Peripheral neuropathies

v.djabatey
Mind Map by , created almost 6 years ago

paeds-neurology Mind Map on Peripheral neuropathies, created by v.djabatey on 01/12/2014.

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v.djabatey
Created by v.djabatey almost 6 years ago
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Peripheral neuropathies
1 Hereditary motor sensory neuropathies
1.1 -> symmetrical slowly progressive distal muscular wasting
1.2 type I
1.2.1 aka peroneal muscular atrophy (Charcot-Marie-Tooth disease)
1.2.2 dominantly inherited
1.2.3 commonest type
1.2.4 affected nerves hypertrophy
1.2.4.1 due to demyelination fb attempts @ remyelination
1.2.4.1.1 so nerve biopsy shows 'onion bulb formation'
1.2.5 onset
1.2.5.1 1st decade
1.2.5.1.1 presentation
1.2.5.1.1.1 distal atrophy
1.2.5.1.1.2 pes cavus
1.2.5.1.1.3 legs> arms affected
1.2.5.1.1.4 distal sensory loss & diminished reflexes
1.2.5.1.1.4.1 rare
1.2.5.1.1.5 loss of walking ability is rare
1.2.5.1.1.6 initial presentation of Friedreich ataxia can be similar
1.2.6 chronic course
2 acute post-infectious polyneuropathy (Guillain-Barre syn)
2.1 presentation
2.1.1 2-3 weeks ff
2.1.1.1 upper resp tract infection
2.1.1.2 campylobacter gastroenteritis
2.1.2 fleeting abnormal sensory sx in legs
2.1.3 prominent feature
2.1.3.1 ascending symmetrical weakness
2.1.3.1.1 w/ loss of reflexes
2.1.3.1.1.1 & autonomic involvement
2.1.4 sensory sx in distal limbs
2.1.5 bulbar mm involvement
2.1.5.1 difficulty chewing & swallowing
2.1.5.2 risk of aspiration
2.1.6 max mm weakness
2.1.6.1 occurs 2-4 weeks after onset of illness
2.2 full recovery expected in 95% of cases
2.2.1 may take up to 2 years
2.3 Ix
2.3.1 CSF protein
2.3.1.1 sig raised
2.3.1.1.1 characteristic
2.3.1.1.2 may not be seen till 2nd wk of illness
2.3.2 CSF WCC
2.3.2.1 not raised
2.3.3 nerve conduction velocities
2.3.3.1 reduced
2.4 Mx
2.4.1 supportive
2.4.1.1 respiration
2.4.1.1.1 ventilator
2.4.2 NOT USEFUL
2.4.2.1 corticosteroids
2.4.3 immunoglobulin infusion
2.4.3.1 reduce time on ventilator
2.4.3.2 if unsuccessful
2.4.3.2.1 use plasma exchange
3 Bell palsy & facial nerve palsies
3.1 Bell's palsy
3.1.1 isolated lower motor neurone paresis of CN7
3.1.1.1 -> facial weakness
3.1.2 aetiology unclear
3.1.2.1 but probably post-infectious
3.1.2.1.1 assoc w/ herpes simplex in adults
3.1.3 Mx
3.1.3.1 Rx
3.1.3.1.1 corticosteroids
3.1.3.1.1.1 to reduce oedema in the facial canal during the 1st week
3.1.3.1.2 NO USE
3.1.3.1.2.1 aciclovir
3.1.4 recovery may take several months
3.1.5 complications
3.1.5.1 conjunctival infection
3.1.5.1.1 caused by incomplete eye closure on blinking
3.1.5.1.1.1 eye protection or tarsorrhaphy
3.1.6 differential diag
3.1.6.1 features of Bell's + sx of CN7 paresis
3.1.6.1.1 compressive lesion in cerebellopontine angle
3.1.6.1.1.1 most likely diag
3.1.6.1.2 painful vesicles on tonsillar fauces, external ear
3.1.6.1.2.1 due to HSV invading geniculate ganglion
3.1.6.1.2.2 Rx = aciclovir
3.1.6.2 hypertension
3.1.6.2.1 cos assocn btw Bell's palsy and coarctatin of aorta
3.1.6.3 if facial weakness bilat
3.1.6.3.1 sarcoidosis
3.1.6.3.2 Lyme disease

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