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Carpal tunnel syndrome: Carpal tunnel syndrome, the most common focal peripheral neuropathy, results from compression of the median nerve at the wrist.

Prepared by Navjot and Kawal, Msc 2nd year, Mai Bhago College of Nursing, Tarn-Taran

Clinical features Pain, Numbness, Tingling Symptoms are usually worse at night and can awaken patients from sleep. To relieve the symptoms, patients often flick their wrist as if shaking down a thermometer (flick sign).

Physical examination: Phalens maneuver Tinels sign weak thumb abduction. two-point discrimination

Prepared by Navjot and Kawal, Msc 2nd year, Mai Bhago College of Nursing, Tarn-Taran

Diagnostic evaluations: History Physical examination Nerve Conduction Study Treatment: CONSERVATIVE TREATMENTS GENERAL MEASURES WRIST SPLINTS ORAL MEDICATIONS LOCAL INJECTION ULTRASOUND THERAPY SURGERY

Medications: little useful Diuretics Nonsteroidal anti-inflammatory drugs (NSAIDs) pyridoxine (vitamin B6) Orally administered corticosteroids Prednisolone 20 mg per day for two weeks followed by 10 mg per day for two weeks

local injections: A mixture of 10 to 20 mg of lidocaine (Xylocaine) without epinephrine and 20 to 40 mg of methylprednisolone acetate (Depo-Medrol) or similar corticosteroid preparation is injected with a 25-gauge needle at the distal wrist crease (or 1 cm proximal to it).

Prepared by Navjot and Kawal, Msc 2nd year, Mai Bhago College of Nursing, Tarn-Taran

Splinting is generally recommended after local corticosteroid injection. If the first injection is successful, a repeat injection can be considered after a few months, Surgery should be considered if a patient needs more than two injections

Gullian barre syndrome:

It is an acute rapidly progressive and fatal form of polyneuritis which affects peripheral nervous system resulting in loss of myelin sheath, edema and inflammation of affected nerves leads to loss of neurotransmission to the periphery. Causes: cell mediated immune reaction trauma viral infections surgery viral immunization HIV campalobacter jejuni mycoplasma pneumoniae cytomegalo virus epstein barr virus varicella zoster virus swine, rabies vaccines others other neuropathies drug intake systemic disorders

Prepared by Navjot and Kawal, Msc 2nd year, Mai Bhago College of Nursing, Tarn-Taran

Clinical manifestations: develops 1-3 weeks after upper respiratory or GI infection. Weakness of lower extremities occurs within hours to days, peak at 14th day. Paresthesia and paralysis Hypotonia and areflexia Sensory loss, affects deep sensations than superficial Alteration in both sympathetic and parasympathetic nervous system Orthostatic hypotension Hypertension Abnormal vagal responses (asystole, heart block, bradycardia) Bowel and bladder dysfunction Facial flushing Diaphoresis SIADH Lower brain stem involvement include III-X cranial nerve dysfunctions Pain, muscular aches and cramps.

Types:

Ascending

Decending ascending starts from feet and legs, progress upwards, decending starts from upper parts and usually fatal

Diagnostic evaluations: CSF shows low protein initially but high >700mg/dl (15-45 mg/dl) 7-10 days later, cell content normal.

Prepared by Navjot and Kawal, Msc 2nd year, Mai Bhago College of Nursing, Tarn-Taran

Nerve conduction test shows reduced nerve conduction velocity in the affected limbs

Management: Plasmapheresis in first 2 weeks High dose immunoglobulins (sandoglobulin) Corticosteroids after 3 weeks

Muscular dystrophy
It is a group of genetically transmitted diseases characterized by progressive wasting of skeletal muscles without neurological involvement leads to loss of strength with increasing disability and deformity. Types:

duchenne
pseudohypertrophic

x linked mutation of dystrophin gene onset before 5, progressive weakness of pelvic and shoulder muscles, unable to walk after age of 12,cardiomyopathy, respiratory failure in teens or 20s mental impairment

becker benign pseudohypertrophic

x linked mutation of dystrophin gene, onset between 515 years,slower course of pelvic and shoulder muscles cardiomyopathy, respiratory failure, may survive 30-40

landouzy dejerine fascio scapulo humeral

autosomal dominant deletion of chromosome 4q35 onset before 20, slowly progression of face, shoulder muscles, foot dorsiflexion,deafness

erb limb girdle

autosomal recessive or autosomal dominant early childhood to early adulthood slow progression of shoulder and hip muscles.

Prepared by Navjot and Kawal, Msc 2nd year, Mai Bhago College of Nursing, Tarn-Taran

Diagnostic studies: Muscle serum enzymes (kreatine kinase) EMG testing Muscle fiber biopsy (confirmatory) Genetic pedigree

Management: Corticosteroids Physical therapy Orthopedic appliances

Prepared by Navjot and Kawal, Msc 2nd year, Mai Bhago College of Nursing, Tarn-Taran