There are several approaches to classification: by mode of onset - acute, subacute, chronic by functional disturbance - motor, sensory, autonomic, mixed by pathological process - axonal, demyelinating by causation - e.g. infections; carcinomatous, diabetic, inflammatory, vascular by distribution - e.g. symmetrical, asymmetrical; proximal, distal. Clinically it is of most value to classify the neuropathies according to mode of onset. The following table is for reference. Certain neuropathies will be dealt with separately (see pages 424-428).
A few days-4 weeks cause
(Postinfectious Guillain-Barré) Diphtheria —
Porphyria functional disturbance
■ Predominantly motor Distal or proximal Autonomic disturbance
Cranial nerve onset Mixed motor/sensory
Motor (may begin in arm). Autonomic disturbance Minimal sensory loss.
Demyelinative with perivascular lymphocytic infiltration
Demyelinative. No inflammatory infiltration.
Develop over weeks
Environmental — toxins
Acrylamide Carbon disulphide Hexocarbons Organophosphates
Deficiency B complex (includes alcoholic neuropathy)
Usually mild sensory motor disturbance
Dapsone - pure motor involvement
Usually sensory, motor disturbance; severity related to dose
Lead - severe, predominantly motor with arms involved first
Sensory disturbance with 'burning feet' and other painful dysaesthesiae Motor component may be present and severe Autonomic disturbance is common but mild -Sensory, (facial numbness) motor disturbance
Peripheral nerve lesion and plexopathies
Lead-axonal degeneration with segmental demyelination. Other heavy metals and solvents produce axonal degeneration
Axonal degeneration with segmental demyelination. (Demyelination is minimal in alcoholic neuropathy)
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