Polyneuropathy

from Wikipedia, the free encyclopedia
Classification according to ICD-10
G62.9 Polyneuropathy, unspecified
frequent Causes:
G62.1 Alcohol polyneuropathy
G62.0 Drug-induced polyneuropathy
G62.8 Criticall illness polyneuropathy
G61.0 Guillain-Barré Syndrome
G63 .- * Polyneuropathy in diseases classified elsewhere, e.g. B. in diabetes, neoplasms, nutritional deficiencies
ICD-10 online (WHO version 2019)

Polyneuropathy is the generic term for certain diseases of the peripheral nervous system that affect several nerves. Depending on the cause, motor , sensory or vegetative nerves can be affected jointly or in particular . The disease is more likely the insulation layer of the nerves ( myelin ) or more of the cell process ( axon affect) itself, it can be rather far from the body ( distal ) on the hands and feet or much more rarely close to the body ( proximal show), there are symmetrical and asymmetrical ( focal and multifocal) forms; however, several peripheral nerves are always affected (Greek poly "many"). The symptoms can be very diverse depending on the type of nerve fiber and body region affected.

HIV-induced autoimmune-antiMyelin Antibodies against human nerve tissue (FITC-Stain) peroneal nerve, incubated with the serum of an HIV-positive patient suffering from polyneuropathy with anti-myelin antibodies
Fluorescence microscopy: cross-section, biopsy material of a normal human peroneal nerve which was incubated with the serum of an HIV-positive patient with anti-myelin antibodies

Common causes

Possible further causes

The spinal stenosis in the lumbar spine, which is common in old age, can cause PNP-like symptoms such as the feeling of socks.

Symptoms

  • Polyneuropathic sensory disorders can occur with various distributions on the body. Since the cell bodies (somata) of the sensitive nerve cells in the ganglia are close to the spinal cord and the nerve processes are supplied from there, the longest fibers that need to be supplied up to the big toe are most likely to be damaged. The disease often begins with unpleasant sensations of the toes on both sides. As the disease progresses, the distribution of the sensory disturbances is sometimes described as "glove or sock-shaped". The affected areas of the body can tingle spontaneously and are then uncomfortable and sometimes very annoying, either numb or burning pain. There may be abnormal sensations such as heat or cold and swelling, e.g. B. occur "like in a vice".
  • Due to the missing or falsified sensitive information about the joint positions, the pressure when stepping on and the degree of muscle tension, “peripherally related”, atactic coordination disorders can occur. Such patients are then no longer able to walk safely, especially when their eyes are closed.
  • Peripheral, atrophic and often symmetrical paralysis
  • Trophic changes in the skin when peripheral autonomic nerve fibers are affected. This can lead to an ulcer , to hypohidrosis (reduced production of sweat ), gastric, intestinal and bladder emptying disorders as well as erectile dysfunction, resting tachycardia and disorders of the pupillomotor system with restricted mydriasis (pupillary dilation).

Diagnosis

  • History : The patients report a lack of awareness ( negative symptoms ) or sensory disorders such as tingling, pins and needles , burning (positive symptoms).
  • Inspection: Noticeably dry skin can be an indication of neuropathy if the infection is symmetrical .
  • Reflex test of the patellar tendon and Achilles tendon reflex. The absence of ASR is a suspicion of polyneuropathy.
  • Cold-warm distinction: the patient should be able to differentiate between a cold metal surface of approx. 1.5 cm in diameter and a plastic surface of the same size when touching the sole of the foot .
  • Sensitivity test with the Semmes-Weinstein monofilament : This is a nylon thread that exerts a defined pressure of 0.1 Newton by bending . The filament is z. B. placed on the ball of the foot between the first and second metatarsophalangeal joint. The patient is first asked to close his eyes and indicate the location of the contact. If there are five points of contact, at least three should be specified correctly.
  • Investigation of the vibration sensation with the tuning fork according to Rydel and Seiffer : The solid metal tuning fork according to Rydel and Seiffer has a frequency of 128  Hz , which is reduced to 64 Hz by two screw-on metal blocks. There are two acute-angled triangles on the metal blocks, which intersect when the fork is swinging and, using a scale with eight subdivisions, allow the strength of the vibration to be determined up to which the patient can still perceive the vibration. During the oscillation, a virtual triangle moves from 0/8 to 8/8. Normal is up to the age of 50 up to 6/8, over the 50th year up to 5/8. If there is less or no awareness, a polyneuropathy is suspected.
  • Electronurography : Measurement of the nerve conduction velocity and the total nerve potential on subcutaneous nerves. Reduction of the nerve conduction speed is found in diseases of the myelin sheath ( demyelination ). In contrast, with axonal damage patterns, the total nerve potential is reduced.
  • Pathological diagnosis: Removal of a piece of the sural nerve . This lies relatively superficially under the skin of the lower leg and after removal has only a slight loss of sensitivity in the area of ​​the lower leg. Investigations are usually carried out on normal paraffin sections , semi-thin sections and with the help of electron microscopy .
  • Participation of the autonomic (autonomic) nervous system can be demonstrated by a sweat test , a tilt table examination , an examination of the gastric emptying time and a measurement of the heart rate variability .

Laboratory values

The HbA1c value , kidney and liver values should be determined, and if alcohol abuse is suspected, the alcohol level and the CDT value . Also important are indications of a vitamin B12 deficiency (erythrocyte size), vitamin B-12 levels, and holo-transcobalamin in the case of borderline vitamin levels, and determination of antibodies against parietal cells of the gastric mucosa in the case of a proven vitamin deficiency.

Differential diagnosis

therapy

Therapy is cause-specific according to the underlying disease and / or symptomatically. Targeted treatment is only possible if the cause of the polyneuropathy has been identified. Cause-dependent therapeutic measures are, for example:

Animal studies suggest that progesterone might work against demyelination. Clinical trials on humans have not yet proven this. Researchers isolated the active substance DHCB ( dehydrocorybulbin ) from the rhizome of the Yanhusuo lark spur ( Corydalis yanhusuo ) , which in animal experiments showed an effect against neuropathic pain.

See also

Special cases

Possible manifestations

To be distinguished from

literature

Individual evidence

  1. ↑ Alphabetical directory for the ICD-10-WHO version 2019, volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 161
  2. ^ Miller RG1, Parry GJ, Pfaeffl W, Lang W, Lippert R, Kiprov D .: The spectrum of peripheral neuropathy associated with ARC and AIDS. In: Muscle Nerve (Ed.): American Association of Neuromuscular & Electrodiagnostic Medicine . tape 11 , no. 8 . Wiley, New York 1988, pp. 857-863 .
  3. ↑ Kidney failure: symptoms on the website of the Apotheken Umschau , accessed on October 13, 2019
  4. ↑ Polyneuropathy: Tingling, numbness & Co. on Onmeda , accessed on October 13, 2019
  5. ↑ Study of micronutrients (copper, zinc and vitamin B12) in posterolateral myelopathies. In: Journal of the neurological sciences Volume 329, Issues 1-2, Pages 11-16
  6. ↑ Spinal stenosis. Retrieved January 20, 2018 .
  7. ↑ Effective treatment of symptomatic diabetic polyneuropathy through high-frequency external muscle stimulation
  8. ↑ Donald G. Stein: Progesterone exerts neuroprotective effects after brain injury. In: Brain Research Reviews. 57, 2008, p. 386, doi : 10.1016 / j.brainresrev.2007.06.012 .
  9. ↑ China root: researchers isolate active ingredient against neuropathic pain Dt. Ärzteblatt online, January 3, 2014