1. Dr Massud Wasel MD DO ND BSc(Hons) P.G.C.A.P
Neurology
Dr Massud Wasel
MD DO ND BSc(Hons)
P.G.C.A.P

2. NEUROPATHY A pathological process affecting peripheral nerve system
Pathology:
Demyelination
Axonal degeneration
Compression
Infarction
infiltration

3. Mononeuropathies Caused by peripheral nerve compression
Carpal nerve syndrome
Idiopathic
Hypothyroidism DM
Pregnancy RA
Obesity
Acromegaly

4. Clinical features Tingling in fingers(esp. at night)
Weakness of thenar muscles
Wasting of thenar muscles
Weakness of abductor pollicis brevis (raising thumb away from palm)
Weakness of opposition of thumb and little finger
Tinel’s sign(tapping over carpal tunnel)
Sensory loss of palm

5. management
Splint wrist
Surgical decompression
OMT

6. Ulnar nerve compression
Usually occurs after trauma of elbow
Clinic:
Wasting and weakness of interossei and hypothenar muscles
Sensory loss inn the ulnar distribution

7. Radial nerve compression
Saturday night palsy
Clinic:
Wrist drop
Weakness of finger extension

8. Mononeuritis multiplex (multiple mononeuritis)
Aetiology : DM
Leprosy
Vasculitis
Sarcoidosis
Malignancy
Neurofibromatosis
HIV infection

9. Polyneuropathies Guillain-Barre syndrome:
Acute inflammatory post-infective polyneuropathy
Follows 1-3 weeks after infection(often trivial,or compylobacter infection)
Clinic:
Weakness of distal limb muscles+- numbness
Weakness ascends over days for up to 3 weeks
Can affect repiratory & facial muscles in 30%

10. Investigations:
Diagnosis is made on clinical grounds
Nerve conduction studies
CSF(cell count normal,protein raised 1-3g/l)

11. Management:
Measurment of respiratory function(art. Blood gases,vital capacity,FEV1)
Assisted ventilation if necessary)
I.V gama-globulin
Plasmapheresis
Heparin for prevention of thromboembolism
Prognosis:spontaneous gradual recovery

12. Other polyneuropathies
Metabolic: DM,uraemia,
Toxic:alcohol,drugs(phenytoin,isoniazid,metronidazole)
Vitamin deficiencies thiamin (B1),pyridoxine(B6), B12, nicotinic acid

13. Vitamin B12 deficiency (sub acute combined degeneration of the cord)
Aetiology:
Low dietary intake(vegan diet)
Impaired absorption (lack of intrinsic factor): pernicious anaemia, gastrectomy, congenital lack of intrisic factor
Impaired absorption (small bowel): pancreatic insufficiency, terminal ileal disease, bacterial overgrowth-bacterial utilization of B12
Abnormal metabolism:transcobalamin II deficiency-congenital lack of B12 transporter

14. Clinic:
Distal sensory loss(light touch,vibration, joint position sense)
Absent ankle jerk
Optic atrophy
Dementia

15. Investigations:
Reduced serum B12
Macrocytosis
Megaloblastic bone marrow
Management:Parenteral B12

16. Peroneal muscular atrophy (Charcot-Marie-Tooth disease)
Inherited sensorimotor neuropathy
Several types:autosomal dominant and recessive
Clinic:
Distal limb wasting&weakness
Pes cavus
Clawing of toes
Loss of sensation
Loss of reflexes

17. Autonomic neuropathy Aetiology:DM,Guillain-Barre syndrome,amylodosis
Clinic:
Postural hypotension
Retentions of urine
Impotence
Diarrhoea
Diminished sweating
Cardiac arrhythmias