The list of substances that may cause toxic polyneuropathy is quite long with some of the most important being [1] [2] [3] [4] [5] [6]:

• Therapeutic drugs - Chemotherapeutics, lithium, antimicrobial agents (isoniazid, metronidazole, nitrofurantoin), cardiovascular (amiodarone, digoxin, hydralazine, nitroprusside), vinca alkaloids, misoprostol, and phenytoin are listed as some of the most common drugs that might induce toxic polyneuropathy [1] [3] [4] [6].
• Occupational pollutants and substances - Heavy metals (arsenic, lead, thallium, mercury) and a number of industrial agents (ethylene oxide, organophosphates, hexacarbons, acrylamide, and several other) [1] [2] [7].
• Drugs of abuse - Alcohol and heroin are the two main substances of abuse that can cause polyneuropathy [1] [6].

The clinical presentation, usually appearing weeks after exposure to the harmful agent, is centered around two main components - sensory and motor deficits [1] [4]. A tingling sensation or numbness in the distal extremities is considered to be one of the first signs of sensory involvement, particularly after the use of chemotherapeutic drugs, which may lead to disturbances in gait, pruritus, and moderate to severe sharp pain [5]. Conversely, motor weakness, typical for heavy metal exposure, manifests as weakness in the extremities (eg. wrist drop) and loss of deep tendon reflexes [1] [5].

• Peripheral Neuropathy

  Textbook of Peripheral Neuropathy is a practical but authoritative reference for clinicians in any medical specialty who are evaluating and treating patients with signs and symptoms of a peripheral neuropathy. [books.google.de]

  Peripheral Neuropathy The term peripheral neuropathy is frequently used interchangeably with the terms neuropathy and polyneuropathy. [innovationsstemcellcenter.com]

  Peripheral neuropathy can be divided into: Acute peripheral neuropathy - this a neuropathy of sudden, or rapid, onset. Chronic peripheral neuropathy - this develops more gradually and becomes persistent. Most peripheral neuropathy is chronic. [patient.info]

  Peripheral neuropathy is the most common neurological complication in patients with HIV/AIDS with an estimated incidence of nearly one-third of all people with HIV/AIDS: For patients with HIV/AIDS, peripheral neuropathy can be caused by the virus itself [atmph.org]

  Peripheral Nerve Disorders Also called: Neuritis, Peripheral neuritis, Peripheral neuropathy Your peripheral nerves are the ones outside your brain and spinal cord. [icdlist.com]

• Hand Tremor

  Lead toxic polyneuropathy (ICD code 10 - G62.2) is expressed in the patient in the form of lethargy, high fatigue, "dull" headache, loss of memory and attention, encephalopathy, anemia, colitis, pain in the limbs, hand tremor. [acikgunluk.net]

Numerous symptoms involving different systems, including additional neurological manifestations, can be present along with the polyneuropathy, such as gastrointestinal irritation (heavy metal exposure), anemia and constitutional complaints [1] [6]. For this reason, a meticulous clinical workup is necessary. Physicians must obtain a complete patient history that will assess the patient's occupation (and to which substances the individual is exposed), presence of underlying diseases (as several systemic and metabolic diseases can present with polyneuropathy, such as hypothyroidism and diabetes mellitus), and history of alcohol and substance abuse [1] [6]. Additionally, a thorough nutritional evaluation must be conducted, keeping in mind that several vitamin deficiencies (thiamine, B6, B12, and also copper) might manifest as a polyneuropathy [1] [6]. History of drug use, however, is the main focus of history taking. Furthermore, a detailed physical examination, focusing on the neurological system (reflex and sensory perception testing, as well as coordination and proprioception) will confirm the extent of peripheral nerve involvement and possibly detect other neurological symptoms that might lead the physician to a presumptive diagnosis [1] [5]. Laboratory studies should be employed later on, including a complete blood count (CBC), a full metabolic panel, serum inflammatory markers (erythrocyte sedimentation rate, or ESR), serum glucose, vitamin B12, thyroid hormone levels, and urinalysis, which is particularly useful for heavy metal exposure [1] [6] [8]. When the diagnosis is inconclusive, nerve conduction studies and electromyography might be performed [5].

• Lymphocytic Infiltrate

  The muscles showed denervation atrophy and focal degenerative myopathic changes, with presence of lymphocytic infiltrates and phagocytosis. [ncbi.nlm.nih.gov]

Features of the treatment of the disease Toxic polyneuropathy, the treatment of which primarily comes down to eliminating the causes of its occurrence, should be considered comprehensively. [acikgunluk.net]

Treatment Treatment for diabetic neuropathy focuses on pain management, sugar control and supportive services. There are several medications and other treatments that help alleviate tingling and burning pains. [umm.edu]

Treatment Treatment options for HIV-related and drug-induced DSP are limited and challenging to practicing physicians particularly in the prevailing situation in the developing world where access to ART is limited and changing regimens may be difficult [atmph.org]

Treatment of diabetic neuropathy (polyneuropathy) and alcoholic polyneuritis Treatment of diabetic and alcoholic neuropathy (polyneuropathy, polyneuritis) chosen individually in each case. [minclinic.ru]

In case of cisplatinum, the abnormalities can still keep developing after quitting the treatment. Fortunately, in case of neuropathy due to anti-cancer medicine, treatment and recovery is generally possible. [neuropathie.nu]

What is the Prognosis for Drug-Induced Neuropathy? (Outcomes/Resolutions) The prognosis of Drug-Induced Neuropathy is good with adequate treatment and management of the signs and symptoms. [dovemed.com]

