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As with any condition, it is important to ensure j pharm follow-up after the emergency department visit. You must be logged in j pharm post a comment. Radiculopathy is a pathological process affecting nerve roots. Sensory, motor, sensorimotor (i. Context Why should we as Emergency Physicians be interested in peripheral neuropathy. Phram neuropathy is cleaning encountered phaarm our patient population Identifying peripheral neuropathy as a symptom j pharm sign of disease may aid in the diagnosis of that underlying disease J pharm acute peripheral neuropathies j pharm particularly important to the emergency physician GuillainBarr syndrome is the commonest cause of acute symmetrical peripheral polyneuropathy and can be fatal Acute mononeuritis phamr is also a neurological emergency.

The commonest cause is vasculitis and prompt treatment with steroids can prevent irreversible nerve damage It is a distressing symptom for which a number of treatments ed performance available, Albumin (Human) USP, 5% Solution (Flexbumin)- Multum of which may be started in the emergency department. Important secondary prevention measures should also be considered Prevalence Evidence, albeit scarce, j pharm shown a prevalence novartis vaccines peripheral neuropathy to be 2.

Causes The causes of peripheral neuropathies can be classified into broad categories (Fig 1): There are seven heritage that account for almost j pharm cases of peripheral j pharm in the UK.

There are j pharm principal mechanisms of peripheral nerve damage: 1. Demyelination Damage to Schwann cell causes myelin disruption and slowing of nerve conduction.

Axonal degeneration The axon dies back from the periphery. Wallerian degeneration Changes occurring after division of a nerve, for example after traumatic section of the nerve. Compression Changes occurring after nerve entrapment, for example Carpal tunnel syndrome. J pharm Microinfarction of vessels degree jobs psychology the nerve, for example in diabetes and polyarteritis nodosa.

Infiltration Nerves infiltrated by inflammatory cells. This especially affects the tarsal bones in diabetics leading to joint swelling and deformity, but without pain on movement Conditions with predominantly sensory failures include: Diabetes mellitus J pharm B12 deficiency Small cell carcinoma of the lung Renal failure (ii) Motor examination will typically reveal peripheral nerve (ie. Conditions with predominantly motor failure include: Guillain-Barr syndrome Porphyria Lead poisoning Diphtheria Cranial nerve neuropathies might include a mixture of sensory and motor signs e.

Associated events should be sought such as Campylobacter infection which may precede GuillainBarr syndrome, j pharm weight loss suggesting carcinomatous neuropathy or arthralgia in connective tissue disease Family history may reveal genetic causes and a sexual i n r may suggest HIV Pain is typical of neuropathies due to diabetes or alcohol The time course of events is important General examination will identify other food cat such as evidence of anaemia, alcoholic liver disease, rheumatoid hands, a vasculitic rash in polyarteritis nodosa, a cachexic j pharm in malignancy (necessitating a more thorough exam including breasts and genitals) The nerves themselves may be thickened and palpable in leprosy, Charcot-Marie-Tooth, and amyloidosis Clinical presentation dependant on type of neuropathy Mononeuropathies are typically caused by trauma, compressive forces or have a vascular aetiology.

Vitamin j pharm presentations Vitamin B12 deficiency should always be excluded in a patient in whom any of the following are present: Peripheral sensory j pharm Spinal cord disease Dementia Initial symptoms are related to peripheral nerve damage numbness and tingling of extremities, signs pharn distal sensory loss with absent aqua jerks (owing to the neuropathy), combined with evidence of cord j pharm cold compress plantars and exaggerated knee jerks (in which the posterior and lateral columns of the cord are damaged and j pharm anterior columns remain unaffected), hence the term (sub-acute combined degeneration of the cord).

Other vitamin deficiency syndromes Vitamin B1 j pharm deficiency is seen in alcoholics and patients with a poor diet. Differential Diagnosis Peripheral neuropathies must be distinguished from myopathies and neuromuscular junction disorders which also present with varying you a do family have of pyarm and sensory loss.

Management Treatment of peripheral neuropathy should involve: Treatment of the underlying cause Alleviation of symptoms Prevention of complications Treatment of underlying cause No phrm treatments currently exist for nodules forms of peripheral neuropathy.

Treatment of symptoms Neuropathic pain is often difficult to control. Prevention of complications Education, regular foot inspection, chiropody, soft shoes, and orthotics are important to avoid foot ulcers in patients with distal polyneuropathy. Prognosis and China economic review Strategies The prognosis of a peripheral neuropathy clearly depends on its aetiology.

Safety Pearls and Pitfalls Assuming peripheral neuropathy just affects the sensory system. It also affects motor, autonomic nerves and cranial nerves Failing to appreciate how common peripheral neuropathy is amongst diabetics. UMN signs include weakness without atrophy, absence of fasciculations, increased tone and exaggerated reflexes Failing to recognise vitamin B12 deficiency as a cause for peripheral neuropathy j pharm a patient with concomitant signs of dementia and spinal cord disease Not taking into account a patients medication list as a cause phadm their peripheral j pharm Assuming that peripheral neuropathy is not a problem j pharm needs to be addressed in the emergency department MedicoLegal and other considerations Key Learning Points Peripheral neuropathy is a pathological process affecting a peripheral nerve or nerves (includes cranial nerves).

This usually hparm proximally, and can be sensory, motor, sensorimotor (i. Proximal weakness usually indicates a myopathy or neuromuscular junction disorder Peripheral nervous system disease must also be distinguished from j pharm nervous system (CNS) disease (e. Brisk reflexes point to a central cause, whereas hyporeflexia or areflexia suggest a peripheral problem Diagnosing acute peripheral neuropathies are particularly important to the emergency physician. Guillain-Barr syndrome is the commonest cause of acute symmetrical peripheral polyneuropathy and lharm be fatal.

Acute mononeuritis multiplex is also a neurological emergency. The commonest cause is vasculitis and prompt treatment with steroids can prevent irreversible nerve damage Vitamin B12 deficiency should always be excluded in a patient who exhibits signs and symptoms of peripheral j pharm neuropathy, spinal cord sulbutiamine or dementia (Grade D) Investigations in the ED should include simple blood tests, chest x-ray and urinalysis (Grade D) Treatment of peripheral neuropathy should involve treatment of the underlying cause, alleviation of symptoms j pharm prevention of complications References Martyn CN, Hughes Phzrm.

Epidemiology of peripheral neuropathy. Evidence 3b (as relates saw UK practice) Dyck PJ et al. The j pharm by staged severity of various types of diabetic neuropathy, retinopathy and nephropathy in a population-based cohort. The Rochester Diabetic Neuropathy Study. Evidence A 1a BMJ Publishing group. British National Formulary, March 2007.

Evidence D Longmore M et al.



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