Peripheral Neuropathy PDF

Peripheral neuropathy By Shaimaa Shaheen Mohammed, Assistant professor of Neurology, Faculty of Medicine, Cairo University. Peripheral neuropathy  Definition  Classification  Etiology  Clinical picture  Types De...

Peripheral neuropathy By Shaimaa Shaheen Mohammed, Assistant professor of Neurology, Faculty of Medicine, Cairo University. Peripheral neuropathy  Definition  Classification  Etiology  Clinical picture  Types Definition peripheral neuropathy  It is a degeneration or inflammation of peripheral nerves leads to impairment of nerve function. Classification peripheral neuropathy  Neuropathy classified into: neuropathy classified according to the number of the nerves affected: - Mononeuropathy: it affects single nerve. - Mononeuritis multiplex: affects multiple nerve trunks asymmetrically. - Polyneuropathy: all peripheral nerves are affected symmetrically.  Classification of polyneuropathy:  It can be classified according to the onset: a. Acute polyneuropathy: Gullian Barre syndrome b. Chronic polyneuropathy: hereditary polyneuropathy.  Classified according to the pathology: a. Demyelinating b. Axonal  Classified according to the type of the nerve affected: a. Motor b. Sensory c. Autonomic d. Mixed  Classification according to the etiology. Etiological classification of polyneuropathy: 1. Herido-familial. 2. Infective: diphtheria, leprosy. 3. Toxic: lead poisoning 4. Nutritional : beri-beri, pellagra. 5. Metabolic: DM, amyloidosis. 6. Endocrinal: acromegaly, myxedema. 7. Autoimmune: collagen disease, Gullian- Barre. 8. Drug induced: isoniazide, dapsone. 9. Neoplastic: bronchogenic carcinoma. Clinical picture peripheral neuropathy Clinical picture: can be classified into motor, sensory and autonomic manifestations. - Motor symptoms: of LMNL. - Sensory symptoms: stoke & glove hyposthesia+deep sensory loss. - Autonomic : brittle nails, loss of hair, trophic ulcers.  Types peripheral neuropathy 1. Peroneal muscle atrophy: Hereditary motor and sensory neuropathy - Herido familial type: (Charcot-Marie Tooth). - Gradual onset , slowly progressive course. - Starts in the 1st & 2nd decade of life. - Wasting and weakness in LL take the shape of inverted champagne bottle appearance. - Stoke & glove hypoesthesia. - Skeletal deformities e.g. pes cavus.  Types peripheral neuropathy  Refsum’s disease: - Herido familial type: deficiency of phytanic acid hydroxylase enzyme. - Gradual onset progressive course. - Starts in 1st & 2nd decade of life. - Hypertrophic neuropathy, retinitis pigmentosa, deafness, icthyosis, skeletal deformities. - Treatment: dietary restriction, plasma-phareseis if needed. Metabolic peripheral neuropathy  Diabetes Miletus: - It may be presented by mononeuropathy, mononeuritis multiplex, polyneuropathy. - The main presentation of polyneuropathy is sensory, and autonomic symptoms. - It may be presented by motor manifestations. - Treatment: a. Control of diabetes. b. Vitamin B12. c. Symptomatic ttt for neuropathic pain.  Post infective neuropathy  Gullian Barre syndrome: - pathogenesis: cross-reactivity of the antibodies (directed against viral infection) to mylienated nerve fibers. - Acute onset of quadri-paresis which is proximal>distal. - Cranial nerve affection: bulber, bilateral facial. - EMG: demyelinating polyneuropathy. - CSF analysis: cytoalbuminous dissociation. - Treatment: care of bed ridden. - Care of respiration. - Plasmapharesis or IVig - Physiotherapy.  Infective neuropathy  Diphtheria: - Exotoxin of corynebactrium diphtheria. - Occurs 2-8 weeks after infection. - Motor neuropathy, it has a descending course. - Treatment : anti-diphteric serum.  Leprosy: - Causative organism: mycobacterium leprae. - Type: sensory neuropathy. - Main nerves: lateral popliteal, ulnar, trigmenal nerves. - Treatment: dapsone, rifampicin.  Nutritional neuropathy  Pellagra : deficiency of niacin due to deficient dietary intake or increase demands or parasitic infestations. - Clinical picture (3d): - Dermatitis: hyperkeratosis in sun exposed area, & on bony prominence. - Diarrhea : gastro-enteritis, stomatitis, glossitis. - Neuropsychiatric manifestations: dementia, paraplegia, polyneuropathy. - Treatment: i.v nicotinamide  Nutritional neuropathy  Beri-Beri: thiamine deficiency affecting the nervous system (dry beri- beri), while that affecting the cardiac system (wet beri-beri). - Dry beri- beri: sensory polyneuropathy. - Wet beri-beri: congestive heart failure. - Cerebral type: Wernicke’s encephalopathy. - Treatment: thiamine 100mg daily.  Nutritional neuropathy  Subacute combined degeneration of the spinal cord: - Etiology: vitamin B12 deficiency: a. Deficient intake. b. Intrinsic factor deficiency: in pernicious anemia, atrophic gastritis. c. Defective absorption: malabsorption syndrome. d. Increase demands. e. Hepatic failure.  Subacute combined degeneration of spinal cord  Clinical picture: a. Megaloblastic anemia: fatigue, pallor, palpitation. b. Gastrointestinal manifestation: stomatitis, nausea, vomiting & diarrhea. c. Neurological manifestation: - Sensory neuropathy: glove &stocks hyposthesia. - Deep sensory loss(posterior column affection). - Pyramidal tract affection (paraplegia). - Treatment: vitamin B 12 replacment.  Investigations:  Investigation to detect type of neuropathy: - EMG, NC : it can be done on the upper limbs only or on both upper & lower limbs according to the patient presentation: - If there decrease in conduction velocity it means demyelinating neuropathy. - If the conduction velocity is normal it means axonal neuropathy. Investigations  Investigation to detect the cause according to the mostly suspected cause: - Fasting blood sugar - Serum vitamin levels - Serum Phytanic acid level.  Peripheral neuropathy  Causes of motor neuropathy: a. GBS b. Lead neuropathy c. Diphteric neuropathy  Causes of sensory neuropathy: a. Diabetic neuropathy b. Leprosy c. Arsenic neuropathy d. Vitamin deficiency induced neuropathy e. Para-neoplastic  Peripheral neuropathy  Causes of thickened nerves: a. Interstitial hypertrophic neuropathy b. Refsum’s neuropathy c. Leprosy d. Myxedema e. Acromegaly f. Amyloidosis g. Neuro-fibroma Thank you