Neuropathy: By: Rey Martino
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rey martinoNeuropathy: By: Rey Martino
Uploaded by
rey martinoNeuropathy By:
Rey Martino
Definition
• a disease or injury of the peripheral
sensory, motor, or autonomic nerves.
• Category:
– Neuronopathy : selective injury to the cell body of
the axon
– Radiculopathy : selective injury to the nerve roots
distal to their origin
– Plexopathy : injury to the brachial or lumbosacral
plexus
Classification
1) Onset of neuropathy
– Acute : Acute Idiopathic Polyneuropathy
– Chronic : DM, Leprosy
2) Severity
– Mild : Sensory only, motor only
– Moderate : Sensory, motor & tendon reflexes
– Severe : Sensory, motor & tendon reflexes,
muscle atrophy
3) Number of nerves involved
– Mononeuropathy simplex
• Only one peripheral nerve involved
– Mononeuropathy multiplex (multifocal
neuropathy)
• Multiple scattered nerve in an irregular distribution
– Polyneuropathy
• Several nerves are involved, symmetrical, same onset & distal
predominant
4) Lesion site
– Distal Axonopathy
• Axonal lesion
– Myelinopathy
• Disorder of myelin sheath
– Neuropathy
• disorder of cell body at anterior horn cells, spinal cord or
dorsal root ganglion
Etiology
1) Idiopathic Inflammatory Neuropathies
– Acute Idiopathic Polyneuropathy (GBS)
– Chronic inflammatory Demyelinating Polyneuropathy
2) Metabolic & Nutritional Neuropathies
– DM, Uremia, liver diseases, Vit. B12 deficiencies
3) Infective & Granulomatous
Neuropathies
– AIDS, Leprosy, Diptheria, Sarcoidosis
4) Vasculitis Neuropathies
– Polyartheritis Nodosa, Rheumatoid Arthritis,
SLE
5) Neoplastic & Paraproteinemic
Neuropathies
– Compression & irritation by tumor, Paraneoplastic
syndrome, Paraproteinemias, Amyloidosis
6) Drug induced & toxic neuropathies
– Dapsone, Isoniazide, Phenytoin, Hydralazine
– Alcohol
– Toxic: organophosphate, arsenic, lead
7) Hereditary Neuropathy
– Idiopathic : Hereditary motor & sensory Neuropathies,
familial amyloidosis
– Metabolic : Porphyria, Abetaliproproteinemia
8) Entrapment Neuropathies
– UL : Carpal Tunnel syndrome
(median n.)
– LL : Femoral nerve
Pathogenesis
Can be divided into 4 major categories :
1) Neuronal degeneration : damage to the motor or sensory nerve cell
bodies, with subsequent degeneration
2) Wallerian degeneration : damage to the axon at a specific point
below the cell body, with degeneration distal to the injury.
3) Axonal degeneration : diffuse axonal damage. The distal portion
undergoes the earliest and most severe change followed by gradual
proximal ascent with continued injury (dying back phenomenon)
4) Segmental demyelination : injury to the myelin sheath without
injury to the axon
Pathogenesis
Clinical symptoms
1) Sensory symptoms
– Involvement of sensory axons produces impairment of sensation with
dysesthesias or paresthesias.
2) Motor symptoms
– Involvement of motor axons produces muscle wasting and weakness
followed by atrophy and fasciculations; LMN type muscle weakness, foot
drop, wrist drop
3) Change of tendon reflexes
– tendon reflexes supplied by the affected nerve are depressed or absent;
decreased or absent of tendon reflexes
4) Autonomic
– Involvement of axons supplying autonomic function produces loss of sweating,
alteration in bladder fuction, constipation, and impotence in male
Diagnosis
1) Clinical symptoms & sign
2) Laboratory studies
3) CXR
4) LP
5) ECG
6) Biopsy: sural nerve or radial cutaneous nerve
7) Electrophysiology: EMG(a recording of electrical
activity in muscles), NCV (a recording of the speed
at which signals travel along nerves)
Treatment
• The first goal manage the condition causing your
neuropathy the neuropathy often improves on its own.
• Second goal relieve the painful symptoms.
– Pain relievers
– Anti-seizure medications (gabapentin, topiramate, pregabalin,
carbamazepine and phenytoin)
– Lidocaine patch
– Antidepressants (Tricyclic antidepressant medications, such as amitriptyline
and nortriptyline )
– Transcutaneous electrical nerve stimulation (TENS)
Complications
• The inability to feel or notice injuries can lead to infection or damage to
the affected part of the body, including:
– Deformity
– Loss of tissue mass
– Poor healing
– Scarring
– Tissue erosions
• Other complications include:
– Decreased self-esteem
– Difficulty breathing
– Difficulty swallowing
– Irregular heart rhythms (arrhythmias)
– Need for amputation
– Partial or complete loss of movement or control of movement
– Partial or complete loss of sensation
– Relationship problems related to impotence
Preventions
• take appropriate measures (such as padding vulnerable parts of the
body) beforehand to reduce the risk of nerve problems
• Avoid spending a long period of time in one position (for example, after
drinking too much alcohol) or doing certain kinds of repetitive
movements (in the case of carpal tunnel syndrome).d
• Reduce your risk of neuropathy by:
– Drinking alcohol in moderation
– Following a balanced diet
– Keeping good control over diabetes and other medical problems, if
you have them
Thank you
