Scribd Logo
Upload

Welcome to Scribd!

  • 18 views

    Hcp#2 KJB Peripheral Neuropathy Carpal Tunnel Syndrome: John Kwon

    Uploaded by

    Jaeho Lee
    This document discusses peripheral neuropathy and carpal tunnel syndrome. It begins by classifying neuropathies as mononeuropathies, which affect a single nerve, or polyneuropathies, which affect multiple nerves. Common causes of neuropathies include diabetes, infections, toxins, and genetic factors. Differential diagnoses are discussed between neurogenic vs. vascular claudication and radiculopathy vs. neuropathy based on patterns of pain and sensory loss. Key references are also provided.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd

    Hcp#2 KJB Peripheral Neuropathy Carpal Tunnel Syndrome: John Kwon

    Uploaded by

    Jaeho Lee
    18 views19 pages
    This document discusses peripheral neuropathy and carpal tunnel syndrome. It begins by classifying neuropathies as mononeuropathies, which affect a single nerve, or polyneuropathies, which affect multiple nerves. Common causes of neuropathies include diabetes, infections, toxins, and genetic factors. Differential diagnoses are discussed between neurogenic vs. vascular claudication and radiculopathy vs. neuropathy based on patterns of pain and sensory loss. Key references are also provided.

    Original Title

    CTS(0)

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses peripheral neuropathy and carpal tunnel syndrome. It begins by classifying neuropathies as mononeuropathies, which affect a single nerve, or polyneuropathies, which affect multiple nerves. Common causes of neuropathies include diabetes, infections, toxins, and genetic factors. Differential diagnoses are discussed between neurogenic vs. vascular claudication and radiculopathy vs. neuropathy based on patterns of pain and sensory loss. Key references are also provided.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    18 views19 pages

    Hcp#2 KJB Peripheral Neuropathy Carpal Tunnel Syndrome: John Kwon

    Uploaded by

    Jaeho Lee
    This document discusses peripheral neuropathy and carpal tunnel syndrome. It begins by classifying neuropathies as mononeuropathies, which affect a single nerve, or polyneuropathies, which affect multiple nerves. Common causes of neuropathies include diabetes, infections, toxins, and genetic factors. Differential diagnoses are discussed between neurogenic vs. vascular claudication and radiculopathy vs. neuropathy based on patterns of pain and sensory loss. Key references are also provided.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 19

    HCP#2 KJB

    Peripheral Neuropathy
    Carpal Tunnel Syndrome

    John Kwon
    Contents
    1. Classification and cause
    2. Etiology of neuropathy
    3. Differential diagnosis :
    Neurogenic vs Vascular
    4. Differential diagnosis :
    Radiculopathy vs Neuropathy

     Case relevance
     Reference
    1. Classification and Cause :
    peripheral neuropathy
     Mononeuropathy : only a single peripheral nerve palsy
     Compressive
    • Carpal tunnel syndrome, ulnar palsy
     Hereditary
    • Hereditary neuropathy w/ predisposition to pressure palsie
    s
     Inflammatory
    • Bell palsy
     Multiple mononeuropathy
    • Vasculitis (mononeuritis multiplex), diabetes, leprosy, sarcoi
    dosis, amyloidosis
     Polyneuropathy : motor, sensory, autonomic nerves
     Hereditary
    • Charcot-Marie-Tooth disease
     Endocrine
    • DM, hypothyroidism
     Metabolic
    • Uremia, liver failure
     Infections
    • Leprosy, diphtheria, HIV, lyme disease
     Immune-mediated
    • GBS, CIDP
     Toxic
    • Lead, arsenic, alcohol, drug-induced
     Paraneoplastic
    • Lung cancer
    2. Etiology of neuropathy
     Acquired disorder
     Metabolic or endocrine
    • DM, renal failure, porphyria
     Immune-mediated
    • GBS, CIDP, multifocal motor neuropathy, anti-myelin-associ
    ated glycoprotein neuropathy
     Infectious causes
    • HIV, Lyme disease, CMV, syphilis, leprosy, diphtheria
     Medications
    • HIV drugs, chemotherapies
     Environmental Toxin
    • Heavy metals
     Paraneoplastic processes

