Polyneuropathy

Polyneuropathies represent an etiologically extensive group of non-traumatic peripheral nerve disorders. Causes may include:
 * 1) toxic substances: lead (mainly extensors), alcohol (mainly peroneus muscle),
 * 2) metabolic diseases: diabetes mellitus, porphyria, uremia, liver cirrhosis, hypothyroidism,
 * 3) infectious diseases: diphtheria, mumps, mononucleosis, typhus,
 * 4) drugs (cytostatics),
 * 5) dysproteinemia and paraproteinemia (myeloma),
 * 6) paraneoplastic polyneuropathies (mainly small cell lung cancer),
 * 7) autoimmune disease (celiac disease)
 * 8) hereditary (Charcot–Marie–Tooth disease).

Common clinical signs
Paresthesia, glove-like and stocking-like hypoesthesia,often symmetrical involvement, rather sensitive than the motor, more frequent involvement of DK (longer course of peripheral nerves), motor disorders (usually later), vegetative disorders (skin atrophy), trophic changes on nails, skin, disorders of internal organs (urination, delayed gastric emptying, constipation, erectile dysfunction, impotence). It develops over weeks, months and years.

Division of polyneuropathies according to course

 * Acute: days to a month (porphyria, motor disorders predominate, more on HKK),
 * Subacute: in weeks - diphtheria, drugs (vincristine), metal poisoning (lead, thallium, arsenic),
 * with a chronic course: paraneoplastic, paraproteinemia, collagenosis, metabolic (diabetes mellitus, uremia, hypothyroidism), hereditary.

Diferential diagnosis
Very difficult. Cause not identified in 20–30 %.

Diagnostics
EMG, detailed laboratory height. blood and urine, sometimes we cannot do without examination of cerebrospinal fluid, nerve and muscle biopsy and other paraclinical tests.

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