Neuropathy د.رشاد عبدالغني

8/3/2019 Neuropathy .

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Neuropathy

Neuropathy is an umbrella term for nonradicular

diseases of the peripheral nerves. Neuropathy can

be acute and life threatening as in Guillain-Barr

syndrome or chronic as in diabetic neuropathy


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classification

Anatomic classification.

Mononeuropathy. Involvement ofa single nerve (e.g., carpal

tunnel syndrome, meralgia

paresthetica).

Polyneuropathy. Diffuseinvolvement of the peripheral

nerves (e.g., diabetic

neuropathy).

Mononeuritis multiplex.Seemingly random

involvement of multiple

isolated nerves. Can occur in

vasculitis, porphyria, diabetes,

HIV, and others.

Cellular classification.

Axonal neuropathy. Loss offunction from loss of nerve

cells.

Demyelinating neuropathy.

Damage to the Schwann cellsleads to impairment of nerve

conduction.


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.classification

Time courseAcute neuropathy.

Sudden onset of

dysfunction from an

injury or immunologic

attack.

Chronic neuropathy.

Usually insidious onset

with slow progressionfrom low-level ongoing

nerve injury.

ClinicalMotor

Sensory

Sensomotor

Autonomic


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Causes of Neuropathies.

Inherited neuropathies

Charcot-Marie-Tooth.Refsum disease

Friedreich Ataxia.

PorphyriaFamilial amylodosis


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Causes of Neuropathies.Collagen diseases

Rheumatoid arthritisVasculitis: Polyarteritis nodosa

Sarcoidosis

Paraneoplastic.

toxic: Heavy metal toxicity:

lead,arsenic, mercury.

Organphosphates insectcids

Alcohol

Drugs

Malnutrition. Vitamin B12,B6and B1 deficiency. Vitamin E,

niacin, and folate are rare

causes of neuropathy

Aquiredmetabolic neuropathies

diabetic mellitus,hypothyroidism, porphyria,

and renal or hepatic failure.

Infectious causes. Leprosy,

Diphteria, Lyme, HIV, and

syphilis, Herpes Zoster,

hepatitis c.

Immune mediated:Guillain-Barr syndrome

Chronic inflammatory

demyelinating polyneuropathy

Monoclonal gammopathies.


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Laboratory testing.

Tests for all patients with unexplained

neuropathy. CBC, glucose tolerance test,Vitamin B12, rheumatoid factor, TSH, free T4,sedimentation rate, ANA, serum proteinelectrophoresis, urine protein electrophoresis,

and skeletal x-ray survey.Other tests to consider: HIV antibody, VDRL,Lyme titer, lumbar puncture.

Folate, urine heavy-metal screen, ganglioside

antibodies (GM1, anti-MAG, antisulfatide),and paraneoplastic antibodies (anti-Hu).Electromyography (EMG) and nerve conduction

studies

Nerve biopsy


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Treatment:

Symptomatic treatment of neuropathic pain

and paresthesias is directed at reducing the pain.Possible treatments include amitriptyline (Elavil)

10 to 75 mg HS, nortriptyline (Pamelor) 10 to 100

mg HS, gabapentin (Neurontin) 400 mg HS to800 mg TID, or carbamazepine (Tegretol) 200 to

400 mg TID. Capsaicin cream has also been used

with some success.

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Neuropathy د.رشاد عبدالغني