POLYNEUROPATHY

BY

DR M.HAROUN

Clinical presentation
Weakness ,wasting ,hypotonia Sensory symptoms Hyporeflexia. Autonomic symptoms

Symptom & sign for a cause

Investigation
For the PN Needle EMG Nerve conduction studies Nerve biopsy Muscle biopsy For the etiology, Blood sugar ,ESR ,chest x-ray CSF,collagen battry ,DNA study

CAUSES OF PERIPHERAL NEUROPATHY

HERIDATRY MOTOR /SENSORY P. N. INHERETED METABLIC DISORDER SYSTEMIC MEDICAL DISODER TOXIC /METAB/ PIOSONING/DRUG INDUCED VITAMIN DEFICIENCY NEUROPATHY NEUROPATHY DUE TO INFECTION IDIOPATHIC(auto-immune) POLYNEUROPATHY

TREATMENT
Treatment of the cause Physiotherapy

Immunomodulation for idiopathic type

Symptomatic treatment ;antiepileptic

Idiopathic polyneuropathy
Acute idiopathic polyneuropathy
Acute idiopathic demyelinating polyneuropathy Acute motor axonal neuropathy Acute sensory neuropathy Acute autonomic neuropathy Miller fisher syndrome

chronic idiopathic polyneuropathy

Chronic inflamatory demyelinating polyneuropathy Multifocal motor neuropathy Pure motor demyelinating polyneuropathy Chronic idiopathic sensory neuropathy Chronic idiopathic axonal polyneuropathy

Etiology Anticedent infection Auto-immune mechanism pathology Evidence of inflamation Segmental demyelination Axonal degeneration

ACTE INFLAMATORY DEMYELINATING POLYNEUROPATHY(GBS)

C/P OF GBS
Sensory feature Motor feature Reflexes Cranial nerves Reflexes Breathing Autonomic dysfunction

Investigation of GBS
CSF Nerve conduction studies Needle EMG & N C studies

D.D OF GBS
ACUTE SPINAL CORD LESION NEUROMUSCLAR TRANSMITION DISORDERS POLYMYOSILIS POLIOMYELITIS OTHER CAUSES OF ACUTE POLYNEUROPATHY

TREATMENT OF GBS
ADMITION TO NEUROLOGY I C U VENTILLATION assesment STERIOD PLASMA EXCHANGE IV IG REHABILITATION TREATMENT OF COMPLICATIONS

SYSTEMIC MEDICAL DISORDER CAUSING POLYNEUROPATHY

DM,HYPOTHYRIODISM,RENAL FAILURE ,ACROMEGALY VASCULITIS , SARCIODOSIS,PRIMARY BILIARY CHIROSIS LYMPHOMA,CARCINOMA HYPERESIOPHELIC,ESIOPHELIAMYALGIA SYNDROME

DIABETIC PN
Incidence :59% in type 2&66 % in type1 Subclinical by exam,electro-neurophysiology Types ,sensory motor,autonmic , Pure sensory ,Pure proximal poly-radiculopathy ,Visceral-autonomic ,Focal neuropathy

Etiology of DM P N
HYPERGLYCEMIC EFFECT ON DORSAL ROOT GANGLION. HYPERGLYCEMIC EFFECT ON PERIPHERAL NERVE--REDUCED SLOW PHASE OF AXONAL TRANSPORT ISCHEMIC EFFECT SORBITAL ACCUMULATION--Na/k ATPase

Investigation
NC STUDY

EMG

NERVE BIOPSY

TREATMENT
CONTROL OF THE BLOOD SUGAR SORBINIL RECOMBINANT HUMAN NERVE GROWTH FACTOR LIPIOC ACIDE SYMPTOMATIC TREATMENT ANTIPLATELET