainting, excessive sweating, heat intolerance, inpotence, bowel/bladder disturbance
2. P/E: orthostasis, hyperhydrosis, anhidrosis, pupillary abnormalities
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Term
| What is the most common pathophysiological process in PN dx? |
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Definition
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Term
| T or F: most neuropathies are asymmetric? |
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Definition
| F - symmetric w/distal loss |
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Term
| Common sxs in length-dependent axonal neuropathy |
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Definition
-reduced sensation distally of LE
-reduced or absent ankle reflexes
-negative Romberg test
-difficulty performing tandem gait |
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Term
| What is the hallmark of small-fiber neuropathies? |
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Definition
| painful burning dysesthesias |
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Term
| What meds can cause relapsing/remitting neuropathies? |
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Definition
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Term
| T or F : Diabetic neuropathy affects small not large fibers? |
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Definition
| False - it affects both large & small fibers |
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Term
| Txt of diabetic neuropathy |
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Definition
1. tight control of bld sugar
2. proper care of feet (to decreases foot ulcers)
3. symptomatic control of pain w/TCAs, Anticonvulsants, Tramadol
4. Mexitil (Mexiletine), an antiarrythmic, to control autonomic sxs |
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