neuropathy

(noo-rop′ă-thē)

[neuro- + -pathy]
Any disease of the nerves.
neuropathic (noor″ŏ-path′ik), adj. SEE TABLE: Common Neuropathies;SEE: polyneuropathy.
Common Neuropathies

NameAffected Nerve(s)Affected Part(s)Affects Sensation?Affects Movement?Clinical FeaturesType of Neuropathy
Bell palsyFacialEye, nasolabial fold, lip (corner of the mouth)OccasionallyYesParalysis of the facial muscles, usually on just one side of the faceInflammatory
Carpal tunnel syndromeMedianWrist and handYesYesPain and numbness of the hand and wrist, often caused by repetitive movements or overuse such as typing, sawing, hammering, or polishingEntrapment
Diabetic sensory neuropathyMultipleFeet, lower extremities; sometimes hands late in the courseYesNoBurning, stinging pain beginning in both feet, typically occurring after several years of poorly controlled diabetes. Can predispose to foot injury and infections.Metabolic
Idiopathic brachial plexopathy (neuralgic amyotrophy; Parsonage-Turner syndrome; shoulder girdle syndrome)BrachialShoulderYesYesPain in the shoulder, esp. after vigorous physical activity. Occasionally followed by shoulder girdle muscle atrophyEntrapment
Meralgia parestheticaLateral femoral cutaneousThighYesNoStinging pain in the anterolateral thigh. Usually found in obesity or in diabetes mellitusEntrapment
Morton neuroma (interdigital neuropathy)Interdigital nerves of the feetBall of footYesNoPain often occurring between the web spaces of the 3rd and 4th toes during walking or standingEntrapment
Piriformis syndromeSciaticButtock, with radiation into the legYesNoButtock pain without back pain that is worsened by sitting and is relieved by walkingEntrapment/compression
Radial nerve palsy (musculospiral paralysis; Saturday night palsy)Radial nerve (spiral groove entrapment)Wrist, hand, and forearmYesYesTemporary paralysis and numbness of the hand and arm, which may mimic a stroke. Caused by nerve compression, e.g., falling asleep on one’s side on a hard surfaceEntrapment/ compression
Suprascapular neuropathySuprascapularBack of the shoulderYesYesShoulder pain and muscular atrophy. Decreased ability to rotate or abduct the shoulderEntrapment
Tarsal tunnel syndromePosterior tibialSole of the footYesNoPain under the foot that is worsened by walkingEntrapment
Trigeminal neuralgiaTrigeminalCheek, nose, upper lipYesNoIntense, repetitive facial pains that are often worsened by chewing, shaving, or toothbrushing, usually accompanied by spasm on the affected side of the faceEntrapment

AIDS peripheral neuropathy

Direct infection of peripheral nerves by HIV, resulting in sensory and motor changes due to destruction of axons or their myelin covering. Acute or chronic inflammatory myelin damage may be the first sign of peripheral nerve involvement. Patients display gradual or abrupt onset of motor weakness and diminished or absent reflexes. Diagnostic biopsies of peripheral nerves show inflammatory changes and loss of myelin. Distal sensory neuropathy occurs in up to 30% of patients with AIDS, usually late in the disease. There is increased risk in older patients and those with diabetes mellitus, nutritional deficiencies, low CD4 cell counts, and vitamin B12 deficiencies. Patients report sharp pain, numbness, or burning in the feet. Destruction of dorsal root ganglions and degeneration of central peripheral axons are seen on autopsy. Some older antiretroviral drugs (ddI, ddC, and d4T) also cause a reversible peripheral neuropathy in about 20% of patients.
SEE: AIDS; SEE: Guillain-Barré syndrome; SEE: chronic inflammatory demyelinating polyneuropathy

TREATMENT
Nonsteroidal anti-inflammatory drugs, opioids, gabapentin, anticonvulsants, and topical agents have all been used with variable success to treat the pain of AIDS-related sensory neuropathy. Acupuncture is not effective. Human nerve growth factor, which stimulates regeneration of damaged nerve fibers, is being studied, esp. to minimize the neuropathy that antiretroviral drugs cause.

ascending neuropathy

Neuropathy that ascends from the lower part of the body to the upper.

auditory neuropathy

ABBR: AN Hearing loss that results from nerve damage or impaired nervous system processing of normal signals received from sensory hair cells in the Organ of Corti.
SYN: SEE: auditory dyssynchrony

chemotherapy-induced neuropathy

Damage to peripheral nerves causing pain, muscle weakness, or autonomic failure after treatment with medications like cisplatin, vincristine, or taxol. VAR: chemotherapy-induced peripheral neuropathy.

