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Polyneuropathy (Aetiology (Infection Guillain-Barre syndrome CIDP HIV …
Polyneuropathy
Aetiology
Infection
Guillain-Barre syndrome
CIDP
HIV
Syphilis
Lyme disease
Leprosy
Autoimmune
Vasculitis (PAN, GPA)
Sarcoidosis
Amyloidosis
RA
Metabolic
DM
Renal failure
Hypothyroidism
Hypoglycaemia
Mitochondrial disorders
Low B1, B12, folate, vit E
High B6
Neoplastic
Paraenoplastic syndromes
Haematological
Polycythaemia rubra vera
Genetic
Charcot-Marie Tooth
Leucodystrophy
Porphyria
Refsum syndrome
Drugs
Alcohol
AED (phenytoin)
Anti-TB (isoniazid)
Chemo (vincristine, cisplatin)
Abx (nitrofurantoin, metronidazole)
Heavy metals (lead, arsenic)
Clinical presentation
Motor loss
Weak and clumsy hands
Difficulty walking, falls
Difficulty breathing
Cranial nerves
Diplopia
Speaking/swallowing difficulty
Sensory loss
Numbness, pins&needles,
burning, pain
Extremities (glove and stocking)
Autonomic
Faints on standing/eating/hot bath
ED/ejaculation failure
Reduced sweating
Constipation/diarrhoea
Urinary retention
Horner's syndrome
Holme's Adie pupil
Classification
Function
Sensory
(DM, renal fail, leprosy)
Motor
(GBS, CMT, lead)
Autonomic
Mixed
Pathology
Demyelinating
Axonal
Mixed
Course
Acute
Chronic
Diagnosis
Examination
Cardiovascular
Postural hypotension
Neurological
Limbs
Sensory
Signs of trauma e.g. burns
Joint deformity
Glove and stocking sensory loss
Motor
LMN lesion
Weakness, wasting, fasiculation
Foot/wrist drop
Reduced reflexes
Cranial nerves
CN II
Horner's
Holme's Adie
CN III/IV/VI
Diplopia
CN IX/X
Dysphagia
Dysphonia
Investigations
Bloods
FBC, CRP/ESR (infection/inflammation)
Glucose (DM), B12/folate (deficiency)
U+E (renal failure), LFTs, TFTs (thyroid)
Microbiology (HIV, syphilis, Lyme)
Autoimmune (ANA/ANCA, ACE)
Toxicology (drugs, heavy metals)
Imaging
CXR (malignancy, sarcoid)
LP
Special tests
Genetics (CMT)
NCS (demyelinating versus axonal)
History
PC/HPC
Onset
Symptoms (sensory, motor, mixed)
Preceding illness (URTI, D&V, weight loss)
SH
Travel
Alcohol/drugs
Sexual history
FH
Anyone suffered
something similar
Management
Treat cause
Conservative
PT, OT
Foot care, shoes
Splinting
Medical
Iv Ig, plasmaphoresis
Steroids, immunosuppressants
Analgesia (amitriptyline, gabapentin)
Definition
Neurological disorder of
peripheral or cranial nerves
with symmetrical distribution,
often distal weakness and
sensory loss (glove and stocking)