Symptoms of neuropathy depends on the nerves affected.

• If it is peripheral, there could be tingling sensation, pain, numbness, loss of function of affected limb amongst others.
• If it affects the cranial nerves, there is loss of sensation to the area supplied like blindness in optic nerve neuropathy or deafness and loss of balance and coordination in auditory nerve neuropathy.
• The autonomic neuropathy also manifests with symptoms affecting the particular organs supplied. Such symptoms may include erectile dysfunction, anhydrosis, and tachycardia amongst others.

• Pain

  […] neuropathy and post-traumatic neuropathic pain only. [en.wikipedia.org]

  […] to touch Pain during activities that shouldn't cause pain, such as pain in your feet when putting weight on them or when they're under a blanket Lack of coordination and falling Muscle weakness Feeling as if you're wearing gloves or socks when you're [mayoclinic.org]

  In one large study focusing on pulsed electromagnetic fields, no beneficial effect on pain was registered. [doi.org]

  Neuropathic Pain An estimated 10% of the population has neuropathic pain. [neuromodulation.com]

• Weakness

  […] in the fingers double vision or other problems with focusing your eyes, sometimes with eye pain weakness of one side of your face (Bell's palsy) foot or shin pain, weakness or altered sensation The most common type of mononeuropathy is carpal tunnel [nhs.uk]

  It is manifested with pain, tingling, numbness, and muscle weakness. It may be the result of physical injury, toxic substances, viral diseases, diabetes, renal failure, cancer, and drugs. [fpnotebook.com]

  Weakness and loss of sensation may be associated with lack of balance and falling. [mayoclinic.org]

  Adaptive devices If weakness of hands or feet interfere with daily activities, adaptive equipment may be needed. An occupational therapist may be consulted to fit devices that will help with muscle weakness. [uihc.org]

• Fatigue

  Many patients with HNPP complain of diffuse pain and severe fatigue. HNPP may cause severe limb paralysis when asymptomatic patients with unknown diagnosis of HNPP are challenged by strenuous physical activities. [orpha.net]

  Another side of neuropathy, and probably the worse, is "fatigue." For months it was difficult to function. [spacedoc.com]

  Epilepsy मिर्गी, मिरगी, मिरगी, अपस्मार, Suresh is suffering from epilepsy / Narcolepsy has been mistaken for epilepsy, chronic fatigue syndrome, and schizophrenia. [studysite.org]

  Specific symptoms before the onset of peripheral neuropathy include paleness, weakness, fatigue, faintness, or breathlessness. The skin may turn yellow, and the mouth and tongue may be sore. [healthcentral.com]

  CIDP can come with pain, fatigue, numbness and tingling. It’s a type of autoimmune neuropathy, occurring when the immune system attacks the covering (myelin sheath) that protects nerves. [ohsu.edu]

• Anemia

  A severe form of vitamin B12 deficiency, known as pernicious anemia, occurs when the body cannot absorb vitamin B12 as it should. [healthcentral.com]

  One would be pernicious anemia. This is often missed, I find. I’ve diagnosed several patients with pernicious anemia that didn’t know that they had it. This is an autoimmune disease that involves destruction of the parietal cells in the stomach. [chriskresser.com]

  Pernicious anemia, which occurs when the body cannot absorb B-12 properly, often leads to peripheral neuropathy. [foundationforpn.org]

  Vitamin B-12 deficiency may also cause anemia. Copper. Copper deficiency may damage nerves and lead to excess zinc in the blood. People with too little copper may need lifelong treatment. Vitamin E. Vitamin E is an important antioxidant. [medicalnewstoday.com]

  Tumor necrosis factor alpha as a uremic toxin: correlation with neuropathy, left ventricular hypertrophy, anemia, and hypertriglyceridemia in peritoneal dialysis patients. Adv Perit Dial. 1999;15:82-6. Hojs-Fabjan T, Hojs R. [homedialysis.org]

• Dyspepsia

  Oxycarbazepine 600-2400 mg Fatigue, nausea, dizziness, leukopenia Lamotrigine 50-500 mg Serious rash, dizziness, nausea, sedation Topiramate 25-400 mg Sedation, weight loss, nephrolithiasis, myopia, angle closure glaucoma Miscellaneous Mexiletine 150-750 mg Dyspepsia [clevelandclinicmeded.com]

