
Peripheral neuropathy is the medicine term for damage to nerves of the peripheral nervous system, which may be caused either by diseases of the nerve or from the side-effects of systemic illness. Peripheral neuropathies vary in their presentation and origin, and may affect the ''nerve'' or the ''neuromuscular junction''. Major causes of peripheral neuropathy include seizures, nutritional deficiencies, and HIV, though diabetes is the most likely cause. Mechanical pressure from staying in one position for too long, a tumor, intraneural hemorrhage, exposing the body to extreme conditions such as radiation, cold temperatures, or toxic substances can also cause peripheral neuropathy. Many of the diseases of the peripheral nervous system may present similarly to muscle problems (myopathy), and so it is important to develop approaches for assessing sensory and motor disturbances in patients so that a physician may make an accurate diagnosis. == Types == Peripheral neuropathies may either be ''symmetrical'' and ''generalized'' or ''focal'' and ''multifocal'', which is usually a good indicator of the cause of the peripheral nerve disease. === Generalized peripheral neuropathy === Generalized peripheral neuropathies are symmetrical, and usually due to various systematic illnesses and disease processes that affect the peripheral nervous system in its entirety. They are further subdivided into several categories: * Distal axonopathy are the result of some metabolic or toxic derangement of neurons. They may be caused by metabolic diseases such as diabetes, renal failure, deficiency syndromes such as malnutrition and alcoholism, or the effects of toxins or drugs. * Myelinopathy are due to a primary attack on myelin causing an acute failure of impulse conduction. The most common cause is acute inflammatory demyelinating polyneuropathy (AIDP; ''aka'' Guillain-Barré syndrome), though other causes include chronic inflammatory demyelinating syndrome (CIDP), genetic metabolic disorders (''e.g.'', leukodystrophiy), or toxins. * Neuronopathy are the result of destruction of peripheral nervous system (PNS) neurons. They may be caused by motor neurone diseases, sensory neuronopathies (''e.g.'', Herpes zoster), toxins or autonomic nervous system dysfunction. Neurotoxicity may cause neuronopathies, such as the chemotherapy agent vincristine. == Signs and symptoms == Those with diseases or dysfunctions of their peripheral nerves can present with problems in any of the normal peripheral nerve functions. In terms of sensory function, there are commonly ''loss of function'' (''negative'') symptoms, which include numbness, tremor, and gait imbalance. ''Gain of function'' (''positive'') symptoms include tingling, pain, itching, crawling, and paresthesia. Motor symptoms include ''loss of function'' (''negative'') symptoms of weakness, fatigue (physical), heaviness, and gait abnormality; and ''gain of function'' (''positive'') symptoms of cramps, tremor, and fasciculations. There is also pain in the muscles (''myalgia''), cramps, ''etc''., and there may also be autonomic nervous system dysfunction. During physical examination, those with generalized peripheral neuropathies most commonly have distal sensory or motor and sensory loss, though those with a pathology (problem) of the peripheral nerves may be perfectly normal; may show proximal weakness, as in some inflammatory neuropathy like Guillain-Barré syndrome); or may show focal sensory disturbance or weakness, such as in mononeuropathy, radiculopathy and plexopathy. Common disorders of the peripheral nerves include ''focal entrapment neuropathies'' (''e.g.'', carpal tunnel syndrome), ''generalized peripheral neuropathies'' (''e.g.'', diabetic neuropathy), ''plexopathies'' (''e.g.'', brachial neuritis) and ''radiculopathies'' (''e.g.'', of cranial nerve VII; Facial nerve). == References == # [http://www.med.uwo.ca/UME/Diane/Year2Postings2004-2005/Trimester%202/CNS/DiseasesOfThePeripheralNervousSystemDrHahn.pdf Diseases of the peripheral system] - These lecture notes were presented to a second year medical school class at the [http://www.uwo.ca University of Western Ontario] on 2 December 2004 by [http://communications.uwo.ca/contact_western/search_results.html?department=CLINICAL%20NEUROLOGICAL%20SCIENCES Dr. Angelika F. Hahn]. # [http://www.med.uwo.ca/UME/Diane/Year2Postings2004-2005/Trimester%202/CNS/NerveMuscleDiseasePowerpointDrMNicolle.ppt Approach to Muscle and nerve problems] - Powerpoint slides from a lecture presented to a second year medical school class at the [http://www.uwo.ca University of Western Ontario] on 2 December 2004 by [http://communications.uwo.ca/contact_western/search_results.html?department=CLINICAL%20NEUROLOGICAL%20SCIENCES Dr. Michael W. Nicolle]. # [http://www.med.uwo.ca/UME/Diane/Year2Postings2004-2005/Trimester%202/CNS/ApproachToMuscleOrNerveDiseaseDrMNicolle.pdf Approach to Muscle and nerve problems] - Lecture notes from a lecture presented to a second year medical school class at the [http://www.uwo.ca University of Western Ontario] on 2 December 2004 by [http://communications.uwo.ca/contact_western/search_results.html?department=CLINICAL%20NEUROLOGICAL%20SCIENCES Dr. Michael W. Nicolle]. == See also == * Neuropathy * Myopathy * Myelinopathy Neurology
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Peripheral neuropathy
