At the top of any UK/US list of causes must be diabetes and alcohol, worldwide think leprosy
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Aetiology
Different forms Comments
Wallerian Degeneration The nerve for one reason or other is transected. There is both a myelin and axonal type neuropathy. The nerve distal to the injury dies off and must regrow proximal to distal usually with variable success
Axonal degeneration Usually toxic, metabolic, nutritional. The largest and longest nerves are the most vulnerable. Tends to the affected distal nerve first and the nerve dies back. Consider diabetes as the commonest cause or toxins.
Demyelination Loss of myelin with preservation of the axon. Can be patchy with the early loss of reflexes. Can be due to Schwann cell damage or an attack on the myelin sheath. Examples include GBS and CIDP.
Neuronal cell body disease Anterior horn cell e.g. Polio Motor weakness or motor neuron disease or some paraneoplastic syndromes Dorsal root ganglion sensory loss affected in paraneoplastic disease and Sjogren's syndrome
Different patterns Comments Polyneuropathy often synonymous with peripheral neuropathy with a distal glove and stocking sensory and/or distal motor loss. These can be axonal like Diabetes where the neuronal cell body is intact. Alternatively, there are diseases where the primary pathology is demyelination. In some, the cell body is affected e.g. Polio and MND. The commonest causes are diabetes and pre-diabetes, B12/folate deficiency, alcohol, Lyme disease. Comprehensive list. Mononeuropathy single nerve affected. Diphtheria and Diabetes and nerve compression Mononeuritis multiplex several different nerves affected simultaneously or sequentially. Vasculitis Autonomic neuropathy affects the non-voluntary, non-sensory nerves. Diabetes, Amyloidosis, Porphyria, Paraneoplastic neuropathy, Lymphoma, Heavy metals, Thiamine deficiency
Vincristine toxicity, GBS, Alcoholic neuropathy
Acute pandysautonomia Abrupt onset Ischaemic neuropathies, PAN, RA, Diabetes (Cranial and amyotrophy), Nerve compression, HIV/AIDS Cranial nerves Often bilateral LMN VII : Diabetes mellitus
GBS, HIV/AIDS, Lyme disease, Sarcoidosis, Neoplastic invasion of skull base or meninges, Diphtheria
Causes of Peripheral neuropathy Comments
Diabetes Mellitus (axonal) Symmetrical distal sensory loss, Autonomic Alcohol Distal, symmetric axonal sensorimotor neuropathy. May be painful. Rheumatoid arthritis Distal motor and sensory symmetrical neuropathy Systemic Lupus erythematosus Distal motor and sensory symmetrical neuropathy Paraneoplastic (axonal) Lymphoma, Pure sensory neuropathies, autonomic, Motor neuropathy B12 deficiency (axonal) Mainly proprioceptive loss and loss of ankle jerks, Symmetrical distal sensory loss Vasculitis (axonal) Distal motor and sensory symmetrical neuropathy Uraemia Often in those on renal replacement therapy Cisplatinum Symmetrical distal loss Guillain-Barré Syndrome Distal motor and sensory symmetrical neuropathy, autonomic, Bilateral LMN VIIth. Elevated CSF protein CIDP (demyelinating) Distal motor and sensory symmetrical neuropathy, Bilateral LMN VIIth. Elevated CSF protein HMSN 1 (demyelinating) and HMSN 2 (axonal) Amyloid Autonomic, Distal sensorimotor Paraprotein related Screen for myeloma, MGUS or other haematological malignancies B1 deficiency Pure sensory neuropathies Folate deficiency Pure sensory neuropathies B6 deficiency and excess Porphyria Autonomic Lead Isoniazid Vincristine Pure sensory neuropathies Toxins (axonal) Diphtheria Sarcoid CMT Distal symmetrical senory and motor Lyme disease Bilateral LMN VIIth Leprosy (axonal) Nerve thickening HIV (demyelinating/axonal) Symmetrical distal. Medications used to treat HIV infection also cause a distal symmetric axonal sensorimotor neuropathy. MMN Motor neurone disease Asymmetrical LMN motor weakness Clinical
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First line Investigations
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Management
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Peripheral neuropathy
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