B5W1L9Peripheral Neuropathy - Slide Presentation：b5w1l9peripheral神经病的幻灯片.ppt

An Approach to Peripheral Neuropathy Peter-Brian Andersson MBChB,BSc(Med)(Hons),DPhil The 3 questions of clinical neurology… #1. Where is the lesion? #2. What is the etiology? #3. What is the treatment? The patterns of peripheral neuropathy…  Overview of the Lecture –Mastering polyneuropathy #1. Where is the injury? The syndrome depends on: what modalities are injured, what fibers are injured, whether axon or myelin (or both) injured. #2. What is the etiology? Tricky – hence an approach necessary at the bedside. #3. What is the treatment? Depends on reversing the underlying cause. Three common examples The clinical effect of a polyneuropathy depends on 1) what modalities involved  2) what fibers are effected  3) whether the injury is axonal or demyelinating. Axonopathies By far the majority of the toxic, metabolic and endocrine causes NCVs: CMAPs ↓ 80% lower limit of normal w/o or min velocity or distal motor latency change. Legs arms. EMG: Signs of denervation (acute, chronic) and reinnervation Segmental Demyelination Myelinopathies Unusual by comparison with axonopathies Clues: hypertrophic nerves on exam global arreflexia weakness without wasting motor sensory deficits NCS can discriminate inherited from acquired NCS: Distal motor latency prolonged (125% ULN) Conduction velocities slowed (80% LLN) May have conduction block EMG: Reduced recruitment w/o much denervation Question #2. What is the etiology? Only a limited number of ways a peripheral nerve can react to injury, thus a multitude of different etiologies can cause similar effects… Problem: The multitude causes of peripheral neuropathy!!! How then are we to sort through the causes to make an etiologic diagnosis?... Use the 6 D’s…. What is the distribution of the deficits? What is the duration? What are the deficits (which fibers are involved)? What is the disease pathology (axon