Medical history (history of illness) represents an important component in the diagnosis of polyneuropathy. Family history Are there any diseases (diabetes mellitus, neurologic diseases) in your family that are common? Social history Do you have a job that exposes you to environmental stress? Current medical history/systemic history (somatic and psychological complaints). Have you noticed symptoms … Polyneuropathies: Medical History
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Hereditary motor-sensitive neuropathy type I (HMSN I; from English, “hereditary neuropathy with liability to pressure palsies” (HNPP); synonyms: Charcot-Marie-Tooth disease (CMT), English Charcot-Marie-Tooth disease) – chronic neuropathy inherited in an autosomal dominant manner, resulting in motor and sensory deficits. Small fiber neuropathies (SFN) – subgroup of neuropathies in … Polyneuropathies: Or something else? Differential Diagnosis
The following are the most important diseases or complications that can be caused by diabetic polyneuropathy, for example: Endocrine, nutritional, and metabolic diseases (E00-E90). Severe hypoglycemia (hypoglycemia) due to lack of awareness of symptoms. Diabetic foot or diabetic foot syndrome (DFS) – ulcerations (ulcers) on the feet due to circulatory disturbances of the limb and … Polyneuropathies: Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin and mucous membranes (skin temperature, skin tugor, and perspiration) [xeroderma (dry skin)/hypo- and anhidrosis (decreased ability to perspire to inability to perspire); disorders of the skin, e.g., chronic … Polyneuropathies: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count Differential blood count [eosinophilia?, macrocytic anemia?, MCV elevation in alcohol abuse/alcohol dependence?] Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Urine status (rapid test for: pH, leukocytes, nitrite, protein, glucose, ketone, blood), sediment, if necessary urine culture (pathogen detection and resistogram, … Polyneuropathies: Test and Diagnosis
Therapeutic target Improvement of the general quality of life Therapy recommendations Treat the cause (e.g. diabetes mellitus; alcohol abuse; vitamin deficiency) as far as treatable! Positive symptoms such as tingling, burning, and pain are treated symptomatically with medication; this applies in particular to the therapy of painful polyneuropathy (= neuropathic pain); it should always be … Polyneuropathies: Drug Therapy
To prevent polyneuropathy, attention must be paid to reducing individual risk factors. Behavioral risk factors Diet Foods containing acrylamide (Group 2A carcinogen) – formed during frying, grilling, and baking; used to make polymers and dyes; acrylamide is metabolically activated to glycidamide, a genotoxic (“mutagenic”) metabolite Micronutrient deficiency (vital substances) – see prevention with micronutrients. Consumption … Polyneuropathies: Prevention
The following symptoms and complaints may indicate polyneuropathy: Sensory insensitivity Formication Burning Lack of sensation of heat or cold Gait insecurity → risk of falling or falls. Tingling Swelling sensation Stinging Feeling numb and furry Motor symptoms Muscle spasms Muscle weakness Muscle twitching/fasciculations Pain* * Ca. 50% of all polyneuropathies are associated with pain. Autonomic … Polyneuropathies: Symptoms, Complaints, Signs
Pathogenesis (disease development) The causes of polyneuropathy (PNP) are manifold: Genetic (hereditary neuropathies). Nutritive (folic acid or vitamin B12 deficiency). Inflammatory/infectious (e.g., Lyme disease) Metabolic (e.g. diabetic polyneuropathy) Immune-mediated (e.g., Guillain-Barré syndrome (GBS)). Vascular (e.g., vasculitides) Tumor-associated (e.g., plasmocytoma) Toxic (e.g., alcohol-associated polyneuropathy or chemotherapy-induced neuropathy (CIN)). Idiopathic A distinction can be made between noxious … Polyneuropathies: Causes
General measures Nicotine restriction (refraining from tobacco use). Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day), as alcohol can lead to hypoglycemia (low blood sugar). Aim for normal weight!Determination of BMI (Body Mass Index, body mass index) or body composition by means of electrical impedance analysis … Polyneuropathies: Therapy
Obligatory medical device diagnostics. Electromyography (EMG; measurement of electrical muscle activity) of affected nerves (to determine type of damage (axonal versus demyelinating) or to detect specific patterns of damage (e.g., conduction blocks)) – if proximal nerve damage is suspected Electroneurography (ENG; method for measuring nerve conduction velocity) of affected muscles [impaired nerve conduction velocity without … Polyneuropathies: Diagnostic Tests