Polyneuropathies

Polyneuropathy (polyneuritis) is a simultaneous defeat of many peripheral nerves, manifested by symmetrical flaccid paralysis and sensory impairment mainly in the distal parts of the extremities with the defeat of cranial nerves in some cases.

Etiology, pathogenesis. Intoxications (alcohol, gasoline, lead, arsenic, sulfonamides), parainfection and allergic complications (diphtheria, pneumonia, parotitis, etc.), dysmetabolic disorders (diabetes, uremia, porphyria), eating disorders (deficiency of vitamins B1, B12) , Systemic diseases (periarteritis, SLE), hemoblastoses, malignant neoplasms. The severity of demyelination and degeneration of axons of nerve trunks is different depending on the etiology of polyneuropathy. The so-called infectious polyneuropathies are based on immunological disorders, rather than direct invasion of infectious diseases.

Symptoms, course. The disease can occur at any age, but more often young people and middle-aged people get sick. The development of painful symptoms is usually subacute or chronic (with the exception of the acute demyelinating polyradiculoneuropathy Guillain-Barre). Progressive muscle weakness, atrophy, paresthesia, pain, hyperesthesia or anesthesia, decrease or loss of reflexes. These disorders are most pronounced in the distal parts of the limbs and rarely extend to the trunk. Gradually upset sensitivity (most often vibrational). Due to the paralysis of the feet, a stepping occurs (cock-gait); In severe cases tetraplegia can be observed. Muscles and nerve trunks are painful in palpation, there are trophic disorders (dryness and cyanosis of the skin, nail damage). Involvement of peripheral nerves in the process of vasomotor fibers causes the development of orthostatic hypotension syndrome, sometimes pupillary disorders.

The nature of polyneuropathy is established only after a comprehensive examination of patients. Most often there is diabetic polyneuropathy, which for many years can only be manifested by the loss of reflexes on the legs and a violation of deep sensitivity. The development of polyneuropathy in old age requires, first of all, the exclusion of malignant neoplasm or myeloma.

In case of differential diagnosis, one should bear in mind polymyositis (there are no sensory and reflex abnormalities), poliomyelitis (purely motor disturbances) and spinal dryness (absence of atrophy, presence of pupillary anomalies). It is also necessary to take into account the subclinical course of polyneuropathy, when the disease is long manifested by the defeat of only one or two nerves, and only a thorough clinical examination and determination of the conduction velocity along the nerves of the extremities allow the polyneuropathic nature of the process to be established. In many cases of polyneuropathy, the level of protein in the cerebrospinal fluid is moderately elevated, which indicates the involvement of not only peripheral nerves, but also rootlets (polyradiculoneuropathy) in the process.

Treatment in case of establishing the cause of the disease is etiotropic: for alcoholic polyneuropathy, parenteral administration of thiamine (vitamin B1) to 1000 mg / day (20 ampoules of a 5% solution), for the poisoning with metals of chelates (EDTA, etc.), and porphyria for adenyl. Apply analgesics, massage, physiotherapy exercises, physiotherapy. In the chronic and residual stages, sanatorium treatment is indicated. The use of plasmapheresis usually has a rapid positive effect.

Forecast. With the timely detection of the exogenous cause of the disease, complete recovery is possible. More often it is possible to achieve stabilization of the process with the preservation of one or another residual symptomatology.