Metabolic, toxic, paraneoplastic, neuropathic disorders affecting NS. M. Bojar Charles University Prague, 2nd Medical School, Dpt. of Neurology, FN Motol. I. Metabolic, toxic, paraneoplastic, disorders of the CNS a PNS.
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Metabolic, toxic, paraneoplastic, neuropathic disorders affecting NS
Charles University Prague, 2nd Medical School, Dpt. of Neurology, FN Motol
Metabolic, toxic, paraneoplastic, disorders of the CNS a PNS
Diabetic polyneuropathy. 2006 – Treated diabetic pts in ČR n748 528.
II. Metabolic, toxic, paraneoplastic, disorders of the CNS a PNS
What is typical for polyneuropathies?
PNP – typical features:
affect mainly long nn – LE, but UE, too. Entreppement sy – „narrow channels“- carpal tunnel sy, elbow tunnel sy
manifest mainly distally.
start typically and „silently“in rest, in night, sleep…
Subjec. problems, complaints - impaired sensitivity and vegetative system
Sensitive neuropathic symptoms – start typically
when resting, in the night. Rarely during the day.
Irritative, positive : neuropathic pain, itching- paresthesias, hot, dysesthesias, oversensitivity. Restless legs sy, usually night + „fire“ feeling. Sy canalis carpi, entrempement sy…
Failure, negative : strange, cold, icy, numb, „wooden“ LE
Subjective complaints, troubles – motor, movement functions
Motor neuropathic symptoms
Irritative, positive : spasms- crampi, fasciculations.
Failure, negative : fatigue, heaviness, weakend UE,LE, palsy, unstable gait
Neuritis vs. neuropathy ...
III. Metabolic, toxic, paraneoplastic, disorders of the CNS a PNS
Myotatic reflex – old, but useful…
Neurologic finding, neurostatus
Impaired function of muscles, movements, trophic functions
Hyporeflexy or areflexy L5/S2, later areflexia L2/4
Hypotonia and atrophy of distal muscles, mainly LE, espec. msc. interossei
Diminished msc. strenght- LE ( gate), later UE( PET bottles , locks, zips )
Paraneoplastic impairment of the NS
Impairment of the NS of
Exogennous – toxic substances – environmental, industry, agriculture - organofosfates, intoxications - org.sbst.
Iatrogennous – cytostatics, antibiotics, immunomodulans, neuropharma drugs
Metabol. & organ impairment – liver, renal, amyloidosis…
Renal, uremic polyneuropathy
form – slowly progressive.
Koincidence with DM, myeloma, vasculitis
n.medianus, n.ulnaris + n.peroneus.
Metabolic, toxic, paraneoplastic, infectious impairment of CNS a PNS