Neuropathy

Question 1

Acute neuropathies (Guillian Barre)

Answer 1

• acute post-infectious polyneuropathy
• 2-3 weeks after:
  
  • URTI
  • campylobacter gastroenteritis
  • ?ABs attaching to protein complements of myelin
• features:
  
  • _​_fleeting abnormal sensory sensations in legs
  • ascending symmetrical weakness with loss of reflexes
  • autonomic involvement
  • bulbar muscle involvement: difficulty swallowing, chewing and risk of aspiration
  • respiratory despression - ventilation
• prognosis:
  
  • _​_full recovery 95% cases, may take up to 2 years

Question 2

Chronic neuropathies (Charcot Marie Tooth, CIPD)

Answer 2

• Charcot Marie Tooth
  
  • ​Autosomal dominant inheritance is the most common mode of inheritance but autosomal recessive, and CMT X-linked (CMTX) forms
  • heterogeneous group of inherited peripheral neuropathies in which the neuropathy is the sole or primary component of the disorder
  • distal limb muscle wasting and sensory loss, with proximal progression over time
  • CMT 1-3, X
• CIPD (Chronic Inflammatory Demyelinating Polyneuropathy)
  
  • ​​progressive weakness/ impaired sensory function in the legs and arms
  • chronic relapsing polyneuropathy
  • damage to the myelin sheath of the peripheral nerves
  • more common in young adults, and in men
  • tingling or numbness (beginning in the toes and fingers)
  • weakness of the arms and legs
  • loss of deep tendon reflexes (areflexia)
  • fatigue
  • abnormal sensations
  • CIDP is closely related to Guillain-Barre syndrome and it is considered the chronic counterpart of that acute disease
  • treatment: corticosteroids, immunosuppressants, IV Igs, plasma exchange