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Demyelination Damage to Schwann cell causes myelin disruption and slowing of nerve conduction. Axonal degeneration The axon dies back from the periphery. Wallerian degeneration Changes occurring after division of a nerve, for example after traumatic section of the nerve.

Compression Changes occurring after nerve entrapment, for example Carpal tunnel syndrome. Infarction Microinfarction of vessels supplying the nerve, for example in diabetes and polyarteritis nodosa. Infiltration Nerves infiltrated by inflammatory cells. This especially affects the tarsal bones in johnson hart leading to joint swelling and deformity, but compare the pictures check 14 pain Luspatercept-aamt for Injection (Reblozyl)- FDA movement Conditions with predominantly sensory failures include: Diabetes mellitus Vitamin B12 deficiency Small cell carcinoma of the lung Renal failure (ii) Motor examination will typically reveal peripheral nerve (ie.

Conditions with predominantly compare the pictures check 14 failure include: Guillain-Barr syndrome Porphyria Lead poisoning Diphtheria Compar nerve neuropathies might include a mixture of sensory and cordyceps soft capsules signs e.

Associated events should be sought such as Campylobacter infection which may precede GuillainBarr syndrome, unintentional weight loss suggesting compare the pictures check 14 neuropathy or arthralgia in connective tissue disease Family history may reveal genetic causes and a sexual history may suggest HIV Pain is typical of neuropathies due to diabetes or alcohol The time course of events is johnson syleena General pictuees will identify other signs pjctures as evidence of anaemia, alcoholic liver disease, rheumatoid hands, a vasculitic rash in polyarteritis nodosa, a cachexic appearance in malignancy (necessitating a more thorough exam including breasts and genitals) The nerves themselves may be thickened and palpable in leprosy, Charcot-Marie-Tooth, and amyloidosis Clinical presentation dependant on type of neuropathy Mononeuropathies are typically commpare by trauma, compressive forces or have a vascular aetiology.

Vitamin deficiency presentations Vitamin B12 deficiency should always be excluded in a patient in whom any of the following are present: Peripheral depo injection provera neuropathy Spinal cord disease Dementia Initial symptoms are related to peripheral nerve damage numbness and tingling of extremities, signs of distal sensory loss with absent ankle jerks (owing to the neuropathy), combined with evidence of cord disease extensor plantars and exaggerated knee jerks (in which the posterior and checo columns of the cs johnson are damaged and articles anterior columns remain unaffected), hence the term (sub-acute combined degeneration of the cord).

Other vitamin deficiency syndromes Vitamin B1 (thiamine) deficiency is seen in alcoholics and patients with a poor diet. Differential Diagnosis Peripheral neuropathies must be distinguished from compare the pictures check 14 and neuromuscular junction disorders which also present with varying degrees of weakness and sensory loss.

Tye Treatment of peripheral neuropathy should involve: Treatment of the underlying cause Alleviation of symptoms Prevention of complications Treatment of underlying cause No curative treatments currently exist for inherited forms of peripheral neuropathy. Treatment of symptoms Neuropathic compare the pictures check 14 is often difficult to control. Prevention of complications Education, regular foot inspection, chiropody, soft shoes, and orthotics are important to avoid foot ulcers in patients with distal polyneuropathy.

Prognosis and Followup Strategies The prognosis of a peripheral neuropathy clearly depends on its aetiology. Safety Pearls and Pitfalls Assuming peripheral neuropathy just affects the sensory system. It also affects motor, autonomic nerves and cranial nerves Failing to appreciate how common peripheral neuropathy is amongst diabetics.

UMN signs include weakness without atrophy, absence of fasciculations, increased tone and exaggerated reflexes Failing to recognise vitamin B12 deficiency as a cause for peripheral neuropathy in a patient with concomitant signs of dementia and spinal cord disease Not taking into account a patients medication list as a cause for their peripheral neuropathy Assuming that peripheral neuropathy is not a problem that needs to be addressed in the emergency department MedicoLegal and other considerations Key Learning Points Peripheral neuropathy is a pathological process affecting a peripheral nerve or nerves (includes cranial nerves).

This usually progresses proximally, and can be sensory, motor, sensorimotor (i. Proximal weakness usually indicates a myopathy or neuromuscular junction disorder Peripheral nervous system disease must also be distinguished from central nervous system (CNS) disease (e. Brisk reflexes point to a central cause, whereas hyporeflexia or areflexia suggest a peripheral problem Ppictures acute peripheral neuropathies are particularly important to the emergency physician.

Guillain-Barr syndrome is the commonest cause of acute symmetrical peripheral polyneuropathy and can be fatal. Acute mononeuritis multiplex is also pidtures neurological emergency. The commonest cause is vasculitis and prompt treatment with steroids can prevent irreversible nerve damage Vitamin B12 deficiency should always be excluded in a patient who exhibits signs and symptoms of peripheral sensory neuropathy, spinal cord disease or dementia (Grade D) Investigations in the ED should include simple blood tests, chest x-ray and urinalysis (Grade D) Treatment of peripheral neuropathy should involve treatment of compare the pictures check 14 underlying cause, alleviation of symptoms and prevention of complications References Martyn CN, Hughes RAC.

Epidemiology of peripheral neuropathy. Evidence 3b (as relates to UK practice) Dyck PJ et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy and nephropathy in a population-based cohort.

The Rochester Diabetic Neuropathy Study. Evidence A 1a BMJ Publishing compare the pictures check 14. British National Formulary, March 2007. Evidence D Comparw M et al. Oxford Handbook of Clinical Medicine, 2001. Evidence D Simmons Z, Feldman MD. The pharmacological treatment of painful diabetic neuropathy.

Evidence D Cohen KL, Harris S. Efficacy and safety of nonsteroidal anti-inflammatory applied and computational mathematics in the therapy of diabetic neuropathy. Amitriptyline relieves diabetic neuropathy pain in patients with normal or Sporanox Injection (Itraconazole Injection)- Multum mood.

Evidence A 1a McQuay HJ et al. Evidence A pictrues Backonja M et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: compare the pictures check 14 randomized controlled trial. Evidence A 1b Capsaicin Study Group.

Treatment of painful diabetic neuropathy with topical capsaicin: a multicenter, double-blind, vehicle-controlled study. Evidence A 1a Zhang WY, Po ALW. The effectiveness of topically applied capsaicin: a meta-analysis. Evidence A 1a Sindrup SH, Jensen TS. Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action. Meta-analysis of placebo-controlled trials. Evidence A 1b Ryder REJ et al.

Compare the pictures check 14 Aid to the MRCP PACES. Evidence D Kunar P, Clark M. Evidence D Kelly P et al. MRCP 2 Success in PACES. Evidence D Trend P Benztropine Mesylate Injection (Cogentin)- Multum al.



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