Polyneuropathy can have a wide variety of causes. For example, various diseases, such as diabetes mellitus, can trigger the disease of the peripheral nervous system, but also poisoning, such as by alcohol. Depending on its form, polyneuropathy manifests itself through different symptoms. Which forms there are and which signs are typical, we present to you in the following.
Polyneuroradiculitis Guillain-Barré type.
This acute form of polyneuropathy is likely due to an overreaction of the immune system directed against the body’s own nerve tissue. The disease occurs in approximately 1.7 cases per 100,000 population per year. Motor nerve fibers are almost exclusively affected, so that in terms of the symptoms, sudden muscle paralysis is in the foreground.
Polyneuroradiculitis: loss of muscle reflexes.
The paralyses are primarily concentrated in the pelvic girdle and shoulder regions and are less pronounced in the hand and foot muscles. In more severe individual cases, facial, ocular, pharyngeal, and trunk muscles may also be affected. Typically, there is a complete loss of muscle reflexes. Sensory disturbances take a distinct back seat to manifestations on the part of the muscular system.
Course of Guillain-Barré polyneuritis.
Guillain-Barré polyneuritis belongs to the category of polyneuropathies associated with damage to the nerve insulation layer. Accordingly, it can also be distinguished from other forms of polyneuropathy on the basis of markedly reduced conduction velocities of the peripheral nerves. With regard to the course of the disease, an acute form usually with a favorable healing tendency is distinguished from a chronic form with a poorer prognosis. However, even in the acute form, there is a possibility of fatal complications due to respiratory paralysis or serious cardiac arrhythmias. Overall, the spectrum of possible manifestations ranges from only minor discomfort with mild fatigability and uncharacteristic sensations to an apparently isolated paralysis of a muscle, for example, in the leg, to sudden paralysis of the whole body “rising up” from the legs.
Diabetic polyneuropathy
Approximately 30 percent of all polyneuropathies are due to diabetes mellitus, although the polyneuropathy is sometimes only a secondary symptom, but in individual cases it can dominate the symptoms. Basis of the nerve damage are chronic vascular changes and circulatory disturbances. In the sensory forms of diabetic polyneuropathy, sensory disturbances of the legs are usually in the foreground, ranging from numbness to the image of “burning soles of the feet”. In addition, painful muscle cramps in the upper and lower leg or generally dull pain in the lumbar, inguinal and thigh region, which increases when lying down, may occur. If motor nerve fibers are affected, paralysis of the pelvic and shoulder girdle muscles, and sometimes of the hands and feet, may also occur. All degrees of severity are found, from early muscle fatigue to severe paralysis with muscle cramps. In some cases, the facial and eye muscles may also be affected. If the polyneuropathy also affects fibers of the autonomic nervous system, disorders of sweating and cardiovascular function may be the result. The extent of diabetic polyneuropathy is often not directly related to the severity of the diabetes. The course of the disease is either gradual, with a very gradual increase in symptoms, or acute, especially in those forms associated with muscle paralysis in the pelvic girdle region.
Alcoholic polyneuropathy
Alcohol-related polyneuropathy is either an expression of the directly toxic effect of alcohol on nervous tissue or a consequence of the malnutrition and undernutrition that often occurs in alcoholics. The symptoms range from only slight sensory disturbances or insensations, mainly in the feet and legs, to more severe pain, calf cramps and sometimes muscle paralysis. Particularly characteristic of alcohol polyneuropathy is paralysis of the peroneal nerve, which runs along the outside of the lower leg and is responsible for the extensor muscles of the forefoot. As a result, the forefoot and toes can no longer be actively raised, which usually leads to a unilateral striking gait pattern.With strict abstinence from alcohol, normalization of eating habits, and especially vitamin intake (vitamin B1), the neurologic deficits and symptoms of alcohol polyneuropathy usually resolve completely or partially.
Lead polyneuropathy
A special form of polyneuropathy occurs in chronic lead poisoning. Especially workers in accumulator factories or people who come into contact with red lead or lead-based paints either professionally or privately are at risk of ingesting toxic amounts of lead by inhalation or through the gastrointestinal tract. In chronic poisoning, patients complain of:
- Headache
- Loss of appetite
- Fatigue
- Intestinal blockage
- Intestinal colic
Their skin is pale to grayish yellow. Polyneuropathy is characteristically manifested by paralysis of the extensor muscles in the hands, and less commonly in the legs. Under certain circumstances, however, there may also be paralysis and muscle atrophy in the area of the thumb and little finger ball or dysfunction in the area of those muscles that are responsible for spreading the fingers and toes. Sensibility is usually less disturbed than motor function, and pain does not occur. Hearing loss and visual disturbances may also be symptoms of lead polyneuropathy. The nerve damage is reversible after elimination of the excess concentrations of lead, leaving only minor functional impairment in the muscles.
Thallium polyneuropathy
Thallium poisoning occurs primarily after oral ingestion of certain rat or mouse poisons. Common symptoms of poisoning include insomnia, increased salivation, palpitations, and hair loss. The resultant polyneuropathy is accompanied by insensations and sometimes severe pain in the feet and hands. Hypersensitivity of the soles of the feet is very characteristic, with even the slightest touch causing unbearable pain. In addition, paralysis descending from the pelvic girdle area may occur, as well as muscle weakness and sensory disturbances in the facial area. Even after thallium has been eliminated from the body, the neurologic deficits of thallium polyneuropathy may partially persist.
Arsenic polyneuropathy
Arsenic poisoning, which is rare, can also damage the peripheral nervous system in the sense of a polyneuropathy. Analogous to thallium poisoning, there are unpleasant sensations and pain in the hands and feet. However, unlike thallium polyneuropathy, the paralytic symptoms are concentrated in the hand and foot regions rather than in the pelvic and shoulder girdles. Complete regression of neurologic deficits usually does not occur.
Polyneuropathy in immune disorders of the vascular system
One particular form of immune-related vascular disease in particular, panarteritis nodosa, often occurs in combination with polyneuropathy. Like all other organ symptoms of the disease, polyneuropathy is thereby explained as an expression of circulatory disturbances in the peripheral nervous system. Initial symptoms are often sensory irritations such as severe muscle and nerve pain. As it progresses, muscle paralysis and atrophy occur.
Polyneuropathy in rheumatoid arthritis.
In the course of rheumatoid arthritis, symptoms may also develop that are primarily due to disturbances in blood flow to the peripheral nervous system. The symptoms range from sensory or motor deficits in the area supplied by individual nerves (for example, in the hands) to isolated sensory disturbances in the fingers without involvement of the thumb to acute pain and insensations in the legs with subsequent signs of paralysis. The prognosis of this polyneuropathy is less favorable with combined involvement of the sensory and motor nervous systems than with pure sensory disturbances.