descending neuropathy

Neuropathy that descends from the upper part of the body to the lower.

diabetic neuropathy

Damage to autonomic, motor, and/or sensory nerves due to metabolic or vascular derangements in patients with long-standing diabetes mellitus. In Western nations, diabetes is the most common cause of neuropathy. Symptoms usually include loss of sensation or unpleasant sensations in the feet, erectile dysfunction, focal motor deficits, gastroparesis, loss of the ability to maintain postural blood pressure, and diseases of cardiac innervation. Sensory loss in the feet may result in undetected injuries that become infected or gangrenous.
SYN: SEE: diabetic polyneuropathy

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NEUROPATHIC FOOT DUE TO DIABETES

TREATMENT
Tight control of blood sugar levels may prevent some neuropathic symptoms in patients with diabetes mellitus.

dysthyroid optic neuropathy

Crowding of and damage to the optic nerve in patients with Grave disease. It is characterized by loss of visual acuity and color vision, swelling of the optic disk, and compression of the optic nerve at the apex of the orbit.
SYN: SEE: apical crowding

entrapment neuropathy

SEE: Nerve entrapment syndrome.

facial sensory neuropathy

SEE: Trigeminal neuralgia.

familial amyloidotic neuropathy

A rare, progressive autosomal dominant disease, ultimately fatal, caused by the deposition of abnormally folded transthyretin (TTR) in multiple body tissues. The first symptoms include altered sensations of pain and temperature in the feet. TTR eventually damages the eyes, heart, liver, and other internal organ.

focal neuropathy

Any nerve disease or injury, e.g., carpal tunnel syndrome or peroneal nerve palsy, that affects a single nerve.

generalized neuropathy

A rarely used synonym for polyneuropathy.

glue-sniffer's neuropathy

Malfunction of sensory and motor nerves due to inhaling toxic hydrocarbons. The lower extremities and trigeminal nerve are most often damaged.

idiopathic facial neuropathy

SEE: Bell palsy.

interdigital neuropathy

SEE: Morton, Thomas George

ischemic optic neuropathy

ABBR: ION Damage to the optic nerve due to insufficient blood flow to the nerve head. It typically occurs in people over 50 and is often associated with chronic diabetes mellitus, hypertension, or temporal arteritis.

Leber hereditary optic neuropathy

SEE: Leber congenital amaurosis.

multifocal motor neuropathy

An asymmetrical motor weakness occasionally found in middle-aged men.

optic neuropathy

Pathological injury to the optic nerves or the blood supply to them. Usually, only one eye is affected. Several forms have been described, including ischemic optic neuropathy, which, if prolonged, leads to blindness in the affected eye; optic neuritis due to acute demyelination of optic nerve fibers; infiltrative optic neuropathy, in which the optic nerve is compressed by a tumor or aneurysm; and optic neuropathy due to toxic nutritional factors, e.g., methanol or a combined nutritional and vitamin deficiency.

peripheral neuropathy

Any syndrome in which muscle weakness, paresthesias, impaired reflexes, and autonomic symptoms in the hands and feet are common. The most common cause of peripheral neuropathy is diabetes mellitus. Other, less common, causes of peripheral neuropathy include nerve entrapment syndromes, alcoholism, medication toxicities, malnutrition, hepatic failure, or chronic kidney disease.

plantar neuropathy

Any of several conditions in which nerves that supply sensation to the sole of the foot are injured or chronically compressed, resulting in burning and tingling sensations and difficulty standing, walking, or running.

subacute myelo-optic neuropathy

subacute myelo-optico neuropathy ABBR: SMON Neuropathy that usually begins with abdominal pain or diarrhea, followed by sensory and motor disturbances in the lower limbs, ataxia, impaired vision, and convulsions or coma. It is reported mostly in Japan and Australia. Most patients survive, but neurological disability remains. Many of those who have the disease have a history of taking drugs of the halogenated oxyquinoline group such as clioquinol (formerly called iodochlorhydroxyquin).

sural neuropathy

A relatively rare form of sensory neuropathy affecting the lateral ankle, typically associated with the wearing of poorly fitting work boots or shoes that compress the sural nerve.

tomaculous neuropathy

The presence of sausage-shaped areas of thickened myelin with secondary axon constriction in some cases of familial recurrent brachial neuropathy.

toxic-nutritional optic neuropathy

Bilateral visual impairment with central scotomas. This is usually associated with a toxic or nutritional disorder, e.g., the ingestion of methyl alcohol.

vibration-induced neuropathy

SEE: Hand-arm vibration syndrome.