L5: Peripheral Neuropathy Flashcards
Anatomy of PNS
Function of PNS
- Carry impulses to & from the CNS.
- These impulses regulate motor, sensory and autonomic activities.
Def of Peripheral Neuropathy
- Neuropathy is an inflammation or degeneration of the peripheral and / or cranial nerves → impairment of conduction along these nerves → motor, sensory and / or autonomic manifestations.
Classification of Peripheral Neuropathy
Mononeuropathy
affection of & single nerve trunk in one limb
Mononeuropathy Multiplex
affection at more than one nerve trunk in the same limb
Polyneuropathy
affection of dore than one nerve trunk in more thair one limb
Causes of Mononeurpathy & Mononeuropathy Multiplex
- Traumatic
- Infective
- Vascular
- Metabolic
Causes of Mononeurpathy & Mononeuropathy Multiplex
- Traumatic
Causes of Mononeurpathy & Mononeuropathy Multiplex
- Infective
- Leprosy
- Herpes Zoster
Causes of Mononeurpathy & Mononeuropathy Multiplex
- Vascular
Polyarteritis Nodosa
Causes of Mononeurpathy & Mononeuropathy Multiplex
- Metabolic
DM
Causes of Polyneuropathy
- Heredofamilial
- Acquired
Causes of Polyneuropathy
- Heredo-Familial
- Peroneal muscle atrophy.
- Hypertrophic interstitial polyneuropathy.
- Refsum disease.
Causes of Polyneuropathy
- Acquired
Acquired Causes of Polyneuropathy
- Infective
- Viral: mumps, measles.
- Bacterial: Typhus, Typhoid, Tetanus.
- Mycobacterial: Leprosy.
Acquired Causes of Polyneuropathy
- Toxic
- Inorganic: lead, copper, arsenic, antimony, gold. (Heavy metals).
- Organic: alcohol, insecticides.
Acquired Causes of Polyneuropathy
- Metabolic & Endocrine
Diabetes mellitus, uremia, amyloidosis, acromegaly, myxedema.
Acquired Causes of Polyneuropathy
- Nutritional
Pellagra, Beri-Beri, subacute combined degeneration.
Acquired Causes of Polyneuropathy
- Iatrogenic
Isoniazid, sulphonamides, phenytoin, vincristine.
Acquired Causes of Polyneuropathy
- Autoimmune
Guillain Barre Syndrome, collagen vascular disorders.
Acquired Causes of Polyneuropathy
- Paraneoplastic
Bronchogenic carcinoma, lymphoma.
Pathology of Axonal Neuropathy
Pathology of Demyelinating Neuropathy
CP of Polyneuropathy
- General
- Bilateral
- Symmetrical
- Distal more than Proximal
- Lower Limbs earlier than Upper Limbs.
CP of Polyneuropathy
- Sensory
CP of Polyneuropathy
- Motor
CP of Polyneuropathy
- Autonomic
Investigations for Polyneuropathy
Investigations for Polyneuropathy
- NCS
- Reduced nerve conduction velocity
Investigations for Polyneuropathy
- Nerve Bx
- usually the Sural Nerve
Investigations for Polyneuropathy
- Detect the cause
- Blood sugar
- Tests for collagen vascular disorders
- S. creatinine
Types of Diabetic Neuropathy
- Diabetic Sensorimotor Polyneurtopathy
- Diabetic Autonomic Neuropathy
- Diabetic Proximal Neuropathy (Diabetic Amyotrophy)
- Diabetic Mononeuropathy
- Diabetic Truncal Neuropathy
Diabetic Sensorimotor Polyneuropathy is common in
Type I DM
CP of Diabetic Sensorimotor Polyneuropathy
Pathogenesis of Diabetic Sensorimotor Polyneuropathy
- Hyperglycemia will cause sorbitol accumulation → decreased myoinositol uptake by nerve Fibers —-> impaired impulse conduction.
CP of Diabetic Autonomic Polyneuropathy
- Sweating
- Diarrhea
- Postural hypotension
- Impotence.
Another Name of Diabetic Proximal Polyneuropathy
Diabetic Amyotrophy
Diabetic Proximal Polyneuropathy is common in ……
Type II DM
CP of Diabetic Proximal Polyneuropathy
CP of Diabetic Mononeuropathy
CP of Diabetic Truncal Neuropathy
- Recurrent attacks of truncal pain with sensory deficit in the distribution of a single thoracic root.
- Spontaneous recovery occurs in few months..
TTT of Diabetic Neuropathy
Another Name of Peroneal Muscle Atrophy (BMSN)
Charcot-Marie-Tooth Disease
Compare between Type I,II,III Peroneal Muscle Atrophy (BMSN)
- Incidence
- Inheritance
- Age
- CP
Compare between Type I,II,III Peroneal Muscle Atrophy (BMSN)
- Incidence
- Inheritance
- Age
- CP
Compare between Type I,II,III Peroneal Muscle Atrophy (BMSN)
- Incidence
- Inheritance
- Age
- CP
Compare between Type I,II,III Peroneal Muscle Atrophy (BMSN)
- Incidence
- Inheritance
- Age
- CP
Compare between Type I,II,III Peroneal Muscle Atrophy (BMSN)
- Incidence
- Inheritance
- Age
- CP
TTT of Peroneal Muscle Atrophy (BMSN)
- Physiotherapy.
- Ankle splints for foot drop.
CP of Diphtheritic Neuropathy
- Starts by true bulbar palsy (within few days).
- Paralysis of eye accommodation (ciliary muscle paralysis ) > blurred near vision.
- Generalized sensorimotor polyneuropathy.
- Diaphragmatic paralysis.
Prognosis of Diphtheritic Neuropathy
- Good if the child survives.
- Bulbar & accommodation weakness improve within 6 weeks.
- Polyneuropathy recovery takes months.
TTT of Diphtheritic Neuropathy
- Penicillin G: 600,000 u/12 hours for 14 days.
- Diphtheritic antitoxin: should be given early as 100,000 u IM.
- Assisted ventilation if need.
Organism Causing Leprotic Neuropathy
Mycobacterium leprae
IP in Leprotic Neuropathy
Long Incubation period (about 3.5 years) with Insidious onset.
Types of Leprotic Neuropathy
CP of Leprotic Neuropathy
TTT of Leprotic Neuropathy
- Dapsone 100mg/day + Rifampicin 600 mg/ day (for 1 -2 years).
- Nerve grafting for severe mononeuropathy with trophic ulcers.
Another Name of Guillian-Barre Syndrome
Acute Post Infective Polyradiculoneuropathy
Etiology of Guillian-Barre Syndrome
CP of Guillian-Barre Syndrome
CP of Guillian-Barre Syndrome
- Motor
CP of Guillian-Barre Syndrome
- Sensory
Glove and stocking hypoesthesia
Prognosis of Guillian-Barre Syndrome
- Recovery in 3-6 months.
- May be with mild residue in 40% of cases.
- Survival for 8 weeks carries a good prognosis.
Investigations for GBS
TTT of GBS
TTT of GBS
- NGT
feeding for bulbar palsy.
TTT of GBS
- Assissted Ventilation
…
TTT of GBS
- SC Heparin
to guard against deep venous thrombosis (DVT).
TTT of GBS
- Plasmapheresis
must be done in the first 2 weeks
TTT of GBS
- IVIG
0.4 g/Kg / day for 5 successive days.
