9. Peripheral neuropathy is caused by damage to your
peripheral nerves. Peripheral nerves are nerves that
are not located in the brain or spinal cord. They are
found throughout your body and help you feel
things. They also control the function of your organs.
The damage is usually to nerves in the hands, feet,
arms, and legs.
11. Peripheral neuropathy may be classified in a varieties of
ways-
according to the
1.number of nerves affected
Mononeuropathy
Mononeuritis multiplex
Polyneuropathy
2.the type of nerve cell affected
motor
sensory
autonomic
12. Mononeuropathy means a process affecting a single
nerve.
Mononeuritis multiplex (multiple mononeuropathy
and/or multifocal neuropathy) affects several or
multiple nerves.
Polyneuropathy describes diffuse, symmetrical
disease, usually commencing peripherally.
13. The course may be
- acute, chronic, static, progressive,
relapsing or towards recovery.
Polyneuropathies are motor, sensory,
sensorimotor and autonomic.
21. Exact cause is unknown
Theories behind Neuropathy
High Glucose Concentration
Chemical changes in nerves
Damaged blood vessels
Genetic Disposition
22. Depends on part of body being affected.
Diffuse Peripheral
Pain
Numbness and tingling in the limbs
Sensitivity to touch
More susceptible to feet injury and infections
Loss of Balance and Control
Loss of sensation
Diffuse Autonomic
Bladder infections
Stomach disorders
dizziness
23. Localized neuropathy
Pain in front of thigh, lower back, chest stomach and behind
eyes
Double vision
Paralysis of one side of the face
24. Based upon symptoms
Pain Assessment
Screening Test for lost sensation
Nerve Conduction Study
Electromyography
Ultrasound
Nerve Biopsy (extreme cases)
25. Treat symptoms and not neuropathy
Manage your glucose levels
Drug Therapy can be used but is not suggested
Pain Medication
Early treatment more successful and reversing
damage. Later stages of neuropathy irreversible
26. the peripheral nerves have been damaged by too
much alcohol use. The peripheral nerves transmit
signals between the body, the spinal cord, and the
brain.
Thiamine, folate, niacin, vitamins B6 and B12, and
vitamin E are all needed for proper nerve function.
Drinking too much can alter levels of these nutrients
and affect the spread of alcoholic neuropathy.
Fortunately, abstaining from alcohol can help restore
your nutritional health.
27. Alcoholic neuropathy can affect both movement and
sensation. Symptoms range from slight discomfort to major
disability. Although the condition is not life threatening, it
can decrease your quality of life. Some areas of the body
affected by alcoholic neuropathy include:
numbness
tingling and burning
prickly sensations
muscle spasms and cramps
muscle weakness and atrophy
28. Alcoholic neuropathy is the result of damage to these
nerves. The damage may be the direct result of long
periods where you drank too much alcohol.
Nutritional problems linked to alcohol use, such as
vitamin deficiency, can also cause nerve damage.
29. nerve biopsy
nerve conduction tests
upper GI and small bowel series
neurological examination
electromyography
esophagogastroduodenoscopy (EGD)
kidney, thyroid, and liver function tests
complete blood count (CBC)
30. vitamin supplements to improve nerve health (folate,
thiamine, niacin, and vitamins B6, B12, and E)
prescription pain relievers (tricyclic antidepressants and
anticonvulsants)
medication for people with problems urinating
physical therapy to help with muscle atrophy
orthopedic appliances to stabilize extremities
safety gear, such as stabilizing footwear, to prevent
injuries
special stockings for your legs to prevent dizziness
31. Disorders of peripheral nerves are the most common
neurological complications of systemic amyloidosis;
an illness where a protein called amyloid is deposited
in tissues and organs. Amyloidosis can affect
peripheral sensory, motor or autonomic nerves and
deposition of amyloid lead to degeneration and
dysfunction in these nerves.
32. The typical symptoms of amyloid neuropathy are due
to sensory and autonomic dysfunction. Patients may
experience painful paresthesias (unusual sensations),
numbness and balance difficulties due to sensory
dysfunction and persistent nausea, vomiting,
diarrhea, constipation, incontinence, sweating
abnormalities or sexual dysfunction due to autonomic
nerve involvement.
