Approach to polyneuropathy part1;

Approach to axonal polyneuropathy

neurooph polyneuropathy lead poisoning with CIDP

basophillic stripping smooth

result

localization

polyneuropathy !

resident med . Lead

"" "" lead poisoning

?

neuropathy

1. Nerve polyneuropathy
entrapment foot
drop, wrist drop, finger drop common short case
resident med
polyneuropathy
nerve 1

2. Symmetry or asymmetry
Step
asymmetry approach mononeuropathy multiplex
nerve asymmetry

symmetry
3. Axon VS myelin
asymmetry symmetry axon
myelin ?
A B C

tripple

 genital area
1. Axonal polyneuropathy : A

A ?
A

( stocking )
A
"glove and stocking pattern"
axonal polyneuropathy

A ""
histoanatomy nerve
nucleus axon myelin

axon cell retrograde

nucleus wallerian degeneration nerve

axon degenerate nerve
"
" "length dependent fashion" axonal
polyneuropathy

muscle atrophy axon involvement

recovery demyelinating run chronic course atrophy
demyelinating

***
Axonal polyneuropathy key point
1. Sensory loss :glove and stocking pattern
2. Length dependent fashion
3. Muscle atrophy in chronic course
4. common : DM, HIV , alcohol complication distal painful
sensorimotor polyneuropathy
Axon
axon sensory involvement
nerve function : motor nerve, sensory nerve, large fiber nerve,

small fiber nerve, autonomic nerve axon step

nerve group differential diagnosis


5
1. Sensory and motor involvement : most common type
Distal reflexes , length dependent, gloves and stockings sensory loss
ddx
DM, toxin, drugs, vasculitis, HIV, paraneoplastic, monoclonal
gammopathy, hereditary, amyloidosis
2.pure motor neuropathy
Ddx mcq short case long case resident
common

motor nerve
Ddx
Lead poisoning upper extremities wrist drop, anemia, GI
symptoms
Dapsone
motor nerve multifocal motor neuropathy with
conduction blocks ALS wasted hands,

chronic course
ALS reflex ALS reflex
3. Pure sensory neuropathy
Ddx ddx mixed motor sensory
4.proprioceptive large fiber neuropathy:sensory neuronopathy
large fiber nerve , dorsal root ganglion
proprioception vibration sensory ataxia
weak vertigo proprioception
Rhomberg's sign positive
Ddx
Paraneoplastic : anti Hu
Sjogren syndrome
Cisplatinum
Vitamin B6toxicity
HIV
5. Small fiber neuropathy( pinprick and temperature loss) with or
without autonomic involvement
small fiber nerves
Loss pain, temperature distally

No motor weakness
Normal reflexes
Autonomic involvement
Normal EMG/NCV
Ddx
DM, amyloidosis, vincristine, alcohol, genetics; Tangier's disease, Fabry's
disease
HIV, GBS variant(pandysautonomia), paraneoplastic, idiopathic
demyelinating polyneuropathy B

555
drugs axonal poly neuropathy
Alcohol
Amiodarone
Dapsone(motor)
Disulfiram
Hydralazine
Isoniazid
Metronidazole
ARV
Phenytoin
Pyridoxine(sensory)
Vincristine
Taxol
Toxin (axonal polyneuropathy)
Arsenic
Thallium
Organophosphates
Lead( motor)

Approach to polyneuropathy part2;

Approach to demyelinating polyneuropathy
B demyelinated polyneuropathy

!!! !!

A japanese
set( gloves and stockings fashion)
axonal polyneuropathy
B

indy ()
myelin axon length dependent pattern

reflex proximal distal

Muscle atrophy recovery axon

*** demyelinated polyneuropathy

1. Loss sensation non- gloves and stockings pattern

2. Loss of reflexes proximal, distal

3. Muscle atrophy axonal polyneuropathy

demy

1. Acute inflammatory demyelinating polyneuropathy (AIDP)

peak 4 weeks
2. Chronic inflammatory demyelinating polyneuropathy(CIDP)

AIDP progress 8 weeks nadir period 4-8 weeks

Guillain Barre syndrome (GBS) ??
GBS
term axonal type and variants type GBS AIDP demy
GBS GBS

variants . simply delicious


AIDP post infectious process

Campylobacter Jejuni !!! most

common organism preceding infection GBS
CIDP

1. Idiopathic

555

!
2. Secondary causes

cause CIDP
cause

U common cause
1. Infection: HIV, leprosy(axon-demy), diptheria, prion: CJD, hepatitis B,
C
2. Tumor: paraneoplastic syndrome: POEMs, osteosclerotic multiple
myeloma
3. Paraproteinemia: IgM monoclonal gammopathy of
undetermined significance( MGUS), Waldenstrom macroglobulinemia,
cryoglobulinemia
4. Endocrine: DM most common
6. Toxin: ARV, alcohol
7. Drugs: amiodarones, hexacarbons
part B demyelinated polyneuropathy part 3 approach
polyneuropathy asymmetry mononeuropathy multiplex

c u next time xxx

Approach to polyneuropathy part3;

Mononeuropathy multiplex

 () !!!
asymmetry

Pathology myelin sheath entrapment

vascular supply nerve vasculitis
Pattern length dependent

weak sensory loss nerve distribution

1. Vasculitis
- vasculitic syndrome Wegener granulomatosis, polyarteritis
nodosa, Churge Strauss syndrome
- systemic connective tissue disease: SLE, RA
-vasculitis
infection , cryoglobulinemia

2. Demyelinating polyneuropathy chronic inflammatory

demyelinating polyradiculopathy
3. Infection; leprosy, HIV
4. DM: asym sym

5. Tumor infiltration hematologic malignancy

6. Chronic granulomatous inflammation sarcoidosis
nerve work up symmetrical
polyneuropathy systemic vasculitis
exclude entrapment