Saturday, 10 September 2016

Some Neuropathies And Their Causes

Today's short post from (see link below) should make you smile at least! It's basically a list of forms and causes of neuropathy and his use of acronyms is creative but will probably make you remember them. You may need further information concerning one or more of these categories - if that's the case, then Google is your best friend (followed by the search button on this blog!).

Peripheral neuropathy Chris Nickson 2016

Diseases that affect the the peripheral nerves, either motor or sensory
Important subgroups for differential diagnosis are: predominately motor, painful peripheral neuropathies and mononeuritis multiplex
Mononeuritis multiplex is a painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas that can be in random areas of the body.


Peripheral neuropathies


drugs and toxins – e.g. heavy metals, isoniazid, vincristine, phenytoin, nitrofurantoin, cis-platinum, amiodarone, larges of vitamin B6,
alcohol and amyloid
metabolic – e.g. DM (30%), acromegaly, hypothyroidism
infectious/post- – e.g. Lyme, diptheria, GBS
tumor – e.g. lung CA
B12, B1, B5 or B6 deficiency
idiopathic (30%)
CTD or vasculitis, e.g. SLE, PAN
hereditary (30%)

or the alternative “DAM IT BITCH”: 

D Drugs and chemicals (Pb, phenytoin, metronidazole, amiodarone, hydralazine, vincristine, isoniazid, organic solvents, sulphonamides, nitrofurantoin, CO, OPs).
A alcohol (with or without Thiamine deficiency)
M metabolic (diabetes, hypoglycemia, uraemia)
I infection (HIV, leprosy, lyme, diptheria, syphilis) or post infectious (GBS)
T tumour (paraneoplastic phenomenon – lung, lymphoma, myeloma)
B B12 & other vitamin deficiency states, as well as pyridoxine excess
I idiopathic and infiltrative (e.g. amyloidosis)
T toxins (botulism, ciguatera, Tetrodotoxin, Saxitoxin, BRO, tick paralysis)
C connective tissue diseases (e.g. SLE, PAN, RhA) and congenital (e.g. CMT)
H Hypothyroidism

Predominately motor peripheral neuropathy

Guillain-Barré syndrome, chronic inflammatory polyradiculoneuropathy
Hereditary motor and sensory neuropathy
Diabetes mellitus
Others-e.g. acute intermittent porphyria, lead poisoning, diphtheria, multifocal conduction block neuropathy

Painful peripheral neuropathy

Diabetes mellitus
Vitamin B1 or B12 deficiency
Arsenic or thallium poisoning

Mononeuritis multiplex


Daibetes mellitus
Polyarteritis nodosum
Connective tissue diseases, e.g. SLE, Rheumatoid arthrits


multiple compressive neuropathies
Lyme disease

Polyneuropathies with autonomic involvement

These are the common ones:

diabetes mellitus
Guillain-Barre Syndrome
Paraneoplastic neuropathy (usually lung cancer)
Sogren’s syndrome-associated neuropathy
References and Links

Journal Articles and Textbooks

Burns JM, Mauermann ML, Burns TM. An easy approach to evaluating peripheral neuropathy. J Fam Pract. 2006 Oct;55(10):853-61. Review. PubMed PMID: 17014750. [Free Full Text]
Talley NJ, O’Connor S. Clinical Examination: A Systematic Guide to Physical Diagnosis. MacLennan and Petty. 3rd edition, 1998.

About Chris Nickson

An oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis. Key areas of interest include: the ED-ICU interface, toxicology, simulation and the free open-access meducation (FOAM) revolution. @Twitter | + Chris Nickson | RAGE | INTENSIVE| SMACC | iTeachEM

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