MEANING • PERIPHERAL NEUROPATHY REFERS TO THE CONDITIONS THAT RESULT WHEN NERVES THAT CARRY MESSAGES TO AND FROM THE BRAIN AND SPINAL CORD FROM AND TO THE REST OF THE BODY ARE DAMAGED OR DISEASED.
Typically, damage to a nerve will affect one or more dermatomes, which can be tracked to specific areas of the body. Damage to these nerves interrupts communication between the brain and other parts of the body and can impair muscle movement, prevent normal sensation in the arms and legs, and cause pain.
CLASSIFICATION • MONONEUROPATHY • POLYNEUROPATHY • MONONEURITIS MUTIPLEX • OTHER:- • AUTONOMIC NEUROPATHY • NEURITIS
CLASSIFICATION MONONEUROPATHY: Affects single nerve due to • Localized trauma • Infection • Compression of the nerve • Carpal tunnel syndrome • Axillary nerve palsy • Ischemia
POLYNEUROPATHY: Many nerve cells in various parts of the body are affected. Due to: • Diabetes • Demyelinatingpolyneuropathies: damage of axons around the myelin sheath. • Inflammatory disease • Vitamin deficiency • Toxins: alcohol,drugs
SYMPTOMS: • weakness or clumsiness of movement • Unusual or unpleasant sensations such as tingling or burning • Ability to feel sensations such as texture or temperature • Impaired balance when standing or walking. In many polyneuropathies these symptoms occur first and most severely in the feet. • Autonomic symptoms also may occur, such as dizziness on standing up, erectile dysfunction and difficulty controlling urination.
MONONEURITIS MULTIPLEX: Involves noncontiguous nerve trunks • DM • Immune-mediated disease such as : rheumatoid arthritis • Infection : leprosy, HIV,
SYMPTOMS: • Mononeuritis multiplex also may cause pain, which is characterized as deep, aching pain that is worse at night and frequently in the lower back, hip, or leg. • In people with diabetes mellitus mononeuritis multiplex typically is encountered as acute, unilateral, and severe thigh pain followed by anterior muscle weakness and loss of knee reflex.
AUTONOMIC NEUROPATHY: Affecting mostly internal organs like bladder muscles, cardiovascular system, the GI tract, genital organs. • DM • Malfunction of autonomic nervous system • Disease condition affecting brain and spinal cord like: multiple system atrophy
SYMPTOMS: • Urinary bladder conditions: bladder incontinence or urine retention • Gastrointestinal tract: dysphagia, abdominal pain, nausea, vomiting, malabsorption, fecal incontinence, gastroparesis, diarrhoea, constipation • Cardiovascular system: disturbances of heart rate (tachycardia, bradycardia), orthostatic hypotension, inadequate increase of heart rate on exertion • Respiratory system: impairments in the signals associated with regulation of breathing and gas exchange • Other areas: hypoglycemia unawareness, genital impotence, sweat disturbances
NEURITIS: Inflammation of a nerve or peripheral nervous system. • Physical injury • Infection: diphtheria, herpes zoster, leprosy, lyme disease. • Alcoholism • Cancer • Beriberi vit B12 deficiency • Celiac disease • Hypothyroidsm • Chemical injury like chemotherapy • Radiation therapy
SYMPTOMS: • Pain • Weakness tiredness • Cramps • Tremor • Gait imbalance • Paresthesia (pins-and-needles) • Paresis (weakness) • Hypoesthesia (numbness) • Paralysis • Disappearance of the reflexes.
CAUSES • GENETIC DISEASE: Friedreich’s ataxia (damage to the nervous system: disturbance in gait), Charcot-Marie-Tooth syndrome (heriditary motor and sensory disorder of peripheral nervous system: progressive loss of muscle tissue and touch sensation various parts of the body) • METABOLIC /ENDOCRINE: Diabetes mellitus, chronic renal failure, liver failure and hypothyroidism. • TOXIC CAUSES: Alcoholism, drugs (vincristine, phenytoin, isoniazid) excess intake of vit B6
CONTINU… • Poisoning due to heavy metals, such as lead • Poor blood flow to the legs • Bone marrow disorders and tumors • INFLAMMATORY DISORDERS: Guillain-Barre syndrome, leprosy • AUTONOMIC DISORDER SUCH AS RHRMATOID ARTHRITIS • INFECTION: HIV /STD, HEP-C • LOW LEVELS OF VIT-A,E,B1 AND B12
Continu… • Trauma or pressure on a nerve • Glue, lead, mercury, and solvent poisoning • Drugs that treat infections, cancer, seizures, and high blood pressure • Being exposed to cold temperatures for a long period of time • Pressure from bad-fitting casts, splints, a brace, or crutches
SYMPTOMS • Symptoms depend on which nerve is damaged, and whether the damage affects one nerve, several nerves, or the whole body. • PAIN AND NUMBNESS • Tingling or burning in the arms and legs may be an early sign of nerve damage. These feelings often start in toes and feet. This often happens in the feet and legs. • Loss of feeling in legs and arms. Because of this, patient may not notice when step on something sharp. He may not notice when touch something that is too hot or cold, like the water in a bathtub. He may not know when he have a small blister or sore on your feet.