33. Diagnosis of amyloid neuropathies is based on
history, clinical examination and supporting
laboratory investigations. These include
electromyography with nerve conduction studies,
skin biopsies to evaluate cutaneous nerve innervation,
and nerve and muscle biopsies for histopathological
evaluation. In cases of familial amyloidosis, genetic
testing in the blood may be useful.
34. Treatment of amyloid neuropathies is directed at both
preventing further deposition of amyloid in
peripheral nerves and treating painful symptoms.
Depending on the type of amyloid protein, patients
may benefit from liver or bone marrow transplant.
Neuropathic pain due to amyloid neuropathy can be
treated with anti-seizure medications,
antidepressants, or analgesics including opiate drugs.
In severe painful conditions patients may be referred
to the Blaustein Chronic Pain Clinic for a
multidisciplinary approach to pain management.
36. Most common type ---
Acute inflammatory demyelinating polyneuropathy
(AIDP)
Symptoms and Signs
Muscles weakness – facial and orophyrengial
cardiac arrhythmias, GI stasis, urinary retention, and
pupillary changes. An unusual variant (Fisher variant)
may cause only ophthalmoparesis, ataxia, and areflexia.
45. Mycobacterium leprae – coolest tissue in the body
Tuberculoid (high-resistance) leprosy – single patch of
hypoesthesia or anesthetic skin in any location
Lepromatous (low resistance) leprosy – numerous bacilli, wide
spread skin thickening, cutaneous anesthesia, anhydrosis
sparing axilla, groin and skin beneath the scalp hair
46. Nerve root disorders result in segmental radicular
deficits (eg, pain or paresthesias in a dermatomal
distribution, weakness of muscles innervated by the
root). Diagnosis may require neuroimaging,
electrodiagnostic testing, and systemic testing for
underlying disorders. Treatment depends on the cause
but includes symptomatic relief with NSAIDs, other
analgesics, and corticosteroids.
71. Axillary lesion : weak triceps and radial innervated m.
Mid-upper arm lesion : ‘Saturday night palsy’ (spiral
groove or intermuscular septum) : wrist drop, normal
triceps, variable motor and sensory deficit
Posterior interosseous : weak extensor of thumb and
other fingers, no sensory loss
Superficial radial n. : terminal cutaneous br.
76. Femoral nerve (L2,3,4)
• Mix sensorimotor
• Quadriceps femoris or knee
extensor
• Weakness of hip flexor in
intraabdominal lesion
• Sensory deficit over
anteromedial aspect of thigh
and perhaps leg
• Absent or diminished knee
jerk
79. Composed of 2 main nerves of leg : common peroneal
and tibial nerve
Paralysis of all muscles below knee plus hamstrings
and for high lesion, external rotators of thigh
Sensory loss below knee except anteromedial aspect
of leg and foot
80. Common peroneal nerve
• Foot-drop
• Paralysis of anterior and
lateral compartment of leg
• Sensory loss over dorsum
of foot and toes and
anterolateral aspect of leg
83. Medial division of sciatic nerve
Lesions at ankle
Tarsal tunnel syndrome
Pain and paresthesia in sole
Paralysis of intrinsic muscles of foot
Tenderness of Tinel’s sign at flexor retinaculum
Sural nerve compression syndrome
Pure sensory
Numbness on lateral aspect of foot
87. Clinical features :
postauricular pain (few days)
lower motor neuron facial weakness
impaired taste
hyperacusis
89. Bell’s palsy : idiopathic, HSV 1
Ramsay Hunt syndrome : external ear pain with presence of
herpes zoster vesicles in auditory canal and pinna, VZV
Trauma : blunt impact to temporal bone
Middle ear infection : otitis media (infrequent in ATB era),
mastoid pain persist after acute infection resolved
Neoplasm : rarely compressed by CPA tumor but due to
surgery for tumor removal
90. Management
Reassurance – not a stroke
Short course of prednisolone 60 mg/day
Prognosis :
complete recovery 75%
satisfactory 15%
poor function 10%