Neuropathy

Neuropathy is an umbrella term for nonradicular diseases of the peripheral nerves. Neuropathy can be acute and life threatening as in Guillain-Barr syndrome or chronic as in diabetic neuropathy

classification
Anatomic classification. Mononeuropathy. Involvement of a single nerve (e.g., carpal tunnel syndrome, meralgia paresthetica). Polyneuropathy. Diffuse involvement of the peripheral nerves (e.g., diabetic neuropathy). Mononeuritis multiplex. Seemingly random involvement of multiple isolated nerves. Can occur in vasculitis, porphyria, diabetes, HIV, and others. Cellular classification. Axonal neuropathy. Loss of function from loss of nerve cells. Demyelinating neuropathy. Damage to the Schwann cells leads to impairment of nerve conduction.

classification
Time course
Acute neuropathy. Sudden onset of dysfunction from an injury or immunologic attack. Chronic neuropathy. Usually insidious onset with slow progression from low-level ongoing nerve injury.

Clinical
Motor Sensory Sensomotor Autonomic

Causes of Neuropathies.
Inherited neuropathies Charcot-Marie-Tooth . Refsum disease Friedreich Ataxia . Porphyria Familial amylodosis

Causes of Neuropathies.
Aquired
metabolic neuropathies diabetic mellitus, hypothyroidism, porphyria, and renal or hepatic failure. Infectious causes. Leprosy, Diphteria, Lyme, HIV, and syphilis, Herpes Zoster, hepatitis c. Immune mediated: Guillain-Barr syndrome Chronic inflammatory demyelinating polyneuropathy Monoclonal gammopathies. Collagen diseases Rheumatoid arthritis Vasculitis: Polyarteritis nodosa Sarcoidosis Paraneoplastic. toxic: Heavy metal toxicity: lead,arsenic, mercury. Organphosphates insectcids Alcohol Drugs Malnutrition. Vitamin B12,B6 and B1 deficiency. Vitamin E, niacin, and folate are rare causes of neuropathy

Laboratory testing.
Tests for all patients with unexplained neuropathy. CBC, glucose tolerance test, Vitamin B12, rheumatoid factor, TSH, free T4, sedimentation rate, ANA, serum protein electrophoresis, urine protein electrophoresis, and skeletal x-ray survey. Other tests to consider: HIV antibody, VDRL, Lyme titer, lumbar puncture. Folate, urine heavy-metal screen, ganglioside antibodies (GM1, anti-MAG, antisulfatide), and paraneoplastic antibodies (anti-Hu).
Electromyography (EMG) and nerve conduction studies Nerve biopsy

Treatment: Symptomatic treatment of neuropathic pain and paresthesias is directed at reducing the pain. Possible treatments include amitriptyline (Elavil) 10 to 75 mg HS, nortriptyline (Pamelor) 10 to 100 mg HS, gabapentin (Neurontin) 400 mg HS to 800 mg TID, or carbamazepine (Tegretol) 200 to 400 mg TID. Capsaicin cream has also been used with some success.