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2.1
Peripheral Polyneuropathy

Presentation

We have discussed the possibility of aluminium phosphide poisoning in view of the clinical presentation. [ncbi.nlm.nih.gov]

It manifests in 3 stages and asthma seems to present years before the other symptoms do. [elsevier.es]

Entire Body System

  • Pain

    Treatment of painful neuropathy should be directed at removing the offending metabolic injury, if possible. [ncbi.nlm.nih.gov]

    Diabetic neuropathy commonly causes painful tingling or burning sensations in the hands and feet—a condition called distal polyneuropathy. Pain is often worse at night and may be aggravated by touch or by a change in temperature. [msdmanuals.com]

    During this visit, he reported having a burning chest pain which made it difficult to breathe. The pain was daily and continuous, although it improved when lying down, and became more intense in the evening. [archbronconeumol.org]

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

    " 20 Mar. 2018 The spiky shoe inserts mimic peripheral neuropathy, the numbness and pain from nerve damage that often affects hands and feet. — Tara Bahrampour, The Seattle Times, "Loud banging, foot pain, flashes of light: a reporter’s 8 minutes as [merriam-webster.com]

  • Severe Pain

    Changes in sensation — Some people feel severe pain, especially at night, and some are unable to feel pain, pressure, temperature, or touch. Loss of coordination. Loss of reflexes. Burning sensation. [my.clevelandclinic.org]

    Referral to specialist pain services or a relevant clinical specialty should be considered at any stage if: pain is severe pain significantly limits daily activities and quality of life an underlying health condition is getting worse Symptoms Symptoms [medicalnewstoday.com]

    (ex, baclofen) An analgesic (ex, ketamine) A steroid for short-term use Lidocaine patches Capsaicin cream (made from chili pepper extract) Opioids or narcotics for severe pain A gentle laxative for constipation Your doctor may recommend some dietary [nccn.org]

  • Epilepsy

    They are also anticonvulsants (drugs used to treat epilepsy). Other anticonvulsants and antidepressants are also used to treat nerve pain. [macmillan.org.uk]

    Many of these medications may also be used for treating other conditions, such as depression, epilepsy, anxiety or headaches. If you're given an antidepressant, this may treat pain even if you're not depressed. [nhsinform.scot]

    Your doctor may prescribe medication that is used to treat other medical problems, such as epilepsy (anti epileptic drugs) or depression, but can have an effect on neuropathic pain. [leukaemia.org.au]

    Drug treatment for neuropathic pain Medications that may help include: drugs normally used for epilepsy, such as carbamazepine antidepressants, such as venlafaxine opioid painkillers, for example, oxycodone or tramadol Opioid painkillers come with warnings [medicalnewstoday.com]

    Medications such as gabapentin (Gralise, Neurontin, Horizant) and pregabalin (Lyrica), developed to treat epilepsy, may relieve nerve pain. Side effects can include drowsiness and dizziness. Topical treatments. [mayoclinic.org]

  • Impaired Balance

    Additionally, motor neuropathy may cause impaired balance and coordination or, most commonly, muscle weakness; sensory neuropathy may cause numbness to touch and vibration, reduced position sense causing poorer coordination and balance, reduced sensitivity [en.wikipedia.org]

Musculoskeletal

  • Muscle Spasm

    […] are affected you may have: Muscle weakness (trouble turning a knob) Muscle cramping Muscle spasms Problems with balance It may not be possible to prevent nerve damage. [uihc.org]

Skin

  • Ulcer

    Loss of sensation increases risk for foot injury, delays treatment and can lead to foot and leg ulceration and infections. Ulcers and infections may eventually lead to amputation of the lower extremities. [effectivehealthcare.ahrq.gov]

    Diabetic foot ulcer A diabetic foot ulcer is an open wound or sore on the skin that's slow to heal. These are common in people with diabetic polyneuropathy. If you have numb feet, it's easy to cut your foot by stepping on something sharp. [nhsinform.scot]

    If the underlying cause of peripheral neuropathy is not treated, you may be at risk of developing potentially serious complications, such as a foot ulcer that becomes infected. [nhs.uk]

    In the U.S., diabetic neuropathy is the main cause of foot problems and ulcers in people with diabetes. Around half of all people with diabetes are believed to have diabetic neuropathy. [medicalnewstoday.com]

    Diabetic neuropathy often involves the feet and legs and is responsible for lack of sensation, foot ulcers, and infections. [jamanetwork.com]

  • Hyperhidrosis

    […] vibration and proprioception Ataxia Clumsiness Areflexia Hypotonia "Tingling" "Pins and needles" Sensory (Small Fiber) Sensory loss to pain and temperature "Burning" "Stabbing" Autonomic Postural hypotension Anhidrosis Impotence Bowel or bladder disturbance Hyperhidrosis [casemed.case.edu]

    […] peripheral neuropathy may be treatable with medication, such as: erectile dysfunction constipation the slow movement of food through your stomach (gastroparesis) In some cases, you may need more invasive treatment, such as botulinum toxin injections for hyperhidrosis [nhsinform.scot]

