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