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DISORDERS OF THE PERIPHERAL NERVOUS SYSTEM. Prepared by: Dr. Sarwer Jamal Al- Bajalan M.B.Ch.B , F.I.B.M.S(Neurology ) 2014. Disorders Of The Peripheral Nervous System Introduction and clinical approach Acquired polyneuropathies(PNP ) Hereditary neuropathies
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Dr. Sarwer Jamal Al-Bajalan
diffuse peripheral nerve lesion, often symmetrical
Age of onset varies, for example
Acuity of onset
• Loss of vibration and position sense
• Diminished or absent reflexes
• Positive Romberg sign
• Loss of pain and temperature sensation
• Reflexes may be normal.
• Orthostatic hypotension (BP supine and erect after 3 minutes)
Cutaneous sensory loss in a stocking-glove distribution
Foot deformities such as pescavus, pesplanus, or hammertoes may indicate a hereditary neuropathy.
Nerve thickening may be seen in CMT, leprosy, Refsumdisease, amyloidosis, or HNPP.
Commonest cause of neuropathy worldwide.
Classification of diabetic neuropathies:
D Dx: Vasculitis, malignantinfiltration
1. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP)
There is a predominantly cell-mediated inflammatory
response directed at the myelin protein of spinal roots,
peripheral and extra-axial cranial nerves, possibly triggered
by molecular mimicry between epitopes found in
the cell walls of some microorganisms and gangliosides
in the Schwann cell and axonal membranes. The resulting
release of inflammatory cytokines blocks nerve conduction
and is followed by a complement-mediated
destruction of the myelin sheath and the associated
May be normal early in the course of the disease
2. Acute motor axonal neuropathy (AMAN)
3. Acute motor sensory axonal neuropathy (AMSAN)
3. Miller Fisher syndrome
4. Acute sensory neuropathy
6. Acute pandysautonomia
Pescavus, Inverted champagne bottole, Samll muscle atrophy
May be caused by:
Facial mononeuropathy (Bell palsy)
EMG/NCVare rarely necessary to make the diagnosis, but can be used to determine prognosis.
DDx: Herpes zoster, HIV, Lyme, facial tumor, sarcoidosis & neuro-brucellosis.
Median at wrist (CTS) Ulnar at elbow MeralgaiaParaesthetica