Peripheral Neuropathy for the Primary Physician
Peripheral Neuropathy for the Primary Physician
Justin Meuse
Neurology Chief Resident Portland VA Medical Center
April 6, 2012
Peripheral Neuropathy for the Primary Physician
Justin Meuse Neurology Chief Resident
Portland VAMC April 6, 2012
? Disclosures: none
NW PADRECC - Parkinson's Disease
Research, Education & Clinical Center
Portland VA Medical Center
parkinsons.Northwest
1
Objectives
? Brief overview of Anatomy ? Clinical Approach to Neuropathy
? History ? Exam ? Labs ? Ancillary Testing
? Treatment ? Clinical Case
April 6, 2012
Three major classes of nerves
1. Large myelinated
Vibration & position
2. Small myelinated
3. Small unmyelinated
Sensory fibers Motor fibers Autonomic fibers
NW PADRECC - Parkinson's Disease
Research, Education & Clinical Center
Portland VA Medical Center
parkinsons.Northwest
2
April 6, 2012
Three major classes of nerves 1. Large myelinated 2. Small myelinated 3. Small unmyelinated
Sensory fibers Motor fibers Autonomic fibers
Three major classes of nerves 1. Large myelinated 2. Small myelinated 3. Small unmyelinated
Sensory fibers Motor fibers Autonomic fibers
NW PADRECC - Parkinson's Disease
Research, Education & Clinical Center
Portland VA Medical Center
parkinsons.Northwest
3
April 6, 2012
? Polyneuropathy can affect the following in varying combinations
? Small fibers -> disturbance pain and temperature ? Small fibers -> disturbance in autonomic
dysfunction ? Large fibers -> disturbance in vibratory sense and
proprioception ? Large fibers -> weakness
When to consider polyneuropathy
? Distal symmetric weakness ? Proximal and distal extremity weakness ? Multifocal weakness ? Hypoesthesia ? Hyperesthesia ? Paresthesias ? Allodynia ? Sensory ataxia ? Atrophy ? Fasciculations
NW PADRECC - Parkinson's Disease
Research, Education & Clinical Center
Portland VA Medical Center
parkinsons.Northwest
4
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