Peripheral neuropathy

1- Ethyl Polyneuropathy:

direct toxicity of alcohol; vitamin deficiency B1 (thiamine), B6 (pyridoxine), PP (niacin) and folate. Sensorimotor the lower limbs. Abolition of the Achilles contrasting with a vivacity of patella (at first). No Korsakoff syndrome sphincter disorders. retrobulbar optic neuropathy; increased GGT and MCV.

2- Toxic neuropathies:

* Lead: mainly motor impairment; beginner multiple mononeuropathy the upper limbs (especially pseudo-radial)

* Arsenic: sensorimotor distal axonopathy

* Mercury: ganglionpathie; reduction of the visual field; ataxia (especially tremor)

* Drugs: vincristine, cisplatin, isoniazid (distal sensory axonopathy per share on vitamin B6), metronidazole, nitrofurantoin, chloroquine, lithium, gold salts, D-penicillamine, amiodarone (demyelinating), pyridoxine (vitamin B6) …

3- Diabetic neuropathy:

* The sensory polyneuropathy is by far the most common presentation; it is a chronic axonal polyneuropathy, symmetrical, which usually occurs in patients with diabetes whose evolving for over 5 years. Achieving predominates on painful and thermoalgiques terms (small diameter myelinated fibers and unmyelinated fibers). Achilles areflexia is common;

* There is often a hyperprotéinorachie

* An autonomic dysfunction is often associated: gastroparesis, diarrhea, orthostatic hypotension, impotence, bladder dysfunction,

* The focal and multifocal neuropathies are rare and can hit every nerve trunks

* The cranial nerves are often affected especially the III and VI

* A painful and amyotrophiante the femoral nerve damage is common (good prognosis)

4- endocrine neuropathy:

Peripheral neuropathy* Acromegaly and hypothyroidism can cause a carpal tunnel syndrome by local infiltration

* In rare cases, hypothyroidism can cause polyneuropathy

* Rare neuropathies can be observed during severe hyperlipidemia

5- Neuropathies of kidney failure:

This is usually a axonopathy distal sensory-motor; kidney transplantation has a beneficial effect; IR will now trains rarely neuropathy in patients on dialysis.

6- Infectious Neuropathies:

* HIV: HIV serology now part of the record of first intension of peripheral neuropathy (concerns ⅓ of patients). acute inflammatory demyelinating polyneuropathy (with hypercytorachie); Multiple mononeuropathy (necrotizing vasculitis);distal axonal polyneuropathy

* Borreliose: table méningoradiculonécrite (Lyme disease)

* Leprosy: Hansen’s bacillus (Mycobacterium leprae)

* Diphtheria: a similar clinical picture to Guillain-Barre syndrome; lymphocytic meningitis is usually associated.

* Infectious mononucleosis: Guillain-Barré syndrome; mononeuritis; sensory neuropathy

7- Neuropathies related to cancer:

* Denny-Brown syndrome (paraneoplastic sensory neuropathy): painful sensory neuropathy, subacute evolution with ataxia, areflexia, and sometimes dysautonomia. There is often elevated protein; most often small cell carcinoma of the lung (which precedes his discovery)

* Neuropathy sensorimotor paraneoplastic: Type Guillain-Barré (Hodgkin’s lymphoma)

* Radiation neuropathy

8- Hematologic:

* Lymphomas: axonal sensorimotor neuropathy, often painful and asymmetric

* Leukemia (especially lymphoid) by neoplastic infiltration

* Dysglobulinémies: ataxic sensory neuropathy with preferential involvement of myelinated fibers of large diameter.

* PAN: frequently reaches the peripheral nervous system

* Other: LED; PR; Sjögren’s syndrome

9- Other causes:

* Disease Charcot-Marie-Tooth: common characteristic: peroneal muscular atrophy; The predominant motor impairment

* Sarcoidosis: peripheral facial paralysis +++

* System disease: PAN; LED; PR

NB: vitamin B6 deficiency is not the cause of peripheral neuropathy that during prolonged treatment with isoniazid.

ADDITIONAL TESTS :

A- LCR:

Hyperprotéinorachie -> 2 etiologies: diabetes and polyneuropathy. lymphocyte reaction in meningoradiculitis (HIV serology and Lyme disease).

B- EMG:

* If axonal damage -> lower amplitudes of action potentials with respect for nerve conduction velocities

* If demyelinating reached: decreased nerve conduction velocities (observed amplitudes); prolonged distal latencies;conduction blocks.

C- SEROLOGY:

* HIV serology: Systematic

* Hepatitis B: in a context of multiple mononeuropathy if nodosa is suspected

* Hepatitis C: before a mononeuropathy or multiple sensory axonal neuropathy especially in cases of cryoglobulinemia

* Campylobacter jejuni: If Guillain Barré syndrome suspected

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Editor-in-chief of the Medical Actu website; general practitioner graduated from the Faculty of Medicine of Algiers in 2005 currently practicing as a liberal.

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