Neuropathy

Clinic

• Disease affecting peripheral nerves which may impair sensation, movement, gland, or organ function depending on which nerves are affected.
• Neuropathy affecting motor, sensory, or autonomic nerves result in different symptoms.
• Neuropathy may cause painful cramps, fasciculations, muscle loss, bone degeneration, and changes in the skin, hair, and nails.

Causes

Dynamic	Static
Leprosy Diabetes Celiac disease Non-celiac gluten sensitivity Viral infection	Hyperglycemia-induced glycation Vitamin deficiency Medications Traumatic injury, Radiation therapy Ischemia Excessive alcohol consumption

Types

Quantity	Quality	Etiology
Mononeuropathy Polyneuropathy = Symmetrical polyneuropathy Mononeuritis multiplex Multifocal mononeuropathy = Multiple mononeuropathy	Motor neuropathy Sensory neuropathy Autonomic neuropathy	Inflammation neuritis Compression neuropathy Chemotherapy-induced peripheral neuropathy

Neuritis

Neuritis is a general term for inflammation of a nerve or the general inflammation of the peripheral nervous system. Symptoms depend on the nerves involved, but may include pain, paresthesia (pins-and-needles), paresis (weakness), hypoesthesia (numbness), anesthesia, paralysis, wasting, and disappearance of the reflexes.

Causes of neuritis include:

• Physical injury
• Infection
  • Diphtheria
  • (shingles)
  • Leprosy
  • Lyme disease
• Chemical injury such as chemotherapy
• Radiation therapy

Types of neuritis include:

• Brachial neuritis
• Cranial neuritis such as Bell's palsy
• Optic neuritis
• Vestibular neuritis
• Wartenberg's migratory sensory neuropathy
• Underlying conditions including:
  • Alcoholism
  • Autoimmune disease, especially multiple sclerosis and Guillain–Barré syndrome
  • Beriberi (vitamin B1 deficiency)
  • Cancer
  • Celiac disease
  • Non-celiac gluten sensitivity
  • Diabetes mellitus (Diabetic neuropathy)
  • Hypothyroidism
  • Porphyria
  • Vitamin B12 deficiency
  • Vitamin B6 excess

Signs and symptoms[edit]

Those with diseases or dysfunctions of their nerves may present with problems in any of the normal nerve functions. Symptoms vary depending on the types of nerve fiber involved.^{[citation needed]} In terms of sensory function, symptoms commonly include loss of function ("negative") symptoms, including numbness, tremor, impairment of balance, and gait abnormality. Gain of function (positive) symptoms include tingling, pain, itching, crawling, and pins-and-needles. Motor symptoms include loss of function ("negative") symptoms of weakness, tiredness, muscle atrophy, and gait abnormalities; and gain of function ("positive") symptoms of cramps, and muscle twitch (fasciculations).

In the most common form, length-dependent peripheral neuropathy, pain and parasthesia appears symmetrically and generally at the terminals of the longest nerves, which are in the lower legs and feet. Sensory symptoms generally develop before motor symptoms such as weakness. Length-dependent peripheral neuropathy symptoms make a slow ascent of the lower limbs, while symptoms may never appear in the upper limbs; if they do, it will be around the time that leg symptoms reach the knee. When the nerves of the autonomic nervous system are affected, symptoms may include constipation, dry mouth, difficulty urinating, and dizziness when standing.

CAP-PRI Scale for diagnosis[edit]

A user-friendly, disease-specific, quality-of-life scale can be used to monitor how someone is doing living with the burden of chronic, sensorimotor polyneuropathy. This scale, called the Chronic, Acquired Polyneuropathy - Patient-reported Index (CAP-PRI), contains only 15 items and is completed by the person affected by polyneuropathy. The total score and individual item scores can be followed over time, with item scoring used by the patient and care-provider to estimate clinical status of some of the more common life domains and symptoms impacted by polyneuropathy.^{[citation needed]}

Causes

• Ribose-5-Phosphate Isomerase Deficiency
• Surgery, chemotherapy
• Genetic diseases: Friedreich's ataxia, Fabry disease, Charcot-Marie-Tooth disease, hereditary neuropathy with liability to pressure palsy
• Hyperglycemia-induced formation of advanced glycation end products (AGEs)
• Metabolic and endocrine diseases: Diabetes mellitus, Chronic kidney failure, Porphyria, Amyloidosis, Liver failure, Hypothyroidism
• Idiopathic
• Toxic causes
• Inflammatory diseases:
  • Guillain–Barré syndrome
  • SLE
  • Leprosy
  • Sjögren's syndrome
  • Babesiosis
  • LBB
  • Vasculitis
  • Sarcoidosis
  • Multiple sclerosis
• Vitamin deficiency states: Vitamin B₁₂ (Methylcobalamin), vitamin A, vitamin E, vitamin B₁ (thiamin)
• Physical trauma: compression, automobile accident, sports injury, sports pinching, cutting, projectile injuries (for example, gunshot wound), strokes including prolonged occlusion of blood flow, electric discharge, including lightning strikes^{[medical citation needed]}

• Others: Carpal tunnel syndrome, electric shock, HIV, malignant disease, , shingles, MGUS (Monoclonal gammopathy of undetermined significance).

Barachial plexopathy

Polyradiculitis

Lyc