CONTINU… • Numbness may make it harder to tell where the feet are moving and can cause a loss of balance. • MUSCLE PROBLEMS • Damage to the nerves can make it harder to control muscles. It can also cause weakness. Patient may notice problems moving a part of the body. He may fall because legs buckle. He may trip over toes. • Doing tasks such as buttoning a shirt may be harder. He may also notice that muscles twitch or cramp. muscles may become smaller.
CONTINU… • PROBLEMS WITH BODY ORGANS • People with nerve damage may have problems digesting food. may feel full or bloated and have heartburn after eating only a little food. Sometimes, may vomit food that has not been digested well. may have either loose stools or hard stools. Some people have problems swallowing. • Damage to the nerves to heart may cause to feel lightheaded, or faint, when stand up. • Angina is the warning chest pain for heart disease and heart attack. Nerve damage may "hide" this warning sign. Other signs of heart attack They are sudden fatigue, sweating, shortness of breath, nausea, and vomiting.
CONTINU… • OTHER SYMPTOMS OF NERVE DAMAGE • Sexual problems. Men may have problems with erections. Women may have trouble with vaginal dryness or orgasm. • Some people may not be able to tell when their blood sugar gets too low. • Bladder problems may not be able to feel when the bladder is full. Some people are not able to empty their bladder. • patient may sweat too little or too much. This may cause problems controlling body temperature.
DIAGNOSTIC EVALUATION • HISTORY COLLECTION • PHYSICAL EXAMINATION • Blood tests may be done to look for causes of nerve damage. • Electromyography-- to check activity in muscles • Nerve conduction studies -- to see how fast signals travel along nerves • Nerve biopsy -- to look at a sample of a nerve under a microscope
MANAGEMENT • Medication: antidepressants, antiepileptic drugs to manage pain (amitriptyline, sodium valproate) • Treating the cause of nerve damage, if known, may improve your symptoms. • People with diabetes should learn to control their blood sugar. • Stop consuming alcohol. • Avoid medication which cause PN • Replacing a vitamin or making other changes in diet may help. If person with low levels of B12 or other vitamins
CONTINU… • Need for surgery to remove pressure from a nerve. • Therapy to learn exercises to improve muscle strength and control. Wheelchairs, braces, and splints may improve movement or the ability to use an arm or leg that has nerve damage.
CONTINU… • SETTING UP AT HOME • Safety is very important for people with nerve damage. Nerve damage can increase the risk for falls and other injuries. To stay safe: • Remove loose wires and rugs from areas where the patient walk. • Fix uneven flooring in doorways. • Have good lighting. • Put handrails in the bathtub or shower and next to the toilet. Place a slip-proof mat in the bathtub or shower.
CONTINU… • CARE OF SKIN • Wear shoes at all times to protect feet from injury. Before put them on, always check inside shoes for stones or rough areas that may hurt your feet. • Check the feet every day. Look at the top, sides, soles, heels, and between the toes. Wash feet every day with lukewarm water and mild soap. Use lotion, petroleum jelly, lanolin, or oil on dry skin. • Check bathwater temperature with elbow before putting feet in the water. • Avoid putting pressure on areas with nerve damage for too long.
CONTINU… • TREATING PAIN • Pain pills • Drugs that treat seizures or depression, which can also manage pain • Talk therapy may help better understand how pain is affecting life. It can also help learn ways to better cope with pain.
CONTINU… • TREATING OTHER SYMPTOMS • Taking medicine, sleeping with head raised, and wearing elastic stockings may help with low blood pressure and fainting. Your provider may give medicines to help with bowel movement problems. Eating small, frequent meals may help. • Do Kegel exercises to strengthen your pelvic floor muscles. • Monitor vital signs • Prevent infections
PREVENTION • You can prevent some causes of nerve damage. • Control alcohol alcohol intake. • Follow a balanced diet. • Keep good control over diabetes and other medical problems. • Learn about chemicals used at your workplace.