Entrapment or compression
type of neuropathy.
Here, let’s say that
remember way back when we did median nerve,
and we did, and we did in great detail.
And with the median nerve, down by the
wrist will be the most common location,
and what you’re seeing
here is exactly that.
And here, you have your carpal tunnel,
and let’s say that you have a patient
that works with the hands a lot,
And so therefore, they may then
cause inflammation of this region
and therefore cause compression
of or entrapment of your nerves.
Ulnar nerve at the elbow,
radial nerve in the spiral groove,
peroneal nerve at
the fibular head,
and lateral cutaneous
nerve of the thigh,
all extremely important.
And remember, when we talked about
the femoral nerve in great detail,
we talked about something
called meralgia paresthetica.
These are entrapment
issues, and very, very --
well, let me say very, very common
but could be a common presentation
based on the occupation and
habits of your patients.
Under peripheral neuropathy.
Acute, generally, here you go.
There is a list of AIDP, porphyrias,
diphtheria, polio, toxins,
your acute type of issues.
deficiency states, maybe
toxins, uremia, diabetes,
just keep things in perspective.
Your chronic with CIDP, chronic
inflammatory demyelinating polyneuropathy,
diabetes, maybe once
again, renal failure.
And then finally, we have relapsing,
more or less kind of behaves like your
multiple sclerosis but
this would be chronic.
Where are we?
In the periphery, right?
So peripheral neuropathy.
And we know that multiple sclerosis
only affects the central, all right?
The things that you want to be
very clear about organization.
Our topic for quite some time now
has been peripheral neuropathy,
and really, what we’re going
to do as we move forward here
just to make sure we summarize
and organize our thoughts,
is make sure that you
know how to approach
or have a proper clinical
approach to such neuropathies.
This is actually quite beautiful.
I say actually as if
I’m in disbelief,
but every time I see this
-- you should get excited.
Every time I see this, I don’t care if I’ve
been seeing this for 5, 10, 15, 20 years.
Every single day, every single
time I see it, I get excited.
Because really, it does organize your
demyelinating or neuropathies
in great detail.
So let’s set this up for you.
If you take a look at the middle
there, the target in the middle, okay?
That’s your acute.
And then around your acute, you
have your various diseases.
And then if you go outside
this ring of acute,
then you start getting into your subacute,
which means it takes
a little bit longer.
And then outside of your subacute,
you start getting into your chronic
type of demyelinating diseases.
As you move from your left
and then to your right,
you’ll notice that you have
And then as you move into the right,
then you have less of a demyelinating
and it’s more of an axonal.
For example, CMT-2.
What does CMT stand for?
Charcot-Marie-Tooth type of issues.
And then if you go from top to bottom,
you’ll have what’s known as symmetrical
type of issues, versus asymmetrical.
For example, with diabetes, or even
when you see the first green box there,
and that is chronic
And there is uremic neuropathy,
and the reason we say that is because if
your kidneys fail, my goodness gracious,
you’re going to start
accumulating all kinds of toxins,
and some of those toxins can be
extremely damaging to the nerves.
And then as you move
from top to bottom,
you’re moving into your
asymmetrical type of issues.
If I were you, once you’ve truly understood
your peripheral neuropathies and such,
you want to walk through here and give
yourself a really good organization pattern
Perhaps, even close your eyes or
take a different piece of paper
and write down on your own, every step of
the way, all these different diseases,
what it means to you in terms of
being acute, subacute, and chronic,
demyelinating versus axonal,
symmetrical versus asymmetrical,
and you will be in really good shape to
come up with differentials really quick
and then go into details as to
what the clinical pearls are
for each one of these issues.
Risk factors: We got a bunch.
Preventive medicine: Glycemic
control if we talk about diabetes.
Signs and symptoms:
Numbness and weakness.
Differential diagnosis: Everything
that we saw in terms of differentials.
Diagnostic: Your nerve conduction test.
And your management,
well, etiology specific.