This document provides an overview of peripheral neuropathy, including: 1. It describes the anatomy of peripheral nerves and different types of peripheral neuropathies such as mononeuropathy, mononeuropathy multiplex, polyneuropathy, polyradiculopathy, and plexopathy. 2. It outlines the various clinical presentations of peripheral neuropathy including sensory, motor, and autonomic symptoms as well as patterns of nerve fiber involvement. 3. It discusses the etiology, clinical course, investigations and management of different peripheral neuropathies.

1. APPROACH TO PERIPHERAL NEUROPATHY PROF.RUCKMANI REDDY’S UNIT M1

3. What forms peripheral nerve?

5. Role of nerve fibres in peripheralneuropathy

9. Motor symptoms SPASMS DIIFFICULTY WITH FOOD INTAKE TREMOR WASTING OF MUSCLE MYOKYMIA DECREASED MANUAL DEXTERITY FASCICULATIONS WEAKNESS MUSCLE CRAMPS

10. Autonomic symptoms ANOREXIA,NAUSEA,VOMITING-GASTROPARESIS BLADDER,BOWEL,SEXUAL DYSFUNCTION HEAT INTOLERANCE SWEATING-INCREASED/DECREASED FAINTING SPELLS ORTHOSTATIC LIGHT HEADEDNESS

12. GE-SKIN,HAIR,NAILS BULLOUS LESIONS VARIEGATE PORPHYRIA HYPERPIGMENTATION OSTEOSCLEROTIC MYELOMA-POEMS SKIN HYPERPIGMENTATION LEPROSY ANGIOKERATOMAS FABRY’S DISEASE PURPURA CRYOGLOBULINEMIA PURPURA,LIVEDORETICULARIS VASCULITIS

13. CURLED HAIR GIANT AXONAL NEURPATHY ALOPECIA THALLIUM POISONING MEE’S LINES ARSENIC/THALLIUM INTOXICATION ICTHYOSIS REFSUM’S DISEASE

19. Pattern of sensory loss Sensory loss of trunk,scalp,face d/t simultaneous damage of proximal&distal part of sensory nerve SENSORY GANGLIONOPATHY ESCUTCHEON pattern of sensory loss over abdomen and thorax SEVERE AXONAL NEUROPATHY Symmetrical,distal,legs>arms Can even progress to face POLY NEUROPATHY

20. NERVE FIBRE AFFECTED? Poor balance Diminished or absent reflexes tingling Decreased joint position sense Pin & needle sensation Decreased vibration sense numbness SIGNS SYMPTOMS LARGE FIBRE NEUROPATHY

22. SMALL FIBRE NEUROPATHY Diminished temperature sensation Tight band like pressure Insensitive to heat and cold Decreased pinprick sensation PAIN-burning,shock like,stabbing,prickling,shooting,lancinating Allodynia

36. ANATOMIC PATTERN?

37. Proprioceptive weakness Distal & proximal weakness Distal weakness Vibration&proprioception>pain&temp Vibration&proprioception>pain&temp Pain&temp affected>vib,proprioception ataxia,paraesthesia Paraesthesia&weakness Dysesthesia&distal weakness rapid Acute/subacute Slow evolution Non length dependent UE,LE,face Proximal=distal Distal>proximal Length dependent NEURONAL DEMYELINATING AXONAL

38. Poor recovery Rapid recovery Slow recovery Axonal degeneration,no regeneration Demyelination&remyelination Axonal degeneration&regeneration Sensoryamplitudeaffected. radial>sural Velocity>amplitude Amplitude affected>velocity areflexia areflexia Distal areflexia NEURONAL DEMYELINATING AXONAL

39. Diabetes mellitus Diabetes mellitus MMN CMT pyridoxine CIDP HIV cisplatin diphtheria metabolic Sjogren’s GBS Toxic NEURONAL DEMYELINATING AXONAL

45. HOW TO DISTINGUISH VARIOUS LMN LESIONS?

46. Nl/dec normal absent dec/Nl DTR + absent Usually+ absent Sensoryloss absent Usually neg Can occur severe wasting absent absent Maybe+ve marked fasciculation Prox except SMA Extraoccular,bulbar distal distal Distribution of weakness ----- More in evening ------ ----- Fatigue,diurnalweakness variation Myopathy NMJ Neuropathy AHC

50. NERVE BIOPSY-indications sural,sup peroneal&sup radialN METACHROMATIC LEUKODYSTROPY Paraprotein neuropathy KRABBE’S CIDPolyradiculoneuropathy LEPROSY CMT 1&3 SARCOIDOSIS Infantile neuroaxonal dystrophy AMYLOIDOSIS GIANT AXONAL NPthy VASCULITIS

52. H/O & EXAMINATION Mononeuropathy EDx Axonal/demyeln? Any systemic disorder Entrapment/compression

53. MNPthy multiplex axonal Demyeln +focal condcn block Vasculitis/multifocal Nerve biopsy CIDP Paraprotein,HIV,lyme

54. polyNPthy axonal Sub a/c c/c Toxins/systemic disease family h/o,genetics

55. demyelination Uniform slowing,C/C Nonuniform slowing,condnblock paraprotein Family h/o,genetics c/c or suba/c-CIDP a/c-GBS