    This is most often secondary to anhidrosis in the limbs and thorax and reflects compensatory hyperhidrosis in the restricted areas that maintain normal sweating. [clevelandclinicmeded.com]

  • Decreased Sweating

    Decreased sweating. Problems with urination. Sexual dysfunction. Diarrhea. Weight loss (unintentional). Dizziness when standing up or fainting. Nausea or vomiting. Problems with digestion. Cleveland Clinic News & More [my.clevelandclinic.org]

Neurologic

  • Guillain-Barré Syndrome

    Little is known about sexual function in women with amyloidosis, Guillain-Barré syndrome, or porphyria. Even for the world's most common peripheral polyneuropathies such as diabetes mellitus, knowledge and consensus are still lacking. [ncbi.nlm.nih.gov]

    Charcot-Marie-Tooth disease is an inherited nerve disease and Guillain-Barré syndrome is a condition where there is inflammation of the peripheral nerves. [cochrane.org]

    Inflammatory Infectious (with a specific casual agent identified) Lyme disease HIV / AIDS Leprosy Herpes Zoster (Shingles) Hepatitis B Hepatitis C Autoimmune or possibly infectious (but with no specific causal infectious agent identified) Sarcoidosis Guillain-Barré [peripheralneuropathycenter.uchicago.edu]

    If the protein level in the fluid is high and few or no white blood cells are present, the cause may be an autoimmune disorder that causes demyelination, such as Guillain-Barré syndrome. [msdmanuals.com]

    Some research focuses on immune system peripheral nerve damage, such as seen in Guillain-Barré syndrome. [childneurologyfoundation.org]

  • Areflexia

    If two of the following four criteria, i.e. complaints of polyneuropathy, neurophysiological changes compatible with polyneuropathy, distal symmetrical areflexia, or distal symmetrical anesthesia for vibration sense, temperature or blunt-sharp discrimination [ncbi.nlm.nih.gov]

    Signs and Symptoms of Peripheral Nerve Disease Nerve Type Negative Positive Motor Weakness Atrophy Clumsiness Areflexia Hypotonia Deformities (pes cavus, kyphoscoliosis) Fasciculations Myokymia Cramps Sensory (Large Fiber) Sensory loss to vibration and [casemed.case.edu]

    […] mainly affects the lungs, followed by the skin and the PNS (80%). 2,3 When the PNS is affected, patients experience paraesthesia and dysaesthesia predominantly on the soles of the feet, hiccups, loss of strength, or patellar tendon and Achilles tendon areflexia [elsevier.es]

    Brisk reflexes point to a central cause, whereas hyporeflexia or areflexia suggest a peripheral problem. [rcemlearning.co.uk]

  • Hyporeflexia

    Brisk reflexes point to a central cause, whereas hyporeflexia or areflexia suggest a peripheral problem. [rcemlearning.co.uk]

    Hyporeflexia is also rare except in the ankles. In fact, tendon reflexes other than at the ankle are lost only if the femoral, musculocutaneous, or radial nerves are affected proximally [ 12, 18, 19 ]. [intechopen.com]

  • Sciatica

    "Which pain medications are effective for sciatica (radicular leg pain)?". BMJ. 359 : j4248. doi : 10.1136/bmj.j4248. PMID 29025735. ^ "Which painkiller?". nhs.uk. 2018-04-26. [en.wikipedia.org]

    Multifocal Peripheral Neuropathies Focal or multifocal peripheral neuropathies include: Carpal tunnel syndrome (caused by pressure on the nerve due to inflammation from repetitive stress), or other so-called “entrapment” syndromes Radiculopathies, including sciatica [neuromodulation.com]

  • Confusion

    Common side effects of tramadol include: nausea dizziness constipation sweating dry mouth confusion headache vomiting [hse.ie]

Workup

An extensive workup for various infectious, autoimmune and other possible aetiologies was carried out to identify the underlying cause for his fulminant illness. [ncbi.nlm.nih.gov]

Clinical Algorithm: Athena Diagnostics offers CMT Advanced Evaluations organized by inheritance pattern (dominant, recessive, or unknown) and electrodiagnostic workup (demyelinating, axonal, or inconclusive). [athenadiagnostics.com]

When a hospitalist identifies this pattern and confirms the comorbid condition of diabetes or alcohol use, further workup may be needed (but, again, can be referred to an outpatient setting). [acphospitalist.org]

(See Workup.) Management of diabetic neuropathy should begin at the initial diagnosis of diabetes. [emedicine.medscape.com]

Treatment

He was started on remission induction treatment with prednisone dosed at 1 mg/kg/day and intravenous bolus cyclophosphamide as well as symptomatic treatment. After a few days, eosinophilia disappeared and respiratory symptoms improved progressively. [elsevier.es]

Treatment of painful neuropathy should be directed at removing the offending metabolic injury, if possible. [ncbi.nlm.nih.gov]

This treatment should be maintained during the subacute phase, and after 6 to 8 weeks, the treatment should be tapered progressively. [intechopen.com]

Epothilones are used in the treatment of advanced breast cancer. [onlinelibrary.wiley.com]

