1 / 17

Neuropathy Morning Report January 5 th , 2010

Neuropathy Morning Report January 5 th , 2010. Summary. Recognizing neuropathy Classifying neuropathy Myriad neuropathies CIDP Diagnosis Spectrum of disease Treatment . Clues a neuropathy is present:. History: Distal motor neuropathy: tripping over toes, dropping coffee cups.

donkor
Download Presentation

Neuropathy Morning Report January 5 th , 2010

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Neuropathy Morning Report January 5th, 2010

  2. Summary • Recognizing neuropathy • Classifying neuropathy • Myriad neuropathies • CIDP • Diagnosis • Spectrum of disease • Treatment

  3. Clues a neuropathy is present: • History: • Distal motor neuropathy: • tripping over toes, dropping coffee cups. • Proximal motor neuropathy: • trouble climbing stairs, getting up from sitting, raising arms to brush teeth and hair. • Sensory neuropathy: • burning, lancinatingpain, paresthesias, dysesthesias, a tight band-like sensation around wrists or ankles, hypesthesia, restless legs, numbness. • Acute vs. chronic

  4. Clues a neuropathy is present: • Physical Exam: • Motor Strength: • 5= full strength, 4= falls to moderate resistance, 3= falls to minimal resistance, 2= falls to gravity, 1= muscle contraction, 0= no movement. • Sensation: • vibration/proprioception (large myelinated axons) vs. pain/temperature (small myelinated axons) • Light touch shared by both fiber types. • Trophic Changes: • pescavus, kyphoscoliosis, loss of hair, ulceration, thinning of phalanges, charcot joints (neurogenicarthropathy).

  5. Ordesignslv.com Mda.org

  6. Myfootshop.com Thefootblog.org

  7. What type of neuropathy? • Neuronopathy • Cell body damage of the motor neuron or dorsal root ganglion. • SMA, ALS, CMT (sometimes). • Axonopathy • Traumatic, toxic, metabolic • Often length dependent- “die back”: symmetric, distal. • Myelinopathy • Hereditary or inflammatory • Non-length dependent. • Patchy or segmental (inflammatory) • Diffuse (hereditary)

  8. Electromyelogram (EMG) andNerve Conduction Studies (NCS) • Axonopathy • Loss of amplitude of AP • Evidence of denervation- fasciculation • Myelopathy • Slowed conduction • Prolonged distal latency • Conduction block • Temporal dispersion • Prolonged minimum f-wave latency. Ispub.com

  9. Ddx: Neuropathy • Carpal tunnel, ulnar, … • Myxedema, • RA, Acromegaly • Leprosy • Borreliosis (Lyme) • HIV

  10. Demyelinating • Guillain-Barré • CIDP

  11. Chronic Inflammatory Demyelinating Polyneuropathy • C = progresses over >1 month. • I = presumed to have an autoimmune origin • D= demyelinating • P = neuropathy that is poly- • Motor and sensory • Symmetrical (or more than one limb) • Non-length-dependent

  12. CIDP Diagnosis • American Academy of Neurology Criteria • Clinical: 2 more more months, hypo/areflexia, motor/sensory involvement, >1 limb. • EMG/NCS: 1. Conduction block, 2. decr conduction velocity, 3. incr distal latency, 4. incr F-wave latency. (Must have 3 of 4) • Pathologic: unequivocal evidence of demyelination, remyelination. • CSF: WBC < 10, VDRL neg, elevated protein.

  13. The Larger World of Demyelinating Polyneuropathies • Distal Acquired Demyelinating Symmetric (DADS) Neuropathy • Men over 50 • Mostly distal sensory loss, mild distal weakness, unsteady gait. 2/3rds have a IgMparaproteinemia. • Multifocal Motor Neuropathy (MMN) • Asymmetric, all weakness, no sensory loss • Some have antiganglioside antibodies • Multifocal Acquired Demyelinating Sensory and Motor (MADSAM) Neuropathy (Lewis-Sumner Syndrome) • Motor and sensory, elevated CSF protein, asymmetric, some with antigangliosideantiboties. • Axonal chronic inflammatory demyelinatingpolyneuropathy, pure sensory chronic inflammatory demyelinatingpolyneuropathy, multifocal acquired sensory and motor axonopathy (MASAM).

  14. Treatment • Goal: block the immune process • Course: continue until maximal improvement and then maintain. • IVIg: 0.4g/kg qdayx 5 days, then monthly x 3 • Plasma exchange • Corticosteroids • Mycophenolatemofetil, azothioprine, cyclophosphamide, etanercept, rituximab

  15. Sources • Koller, H. et al. (2005) Chronic Inflammatory Demyelinating Polyneuropathy. NEJM 352(13): 1343-1356. • Poncelet, AM. (1998) An Algorithm for the Evaluation of Peripheral Neuropathy. AFP, Feb 15th, 1998. • Said, G. (2006) Chronic Inflammatory Demyelinating Polyneuropathy. Neuromusc Disorders 16:293-303. • Sander, HW et al. (2003) Research Criteria for defining patients with CIDP. Neurology 60(Suppl 3):S8-S15.

More Related