Prognosis  Each patient's prognosis depends on the severity of the neuropathy when exposure is ceased or reduced to levels that will not affect health negatively. 44. [slideshare.net]

The outlook (prognosis) for peripheral neuropathy depends on the underlying cause. In general, if a problem can be identified early and treated successfully, the prognosis is very good. [patient.info]

The prognosis for getting rid of the disease is favorable. Arsenic polyneuropathy Arsenic can penetrate into the human body along with insecticides, medicines, paints. This disease is a professional for smelters. [acikgunluk.net]

[…] affected (large-fiber, small-fiber, or both), the most distal portions of axons are usually the first to degenerate, and axonal atrophy advances slowly toward the nerve's cell body, however if the cause is removed, regeneration is possible, although the prognosis [en.wikipedia.org]

Code First Code First Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]

The etiologic factor in common turned out to be consumption, ritually, of gingili oil, which is used in a ritual at menarch and after childbirth. [popline.org]

This survey provided a crude etiological picture of generalized neuropathy on this island. © 1993 S. Karger AG, Basel Article / Publication Details First-Page Preview [karger.com]

The findings raise the possibility that other acquired polyneuropathies may also be codetermined by genetic etiological factors, of which some may be related to genes already known to cause the phenotypically related Mendelian disorders of CMT. [mayoclinic.pure.elsevier.com]

Progressive ascending motor neuron paralysis of unknown etiology, frequently following an enteric or respiratory infection. [icd9data.com]

Abstract: The epidemiological and clinical aspects of an unusual type of polyneuropathy which reached epidemic proportion in Sri Lanka in 1977-1978 are reported. 20 young women in Sri Lanka were affected by this illness, characterized by pain in the calves [popline.org]

Epidemiological data suggested strongly that methyl N -butyl ketone (MBK) was responsible for the outbreak. [science.sciencemag.org]

Lead  Epidemiology of lead toxicity  Common in children: Especially black non-hispanic children (22%)  Most common in homes built from 1920 to 1950  Identical twins often have concordant lead levels  Lead neuropathy: Especially from industrial exposure [slideshare.net]

Causation and causal inference in epidemiology. Am J Public Health 95 (Suppl 1): S144–50, 2005. Dalakas MC. Peripheral neuropathy and antiretroviral drugs. J Periph N Syst 6:14-20, 2001. Gaist D, Jeppesen U, Anderson M, et al. [now.aapmr.org]

Some of these have been associated with neuropathy in clinical epidemiologic studies, confirming their ability to injure the human peripheral nervous system (PNS). [emedicine.medscape.com]

[ edit ] In regards to the pathophysiology of polyneuropathy, of course, the former depends on which polyneuropathy. [en.wikipedia.org]

Because pathophysiology and symptoms are related, polyneuropathies are often classified by area of dysfunction: Myelin Vasa nervorum Axon Polyneuropathies may be acquired or inherited. [merckmanuals.com]

Pathophysiology Although peripheral neuropathy has multiple etiologies, the nerve has a limited number of ways to respond to injury. 4, 5 The damage can occur at the level of the axon (i.e., axonopathy). [aafp.org]

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]

Pathophysiology Neuropathy may be categorized by presentation (ie, motor or sensory symptoms), electrodiagnostic features, and neuroanatomical location within the peripheral nerve (ie, demyelinating or axonal, neuronopathy, ion channel neuropathy, neuromuscular [emedicine.medscape.com]

Knowledge of the pathogenesis, genetics, and molecular biology of neuromuscular disorders is essential both in developing and applying new therapies and preventive measures, and in formulating genetic and prognostic advice. [books.google.de]

This may improve your symptoms and help prevent further nerve damage. [healthline.com]

Prevention Peripheral neuropathies are preventable only to the extent that the underlying causes are preventable. [encyclopedia.com]

Prevention Manage underlying conditions The best way to prevent peripheral neuropathy is to manage medical conditions that put you at risk, such as diabetes, alcoholism or rheumatoid arthritis. [mayoclinic.org]

1. Staff NP, Windebank AJ. Peripheral Neuropathy Due to Vitamin Deficiency, Toxins, and Medications. Continuum (Minneap Minn). 2014;20(5 Peripheral Nervous System Disorders):1293-1306.
2. Ratnaike RN. Acute and chronic arsenic toxicity. Postgrad Med J. 2003;79(933):391– 396.
3. Marchettini P, Lacerenza M, Mauri E, Marangoni C. Painful Peripheral Neuropathies. Curr Neuropharmacol. 2006;4(3):175-181.
4. Ludolph AC, Spencer PS. Toxic neuropathies and their treatment. Baillieres Clin Neurol. 1995;4(3):505-527.
5. Grisold W, Cavaletti G, Windebank AJ. Peripheral neuropathies from chemotherapeutics and targeted agents: diagnosis, treatment, and prevention. Neuro Oncol. 2012;14(4):iv45-iv54.
6. Azhary H, Farooq MU, Bhanushali M, Majid A, Kassab MY. Peripheral neuropathy: differential diagnosis and management. Am Fam Physician. 2010;81(7):887-892.
7. Krishnan AV, Phoon RK, Pussell BA, et al. Ischaemia induces paradoxical changes in axonal excitability in end-stage kidney disease. Brain. 2006;129(pt 6):1585– 1592.
8. Willison HJ, Winer JB. Clinical evaluation and investigation of neuropathy. J Neurol Neurosurg Psychiatry. 2003;74(2):ii3–ii8.