Approach to polyneuropathy part1;

Approach to axonal polyneuropathy neurooph polyneuropathy lead poisoning with CIDP 1 basophillic stripping smooth result localization polyneuropathy ! resident med . Lead "" "" lead poisoning ?

neuropathy 1. Nerve polyneuropathy entrapment foot drop, wrist drop, finger drop common short case resident med polyneuropathy nerve 1 2. Symmetry or asymmetryStep asymmetry approach mononeuropathy multiplex nerve asymmetry symmetry 3. Axon VS myelin asymmetry symmetry axon myelin ? A B C tripple genital area

1. Axonal polyneuropathy : A A ? A ( stocking ) A "glove and stocking pattern" axonal polyneuropathy A "" histoanatomy nerve nucleus axon myelin axon cell retrograde nucleus wallerian degeneration nerve axon degenerate nerve "" "length dependent fashion" axonal polyneuropathy muscle atrophy axon involvement recovery demyelinating run chronic course atrophy demyelinating***Axonal polyneuropathy key point1. Sensory loss :glove and stocking pattern2. Length dependent fashion3. Muscle atrophy in chronic course4. common : DM, HIV , alcohol complication distal painful sensorimotor polyneuropathyAxon axon sensory involvement nerve function : motor nerve, sensory nerve, large fiber nerve, small fiber nerve, autonomic nerve axon step nerve group differential diagnosis 5 1. Sensory and motor involvement : most common typeDistal reflexes , length dependent, gloves and stockings sensory loss ddx DM, toxin, drugs, vasculitis, HIV, paraneoplastic, monoclonal gammopathy, hereditary, amyloidosis2.pure motor neuropathyDdx mcq short case long case resident common motor nerveDdxLead poisoning upper extremities wrist drop, anemia, GI symptomsDapsone motor nerve multifocal motor neuropathy with conduction blocks ALS wasted hands, chronic course ALS reflex ALS reflex 3. Pure sensory neuropathyDdx ddx mixed motor sensory 4.proprioceptive large fiber neuropathy:sensory neuronopathy large fiber nerve , dorsal root ganglion proprioception vibration sensory ataxia weak vertigo proprioception Rhomberg's sign positiveDdx Paraneoplastic : anti HuSjogren syndromeCisplatinumVitamin B6toxicityHIV5. Small fiber neuropathy( pinprick and temperature loss) with or without autonomic involvement small fiber nervesLoss pain, temperature distallyNo motor weaknessNormal reflexesAutonomic involvementNormal EMG/NCVDdx DM, amyloidosis, vincristine, alcohol, genetics; Tangier's disease, Fabry's diseaseHIV, GBS variant(pandysautonomia), paraneoplastic, idiopathic demyelinating polyneuropathy B 555 drugs axonal poly neuropathy AlcoholAmiodaroneDapsone(motor)DisulfiramHydralazineIsoniazidMetronidazoleARVPhenytoinPyridoxine(sensory)VincristineTaxolToxin (axonal polyneuropathy)ArsenicThalliumOrganophosphatesLead( motor)

Approach to polyneuropathy part2;

Approach to demyelinating polyneuropathy B demyelinated polyneuropathy !!! !! A japanese set( gloves and stockings fashion) axonal polyneuropathy B indy () myelin axon length dependent pattern reflex proximal distal Muscle atrophy recovery axon

*** demyelinated polyneuropathy 1. Loss sensation non- gloves and stockings pattern2. Loss of reflexes proximal, distal3. Muscle atrophy axonal polyneuropathy demy 1. Acute inflammatory demyelinating polyneuropathy (AIDP) peak 4 weeks2. Chronic inflammatory demyelinating polyneuropathy(CIDP) AIDP progress 8 weeks nadir period 4-8 weeks Guillain Barre syndrome (GBS) ?? GBS term axonal type and variants type GBS AIDP demy GBS GBS variants . simply delicious AIDP post infectious process Campylobacter Jejuni !!! most common organism preceding infection GBS CIDP1. Idiopathic 555 !2. Secondary causes cause CIDP cause U common cause1. Infection: HIV, leprosy(axon-demy), diptheria, prion: CJD, hepatitis B, C2. Tumor: paraneoplastic syndrome: POEMs, osteosclerotic multiple myeloma3. Paraproteinemia: IgM monoclonal gammopathy of undetermined significance( MGUS), Waldenstrom macroglobulinemia, cryoglobulinemia4. Endocrine: DM most common 6. Toxin: ARV, alcohol7. Drugs: amiodarones, hexacarbons part B demyelinated polyneuropathy part 3 approach polyneuropathy asymmetry mononeuropathy multiplex c u next time xxx

Approach to polyneuropathy part3;

Mononeuropathy multiplex () !!! asymmetry Pathology myelin sheath entrapment vascular supply nerve vasculitisPattern length dependentweak sensory loss nerve distribution 1. Vasculitis- vasculitic syndrome Wegener granulomatosis, polyarteritis nodosa, Churge Strauss syndrome- systemic connective tissue disease: SLE, RA-vasculitis infection , cryoglobulinemia2. Demyelinating polyneuropathy chronic inflammatory demyelinating polyradiculopathy3. Infection; leprosy, HIV4. DM: asym sym5. Tumor infiltration hematologic malignancy6. Chronic granulomatous inflammation sarcoidosis nerve work up symmetrical polyneuropathy systemic vasculitis exclude entrapment