Neuro Week 1: neuropathy

What is peripheral neuropathy?

When the message from the peripheral nerves to the brain is disrupted, this results in the loss of sensory or perception of pain

The most common type of peripheral neuropathy is:

diabetic peripheral neuropathy 

Peripheral neuropathies are length dependent impacting which part of the body first?  

feet and hands

Large fibers neuropathy leads to loss of:

vibration and sensation/touch leading to numbness and tingling, severe deficits lead to loss of proprioception 

Small fiber neuropathy leads to loss of:

unable to feel temperature, leading to neuropathic pain that is usually worse at night, allodynia 

Causes of neuropathy

1.  Charcot Marie Foot 

2. Diabetes 

3. Injury 

4. Infection  

5. Hormonal 

6. autoimmune  

7. vascular disorders 

8. tumors 

9. alcohol 

10. chemotherapy 

11. idiopathic (common after 60) 

12. kidney/liver failure 

13. vitamin/nutritional deficiencies 

True or false: Neuropathic pain feels like electricity up/down legs, possibly achy or stabby.

true

True or false: Numbness/tingling may occur but will feel normal at plantar surface of feet.

false, it will feel like a thick pair of socks

true or false: Weakness tends to occur occur more proximally.

false: more distal, bilateral

True or false: Due to changes in proprioception, patient’s with peripheral neuropathy may rely heavily on vision

true

Nerve conduction velocity testing

measures speed of nerve travels to determine damage to myelin sheath (slow rate) or axon (reduced strength of impulse) no signal traced indicates greater severity of neuropathy 

Electromyography

detects irritability and responsiveness of nerves in addition to abnormal muscular electrical activity, differentiates between muscle and nerve disorders 

Nerve biopsy

sample of nerve tissue to determine type of nerve cells, what is affected, if further damage will lead to chronic pain or sensory loss

Neurodiagnostic skin biopsy

examine nerve fiber endings on skin —> new standard for small fiber neuropathies

Treatment for neuropathy

Lifestyle factors: 

1. cessation of smoking 

2. exercise 

3. proper diet 

• Immunosuppressive  drugs 

• bracing/shoes

  • acupuncture/massage

Preventative strategies for peripheral neuropathy

lifestyle factors, avoiding unnecessary medical procedures

What are the types of diabetic neuropathy

1. distal symmetric polyneuropathy (most common)

2. autonomic neuropathy 

3. radiculo-plexopathies 

4. mononeuropathies 

Describe the pattern of progression with diabetic neuropathy: 

Starts with longest and most susceptible nerves, then progresses distal to proximal in stocking and glove pattern 

Diabetic neuropathy is believed to be caused by:

hyperglycemia, dyslipidemia, microvascular disease

True or false: Diabetic neuropathy only includes small fiber neuropathy.

false: both are involved

5 risk factors for diabetic neuropathy

poor glycemic control, high BP, smoking, advanced age, obesity

Small fiber neuropathy

affects small myelinated A-d and unmyelinated C fibers, unknown mechanism of injury, leads to sensory changes, autonomic dysfunction or a combo, sx include fatigue, cognitive disturbances, headache, widespread MSK pain, pain/paresthesia at night

Large fiber neuropathy

thicker myelinated fiberrs that deliver messages tot muscle for movement, certain sensory relations back to spinal cord/brain, sx include potential loss of proprioception, impaired vibration, balance changes, painless paresthesia

True or false: You are more likely to develop peripheral arterial disease with diabetes.

true

The gold standard for diagnosing diabetic neuropathy is:

there is no gold standard

Walking is now encouraged in those with diabetic neuropathy, but which two things should be considered and the individual educated on prior to initiating a walking program? 

skin checks, proper footwear

To meet criteria for metabolic syndrome, individuals must have 3 out of 5 of which signs/symptoms? 

1. hypertension 

2. hyperglycemia 

3. waist circumference/abdominal obesity 

4. hypertrigliceridemia 

5. reduced HDL cholesterol 

Autonomic neuropathy is neuropathy involving multiple body systems. Name some sx

tachycardia, OH, diarrhea, neurogenic bladder, sweating, dry skin

True or false: Idiopathic neuropathy is more common in those >60 years of age.

true

True or false: Idiopathic neuropathy is less likely to occur with metabolic syndrome.

false, it is more likely

The current acronym for idiopathic neuropathy is CIAP which stands for: 

C: chronic 

I: idiopathic 

A: axonal 
P: polyneuropathy 

Define the difference between idiopathic and diabetic neuropathy onset, if any:

Idiopathic comes on without diabetes, also more sensory whereas diabetic has strength