Hereditary, Toxic and Infectious Neuropathy

00:01 We’ll take a look at types of hereditary neuropathy.

00:04 Under here, we’ll take a look at a very important differential, and this is called Charcot-Marie-Tooth disease.

00:12 We’ll take a look at amyloid neuropathies.

00:15 We have what’s known as HNPP, hereditary neuropathy with liability to pressure palsies.

00:22 Pressure palsies.

00:24 And we have hereditary sensory and autonomic neuropathy, and that actually will make perfect sense because the name will imply exactly what’s going on with your patient.

00:34 And then you have neuropathy with what’s known as leukodystrophy.

00:37 These are hereditary neuropathies.

00:41 Most prevalent inherited neurologic disease we’ll take a look at would be Charcot-Marie, CMT, Charcot-Marie-Tooth.

00:48 There are multiple types.

00:49 There are.

00:50 We have CMT Type 1, 2, and such.

00:53 High variability in symptoms even within the family, even though it’s hereditary.

00:58 All are demyelinating except the CMT-2, it’s an axonal CMT.

01:03 No specific treatment available, however.

01:06 Under toxic neuropathy.

01:08 Heavy metals: arsenic, your patient might be exposed to water, lead, mercury, thallium.

01:16 Drugs such as vincristine, cisplatin, anti-retrovirals.

01:22 Substance abuse such alcohol, glue inhalation, and of course, nitric oxide type of inhalation, or nitrous oxide.

01:32 Industrial poisons: These are risk factors for toxic neuropathy.

01:37 Infectious neuropathy: HIV, Lyme, leprosy, most common neuropathy in the world, actually, and even -- well, think about your immunocompromised patients here, and CMV and herpes.

01:51 There are many type of neuropathies in which we are going to walk through in terms of classifications.

01:57 We'll begin by looking at infectious neuropathy.

02:00 We have HIV.

02:02 Distal sensory polyneuropathy, one-third of your AIDS patients actually have distal sensory polyneuropathy.

02:10 You have something called mononeuropathies, and this is typically later in the disease.

02:15 So, if I were you, I would know the timeline here for HIV neuropathy, please.

02:19 And may actually have and develop what’s known as acute inflammatory demyelinating polyneuropathy; acute, acute, acute.

02:28 The reason that I bring that to your attention is because you know in HIV, your CD4 count is on a downhill swing, right? But if it’s acute inflammatory, maybe, maybe, there might be a lymphocytic pleocytosis in CSF, but that´s obviously highly variable.

02:46 In this case, the only reason I bring that to your attention is because it may result in acute inflammatory.

02:52 Or lumbosacral, in other words, down by your lower region, polyradiculopathy associated with CMV.

03:00 Usually, when you think about CMV type of infection.

03:03 Unfortunately, immunocompromise should come to mind.

03:08 Neuropathy of leprosy.

03:09 We have to talk about this because it’s one of the most common infectious neuropathies worldwide.

03:14 It’s a sensory versus a motor type of neuropathy, more so.

03:17 Usually, mononeuropathy multiplex.

03:19 Now at this point, can we now have a discussion, a healthy discussion where you’re not just memorizing stuff? So what does that mean to you? You have one nerve that is undergoing damage or injury but in multiple locations, right? Presentation of immunologic origin.

03:36 Predilection for ulnar and peroneal nerve.

03:39 Now, think about your ulnar that we’ve talked about in great detail.

03:42 You’re worried about your medial aspect in fourth and fifth digits.

03:45 And if it’s peroneal, then by the leg, obviously.

03:49 An there, I’ve given you much detail about how to localize where the damage to the nerves are, and you know every single board and every single ward love that type of information.

04:01 So, spend some time to make sure that you know how to conduct a proper physical exam to localize your nerve injury, please.

04:08 And if you don’t, we’ve done it.

04:10 We've done it.

04:12 Make sure you go back and review it.