Other types of cancer treatments can also cause peripheral neuropathy. What Cancer Treatments Cause Peripheral Neuropathy? Drugs for cancer treatment are the most common cause of peripheral neuropathy. [nccn.org]

Prognosis

Prognosis The prognosis for patients suffering from peripheral neuropathy depends to a large extent on whether an underlying cause can be identified and treated. [brainfoundation.org.au]

More than 100 types of peripheral neuropathy have been identified, each with its own characteristic set of symptoms and prognosis. Impaired function and symptoms depend on the type of nerves that are damaged. [childneurologyfoundation.org]

What You Need to Know There are more than 100 types of peripheral neuropathy, each with its own set of symptoms and prognosis. Peripheral neuropathy has many different causes. [hopkinsmedicine.org]

More than 100 types of peripheral neuropathy have been identified, each with its own characteristic set of symptoms, pattern of development, and prognosis. [news-medical.net]

Prognosis & Followup strategies Prognosis and follow-up The prognosis of a peripheral neuropathy clearly depends on its aetiology. [rcemlearning.co.uk]

Etiology

Treatment of DSP depends on the underlying etiology. Vitamin deficiencies should be corrected and metabolic or autoimmune etiologies addressed as appropriate. There are multiple pharmacologic options for treating persistent pain or discomfort. [mdedge.com]

Despite an extensive evaluation, in approximately half of patients no etiology is ever found; these patients typically have a predominately sensory polyneuropathy and have been labeled as having idiopathic or cryptogenic sensory polyneuropathy (CSPN). [accessmedicine.mhmedical.com]

An relapsing/remitting course suggests an autoimmune etiology or an intermittent exposure. A step-wise progression course suggest a mononeuropathy multiplex pattern. [casemed.case.edu]

With a systematic approach to the evaluation of these disorders, approximately 75% of patients have a specific etiologic diagnosis. [clevelandclinicmeded.com]

That said, when it comes to peripheral neuropathy, it is important to be aware of the array of potential etiologies beyond diabetes in order to ensure accurate diagnosis and effective treatment. [podiatrytoday.com]

Epidemiology

A blinded epidemiological survey was performed in 13 retired, long-term Cd-exposed workers and 19 age-matched controls. Historical Cd biomonitoring data were available over the last two decades. [ncbi.nlm.nih.gov]

This Primer summarizes the epidemiology, mechanisms, diagnosis and treatment of diabetic nephropathy and discusses the quality-of-life issues faced by patients. Eva L. Feldman, Brian C. Callaghan, Rodica Pop-Busui, Douglas W. Zochodne, Douglas E. [nature.com]

Epidemiology of peripheral neuropathy associated with connective tissue diseases and its topographic distribution PN is one of the clinical features of CTD with variable frequency and prognosis. It is often seen in the course of the disease. [intechopen.com]

Quantitative sensation testing in epidemiological and therapeutic studies of peripheral neuropathy. Muscle Nerve. 1999 Jun. 22(6):659-62. [Medline]. Pirart J. [emedicine.medscape.com]

Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in Type 1 diabetes: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications. [scielo.br]

Pathophysiology

Anti-GM1 IgM was significantly elevated in his serum during the acute phase, which suggested that it was related with the pathophysiology in this patient. [ncbi.nlm.nih.gov]

Churg–Strauss syndrome: update on pathophysiology and treatment. Curr Opin Rheumatol, 24 (2012), pp. 24-30 Please cite this article as: Bonaventura Ibars I, de Francisco Moure J, Pineda Barrero S, Rodriguez Carballeira M, Saura Salvado J. [elsevier.es]

Small fiber neuropathy in fabry disease: A review of pathophysiology and treatment. J Inborn Errors Metab Screen. 2016;4:1-5. DOI: 10.1177/2326409816661351 [ Links ] 21. Stüve O, Zettl U. [scielo.org.co]

Their presentation varies depending on the underlying pathophysiology. The speed of progression of the polyneuropathy coupled with its nature (axonal or demyelinating) can help identify its aetiology. [rcemlearning.co.uk]

Back to Top Pathophysiology and Natural History Despite the diverse array of medical disorders that cause peripheral neuropathies, peripheral nerves exhibit only a few distinct pathologic reactions to an insult or disease: wallerian degeneration, axonal [clevelandclinicmeded.com]

Prevention

Can Peripheral Neuropathy be Prevented? There is no proven way to prevent nerve damage in patients undergoing treatment. It probably helps to give less of the cancer drug. [nccn.org]

Peripheral Neuropathy Prevention Lifestyle choices can play a role in preventing peripheral neuropathy. [hopkinsmedicine.org]

Eat a healthy diet to prevent vitamin deficiency. Do not smoke as it reduces your circulation. Support Peripheral neuropathy can be hard to live with both physically and emotionally. It can reduce your mobility and prevent you from working. [cancer.ie]

such as foot care for prevention of foot ulcers, as well as exercise and balance training for the prevention of falls. [effectivehealthcare.ahrq.gov]

How Do I Prevent Neuropathy? Neuropathy is preventable only to the extent that the underlying condition or cause is preventable. [emedicinehealth.com]

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