• Heart Disease

  […] and diabetes Eye damage and diabetes (diabetic retinopathy) Heart disease & stroke High blood pressure Kidney disease Mental health issues Nerve damage & amputation Sub Navigation for Kids, teens & diabetes About Kids, teens & diabetes Adjusting to a [diabetes.ca]

  Too much salt can raise your blood pressure, which puts you at increased risk of health problems like heart disease and stroke. [nhs.uk]

  Posted on Dec 13, 2019 Neurological (stroke, multiple sclerosis, Parkinson's) Neuromusculoskeletal (back pain, whiplash associated disorder, sports injuries, arthritis) Cardiovascular (chronic heart disease, rehabilitation after heart attack) Respiratory [kamran-physio-clinic.business.site]

  Damage to the nerves to your heart may cause you to feel lightheaded, or faint, when you stand up. Angina is the warning chest pain for heart disease and heart attack. Nerve damage may "hide" this warning sign. [nlm.nih.gov]

• Hypertension

  Hypertension appears to be better tolerated than hypotension. [ncbi.nlm.nih.gov]

  Zoster Vaccinations Diabetes and Transplantation Diabetes and Driving Complementary and Alternative Medicine for Diabetes Cardiovascular Protection in People With Diabetes Screening for the Presence of Cardiovascular Disease Dyslipidemia Treatment of Hypertension [diabetes.ca]

  Hypertension as a comorbid condition was significantly more common ( P < 0.05) in patients found to have diabetes (8 of 13 patients, 61%) and in patients with IGT or IFG (21 of 40 patients, 52%) than in patients with normoglycemia (18 of 54 patients, [care.diabetesjournals.org]

  "Fundus lesions in malignant hypertension. V. Hypertensive optic neuropathy". Ophthalmology. 93 (1): 74–87. doi:10.1016/s0161-6420(86)33773-4. PMID 3951818./ ^ Kawana T, Yamamoto H, Izumi H (December 1987). [en.wikipedia.org]

  […] outpatient visits (excluding emergency department visits) with a chief symptom and/or a primary diagnosis of back or neck pain, as well as those with secondary symptoms and diagnoses of back or neck pain but unrelated primary reasons for the visit (eg, hypertension [doi.org]

• Blurred Vision

  Other symptoms are erectile dysfunction, increased heart rate, constipation, nausea, vomiting, blurred vision, blindness and deafness depending on the nerves affected. [symptoma.com]

  vision; slow pupil reaction, which affects night vision Decreased or excessive sweating and heat intolerance Difficulty swallowing or breathing Dizziness and fainting when standing due to low blood pressure Erectile dysfunction in males; vaginal dryness [labtestsonline.org.uk]

  Common side effects include dry mouth and nose, blurred vision, drowsiness, difficult urination and constipation, among many others. [poz.com]

  vision Heat intolerance or decreased ability to sweat Hypoglycemia unawareness : Low blood sugar levels ( hypoglycemia ) are associated with trembling, sweating, and palpitations. [emedicinehealth.com]

• Muscle Weakness

  It is manifested with pain, tingling, numbness, and muscle weakness. It may be the result of physical injury, toxic substances, viral diseases, diabetes, renal failure, cancer, and drugs. [fpnotebook.com]

  This syndrome is associated with myokymia, muscle cramps and stiffness, delayed muscle relaxation after contraction, muscle weakness, and hyperhydrosis. [go.gale.com]

  Wide range of symptoms are seen due to damage of peripheral nerves numbness and tingling in the feet or hands, burning, stabbing or shooting pain in affected areas, loss of balance and co-ordination, muscle weakness especially in the feet. [imedpub.com]

  Get NCI’s Dictionary of Cancer Terms Widget. neuropathy listen (noor-AH-puh-thee) A nerve problem that causes pain, numbness, tingling, swelling, or muscle weakness in different parts of the body. [cancer.gov]

  For example, treatment for muscle weakness may involve physiotherapy and walking aids. Complications of peripheral neuropathy The outlook for peripheral neuropathy varies, depending on the underlying cause and which nerves have been damaged. [nhs.uk]

