Pathophysiologic Classification

Based on the primary site of involvement, peripheral neuropathies can be classified as neuronopathies, axonal neuropathies, and myelinopathies. Electrodiagnostic studies can help define this in a clinical setting. Neuronopathies result from damage to the sensory cell bodies in the dorsal root ganglia or motor neuron cell bodies in the spinal cord. Their location in the CNS usually results in a degenerative process that produces incomplete recovery. Diseases that specifically affect the motor neuron cell bodies in the CNS are usually not categorized as peripheral neuropathies. Axonal neuropathies occur when damage occurs at the level of the axon. When the axon is disrupted (e.g., by trauma), the axon and distal myelin sheath may degenerate distal to the site of injury (wallerian degeneration). In toxic or metabolic injuries, when the distal axon is injured and myelin degeneration spreads proximally, it is known as "dying back" neuropathy. With the dying back process, the longer nerves tend to be affected earlier and more severely. Myelinopathies (demyelin-ating neuropathies) result from a process affecting primarily the myelin sheath. They can result from acute conditions such as Guillain-Barre syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathies (CIDPs), and certain hereditary neuropathies.

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