Polyneuropathy

(Peripheral Neuropathies)
Praluki Herliawan
FK UNISBA 2017
 Definition:

an apparent disturbance of function or

pathologic change in several sensory, motor,
or autonomic fibers.
Classification of peripheral
neuropathy?

• Mononeuropathy?

• Polyneuropathy?
multiple nerves contiguous
typically length dependent
(“stocking-glove”)

Polyneuropathy is common! 2.4%

(8% over 55 yrs)

www.ama-assn.org/ ama/pub/category/7172.html
Classification of peripheral
neuropathy?
The type of nerve cell affected
- motor
- sensory
- autonomic

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The clinical response to motor nerve injury

Loss of function Disturbed function

“- symptoms” “+ symptoms”

Motor nerves Wasting Fasiculations

Hypotonia Cramps
Weakness
Hyporeflexia
Orthopedic deformity
The clinical response to sensory nerve injury

Loss of function Disordered function

“- symptoms” “+ symptoms”

Sensory ↓ Vibration Paresthesias

“Large Fiber” ↓ Proprioception
Hyporeflexia
Sensory ataxia
Sensory ↓ Pain Dysesthesias
“Small Fiber” ↓ Temperature Allodynia
The clinical response to autonomic nerve injury

Loss of function Disturbed function

“- symptoms” “+ symptoms”

Autonomic nerves ↓ Sweating ↑ Sweating

Hypotension Hypertension
Urinary retention
Impotence
Vascular color changes
Classification of peripheral neuropathy?

The process affecting the nerves:

- Demyelinating
- Axonal

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The two types of peripheral neuropathies:
axonopathies and myelinopathies
From Kumar: Robbins and Cotran: Pathologic Basis of Disease, 7th ed.
How then are we to sort through the causes to make an
etiologic diagnosis?
Use the 6 D’s

1. What is the distribution of the deficits?

2. What is the duration?
3. What are the deficits (which fibers are involved)?
4. What is the disease pathology (axonal or
demyelinating or mixed)
5. Is there an inherited (developmental) neuropathy?
6. Is there drug/toxin exposure?

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1. What is the distribution of the
deficits?
• Asymmetry
1. Mononeuropathy
2. Mononeuritis multiplex – e.g.
vasculitis

• Symmetric (glove/stocking) =
polyneuropathy

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2. What is the duration?

• Most polyneuropathies are chronic – months-

years

• Acute polyneuropathies
e.g. Guillain Barre syndrome
Vasculitis

• Relapses and remissions

e.g. Intermittent toxin exposure

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3. What are the deficits (which fibers affected)?

• If predominant motor fibers think of:

Guillain Barre syndrome
Lead toxicity
Charcot-Marie-Tooth disease

• If pure sensory/ severe proprioceptive deficit, think of

sensory neuronopathy:
Carcinoma (paraneoplastic)
Vitamin B6 toxicity

• If autonomic nerves involved (small fiber) think of:

Diabetes
Amyloid
Drugs like vincristine, ddI, ddC

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4. What is the disease
pathology?
• Axonal?
• Demyelinating?

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5. Is there an inherited
(developmental) neuropathy?
• Long duration
• Indolent progression
• Examine/question the family members!

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6. Drug or toxin exposure?

Demyelinating Axonal

e.g. e.g.
Glue sniffing Cancer drugs like vincristine
Arsenic and paclitaxel
Antibiotics like chloroquine,
ethambutol, isoniazid and
metronidazole
Cardiac medications like
amiodarone