     Hereditary

    Inheritance pattern Genetic defect Clinical features


    Hereditary sensorimotor AR, AD or XL Pes cavus, distal atrophy and
    neuropathies weakness, hammer toes
    Familial amyloid AD Transthyretin Pain, autonomic dysfunction
    polyneuropathy Gelsolin
    Apolipoprotein AI
    Fabry disease XL Alpha-galactosidase Cardiac ischemia, renal disease,
    stroke, cutaneous angiokeratomas
    Tangier disease AR Apolipoprotein A Low HDL levels, orange tonsils
    Refsum disease AR Phytanic acid oxidase Retinitis pigmentosa,
    cardiomyopathy, deafness, ichthyosis
    (Appendix)
     Fabry disease
    • Incidence : 1:40,000-1:170,000 all ethnicities.
    • X-linked lysosomal storage disorder
    • Affect predominantly skin, kidneys, heart, eyes, and brain.
    • Life expectancy shorten : M 20 yrs, F 15 yrs
     Tangier disease
    • Defect in transmemb transporter :
    accumulation of cholesterol
    • Older patients often develop CHD
     Refsum disease
    • degenerative disorder of lipid metabolism
    • failure to break down dietary phytanic acid and its subseq
    uent accumulation in tissues
    3. DDx : Neurogenic vs Vascular
     Claudication
    Neurogenic claudication Vascular claudication

    Pain Sharp, ache, numbness Crampy, tight

    Precipatation Standing / low back Exercise


    extension
    Walking Proximal  distal Distal  proximal

    Rest Rapid relief with squat Slow relief with standing


    still
    Walking distance Variable Constant

    정성수 : 성균관대학교 정형외과학교실 강의록 , 2010


     Vasculitic neuropathies
     Ischemia and inferction of isolated peripheral nerves
     Mononeuritis multiplex
     Asymmentrical, distal weakness, sensory loss w/ severe pain
     Cause
    • Systemic vasculitis
    – RA, SLE, Wegener granulomatosis,
    Churg-Strauss syndrome, Polyarteritis nodosa
    • Primary peripheral system vasculitis
    – 25% of cases
    4. DDx : Radiculo vs Neuro
     Interruption of Single peripheral nerve
     Tactlie loss > pain
     Compression
    • Loss : large touch, pressure fibers
    • Intact : small pain, thermal, and autonomic fibers
    • Cf. procaine, ischemia

     Sens loss is always less than its anatomical distribution


    • Because of overlap from adjacent nerve
     Example :
    median nerve
    innervation
     Polyneuropathy
     Symmetrical distal sens loss
    • Longest, largest fiber involved
    • Glove-and-stocking
    • Sens loss may affect one modality preferentially
     Areflexia or hyporeflexia
     Weakness, if present, symmetrical

     Normal-abnormal margin is vague


    • cf. hysteria : sharply defined
     Figure :
    Glove-and-stocking
    pattern
     Polyradiculopathy
     Asysmetrical sens and motor loss
     Proximal and distal parts of limb differentially affected
     Reflex loss limited to region of affected root(s)
     Asymmetrical muscle weakness

     Pain
    • Shooting (lancinating), burning pain
    • Radiate : proximal to distal
    – Sciatica
    – Cervical disc protrusion : sharp pain, shoulder to upper
    arm
     Dermatome
    • Segmental impairment
    of cutaneous sensation
     Case relevance
     C.C
     Asymmetrical sensory loss
    • R/O polyneuropathy
     Hx
     Distal to proximal
     Pain
    • Radiculopathy? (No, because of OA)
     P/E
     All modality loss
    • R/O polyneuropathy
     Sensory loss region
    • R/O Radiculopathy
     Reference
     Allen H. Ropper, et al. :
    Adams and Victor’s Principle of Neurology, 9th ed. 2009,
    McGraw-Hill.
     Goldman :
    Cecil medicine, 23rd ed. 2007,
    Saunders.
     Fauci AS, et al. :
    Harrison’s principle of internal medicine, 17th ed. 2008,
    McGraw-Hill.

    You might also like