Post on 09-Apr-2018
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Neuropathy By:Rey Martino
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DefinitionDefinition
a disease or injury of the peripheralsensory, motor, or autonomic nerves.
Category: Neuronopathy : selective injury to the cell body of
the axon
Radiculopathy : selective injury to the nerve rootsdistal to their origin
Plexopathy : injury to the brachial or lumbosacralplexus
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ClassificationClassification
1) Onset of neuropathy
Acute : Acute Idiopathic Polyneuropathy
C
hronic : DM, Leprosy
2) Severity
Mild : Sensory only, motor only
Moderate : Sensory, motor & tendon reflexes
Severe : Sensory, motor & tendon reflexes,muscle atrophy
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3) Number of nerves involved
Mononeuropathy simplex Only one peripheral nerve involved
Mononeuropathy multiplex (multifocalneuropathy)
Multiple scattered nerve in an irregular distribution
Polyneuropathy Several nerves are involved, symmetrical, same onset & distalpredominant
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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
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EtiologyEtiology
1) Idiopathic Inflammatory Neuropathies Acute Idiopathic Polyneuropathy (GBS)
Chronic inflammatory Demyelinating Polyneuropathy
2) Metabolic & Nutritional Neuropathies
DM, Uremia, liver diseases, Vit. B12 deficiencies
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3) Infective & GranulomatousNeuropathies
AIDS, Leprosy, Diptheria, Sarcoidosis
4) Vasculitis Neuropathies
Polyartheritis Nodosa, Rheumatoid Arthritis,SLE
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5) Neoplastic & ParaproteinemicNeuropathies
Compression & irritation by tumor, Paraneoplasticsyndrome, Paraproteinemias, Amyloidosis
6) Drug induced & toxic neuropathies
Dapsone, Isoniazide, Phenytoin, Hydralazine
Alcohol
Toxic: organophosphate, arsenic, lead
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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
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PathogenesisPathogenesisCan 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 pointbelow the cell body, with degeneration distal to the injury.
3) Axonal degeneration : diffuse axonal damage. The distal portionundergoes 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 injuryto the axon
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PathogenesisPathogenesis
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ClinicalClinical symptomssymptoms1) Sensory symptoms
Involvement of sensory axons produces impairment of sensation withdysesthesias or paresthesias.
2) Motor symptoms
Involvement of motor axons produces muscle wasting and weaknessfollowed by atrophy and fasciculations; LMN type muscle weakness, footdrop, wrist drop
3) Change of tendon reflexes tendon reflexes supplied by the affected nerve are depressed or absent;
decreased or absent of tendon reflexes
1) Autonomic Involvement of axons supplying autonomic function produces loss of sweating,
alteration in bladder fuction, constipation, and impotence in male
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DiagnosisDiagnosis
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 electricalactivity in muscles), NCV (a recording of the speedat which signals travel along nerves)
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TreatmentTreatment
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-seizuremedications (gabapentin, topiramate, pregabalin,
carbamazepine and phenytoin)
Lidocaine patch
Antidepressants (Tricyclic antidepressantmedications, such as amitriptyline
and nortriptyline ) Transcutaneous electrical nerve stimulation (TENS)
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ComplicationsComplications
The inability to feel or notice injuries can lead to infection or damage to
the affected part of the body, including: Defor mity
Loss of tissue mass
Poor healing
Scarring
Tissue erosions
Other complications include: Decreased self-esteem
Difficulty breathing
Difficulty swallowing Irregularheart rhythms (arrhythmias)
Need for amputation
Partial or complete loss ofmovement or control ofmovement
Partial or complete loss of sensation
Relationship problems related to impotence
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PreventionsPreventions
take appropriate measures (such as padding vulnerable parts of thebody) beforehand to reduce the risk of nerve problems
Avoid spending a long period of time in one position (for example, afterdrinking too much alcohol) or doing certain kinds of repetitivemovements (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, ifyou have them
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ThankThank youyou