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