polyneuritis
Introduction
Introduction to polyneuritis Polyneuritis, formerly known as peripheral neuritis, refers to the symmetry damage of most peripheral nerves caused by various causes, mainly characterized by the symmetry of the distal limbs, motor and autonomic disorders, and lower motor neurons. And diseases of autonomic dysfunction. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications:
Cause
Cause of polyneuritis
Pathological changes:
1. Acute inflammatory demyelinating polyneuritis: is a group of autoimmune diseases that may be induced by infection or serum injection and vaccination.
2, metabolic and endocrine disorders: diabetes, uremia, hematoporphyria, amyloidosis, gout, hypogonadism, acromegaly, xanthomatosis, hemophilia, cachexia caused by various causes, burns Wait.
3, nutritional disorders: beriberi, pellagra, vitamin B12 deficiency, chronic alcoholism, pregnancy, chronic diseases of the gastrointestinal tract and after surgery.
Chemical factors (15%):
1, drugs: furan drugs, isoniazid, phenytoin, sulfonamides, vincristine, chloroquine, ethambutol, cytarabine and so on.
2. Chemistry: carbon monoxide, carbon disulfide, carbon tetrachloride, benzene and its derivatives (aniline, dinitrobenzene, etc.), methanol, methyl bromide, n-hexane, acetone, chloroform, chloropropene, chlorobutanol, trichloroethylene , organochlorine pesticides, organophosphorus pesticides (trichlorfon, dichlorvos, 1605, 1059) and so on.
3. Heavy metals: arsenic, lead, mercury, antimony, antimony, etc.
Infectious disease (5%):
1, direct infection of peripheral nerves such as leprosy, herpes zoster.
2, accompanied or secondary to various acute and chronic infections, such as influenza, measles, chickenpox, mumps, scarlet fever, infectious mononucleosis, leptospirosis.
3. Toxins secreted by bacteria have special affinity to peripheral nerves, such as diphtheria, tetanus, and bacillary dysentery.
other factors
1, connective tissue diseases: such as lupus erythematosus, nodular polyarteritis, scleroderma, rheumatoid arthritis and so on.
2, genetics: such as hereditary ataxia peripheral neuritis (Refsum disease), progressive hypertrophic polyneuritis.
3, other reasons: such as multiple myeloma, lymphoma, polycythemia vera, cancer, abnormal globulinemia.
4, the cause is unknown: chronic progressive or recurrent polyneuritis.
Prevention
Multiple neuritis prevention
1. Strengthen physical exercise and enhance anti-infective ability.
2, reasonable adjustment of diet, not only to ensure comprehensive nutrition, but also to prevent excess nutrients, leading to obesity, avoid tobacco, alcohol.
3, to avoid long-term exposure to chemical poisons, for long-term use of isoniazid, phenytoin, chloroquine, sulfa drugs and other drugs, once the symptoms of the disease are found, should be discontinued immediately.
Complication
Polyneuritis complications Complications
Limb paralysis may occur, occasionally segmental or conduction beam type sensory disturbances, and some patients may have complications such as blood pressure instability, tachycardia and abnormal ECG.
Symptom
Symptoms of polyneuritis Symptoms Muscular atrophy, reflexes, disappearance, cortical follicular atrophy, fasciculation, sensation, male sexual dysfunction, positional sensation, hypotonic astigmatism, interphalangeal muscle, and intermuscular muscle atrophy, diarrhea
The common features of this disease are distal symmetry of the limb, movement, and autonomic dysfunction.
1. All kinds of sensation loss are in the form of gloves and socks. It can be accompanied by sensation of abnormal feeling, hyperactivity and pain. The pain is microfibrous damaged neuropathy (such as diabetic alcoholism porphyria), and AIDS, hereditary sensory neuropathy. , paraneoplastic sensory neuropathy, invasive neuropathy, idiopathic brachial plexus neuropathy, hereditary sensory neuropathy, amyloid neuropathy with isolated sensory loss.
2, distal motor motoneurons of the limbs: severe cases with muscle atrophy and fasciculation, quadriplegia tendon reflexes or disappear, sputum reflexes are obvious, can not perform fine tasks, distal end is more important than the proximal, lower extremity tibialis anterior, tibia Muscle, upper limb interosseous muscle, sacral muscle and intermuscular muscle atrophy, hand, foot drop and cross-threshold gait, late muscle contracture deformity.
3, autonomic nervous disorders: orthostatic hypotension, cold limbs, sweating or no sweat, finger (toe) nails crisp, thin skin, dry or desquamation, vertical hair disorder, afferent neuropathy leading to tension-free bladder, Impotence and diarrhea.
Examine
Examination of polyneuritis
1, cerebrospinal fluid examination: normal or protein content increased slightly.
2, EMG and nerve conduction velocity: If there is only a slight axis mutation, the conduction velocity is still normal, when there is severe axonal degeneration and secondary myelin loss, the conduction velocity is slow, EMG There is a neurological abnormal change. When the segmental myelin sheath is lost and the axonal degeneration is not significant, the conduction velocity is invaded, but the EMG can be normal. Measuring the EMG and nerve conduction velocity contributes to the nerve of the disease. The identification of source damage and myogenic damage is also conducive to the differentiation of axonal lesions and segmental demyelination lesions. Axonal lesions show a decrease in amplitude, while demyelin lesions show a slower nerve conduction velocity.
3, immune examination: for suspected immune diseases, can be used for immunoglobulin, rheumatoid factor, anti-nuclear antibody, anti-phospholipid antibody detection and lymphocyte transformation test and flower rectangular test.
4, nerve biopsy: nerve tissue biopsy can provide more accurate evidence for determining the nature and extent of neuropathy.
Diagnosis
Diagnosis and diagnosis of polyneuritis
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory findings.
Differential diagnosis
Clinically, it should be identified with the following diseases:
1, periodic paralysis: no clear gloves, socks-type sensory disturbances, and the course of the disease is short-lived and recovers quickly.
2, polio (polio sequelae): muscle spasm most asymmetrical, and no skin feeling loss.
3, subacute combined degeneration of the spinal cord: may have symptoms of multiple neuropathy such as numbness of the extremities and weakened muscles, but increased muscle tone, hyperreflexia and positive pyramidal tract signs can be identified.
