Causes
Hereditary |
Metabolic/endocrine |
Vascular |
Toxic |
Autoimmune |
Paraproteinaemia |
Paraneoplastic disease |
Iatrogenic |
Deficiencies |
Trauma |
Infective |
Compression/entrapment |
Idiopathic |
Negative Symptoms
Loss of feeling, numb, deadness |
Hypeaesthesia |
Hypalgesia |
Positive Symptoms
Pins and needles, tingling, burning |
Paraesthesias |
Dysaesthesias |
Hyperalgesia |
Hypeaesthesia |
Allodynia |
Other symptoms:
Diminished proprioception
Cramps
Diminished reflexes
Acute Symmetrical Peripheral Neuropathy
Caused by Guillain-Barre syndrome |
Distal paraesthesia and proximal/distal wasting |
1-2 weeks after a GI/respiratory infection |
Schwann cells are attacked by immune cells |
S&S
- Paraesthesia/pain in the limbs |
- Weakness in the limbs (symmetrical) |
- Both proximal and distal muscles affected |
- Facial and bulbar paralysis |
- Reflexes depressed/absent |
- Variable sensory loss - rare |
- Weakness of extraocular muscles -rare |
- Usually affects the lower limbs and works its way up. Treatment needed ASAP before the condition affects the phrenic nerve |
Multiple Mononeuropathy
- Caused by vasculitis (neurological emergency) |
- Treated with steroids |
- RA, SLE, Polyarteritis nodosa should increase suspicion of vasculitis |
Chronic Symmetrical Peripheral Neuro
- Chronic + develops over several months |
- Ask about alcohol consumption, toxin exposure (insecticides,solvents), drugs, carcinoma |
B12 Deficiency
- Demyelinative and axonal - sensory |
- Constant, distal tingling in paraesthesia |
- Glove and stocking- hands before feet |
- Can have distal motor loss |
- Serum B12 levels to be checked |
- Treated by intramuscular injections |
Alcoholic Neuropathy
- Often affects small fibres - primarily sensory |
- Usually starts in the feet - dysaesthesia |
- Painless distal motor neuropathy |
- Refer to GP to be treated with high does of B1 + alcohol programs |
Diabetic Neuropathy
- Burning in the feet - aching, cramping and tingling |
- Worse at night |
- Can present in the hands as erythermalgia |
- Sensory ataxia can be present |
- Urine: Glucose/protein
Haematology: FBC, ESR, B12 folate
Biochemistry: Fasting glucose, TSH, Renal function, liver function |
- Can mimick iatrogenic (cisplatin), neoplasm, Sjorgerns or idiopathic sensory mononeuropathy |
Paraneoplastic syndromes
- Rare, an immune system reaction to a neoplasm/cancerous tumour |
- Affects middle aged to older persons with lung, ovarian, lymphatic or breast cancer |
- Neurological symptoms occur when immune cells attack cells in the nervous system |
- Neurological symptoms = difficulty in walking/swallowing, loss of muscle tone, loss of fine motor coordination, slurred speech, memory loss, vision problems, sleep disturbances, dementia, seizures, sensory loss in the limbs, vertigo |
- Lamber-Eaton, Stiff person syndrome, encephalomyelitis, myasthenia gravis, cerebellar degeneration, limbic/brainstem encephalitis, neuromyotoma, opsoclonus and sensory neuropathy are all neuro paraneoplastic syndromes |
- Treated by steroids (decreases immune response), high dose intravenous immunogloblin, plasmapheresis |
Paraproteinemia
- Excessive amounts of single monoclonal gammagloblin |
- Underlying immunoproliferative disorder |
- Caused by Leukaemias and lymphomas, Myeloma, Waldenström macroglobulinemia, Amyloidosis |
- If no cause found "Monoclonal gammopathy of undetermined siginificance" is used |
Erythromelalgia
- AKA Mitchell's disease, red neuralgia or erthermalgia |
- Blood vessels in lower extremities are blocked and inflammed |
- Symmetrical severe burning pain, skin redness, swelling |
- Triggered by: Heat, alcohol, sugar and melon consumption and exertion |
- Can be primary or secondary
Primary: mutuation of voltage gated sodium channel
Secondary: small fibre peripheral neuropathy, hypercholesterolemia, mushroom/mercury poisoning, some autoimmune disorders |
- Primary suffers often avoid wearing shoes/socks |
Vasculitis
- Inflammation of the blood vessels due to an immune response |
- Inflammation of a vessel can: Narrow it, Close off and stretch and weaken (aneurysm) |
- Fever, swelling, feeling unwell |
- Treated with steroids |
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