Peripheral neuropathy is the medicine term for damage to nerves of the peripheral nervous system, which may be caused either by diseases of the nerve or from the side-effects of systemic illness. Peripheral neuropathies vary in their presentation and origin, and may affect the ''nerve'' or the ''neuromuscular junction''. Major causes of peripheral neuropathy include seizures, nutritional deficiencies, and HIV, though diabetes is the most likely cause. Mechanical pressure from staying in one position for too long, a tumor, intraneural hemorrhage, exposing the body to extreme conditions such as radiation, cold temperatures, or toxic substances can also cause peripheral neuropathy. Many of the diseases of the peripheral nervous system may present similarly to muscle problems (myopathy), and so it is important to develop approaches for assessing sensory and motor disturbances in patients so that a physician may make an accurate diagnosis. == Types == Peripheral neuropathies may either be ''symmetrical'' and ''generalized'' or ''focal'' and ''multifocal'', which is usually a good indicator of the cause of the peripheral nerve disease. === Generalized peripheral neuropathy === Generalized peripheral neuropathies are symmetrical, and usually due to various systematic illnesses and disease processes that affect the peripheral nervous system in its entirety. They are further subdivided into several categories: * Distal axonopathy are the result of some metabolic or toxic derangement of neurons. They may be caused by metabolic diseases such as diabetes, renal failure, deficiency syndromes such as malnutrition and alcoholism, or the effects of toxins or drugs. * Myelinopathy are due to a primary attack on myelin causing an acute failure of impulse conduction. The most common cause is acute inflammatory demyelinating polyneuropathy (AIDP; ''aka'' Guillain-Barré syndrome), though other causes include chronic inflammatory demyelinating syndrome (CIDP), genetic metabolic disorders (''e.g.'', leukodystrophiy), or toxins. * Neuronopathy are the result of destruction of peripheral nervous system (PNS) neurons. They may be caused by motor neurone diseases, sensory neuronopathies (''e.g.'', Herpes zoster), toxins or autonomic nervous system dysfunction. Neurotoxicity may cause neuronopathies, such as the chemotherapy agent vincristine. == Signs and symptoms == Those with diseases or dysfunctions of their peripheral nerves can present with problems in any of the normal peripheral nerve functions. In terms of sensory function, there are commonly ''loss of function'' (''negative'') symptoms, which include numbness, tremor, and gait imbalance. ''Gain of function'' (''positive'') symptoms include tingling, pain, itching, crawling, and paresthesia. Motor symptoms include ''loss of function'' (''negative'') symptoms of weakness, fatigue (physical), heaviness, and gait abnormality; and ''gain of function'' (''positive'') symptoms of cramps, tremor, and fasciculations. There is also pain in the muscles (''myalgia''), cramps, ''etc''., and there may also be autonomic nervous system dysfunction. During physical examination, those with generalized peripheral neuropathies most commonly have distal sensory or motor and sensory loss, though those with a pathology (problem) of the peripheral nerves may be perfectly normal; may show proximal weakness, as in some inflammatory neuropathy like Guillain-Barré syndrome); or may show focal sensory disturbance or weakness, such as in mononeuropathy, radiculopathy and plexopathy. Common disorders of the peripheral nerves include ''focal entrapment neuropathies'' (''e.g.'', carpal tunnel syndrome), ''generalized peripheral neuropathies'' (''e.g.'', diabetic neuropathy), ''plexopathies'' (''e.g.'', brachial neuritis) and ''radiculopathies'' (''e.g.'', of cranial nerve VII; Facial nerve). == References == # [http://www.med.uwo.ca/UME/Diane/Year2Postings2004-2005/Trimester%202/CNS/DiseasesOfThePeripheralNervousSystemDrHahn.pdf Diseases of the peripheral system] - These lecture notes were presented to a second year medical school class at the [http://www.uwo.ca University of Western Ontario] on 2 December 2004 by [http://communications.uwo.ca/contact_western/search_results.html?department=CLINICAL%20NEUROLOGICAL%20SCIENCES Dr. Angelika F. Hahn]. # [http://www.med.uwo.ca/UME/Diane/Year2Postings2004-2005/Trimester%202/CNS/NerveMuscleDiseasePowerpointDrMNicolle.ppt Approach to Muscle and nerve problems] - Powerpoint slides from a lecture presented to a second year medical school class at the [http://www.uwo.ca University of Western Ontario] on 2 December 2004 by [http://communications.uwo.ca/contact_western/search_results.html?department=CLINICAL%20NEUROLOGICAL%20SCIENCES Dr. Michael W. Nicolle]. # [http://www.med.uwo.ca/UME/Diane/Year2Postings2004-2005/Trimester%202/CNS/ApproachToMuscleOrNerveDiseaseDrMNicolle.pdf Approach to Muscle and nerve problems] - Lecture notes from a lecture presented to a second year medical school class at the [http://www.uwo.ca University of Western Ontario] on 2 December 2004 by [http://communications.uwo.ca/contact_western/search_results.html?department=CLINICAL%20NEUROLOGICAL%20SCIENCES Dr. Michael W. Nicolle]. == See also == * Neuropathy * Myopathy * Myelinopathy Neurology
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