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CME February 2016 Neurocutaneous Dysesthesia

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waderm's version from 2017-03-20 13:46

Section 1

Question Answer
Scalp dysesthesia is only due to psychiatric conditiosnF - also due to nerve trauma
Nerve trauma can occur indirectly through surgeryF - occurs directly through surgery and indirectly through muscle tension
Scalp dysesthesia is seen in patients with psych history, cervical spinal diseaseT
A history of facial/brow lift is not relevant in scalp dysesthesiaF
There is a high rate of C2 spinal disease in scalp dysesthesiaF - C5/6
Treatment includes gabapentin, topical steroids, antidepressants, doxepin, pregabalin, physical therapy and referral to psychiatryF - not referral to psychiatry
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Section 2

Question Answer
Trigeminal trophic syndrome most commonly affects V3 of the trigeminal nerveF - V2
Trigeminal trophic syndrome results most commonly in ulceration of the tip of the noseF - nasal ala
Trigeminal nerve ablation for trigeminal neuralgia and cerebral vascular accidents are uncommon causes of trigeminal trophic syndromeF - common
Patients with trigeminal trophic syndrome have underlyign psychologic/cognitive cause for picking/scratchingF
The tip of the nose is frequently involved in trigeminal trophic syndromeF - spared
Women are more likely to be affected than menT
Right side of the face is more commonly involved than the leftT
If the cause of trigeminal trophic syndrome is due to a stroke, the most commonly involved artery is the posterior inferior cerebellar arteryT
Craniofacial surgery, trauma, zoster, HSV, meningioma, intracranial neoplasms and leprosy can cause trigeminal trophic syndromeT
Damage to the trigeminal nerve and ulceration can be delayed by decadesT
CVA's are the most common causative events for trigeminal trophic syndromeT
physical treatments include: keeping nails short, wearing gloves, thermoplastic face masks, transcutaneous electrical nerve stimulation unitsT
Gabapentin, carbamazepine, pregabalin, amitriptyline, pimozide and aloprazolam as a single agent are usefulF - alprazolam is used with citalopram synergistically
Topical tacrolimus added to PO pregabalin makes it more effectiveF - gabapentin not pregabalin
ILCS are most effective if aetiology is to HSVT
The paramedian forehead flap, forearm free flap and nasolabial flaps are surgical treatment optionsT
The paramedian forehead flap is most effective after division of the pedicleF - prior to division
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Section 3

Question Answer
Meralgia paraesthetic affects the posteriolateral thighF - anterolateral
Weight gain can cause meralgia paraestheticT
Diabetes, pregnancy and loose clothing can cause MPF - tight clothing
MP is a result of damage to the lateral femoral cutaneous nerve (LFCN)T
the LFCN is primarily a motor nerveF - primarily sensory
The LFCN originates from L2/3T
Local hair loss can be a sign of MPT
MP improves on sitting and worsens on standignT
The incidence of ddiabetes in MP is 50 times that of the general populationF - 7.5
Diabetes is usually present before MP developsF - occurs after. Patients should be evaluated for it
Palpation of the anterolateral thigh does not elicit symptomsF
Tenderness over the lateral inguinal ligament can be a sign of MPT
The pelvic compression test and the Tinel signs can help confirm the diagnosis of trigeminal trophic syndromeF - of MP
In the Tinel test, the patient is placed laterally on the asymptomatic side and pressure is applied for 45 seconds -> improvement in symptomsF - this is the Pelvic Compression Test
In the Tinel test the nerve is tapped -> symptomsT
Injecting local anaesthetic around the LFCN -> relief of symptomsT
A positive straight leg raise confirms the diagnosis of MPF - should be egative
Simple measures include NSAIDS, protection of area, avoiding tight clothing and weight lossT
ILCS plus lignocaine injected near the joint can be usefulT
Capsaicin is effective and leads to sustained improvementF - no benefit after cessation
Botox can be used for MPT
Physical therapy, chiropractic manual therapy, KinesioTaping, pulsed radiofrequency ablation and acupuncture are all reported for MPT
Surgery is not required in MPF - can refer to neurosurg/orthopaedic surgery
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Section 4

Question Answer
Notalgia paraesthetica is often associated with hypopigmented patches/plaques and occasional hyperkeratosisF - hyperpigmented
Notalgia paresthetica occurs throughout the entire backF - between scapular and vertebra T2-T6
NP is associated with MEN1F - MEN2A
NP symptoms are usually unilateralT
In patients with MEN2A associated disease, there should be strict sun protectionF - sunlight is beneficial
The aetiology of NP is probably related ot damage to cutaneous sensory nervesT
The hyperpigmentation on histopathology shows amyloidT
The discomfort of NP improves wit forward flexion or extension of the armsF - worsens
Check for hx of: neck trauma, MVA, vertebral fracture, cervical neoplasm, malignancy, cervical disc disease, OAT
In children with NP, consider a check of calcitonin levelsT - to screen for medullary thyroid cancer
Capsaicin and EMLA are effective but not on cessationT
Gabapentin, oxycarbazepine, amitryptiline are used in NPT
Transcutaneous electrical muscle stimulators are useful in NPT
Exercising of the rhomboids and latissimus dorsi can be beneficialT
NBUVB, botox can be helpfulT
Bupivacaine and methylpred as a paravertebral block is not effectiveF - can -> resolution at 12/12
memorize

Section 5

Question Answer
Brachioradial pruritus most often effects the anteriolateral aspect of the armF - dorsolateral
The elbows are affected more than the wrists T
Sun exposure does not improve/worsen brachioradial pruritusF - worsens it
Brachioradial pruritus is bilateral > unilateralT
Application of cool substances to the area can be helpful in relieving symptomsT - the ice pack sign
Sun exposure and nerve injury both play a role in brachioradial pruritusT
Sun protection can be useful in brachioradial pruritusT
Topical steroids and antihistamines are usually beneficial in brachioradial pruritusF - usually not beneficial
Amitryptiline and ketamine combinations topically are the most effective topical therapies in brachioradial pruritusT
Gabapentin is a commonly used oral treatmentT
Lamotrigine, amitriptyline, valproate, carbamazepine and NSAIDS are usefulF
Surgery, spinal manipulation and steroid injections can e usefulT
memorize