Peripheral Neuropathies, general Flashcards
What are the causes of mixed peripheral neuropathies?
Diabetes 30%, hereditary 30%, idiopathic 30%, other 10%
Drugs – phenytoin, isoniazid, vincristine, cisplatinum, amiodarone
Alcohol / amyloid
Metabolic- diabetic, uraemic, hypothyroid
Immune mediated – GBS, CIDP
Tumour / paraneoplastic
Vitamin B12, B1 deficiency, B6 excess
Idiopathic
Connective tissue / autoimmune – vasculitis, SLE polyarteritis nodosa
Hereditary - CMT
What are the causes of painful sensory neuropathy?
Diabetes, alcohol, paraneoplastic, Vit B12 deficiency, Vit B1 deficiency
What are the causes of painless sensory neuropathy?
Paraneoplastic, paraprotein (POEMS, amyloidosis, myeloma), B6 intoxication, Sjogren’s, diabetes, syphilis, B12, idiopathic, HIV, uremia, chemotherapy
What are the causes of predominantly motor neuropathy?
MMAGIC MND, multifocal motor neuropathy Metabolic – diabetes, lead Acute intermittent porphyria GBS / CIDP Infectious – polio, paralytic rabies CMT – charcot marie tooth
What is CIDP and how is it diagnosed
CIPD – chronic inflammatory demylenating neuropathy –
Has a lower incidence than GBS but greater prevalence.
Characterised by symmetrical weakness in both proximal and distal muscles which increases over at least 2/12. Or relapses at least 3 x
Differentiated from AIDP by time length but also generally has a less clear onset compared to GBS and less likely to find an anticeding cause than AIDP
Symmetrical proximal and distal weakness, Altered sensation – most often vibration and proprioreception- tends to be distal more than proximal, diminished reflexes,
Diagnosis is clinical however typical findings can help: elevated CSF protein, demyelination on NCS, onion bulb changes on biopsy
Treatment of CIDP
CIDP responds to glucocorticoids. High dose IVIg and plasmapheresis are all indicated.
Can try immunosuppressants if these fail (azathioprine or methotrexate).
