1. Diarrhea and Neuro Sx Seizures (shigella) Blurred vision, diplopia, dysarthria, dysphagia, descending paralysis (Clostridium botulinum Headache, dizziness (scombroid fish) Paresthesias and hot-cold sensation reversal (ciguatera) Respiratory paralysis (paralytic shellfish poisoning) Fatalities and respiratory depression (tetrodotoxin from puffer fish)

2. Paresthesias Definition –A spontaneous and abnormal sensory aberration Problem –abnormality along the sensory pathway from the peripheral nerves to the sensory cortex. Described as a pins-and-needles sensation May be confused w/ weakness

3. Paresthesias Transient paresthesias are common in normal Persistent paresthesias imply an abnormality of sensory pathways.

4. Paresthesias Peripheral neuropathy –Diabetes –ETOH –Thiamine deficiency Peripheral nerve entrapment –Trauma –Disc –Carpal tunnel Spinal cord disease –MS –Demyelination Metabolic –Hypocalcemia –Resp. Alkalosis –Toxins/drugs –Infectious Vascular –PVD –Vasculitis

5. Paresthesias Other –Sarcoid/Lupus –Amyloidosis –Myxedema –Leprosy –Multiple myeloma –Guillain-Barre –Mononucleousis –Viral hepatitis –Porphyria Toxins –Arsenic –Mercury –Thalium –Lithium –Gold –Lead Drugs –Nitrofurantoin –Hydralazine –Phenytoin –INH –Disulfiram –Amiodorone

6. Multiple symmetric peripheral neuropathy Stocking – glove distribution Feet alone or with the hands; –hands are rarely affected alone. Neuropathies may be: –Sensory (paraneoplastic) –Motor (Guillian-Barre) –Mixed sensorimotor (diabetes) There is overlap Motor and sensorimotor neuropathies –motor abnormalities, weakness, wasting, loss of tendon reflexes.

7. Guillian-Barre Acute inflammatory demyelinating neuropathy –Viral resp., GI infection, immunization, surgery often precedes sx by 5d –3 weeks –Rapid, progressive weakness, loss of reflexes, oropharyngeal and respiratory paresis, impared sensation of hands and feet.

8. Guillian-Barre Etiology –? Immune mediated –Focal demyelination Incidence –0.6 – 1.9 / 100,000 –M=W –Increases w/ age

9. Guillian-Barre Signs and Sx –Limb weakness, paresthesias –> 50% have facial nerve plegias (facial, ocular, oropharyngeal muscles) –Loss of reflexes (may be nl first days) –Variable sensory loss Lab –Elevated CSF protein –Increased Ig to GM1 ganglioside

10. Guillian-Barre Diagnosis 1.Symmetric motor/sensory motor neuropathy after a viral illness, surgery, or delivery 2.Slowing of nerve conductions 3.High CSF protein Treatment –Plasmapheresis, IV IG –Mechanical ventilation