Today we discussed peripheral neuropathy. A few points on this very broad topic:
Important differential: 'THIN'
1) Toxic, Metabolic- medications, DM2, EtOH, metals, B12
2) Hereditary- Charcot-Marie-Tooth and variants
3) Inflammatory and infectious- Guillain-Barre, CIDP (chronic inflammatory demyelinating polyneuropathy), vasculitis, and HIV, HTLV, leprosy
4) Neoplastic/paraneoplastic: multiple myeloma
Important points on history:
1) Temporal course- acute (days to weeks), subacute (4-8 weeks), chronic (>8 weeks); relapsing? progressive?
2) Proximal vs. distal motor and sensory symptoms (trouble reaching overhead, climbing stairs vs. opening jars, picking things up)
3) What are the sensory symptoms? negative- e.g. numbness or positive- e.g. paresthesias, burning, throbbing, etc.
4) Questions around above differential
Important physical exam:
Atrophy, fasiculations for LMN lesion
Distribution of weakness- nerve vs. plexus vs. root
Reflexes
Sensory- pin prick, vibration (named nerve vs. nerve root vs. length-dependent)
Important investigations:
FBG, HbA1C
CBC, Cr, Vitamin B12, TSH, serum and urine electrophoresis, HIV
Multiple named nerve palsies = mononeuritis multiplex
Essentially diabetes-related vs. vasculitis.
Common nerves involved in DM2: CN III, IV, VI, median nerve, peroneal nerve.
Vasculitides that commonly cause mononeuritis multiplex: Churg-Strauss, polyarteritis nodosa, rheumatoid arthritis with vasculitic component
Link:
Click here for an excellent review of peripheral neuropathy from Lancet
The Natural Treatment for Peripheral Neuropathy is highly effective, simply available and easy to prepare. You can find these herbs and medicines in any kitchen. Let us have a look at some of the most common Home Remedies for Peripheral Neuropathy to this disorder. Try one of these home remedies for nerve pain next time you experience it.
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