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Polyneuropathy

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Polyneuropathy

  1. 1. Peripheral neuropathy Damage to peripheral nerves
  2. 2. Types  Mononeuropathy- affects single nerve  Compression, trauma, ischemia, inflammation  Mononeuritis multiplex- multiple nerves involved, asymmetrically  DM, vasculitides, SLE, sarcoidosis, leprosy, amyloid  Polyneuropathy- multiple nerves involved, concurrently & symmetrically  DM, AIDP/CIDP, toxic/metabolic, hereditary
  3. 3. Polyneuropathy- classification  Axonopathy  Stocking & glove type sensory loss, diminished DTR & autonomic function in involved areas  Toxins, DM, SACD, alcoholism, chemotherapy drugs  Myelinopathy  AIDP, CIDP  Neuronopathy  MND, Herpes zoster, Vincristine
  4. 4. Symptoms & signs  -ve symptoms/signs-  Sensory- numbness, tremor, gait abnormality  Motor- weakness, heaviness, gait abnormality  +ve symptoms/signs-  Sensory- tingling, pain, itching, pins & needles  Motor- cramps, tremor, fasciculations  Absent ankle jerk
  5. 5. Evaluation  History-  Pattern of onset- mostly LL>UL & distal>proximal  Progression- acute-AIDP or chronic-DM/hereditary  Fluctuation- toxin exposure  Other systemic diseases  Family history  Examination-  Palpate nerve- thickened-leprosy  Small-fibre- predominantly spinothalamic tract- dysesthesias, impaired pain/temperature sensation, autonomic dysfunction ±, Fabry’s dis./DM/amyloid  Large-fibre- predominantly posterior column- areflexia, ataxia, severe motor dysfunction, minor cutaneous sensory deficit
  6. 6. Diagnosis Nerve conduction studies Sural nerve (at ankle) biopsy, specially for mononeuritis multiplex
  7. 7. Treatment  Correct underlying cause  Control of DM  Correction of vitamin deficiency  Rx of leprosy  Avoid alcohol  Immunosuppression for AIDP/CIDP  Surgery for carpal tunnel syndrome  Neuropathic pain-  Amitriptyline, Carbamazepine, Gabapentin, Pregabalin
  8. 8. SACD  Sub-acute combined degeneration  Due to vitamin B12 deficiency  Manifestation-  Paresthesias, sensory loss- LE>UE  Ataxia  Loss of ankle jerk, extensor plantar  Memory loss  Reduced vision, central scotoma  Sphincter disturbance  Rx- vitamin B12 supplementation, IM

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