Primary Sensory Neuropathy Pure Sensory Distal Nerve Lesions

The Peripheral Neuropathy Solution

Dr. Labrum Peripheral Neuropathy Solution

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Primary sensory neuropathies reflect a focal mononeuropathy of a nerve that carries only sensory fibers. Examples (see Fig 19-3 and Fig,;, 19-.4 ) include the following:

Meralgia paresthetica with involvement of the lateral femoral cutaneous nerve Gonalgia paresthetica due to entrapment of the infrapatellar saphenous nerve Cheiralgia paresthetica due to entrapment of the superficial branch of the radial nerve Medial antebrachial cutaneous neuropathy Dorsal ulnar neuropathy Sural neuropathy Diffuse Sensory Polyneuropathy

In generalized peripheral neuropathy the sensory loss is length dependent such that it begins symmetrically at the most distal aspect of the lower extremities and ascends proximally. Generally the distal upper extremities will begin to show involvement when the sensory deficit in the lower extremity has ascended to the level of the proximal calf. In the most severe stage of peripheral neuropathy only a midline strip over the posterior trunk and neck and the peripheral aspects of the face have sustained sensation.y

TABLE 19-5 -- ETIOLOGY OF DISORDERS AFFECTING POSITION AND VIBRATION SENSES

Etiological Category

Specific Etiologies

Chapter

STRUCTURAL DISORDERS

Developmental

Tethered spinal cord

28

Degenerative and compressive

Herniated disc

29

HEREDITARY AND DEGENERATIVE DISORDERS

Storage diseases: lipidoses, glycogen disorders, and leukoencephalopathies

Tangier disease

30

Amino/organic acidopathies

Hereditary tyrosinemia

31

Chromosomal abnormalities and neurocutaneous disorders

Neurofibromatosis with foramen magnum tumor or neurofibroma

32

Movement disorders

Parkinsons disease

34

Ataxias

Friedreichs ataxia

35

Degenerative motor, sensory, and autonomic disorders

Hereditary spastic paraplegia

36

Inherited muscle, neuromuscular and neuronal disorders

Hereditary sensory autonomic neuropathy 1

37

ACQUIRED METABOLIC AND NUTRITIONAL

DISORDERS

Endogenous metabolic disorders

Hypothyroid neuropathy

38

Exogenous acquired metabolic disorders of the nervous system:

Pyndoxine toxic neuropathy

39

toxins and illicit drugs

Nutritional deficiencies and synclromes associated with alcoholism

Vitamin Bl2 -subacute combined degeneration

40

INFECTIOUS DISORDERS

Viral infeetions

Herpes zoster "shingles"

41

Nonvira] infeetions

Aeute disseminated eneephalomyelitis

42

Human immunodefieieney virus infeetion and acquired

Distal sensonmotor penpheral neuropathy

44

immunodefieieney syndrome

Mononeuritis multiplex

NEUROVASCULAR DISORDERS

Parietal stroke

45

Abdominal aortie disseetion

NEOPLASTIC DISORDERS

Primary neurological tumors

Neurofibroma

46

Metastatic neoplasms and paraneoplastic syndromes

Brachial plexopathy-usually lower trunk

47

Sensory ganglionitis

DEMYELINATING DISORDERS

Demyelinating disorders of the c entral nervous system

Multiple sclerosis

48

Demyelinating disorders of the peripheral nervous system

Chronce inflammatory demyelinating polyradiculoneuropathy

49

AUTOIMMUNE AND INFLAMMATORY DISORDERS

Sensory neuronopathy associated with Sjogrens syndrome

50

TRAUMATIC DISORDERS

Infraclavicular brachial plexopathy from humeral dislocation

51

EPILEPSY

Parietal lobe irritative focus with focal sensory seizure

52

HEADACHE AND FACIAL PAIN

Migraine with sensory aura

53

DRUG-INDUCED AND IATROGENIC NEUROLOGICAL

Radiation plexitis

55

DISORDERS

Postanesthesia brachial plexopathy

Examples of causes of diffuse sensory neuropathy include a dysproteinemic state (IgM monoclonal gammopathies with antimyelin-associated glycoprotein), amyloidosis (generally small fiber), hereditary, diabetes mellitus, uremia, hypothyroidism, immunological (scleroderma, sarcoid), and toxins. A generalized peripheral neuropathy can show selective involvement of certain fiber types such as large myelinated fibers. In these circumstances there will be a dissociated sensory loss with a deficit of vibration and proprioception while sparing pain and temperature on sensory examination. Examples of these conditions include Friedreich's ataxia, Charcot-Marie-Tooth disease, uremia, and Guillain-Barre syndrome.

There are more unusual length-dependent generalized symmetrical proximal neuropathies such that the shortest peripheral nerves are selectively involved. This results in sparing of sensation at the distal aspects of the extremities. This pattern may be seen in the neuropathy associated with Tangier disease, in acute intermittent porphyria, and in a unique familial sensorimotor neuropathy. 4ai

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