Peripheral Nerve Diseases

Peripheral Nerve Diseases

Dr
Heewa A. Younis
FIBMSN MAAN

Preface

1-Peripheral Neuropathy:

• Causes:
Ideopathic Inflammatory Polyradiculoneuropathy:
Metabolic & Endocrine:
Neutritional deficiency
Infective & Granulomatous Neuropathy
Drugs:
Toxic Neuropathy


Peripheral Neuropathy
Causes:
Neoplastic Neuropathy
Hereditory Neuropathy
Hereditory Neuropathy
Entrapment Neuropathy

Investigations:

Hematology: CBC.......
Biochemistry
Immunology
NCS-EMG
CXR.
Cancer Scanning
Lumbar Punture
Nerve & Muscle Bx

Treatment: includes CONTROL OF UNDERLYING DISEASE

Treatment of Painful Peripheral Neuropathy
AED.s: Gabapentine, Carbamazepine, Pregabalin, Lamotrigine
Antidepressants:
TCA: Amitryptilline, nortryptilline, Imipramine
SSRI: Less effective as Fluoxetine, Sertraline
SNRI: Duloxetine, Venlafaxine
Antiarrhythmic: Mexilietine, Flecainide
Local Treatment: a- Lidocaine Patch.
b- Capsiacine Ointment.


Guillain Barre Syndrome

(AIDP) with 1-4 weeks, in 70% postinfectious after Compylobacter diarrhoea or RTI.

Cell mediated immune reaction directed at schwan cell due to Molecular Mimicry with some microorganisms Ag.

Clinical Presentation:

Distal paraesthesia & limb pains (often severe) staring in lower limbs
rapidly progressing weakness (Ascending Fashion)
symmetrical or mildly assymetrical
Unilteral or bilateral LMNL VII is found up to& 70% of cases
Bulbar and respiratory weakness in about 20%

On Examination

Afebrile
weakness of LMNS
sensory examination features of posterior column dysfunction
there may be evidence of autonomic dysfunction.

Investigations:

CSF STUDY
NCS-EMG
Ix to look for the cause, CXR, Serology for Compylobacter, CMV, Myocoplasma
Secondary Infections
DVT
Hyponatremia


Treatment
Plasma Exchange PE or IV IgG IN THE 1ST two weeks
Monitoring respiration with VC & ABG, if VC less than 1L.

Carpal Tunnel Syndrome

Entrapment of Median nerve at wrist under the flexor retinaculum

Numbness, tingling, burning sensation in hands & fingers
Pain in anterior wrist may radiate to anterior forearm, prominently at night, relieved by shaking & wrist extension
Weakness in thenar muscles while atrophy is late sign

CONFIRMATION

TINEL'S TEST: tapping the wrist elicit pain
PHALEN TEST: forced flexion of the wrist produces the symptoms
Bilateral in 40%, may be associated with:
- overuse of the wrist. – Pregnancy - Myxedema - Rheumatoid - Cole fracture
NCS Nerve conduction study

Treatment

underlying cause
Splint
NSAID
ISurgery
njection


AUTONOMIC NEUROPATHY
Is disease of non sensorimotor nervous system

be primary, or associated with Diabetes mellitus, alcohol, certain drugs.

affecting internal organs that regulate pulse rate, blood pressure, bowel & bladder functions

Trigeminal Neuralgia

(Tic Douloureux)

ETIOLOGY aberrant loop of cerebellar artery compresing the nerve or other compressive lesion ex MS plaque
CLINICALLY severe repetitive very brief pain causing the patient to flinch as if motor tic (Tic Douloureux), may be precipitated by touch, cold wind, eating. It may show Relapsing Remitting Course over years.
Reccurent attacks of lancinating pain in V2, V3 territory distribution
Sensory signs are negative their presence should point toward structural lesion as MS, Tumor…etc

TREATMENT

AED: Carbamazepine or Gabapentine or Pregabalin

Injection Phenol or Alcohol injection into the branch of the nerve

Radiofrequency Ablasion near the Gasserian Ganglion

Vascular Decompression Surgery with substantial success

Bell's Palsy

- LMNL VII,

preceding viral illness in 60%,
possible association with herpes simplex
Progression to plateau within hours to a day, the weakness is variable.
Untreated 85% untreated recover completely

- Weakness of muscles of facial expression

eye (Bell's Sign) & (CROCODILE tearing).
25% with Taste impairment
10% ear ( Hyperacusis),

Treatment:

Bestly:
Prednisolone tab 1mg/kg/d for 5-10 days


Controversial Benefit:
- Aciclovir tab 30mg/kg/day
Supportive Treatment for eye

Galvanic Stimulation: controversive

Prognosis:
Bad Prognostic features for full recovery:
- age extremities
- diabetes mellitus
- hypertension
- pregnancy