neuropathy د.رشاد عبدالغني
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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.