• Fracture

  We report the case of a 20-year-old woman who fell in a motocross accident and had an anterior shoulder dislocation, humeral fracture and axillary neuropathy. The fracture was treated surgically with open reduction and internal fixation. [ncbi.nlm.nih.gov]

  Tarsal tunnel syndrome Caused by ankle sprains and fractures, ill-fitting footwear, cysts, ganglia, arthritis, tenosynovitis. Pain in the ankle and the sole of the foot. Paraesthesia on walking. [patient.info]

  […] conditions that cause peripheral neuropathy include autoimmune diseases such as rheumatoid arthritis; infections such as leprosy or AIDS; pressure on a nerve; certain toxic substances, including alcohol; vitamin deficiency; radiation; trauma (eg bone fractures [brainfoundation.org.au]

• Leg Pain

  Efficacy of anticonvulsants for low back pain with or without radiating leg pain Three trials investigated a gabapentinoid (gabapentin) versus placebo for chronic low back pain with or without radiating leg pain. 26, 31, 32 There was no effect for pain [doi.org]

  For calculation of effect size (see appendix tables A and B on bmj.com), we pooled leg pain and overall pain, as leg pain is usually worse than pain in the back. [bmj.com]

• Numbness of the Feet

  Numbness in the feet can lead to skin sores that do not heal. In rare cases, numbness in the feet may lead to amputation. There is no cure for most neuropathies that are passed down in families. [nlm.nih.gov]

  If you've noticed numbness or tingling in your feet and muscle weakness that's been going on for a while, it's possible you have a problem with your peripheral nervous system. [honorhealth.com]

  You might not feel temperature changes or pain on parts of your body that are numb. Infection. Your feet and other areas lacking sensation can become injured without your knowing. [mayoclinic.org]

• Myalgia

  2 The item concluded that if they did, the risk was very low, although isolated case reports suggested a myopathy risk for all statins, ranging from benign myalgia to fatal rhabdomyolysis. [jfponline.com]

  Accompanying clinical manifestations reported in 25-50% of patients include myalgias, low-grade fever, headache, and chills. It is not clear whether these symptoms are due to viremia or due to interferon. [meddean.luc.edu]

  Illness is characterized by the abrupt onset of vomiting and/or non-bloody diarrhea; abdominal cramps are common. 25-50% of patients report headache, nausea, malaise, myalgias and low-grade fever. [eportal.mountsinai.ca]

• Peripheral Neuropathy

  The search yielded 11 references, including useful guidelines for the diagnosis and management of diabetic peripheral neuropathy, 2 but no guidelines on the diagnosis and management of generic peripheral neuropathy. [doi.org]

  Complications Complications of peripheral neuropathy can include: Burns and skin trauma. [mayoclinic.org]

  Nerve damage caused by injury can also be classified as peripheral neuropathy. There are three primary criteria used to categorize peripheral neuropathy into one of its specific classifications. [neuravite.com]

  What is peripheral neuropathy? Peripheral neuropathy is a disease in a nerve that causes numbness in the arms, hands, legs and feet. [mercy.com]

  Find out more about diagnosing peripheral neuropathy Causes of peripheral neuropathy In the UK diabetes (both type 1 and type 2) is the most common cause of peripheral neuropathy. [nhs.uk]

• Tingling

  It is manifested with pain, tingling, numbness, and muscle weakness. It may be the result of physical injury, toxic substances, viral diseases, diabetes, renal failure, cancer, and drugs. [fpnotebook.com]

  The most classic example of a mononeuropathy is carpal tunnel syndrome, which refers to compression of the median nerve, causing numbness and tingling in the wrist. [verywellhealth.com]

  When to see a doctor Seek medical care right away if you notice unusual tingling, weakness or pain in your hands or feet. [mayoclinic.org]

  You may also feel pain, tingling, or burning in your arm and shoulder. [webmd.com]

• Polyneuropathy

  There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy. [dx.doi.org]

• Guillain-Barré Syndrome

  Unfortunately, none of these tests can diagnose Guillain-Barré syndrome. In suspected Guillain-Barré syndrome patients, lab tests are done mainly to rule out other possible causes. [medbroadcast.com]

  In acute neuropathies, such as Guillain-Barré syndrome, symptoms appear suddenly, progress rapidly, and resolve slowly as damaged nerves heal. In chronic forms, symptoms begin subtly and progress slowly. [news-medical.net]

  Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2001; (2):CD002063. 10. Raphaël JC, Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2001;(2):CD001798. 11. [aafp.org]

  syndrome (GBS) and muscular dystrophies. [pennmedicine.org]

  Guillain-Barré syndrome (GBS) respond to treatment with intravenous immunoglobulin, but it is not uncommon for some to continue to deteriorate for a period after treatment has been started. [dx.doi.org]

• Paresthesia

  This slowly progressed to paresthesia in the anterior segments of both feet on the plantar and dorsal surfaces. [jfponline.com]

  The latter may include positive signs, such as hyperalgesia, allodynia, hyperesthesia, paresthesia (burning, pricking), or dysesthesia. [practicalpainmanagement.com]

  Weakness and numbness in the affected limb or limbs may be accompanied by abnormal sensations (paresthesia) – that is, tingling, “pins and needles”, burning, pain etc. Frequently the symptoms are worse at night. [brainfoundation.org.au]

  Peripheral neuropathy following HIV infection is frequently seen among HIV-positive-, ARC- and AIDS patients who often complain of debilitating paresthesias. [portal.findresearcher.sdu.dk]

  In HIV polyneuropathy, the patient may experience unusual sensations (paresthesias), numbness and pain in their hands and feet. Often non-painful stimuli, such as touching, can elicit pain sensation. [hopkinsmedicine.org]

Laboratory studies

• Fasting blood glucose
• Hemoglobin A1c
• Complete blood count
• Liver function test
• Renal function tests
• Thyroid function test
• Erythrocyte sedimentation rate
• Vitamin B12 and folate levels
• Paraneoplastic antibodies
• Antinuclear antibodies
• Genetic screening

Imaging

• MRI
• CT
• Doppler studies
• Nuclear imaging

Other investigations that may be carried out are electromyography, nerve conduction tests, nerve biopsy, electrocardiogram, and microdialysis.

The treatment of neuropathy usually targets the underlying cause. For example, vitamin supplements in Vitamin B12 and folate deficiency. Also, if diabetes is diagnosed and managed early, the risk for developing peripheral neuropathy is greatly reduced.

Pain management is also very important and because patients with neuropathy do not readily respond to regular analgesics, medication that target specific nerve cells are preferred. Drugs such as duloxetine hydrochloride is used. Other drugs include some anticonvulsants, antiarrhythmics, and local anesthetics. Topical analgesics can also be used in patients with focal neuropathy.

Physical therapy like massage also has a role in alleviating the pain of neuropathy. Surgery also has a role in the management of neuropathy. For example patients who have developed a gangrenous foot from a diabetic foot ulcer secondary to neuropathy may require amputation.

The prognosis depends on the type of neuropathy. However, if diagnosis is made early and treatment instituted, then the progression of the disease can be slowed or even reversed thereby giving the patient a better prognosis.

The cause of neuropathy can either be acute or chronic and they include diabetes, which is the commonest cause. Others are chronic alcoholism, vitamin B12 deficiency, autoimmune diseases, renal failure, hepatic failure, inherited disorders, toxins, infections, drugs, trauma and tumors. It could also be idiopathic, meaning that there could be no known cause.

The incidence and prevalence, along with the distribution amongst sex, race and age is largely dependent on the type of neuropathy.

Metabolic neuropathies like diabetes mellitus and uremia of renal failure occur more frequently in advancing age. There is not preference for any race and the incidence is slightly higher in males.

Neuropathy due to trauma is more likely to occur in the mid-life as this is when individuals are more prone to accidents. The incidence is predominantly higher in males as they are more at risks of trauma from falls or assault.

Neuropathies of hereditary origin usually start in childhood but may remain unnoticed until later in life. They have no clear age, sex or race predilection.

The pathophysiology of neuropathy is largely dependent on the underlying cause.

In diabetes mellitus, there have been different postulated theories about the pathway that leads to nerve damage. It is however agreed that many factors interplay in its pathophysiology, like the reaction of excess glucose with certain cellular bodies that leads to production of glycation end product which affects nerve function. Also, the accumulation of sorbitol and fructose from the metabolism of excess glucose in the polyol pathway can lead to nerve damage. Also, the increased production of free radicals in patients with diabetes has been implicated in its pathophysiology.

