The Polyneuropathies Classification

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).

ACUTE

A few days-4 weeks cause

Inflammatory -

(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.

pathology

Demyelinative with perivascular lymphocytic infiltration

Demyelinative. No inflammatory infiltration.

Axonal

SUBACUTE

Develop over weeks

Drug-induced

Isoniazid

Metronidazole

Dapsone

Nitrofurantoin

Cisplatin

Vincristine etc.

Intramuscular injection

Environmental — toxins

Solvents Lead

Acrylamide Carbon disulphide Hexocarbons Organophosphates

Nutritional-

Deficiency B complex (includes alcoholic neuropathy)

Substance abuse

Solvents Heroin

Usually mild sensory motor disturbance

Dapsone - pure motor involvement

Localised neuropathies

-Occasionally acute

Usually sensory, motor disturbance; severity related to dose

Lead - severe, predominantly motor with arms involved first

Axonal degeneration

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)

Axonal degeneration

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