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18 September 2015
4 steps
Overview
Step 1
Step2
Step 3
Step4
: Symptom defined
: Anatomical diagnosis
: Pathological diagnosis
: Clinical diagnosis
Step 1
-> Step2
-> Step 3
Neuromuscular problem
CNS
A. AMSAN
C. Alcohol
Length dependent
Pinprick loss
H. CMT type 2
A. Acute PAN
C.Amyloidosis
H. HSAN
MND
Early autonomic
Nerve
NMJ
Symmetrical
distal
Motor
-> Step 4
Sensory ataxia
A. SCCA lung
C. Sjogren
Muscle disease
A. AIDP
C. CIDP
H. CMT type 1
Symmetrical
Proximal and distal
Sensory
with/without motor
Vascutitic neuropathy
Nerve
Asymmetrical
Subarachnoid
infiltration
Demyelination
Multiple entrapment
A. Polyarthritis nodusa
A. Tumor infiltrative
C. MMN
H. HNPP
D
M
Dysesthesia
- unpleasant sensations when exposed to touch
- Hyperexcitability of small fiber nerve terminal
Allodynia
- Painful with stimuli which do not normally provoke pain
- Central sensitization
Autonomic
Orthostatic hypotension
Constipation, Urinary incontinence
Early satiety
Impotence
Anhidrosis
Erythromelalgia
Note:
Preganglionic fiber myelinated
Postganglionic unmyelinated small fiber
Ach receptor of autonomic ganglion
Pure motor
MND
atrophy -> weak -> reflex
Nerves
reflex -> weak -> atrophy
NMJ
not impaired unless repetition
Muscle
weak -> atrophy -> reflex
Polyneuropathy with
dominant motor
Porphyria
Lead
GBS (AMAN)
CMT (Charcot-Marie-Tooth type I)
Diptheria/ Dapsone
HNPP (Hereditary liability pressure palsy)
MMN (Multifocal Motor neuropathy)
Sensory
with/without motor, autonomic
Nerves
Root
Peripheral nerve
Each nerve function
Confluence -> polyneuropathy
Nerve ending
Dysesthesia
Nerves?
Progression
Progression
Progression
Pattern of axonopathy
Large fiber
most common: DM, Drug, Deficiency etc...
Autonomic neuropathy
Porphyria
Amyloidosis ( familial and primary)
HSAN
6 Pack So Hit
Sensory ganglinopathy
6
Vitamin B6 toxicity
Pack Paraneoplastic anti Hu, Cisplatin
So
Sjogrens syndrome
Hit
HIV, HTLV-1
Idiopathic
Asymmetrical
polyneuropathy
Vasculitic neuropathy
Vasculitis
Diabeic polyradiculoplexopathy
Bruns-Garland syndrome (diabetic amyotrophy)
Subarachnoid infiltration
Multiple entrapment
HNPP
Demyelination
MADSAM
MMN
Progression
Acute (4 wks) to subacute (4-8 wks)
GBS, Paraneoplastic
Chronic (>8 wks to year)
CIDP ,Paraproteinaemic
Hereditary
(definite onset no paresthesia)
CMT, HSAN
Host status
Multiple presenatation :
Atypical presentation :
Medication associated :
Special situation
:
Reference
.
2557 780-798
Adams and Victors principle of clinical
neurology 10th edition 2014