Cause of metabolic neuropathy.
Diabetes is always on top of that
list, as is thyroid disease,
your kidney is failing, uremic
neuropathy, that’s an important one.
At the end of this entire section,
I want to walk you through
a very, very important,
what I call a polyneuropathy
Nirvana diagram, as we shall see.
what does that mean?
You know much biochemistry,
you should know about your porphyria
pathway on your way to produce your heme.
And in that porphyria pathway,
there are a couple of
diseases or biochemical pathologies
that you should be familiar with.
One of them being acute
either B1, B6, or B12.
Once again, remember,
B1, that's a problem.
B6 required, for once
again, proper myelination.
And of course, B12.
Critical care neuropathy, these
are metabolic neuropathies,
Let’s quickly walk through
Chronic progressive distal
symmetric diabetic polyneuropathy.
Every single word there
is incredibly important.
Diabetes, in the U.S., type 2 diabetes,
of course, extremely common.
Chronicity, decades have gone by,
and now at this point, you’re going to have
symmetric distal neuropathy taking place.
We call this stocking-glove, don't we?
Most common presentation, small
and large fiber involvement.
There is no discrimination
with diabetic neuropathy.
It affects you everywhere.
Neuropathic pain is usually prominent.
For example, what about the nerves
in the stomach, would they be lost?
So, you have paralysis
of the stomach.
We call this gastroparesis,
or maybe your patient has
suffered myocardial infarction,
and there was no chest pain.
A sound myocardial infarction,
nerves have been lost.
Or down in the feet,
and here once again, the nerves,
you’re worried about decubitus
ulcers, aren’t you?
small and large fibers.
Neuropathic pain, usually prominent,
if you’re actually wondering about
what’s happening to your nerves.
initial symptoms are severe thigh and
back pain with diabetic neuropathy.
And with diabetic proximal
what we’re referring to specifically,
our diabetic, what’s
known as amyotrophy.
Followed by hip and thigh
muscle weakness and atrophy.
So, you begin initially
with thigh and back pain,
and then followed by hip and thigh
muscle weakness and atrophy.
You put all this together and you
call it amyotrophy, proximal motor.
We have the diabetic
proximal motor neuropathy.
Continuing with our discussion.
Acute axonal diabetic polyneuropathy.
And then with diabetes, remember,
there’s no discrimination here.
By that, I mean, you could
have diabetic mononeuropathy.
What does that mean?
You could have one nerve
that is being affected.
Maybe radial nerve, maybe the ulnar
nerve, maybe the median nerve,
maybe the common peroneal nerve.
You could have the nerves
coming at a spinal cord,
All are significantly much more
common in patients that are diabetic,
every single nerve, just about.
In a patient with diabetes,
over a long period of time,
if not properly managed,
is at risk for injury.
Plain and simple
to pathologists maybe,
to a doctor possibly,
but for the patient, it’s a
lot of education, isn’t it?
Well, the most important thing
is going to be glycemic control.
That’s your best
measure of treatment.
And by this, we mean what?
lose weight, watch your diet.
Why do I roll my eyes when I do that?
Because you know
if you’ve done your rotations or
those of you that are practicing,
it’s easier said than done.
Well, now if you’re actually
getting into diabetic neuropathy
and you need to
treat the symptoms,
tricyclic antidepressants, antiepileptics,
and perhaps, gabapentin.
that was actually a first line
drug for trigeminal neuralgia.
So, we know the carbamazepine
definitely helps out with
people that have neuropathies.
Tramadol, opioids, maybe perhaps
because of refractory cases
that pain is actually
This is a deadly road,
isn’t it, the opioid?
A huge discussion in
And NSAIDS for entrapment
neuropathies as well.