Neuropathy (General)

8/8/2019 Neuropathy (General)

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Neuropathy By:Rey Martino


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DefinitionDefinition

a disease or injury of the peripheralsensory, motor, or autonomic nerves.

Category: Neuronopathy : selective injury to the cell body of

the axon

Radiculopathy : selective injury to the nerve rootsdistal to their origin

Plexopathy : injury to the brachial or lumbosacralplexus


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ClassificationClassification

1) Onset of neuropathy

Acute : Acute Idiopathic Polyneuropathy

C

hronic : DM, Leprosy

2) Severity

Mild : Sensory only, motor only

Moderate : Sensory, motor & tendon reflexes

Severe : Sensory, motor & tendon reflexes,muscle atrophy


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3) Number of nerves involved

Mononeuropathy simplex Only one peripheral nerve involved

Mononeuropathy multiplex (multifocalneuropathy)

Multiple scattered nerve in an irregular distribution

Polyneuropathy Several nerves are involved, symmetrical, same onset & distalpredominant


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4) Lesion site

Distal Axonopathy Axonal lesion

Myelinopathy Disorder of myelin sheath

Neuropathy disorder of cell body at anterior horn cells, spinal cord or

dorsal root ganglion


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EtiologyEtiology

1) Idiopathic Inflammatory Neuropathies Acute Idiopathic Polyneuropathy (GBS)

Chronic inflammatory Demyelinating Polyneuropathy

2) Metabolic & Nutritional Neuropathies

DM, Uremia, liver diseases, Vit. B12 deficiencies


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3) Infective & GranulomatousNeuropathies

AIDS, Leprosy, Diptheria, Sarcoidosis

4) Vasculitis Neuropathies

Polyartheritis Nodosa, Rheumatoid Arthritis,SLE


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5) Neoplastic & ParaproteinemicNeuropathies

Compression & irritation by tumor, Paraneoplasticsyndrome, Paraproteinemias, Amyloidosis

6) Drug induced & toxic neuropathies

Dapsone, Isoniazide, Phenytoin, Hydralazine

Alcohol

Toxic: organophosphate, arsenic, lead


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7) Hereditary Neuropathy Idiopathic : Hereditary motor & sensory Neuropathies,

familial amyloidosis

Metabolic : Porphyria, Abetaliproproteinemia

8) Entrapment Neuropathies

UL : Carpal Tunnel syndrome(median n.)

LL : Femoral nerve


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PathogenesisPathogenesisCan be divided into 4 major categories :1) Neuronal degeneration : damage to the motor or sensory nerve cell

bodies, with subsequent degeneration

2) Wallerian degeneration :damage to the axon at a specific pointbelow the cell body, with degeneration distal to the injury.

3) Axonal degeneration : diffuse axonal damage. The distal portionundergoes the earliest and most severe change followed by gradual

proximal ascent with continued injury (dying back phenomenon)

4) Segmental demyelination : injury to the myelin sheath without injuryto the axon


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PathogenesisPathogenesis


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ClinicalClinical symptomssymptoms1) Sensory symptoms

Involvement of sensory axons produces impairment of sensation withdysesthesias or paresthesias.

2) Motor symptoms

Involvement of motor axons produces muscle wasting and weaknessfollowed by atrophy and fasciculations; LMN type muscle weakness, footdrop, wrist drop

3) Change of tendon reflexes tendon reflexes supplied by the affected nerve are depressed or absent;

decreased or absent of tendon reflexes

1) Autonomic Involvement of axons supplying autonomic function produces loss of sweating,

alteration in bladder fuction, constipation, and impotence in male


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DiagnosisDiagnosis

1) Clinical symptoms & sign

2) Laboratory studies

3) CXR

4) LP

5) ECG

6) Biopsy: sural nerve or radial cutaneous nerve

7) Electrophysiology: EMG(a recording of electricalactivity in muscles), NCV (a recording of the speedat which signals travel along nerves)


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TreatmentTreatment

The first goal manage the condition causing your

neuropathy the neuropathy often improves on its own.

Second goal relieve the painful symptoms. Pain relievers

Anti-seizuremedications (gabapentin, topiramate, pregabalin,

carbamazepine and phenytoin)

Lidocaine patch

Antidepressants (Tricyclic antidepressantmedications, such as amitriptyline

and nortriptyline ) Transcutaneous electrical nerve stimulation (TENS)


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ComplicationsComplications

The inability to feel or notice injuries can lead to infection or damage to

the affected part of the body, including: Defor mity

Loss of tissue mass

Poor healing

Scarring

Tissue erosions

Other complications include: Decreased self-esteem

Difficulty breathing

Difficulty swallowing Irregularheart rhythms (arrhythmias)

Need for amputation

Partial or complete loss ofmovement or control ofmovement

Partial or complete loss of sensation

Relationship problems related to impotence


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PreventionsPreventions

take appropriate measures (such as padding vulnerable parts of thebody) beforehand to reduce the risk of nerve problems

Avoid spending a long period of time in one position (for example, afterdrinking too much alcohol) or doing certain kinds of repetitivemovements (in the case of carpal tunnel syndrome).d

Reduce your risk of neuropathy by:

Drinking alcohol in moderation

Following a balanced diet

Keeping good control over diabetes and other medical problems, ifyou have them


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ThankThank youyou

Neuropathy (General)

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