Peripheral neuropathy Flashcards
How common is peripheral neuropathy?
2 in 100 people have some form of peripheral neuropathy.
It is more common in people who have recognised risk factors
What are the causes of peripheral neuropathy?
- Diabetes
- Dietary deficiencies (B12 / folate)
- Drugs (chemotherapy)
- Toxins (insecticides)
- Cancers
- Alcohol
- CKD
- Trauma (broken bones)
- Infection (shingles, HIV, lyme disease)
- connective tissue diseases (RA, Sjogren’s, SLE)
- Hereditary
- Idiopathic
What are the metabolic causes of peripheral neuropathy?
- diabetes
- renal failure
- hypothyroid
What are some infectious causes of peripheral neuropathy?
- Leprosy
- HIV
- Syphilis
- lyme disease
- shingles
What dietry deficiencies can cause peripheral neuropathy?
B12, folate
What are the signs and symptoms of sensory neuropathy?
-Glove and stocking distribution
-numbness
-pins and needles
-burning
-difficulty handling small objects e.g. buttons
-signs of trauma e.g. finger burns
-
What are the signs and symptoms of motor neuropathy?
- progressive
- weak / clumsy hands
- difficulty walking
- wasting of muscles
- foot / wrist drop
- reduced reflexes
- breathing difficulty
- muscle twitching / cramps
what are the signs of autonomic neuropathy?
- dizziness / fainting
- reduced sweating
- inability to tolerate heat
- urinary incontinence
- bloating, const or diarrh
- impotence
What investigations are done for suspected peripheral neuropathy?
1) Bloods
- FBC (infection?)
- ESR
- glucose (diabetes?)
- U&E
- LFT (alcohol excess)
- TSH (hypothyroid)
- B12
2) Nerve conduction tests
What is the management of peripheral neuropathies?
1) treat cause
2) physiotherapy
3) foot care (to minimise trauma)
4) Steroids for vasculitic causes like wegener’s granulamatosis
5) pain relief (amitryptyline or nortriptyline, gabapentin or pregablin)
Give examples of drugs used to treat neuropathic pain?
- amitriptyline
- nortriptyline
- gabapentin
- pregablin
