What are metabolic causes of polyneuropathy?
- Diabetes mellitus
- Hepatic disease
- Thyroid disease
- Amyloid disease
- Refsum’s disease
- Critical illness
What vitamin deficiencies can cause polyneuropathy?
- B1, 6, 12
- Nicotinic Acid
- Drug related neuropathies
What types of neuropathy can occur in diabetes?
- Distal symmetrical sensory neuropathy
- Acute painful sensory neuropathy
- Mononeuropathy and mononeuritis multiplex
- Diabetic amyotrophy
- Autonomic neuropathy
What investigations would you do in someone with features of polyneuropathy?
- Bloods - FBC, ESR, Glucose, U+Es, LFTs, TSH, B12, ANA, ANCA
- Consider LP
- Genetic testing
- NErve conduction studies
What are features of sensory neuropathy?
- Affects glove/stocking distribution
- Difficulty handling small objects
Are diabetic and alcoholic neuropathies painful?
What are features of motor neuropathy?
- Weak/clumsy hands
- Difficulty walking
- Difficulty breathing
- Signs of LMN lesion - flaccid, hyporeflexive, wasting, fasciculations
What are infectious causes of polyneuropathy?
- Lyme disease
What are causes of autonomic neuropathy?
What are signs of sympathetic autonomic neuropathy?
- Postural hypotension
- Decreased sweating
- Ejaculatory failure
- Horner's syndrome
What are features of Parasympathetic autonomic neuropathy?
- Nocturnal diarrhoea
- Urinary retention
- Erectile dysfunction
How would you investigate someone for autonomic neuropathy?
- Paraneoplastic antibodies
What spinal condition can occur asa complication of B12 deficiency?
Subacute combined degeneration of the cord
What are features of subacute combined degeneration of the cord asa complication of B12 deficiency?
Degeneration of posterior and lateral columns of the spinal cord
- Numbness/tingling of fingers/toes
- Distal sensory loss
- Absent ankle jerks
- Exaggerated knee jerks
- Extensor plantars