In neuropathy due to trauma, the major mechanism is shearing of nerves either by accidents or during surgeries to remedy other conditions like a brachial plexus injury following surgery on the axilla. The development is usually sudden

In other forms like Vitamin B12 deficiency and the inherited types, the major end result appears to be demyelination of nerves although the clear pathway by which this occurs is not clearly understood.

The mainstay of prevention is to prevent the root cause of neuropathy. Patients with diabetes should ensure adequate glycemic control. Also, a healthy diet prevents vitamin deficiency.

Neuropathy defines any type of disease that affects the nerves in the body. It is a broad term that defines injuries or diseases to many of the nerves in the body and there are various forms of neuropathy. This group of diseases is characterized by impaired nerve function which causes a problem with sensation, function and movement of the areas affected.

Neuropathy could be:

• Peripheral when it affects peripheral nerves. This nerves are mainly in the extremities.
• Cranial if it affects any of the cranial nerves that have their nucleus in the brain.
• Autonomic when it affects nerve of the autonomic (involuntary) nervous system, like nerves to the bowels or heart.
• Focal neuropathy is the fourth type, and like the name implies, it is when the damage is limited to a single nerve or nerve groups.

Definition

Neuropathy is a condition that refers to various diseases that affects the nerves of the body.

Cause

It is caused by a number of factors like diabetes, vitamin deficiency, infections and inherited disorders. Other causes include injuries, kidney disease, liver disease, drugs, poisons and long term use of alcohol.

Signs and symptoms

Common symptoms of neuropathy are pain, feeling of numbness, tingling sensation also known as ‘pins and needles’ sensation and in some cases, ulcers might develop like in diabetes. Other symptoms are erectile dysfunction, increased heart rate, constipation, nausea, vomiting, blurred vision, blindness and deafness depending on the nerves affected.

Diagnosis

Diagnosis involves a lot of laboratory tests to check the level of sugar and vitamins, to ascertain the kidney and liver function, to know the blood level and to screen for cancers. Some other tests will also be done to check the electrical activity of nerves and the blood supply to affected areas

Treatment

Treatment involves managing the cause of the neuropathy. It also involves reducing the pain felt by patients via a number of methods. In some patients, surgery might be indicated.

1. Bejaoui K, Wu C, Scheffler MD, et al. SPTLC1 is mutated in hereditary sensory neuropathy, type 1. Nat Genet. Mar 2001;27(3):261-2
2. Ohto T, Iwasaki N, Fujiwara J, et al. The evaluation of autonomic nervous function in a patient with hereditary sensory and autonomic neuropathy type IV with novel mutations of the TRKA gene.Neuropediatrics. Oct 2004;35(5):274-8.
3. Stewart JD, Low PA, Fealey RD. Distal small fiber neuropathy: results of tests of sweating and autonomic cardiovascular reflexes. Muscle Nerve. Jun 1992;15(6):661-5.
4. Clements RS Jr, Flint MA. Coping with autonomic neuropathy. J Diabet Complications. Jul-Sep 1988;2(3):130-2.
5. Zochodne DW. The autonomic nervous system in peripheral neuropathies. Handbook of Clinical Neurology. 2000;75(31):681-712.
6. Pickett JB 3rd. AAEE case report #16: Botulism. Muscle Nerve. Dec 1988;11(12):1201-5.
7. Gibbons CH, Freeman R. Autonomic neuropathy and coeliac disease. J Neurol Neurosurg Psychiatry. Apr 2005;76(4):579-81.
8. Suarez GA, Opfer-Gehrking TL, Offord KP, et al. The Autonomic Symptom Profile: a new instrument to assess autonomic symptoms. Neurology. Feb 1999;52(3):523-8.
9. England JD, Gronseth GS, Franklin G, Carter GT, Kinsella LJ, Cohen JA, et al. Practice Parameter: evaluation of distal symmetric polyneuropathy: role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review). Report of the American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Neurology. Jan 13 2009;72(2):177-84.
10. Modoni A, Mirabella M, Madia F, Sanna T, Lanza G, Tonali PA, et al. Chronic autoimmune autonomic neuropathy responsive to immunosuppressive therapy. Neurology. Jan 9 2007;68(2):161-2.