Peripheral Neuropathies A Practical Approach PDF
Peripheral neuropathy is a general term, which refers to disorders of the peripheral nervous system. Th e peripheral nervous system consists of all nerves distal to the spinal cord, and includes nerve fi bers that either originate in the spinal cord (motor neurons) or terminate in the spinal cord (sensory nerves). It also includes autonomic nerve fi bers. Th e pattern of nerve involvement in peripheral neuropathies includes: • Radiculopathies • Plexopathies • Mononeuropathies • Polyneuropathies Polyneuropathies represent the largest group, and the term “poly” refers to generalized and homogenous involvement of many nerves, and usually following a distal to proximal pattern. Th ere are a large number of underlying causes (many of which remain unidentifi ed despite eff orts), and, unfortunately, few polyneuropathies can be stopped or reversed with treatment.
Disorders of peripheral nerves are relatively common, but it is diffi cult to determine true prevalence numbers for diff erent types of neuropathies as study designs and reporting metrics are not uniform. Prevalence estimates include: polyneuropathy in people >55 years of age ~8,000/ 100,000; diabetic neuropathy 300/ 100,000; hereditary neuropathy 8– 41/ 100,000; and carpal tunnel syndrome 5,800/ 100,000 for women and 600/ 100,00 for men (Martyn and Hughes, 1997 ). Th e evaluation process of a patient with a neuropathy has many possible approaches. Th is book is based on personal experience using a structured approach. Th is approach is not wholly unique, but is applied here in a rigorous fashion for each type of neuropathy (Barohn, 1998 ). Th is book is written to be concise and readily usable, and covers relatively common types of neuropathies, and hence descriptions and discussions are focused. Chapters are organized in sections. Th e fi rst section is basic background information on peripheral nerve anatomy and pathology, followed by structured approaches to the clinical and electrodiagnostic evaluation, and concludes with informative laboratory tests. While no classifi cation scheme of neuropathies is entirely satisfactory, clinical sections are organized by the patterns of nerve involvement listed above. Chapter content for each type of neuropathy is based on underlying pathology, clinical features, diagnostic evaluation (including electrodiagnostic and informative laboratory tests), and ends with management and treatment options.