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You are here: Home / 09. Medical/Surgical / Peripheral Nerve Disorders

Peripheral Nerve Disorders

July 14, 2011 by CrashMaster

 

 

Guillain-Barre

Most common acute motor polyneuropathy, probably due to post-infectious etiology

mycoplasma and campylobacter infections as well as lymphoma have been associated.

Classically, bilateral ascending weakness, may go all the way to the face.  Often heralded by paresthesias.

(rarely, there is a descending form Miller Fisher Variant, ataxia, areflexia, & opthalmoplegia)

 

Can develop acutely over days or subacutely over weeks.

motor>>than sensory, almost invariably have  decreased reflexes,

 

If you intubate, DO NOT USE SUX.  Consider autonomic dystability.

Get PFTS or ABG. Extensors of neck are quick/dirty test of impending failure

CSF:  Albumin-cytologic disassociation:  prot>400, WBC<10

In diff, tick paralysis

Rx:

Plasmapheresis

and/or IVIG  0.4 g/kg/day x 2 weeks

(Steroids are safe to give, but probably have no benefit as treatment)

ICU Care

occupational and physical therapy

DVT prophylaxis

Splinting to prevent Achilles’ contractures

Eye Care

Chest PT

Pts are prone to dysrhythmias so ecg monitoring is essential

Nutrition

Psychological support-feelings of hopelessness and depression are quite common

 

Tom Bleck:

Speaking of knee jerks, what are his deep tendon reflexes? Sensory exam?  I’ve had a couple of postop patients who seemed like they had GBS but improved quickly when their painless cervical disk herniations were repaired.

get vital capacity (make sure they can create a mouth seal) and check cough, if either fails, intubate in GBS, Myesthenia may get better quick, so you can try NIV

 

Critical Care 2011, 15:R65doi:10.1186/cc10043. Published: 21 February 2011

Conclusions: In patients admitted to ICU with Guillain-Barre syndrome and acute respiratory failure, the lack of foot flexion ability at the end of immune therapy predicts a prolonged duration of MV. Combined with a sciatic motor conduction block, it may be a strong argument to perform an early tracheotomy.

Isolated Mononeuropathies

Radial

Sat. night palsy.  Humeral compression of radial nerve

Wrist and finger drop.

When testing the ulna during this, place palm on flat surface to extend the fingers

Ulnar

Usually injured at elbow

Median

Carpal tunnel Syndrome-L lumbricals (MCP flexion) and thumb O opposition A abduction and F flexion

 

Plexopathies

Amytrophic Lateral Sclerosis (ALS)

upper and lower motor neurons, no sensory effects, hypotonic DTRs, atrophy, fasiculations

 

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Filed Under: 09. Medical/Surgical, neurology


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