Peripheral neuropathy
Download as PPTX, PDF16 likes5,766 views
This document discusses peripheral neuropathy, including: - The clinical effects of motor, sensory, and autonomic nerve injury, including weakness, loss of sensation, and autonomic dysfunction. - The two main types of peripheral neuropathies - axonopathies which affect nerve fibers, and myelinopathies which affect the myelin sheath. - The many potential causes of peripheral neuropathy both inherited and acquired, such as diabetes, toxins, infections, inflammation and genetic disorders. A thorough history and examination is needed to determine the underlying cause.
Peripheral neuropathy
- 1. Peripheral Neuropathy Dr. Mohammad Tanvir Islam
- 2. Nervous System • CNS • PNS
- 5. Loss of function “- symptoms” Disturbed function “+ symptoms” Motor nerves Wasting Hypotonia Weakness Hyporeflexia Orthopedic deformity Fasiculations Cramps The clinical response to motor nerve injury
- 7. Loss of function “- symptoms” Disordered function “+ symptoms” Sensory “Large Fiber” ↓ Vibration ↓ Proprioception Hyporeflexia Sensory ataxia Paresthesias Sensory “Small Fiber” ↓ Pain ↓ Temperature Dysesthesias Allodynia The clinical response to sensory nerve injury
- 8. Loss of function “- symptoms” Disturbed function “+ symptoms” Autonomic nerves ↓ Sweating Hypotension Urinary retention Impotence Vascular color changes ↑ Sweating Hypertension The clinical response to autonomic nerve injury
- 10. The two types of peripheral neuropathies: axonopathies and myelinopathies
- 12. Causes Conditions causing mononeuropathy • Acute (trauma-related) • Chronic (nerve entrapment) Disorders causing mononeuropathy multiplex Acute • Diabetes mellitus • Multifocal motor neuropathy • Vasculitic syndromes Chronic • Acquired immunodeficiency syndrome • Leprosy • Sarcoidosis
- 13. Causes Conditions causing neuropathy with autonomic features • Alcoholism • Amyloidosis • Chemotherapy-related neuropathy • Diabetes • Heavy metal toxicity • Porphyria • Vitamin B12 deficiency
- 14. Causes Conditions causing painful neuropathy • Diabetes • Alcoholism • Amyloidosis • Chemotherapy (heavy metal toxicity) • Idiopathic polyneuropathy • Porphyria • Paraneoplastic syndrome
- 15. Axonal & Demyelinating causes • Axonal • Diabetes mellitus • Alcohol • Uraemia • Cirrhosis • Amyloid • Myxoedema • Acromegaly • Paraneoplastic • Drugs and toxins • Deficiency states • Hereditary • Infection • Idiopathic • Demyelinating • Chronic inflammatory demyelinating polyradiculoneuropathy • Multifocal motor neuropathy • Paraprotein-associated demyelinating neuropathy • Charcot–Marie–Tooth disease type I and type X
- 18. In short Inherited: e.g. Charcot-Marie-Tooth disease (HMSN) Infectious: e.g. Leprosy Inflammatory: e.g. Guillain Barre syndrome (AIDP) Neoplastic: e.g. Monoclonal gammopathy Metabolic: e.g. Diabetes Drug: e.g. Vincristine Toxic: e.g. Ethanol
- 19. History • The temporal course of a neuropathy varies, based on the etiology. • Trauma or ischemic infarction-acute, with the most severe symptoms at onset • Inflammatory and some metabolic neuropathies have a subacute course extending over days to weeks. • A chronic course over weeks to months is the hallmark of most toxic and metabolic neuropathies
- 20. History • A chronic, slowly progressive neuropathy over many years • Hereditary neuropathies • Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) • Neuropathies with a relapsing and remitting course include • CIDP • acute porphyria • Refsum's disease • hereditary neuropathy with liability to pressure palsies (HNPP) • familial brachial plexus neuropathy • repeated episodes of toxin exposure
- 21. • Ischemic neuropathies often have pain as a prominent feature • Small-fiber neuropathies often present with burning pain, lightning- like or lancinating pain, aching, or uncomfortable paresthesias (dysesthesias). History
- 22. • The clinical assessment should include: • Careful past medical history • looking for systemic diseases, eg. CTD History
- 23. • All patients should be questioned regarding • HIV risk factors • diet (nutrition) • vitamin use (especially B6) • possibility of a tick bite (Lyme disease) • Constitutional symtoms (malignancy) History
- 24. Investigations: