Toxic and Metabolic Polyneuropathies

by Roy Strowd, MD

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    00:01 When we think about the toxic/metabolic polyneuropathies.

    00:05 These are patients presenting often with sensorimotor polyneuropathies.

    00:11 The vast majority of these are length-dependent.

    00:13 They start in the most, in the longest nerves out in the legs and work their way proximally.

    00:18 They often follow a stocking glove distribution and present chronically and progressively over time.

    00:24 Immunologic work-up for AIDP or CIDP is negative.

    00:29 There's no increased inflammation in the body that is precipitating the attack.

    00:34 This is the result of a chronic toxic ingestion or a metabolic deficiency or overload.

    00:40 Some of the things that we consider on the differential diagnosis for a toxic metabolic polyneuropathy is alcoholism which presents with prominent sensory findings and often a paucity of motor weakness.

    00:52 Diabetes is the most common cause of distal symmetric polyneuropathy in the United States, and presents with a sensorimotor polyneuropathy with some demyelinating, as well as a prominent axonal features.

    01:06 Uremia can present with a polyneuropathy that has a sensory predominance and is reversible and can be treated and is important to recognize.

    01:14 Vitamin B12 may often present in the combination of neuropathy and myelopathy, It's a Myeloneuropathy.

    01:22 Rarely patients will present with neuropathic symptoms early and slow development of myelopathy and so this needs to be a consideration in patients presenting with a polyneuropathy.

    01:33 Vitamin B1 deficiency as well as others vitamin B6 can also present with polyneuropathy.

    01:40 Importantly, vitamin B6 presents with a sensory neuropathy that is a result of an overdose of vitamin B6 and needs to be a consideration in selected patients.

    01:51 There's a long list of drugs or medications that can present with side effects of polyneuropathy.

    01:57 You can see a short list on the slide and any patient presenting with a chronic onset, length-dependent, symmetric sensorimotor polyneuropathy should have a robust medication review to evaluate any potential offending agents.

    02:11 Heavy metals can present with a polyneuropathy, arsenic with a sensorimotor neuropathy and lead or plumbism with a motor predominant polyneuropathy.

    02:21 And then lastly, porphyric polyneuropathy is can be present in some patients, this presents with a motor predominant often proximal involving polyneuropathy.

    About the Lecture

    The lecture Toxic and Metabolic Polyneuropathies by Roy Strowd, MD is from the course Toxic and Metabolic Polyneuropathies.

    Included Quiz Questions

    1. Alcoholism typically causes sensory polyneuropathy.
    2. Uremia typically causes motor polyneuropathy.
    3. Diabetic polyneuropathy shows purely axonal features during electrodiagnostic testing.
    4. Vitamin B6 deficiency causes motor neuropathy.
    5. Porphyrias cause distal sensory polyneuropathy.

    Author of lecture Toxic and Metabolic Polyneuropathies

     Roy Strowd, MD

    Roy Strowd, MD

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