Neurology
Fazal-I-Akbar Danish in Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Polyneuropathy:1 Idiopathic.2 Metabolic (diabetes mellitus; uraemia; amyloidosis; porphyria).3 Vitamin deficiency (B1, B6, B12).4 Drugs (INH; nitrofurantoin; vincristine; heavy metals).5 Inflammation (CT disorders); infection (botulism; diphtheria; leprosy; tetanus); malignancy; GB syndrome.6 Compressive neuropathy (e.g. carpal tunnel syndrome).7 Hereditary: a Friedreich’s ataxia.b Charcot–Marie–Tooth’s disease (peroneal muscular atrophy).c Dejerine–Sottas’ disease (hypertrophic interstitial neuritis).
Neuromuscular Disorders
Louis Solomon, David Warwick, Selvadurai Nayagam in Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
Classification by anatomical level and distribution is the simplest. In over 40% of cases no specific cause has been found! Radiculopathy – involvement of nerve roots, most commonly by vertebral trauma, intervertebral disc herniation and nerve root infections like herpes zoster.Plexopathy – e.g. brachial plexus injury or viral infection (neuralgic amyotrophy).Distal neuropathy – involvement of neurons in distinct peripheral nerves: Mononeuropathy – involvement of a single nerve, (e.g. nerve injury, or nerve compression). •■ Multiple mononeuropathy – involvement of several nerves (e.g. leprosy).Polyneuropathy – widespread symmetrical dysfunction (e.g. diabetic neuropathy, alcoholic neuropathy and various hereditary neuropathies).
Peripheral neuropathies
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in Clinical Pain Management, 2008
This predominantly sensory form is the most common type of diabetic neuropathy. Symptoms are variable, but when the polyneuropathy becomes symptomatic the main complaints are persistent and often distressing numbness and tingling. This is often confined to the feet and lower legs and is worse at night. Pain may be a troublesome feature and is felt as aching and deep as if “arising in the bones.” Lancinating pain and burning paresthesiae may also occur. In the early stages, signs are confined to the distal part of the legs and include decreased light touch, pain, and vibration sensation. As the neuropathy progresses, sensory loss may spread to proximal parts, hands, and the trunk. Ankle jerks are decreased or absent and weakness is usually mild. If there is more severe distal motor involvement, other causes of neuropathy need to be excluded.
Eosinophilic granulomatosis with polyangiitis
Published in Postgraduate Medicine, 2023
Despite great improvement of survival, patients with EGPA often suffer from long-term damage or chronic symptoms caused by the disease itself and/or treatment toxicity. Over 60% of patients continue to have symptoms of chronic asthma despite therapy. Polyneuropathy is also an important cause of chronic symptoms and morbidity. Despite the high rate of disease remission with current therapy, the frequency of relapses is high and recurring courses of GC to re-induce remission is still an important problem, causing significant morbidity, especially in older patients. Cardiac involvement is associated with poorer prognosis, and it is the most frequent cause of mortality in EGPA. Although ANCA-positive patients appear to be more likely to have GN and polyneuropathy, and less likely to have pulmonary or cardiac involvement, relapses and deaths do not appear to be different based on ANCA positivity [28,69,70].
Clinical relevance of testing for metabolic vitamin B12 deficiency in patients with polyneuropathy
Published in Nutritional Neuroscience, 2022
Janna K. Warendorf, Perry T.C. van Doormaal, Alexander F.J.E. Vrancken, Nanda M. Verhoeven-Duif, Ruben P.A. van Eijk, Leonard H. van den Berg, Nicolette C. Notermans
Our study supports the usefulness of testing for, and treating, metabolic vitamin B12 deficiency in patients with polyneuropathy. We found that 9% of patients with polyneuropathy in our cohort classify as having metabolic vitamin B12 deficiency, of which 43% could potentially benefit from supplementation (with 11% reporting improvement and 16% stabilization). Considering the high prevalence of polyneuropathy this is an important finding with implications at the population level. As shown in Figure 4, we advise a stepwise approach in diagnosing vitamin B12 deficiency. The initial step consists of determining vitamin B12 levels and starting supplementation in those patients with absolute deficiency. Next, performing additional testing of MMA when vitamin B12 levels are between the local lower limit of normal and 304 pmol/L (412 pg/mL), and considering starting supplementation in patients with metabolic deficiency, defined as elevated MMA when vitamin B12 levels are above the lower limit of normal.
Guidelines and new directions in the therapy and monitoring of ATTRv amyloidosis
Published in Amyloid, 2022
Yukio Ando, David Adams, Merrill D. Benson, John L. Berk, Violaine Planté-Bordeneuve, Teresa Coelho, Isabel Conceição, Bo-Göran Ericzon, Laura Obici, Claudio Rapezzi, Yoshiki Sekijima, Mitsuharu Ueda, Giovanni Palladini, Giampaolo Merlini
The quantitative evaluation of the sensory-motor alterations remains challenging. Combined clinical and neurophysiological scores, such as the modified neuropathy impairment score (mNIS) +7 proved useful to follow the sensory-motor course of polyneuropathy in recent clinical trials. However, these procedures are complex and time consuming, hindering their use in clinical practice. The composite clinical score NIS, combining motor function, sensory function, and tendon reflexes, is more convenient and proved reliable to monitor the polyneuropathy in several post marketing studies. The polyneuropathy disability (PND) score grades the impact of the neuropathy on ambulation. Also the six-minute walk test (6-MWT) performance and the timed 10-meter walk test (10-MWT) were pertinent end points, correlated with the polyneuropathy, longitudinally [9]. Neurophysiological tests corroborate the clinical assessment in mild to moderate polyneuropathy. Motor and sensory nerve conduction studies, including compound muscle action potentials and sensory action potentials, are performed in the four limb extremities. Investigations of the small nerve fibres, like laser evoked potentials, temperature quantitative sensory testing can be proposed but they are not broadly available.
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