Diarrhea and Neuro Sx • Seizures (shigella) • Blurred vision, diplopia, dysarthria, dysphagia, descending paralysis (Clostridium botulinum • Headache, dizziness (scombroid fish) • Paresthesias and hot-cold sensation reversal (ciguatera) • Respiratory paralysis (paralytic shellfish poisoning) • Fatalities and respiratory depression (tetrodotoxin from puffer fish)
Paresthesias • Definition • A spontaneous and abnormal sensory aberration • Problem • abnormality along the sensory pathway from the peripheral nerves to the sensory cortex. • Described as a pins-and-needles sensation • May be confused w/ weakness
Paresthesias • Transient paresthesias are common in normal • Persistent paresthesias imply an abnormality of sensory pathways.
Peripheral neuropathy Diabetes ETOH Thiamine deficiency Peripheral nerve entrapment Trauma Disc Carpal tunnel Spinal cord disease MS Demyelination Metabolic Hypocalcemia Resp. Alkalosis Toxins/drugs Infectious Vascular PVD Vasculitis Paresthesias
Other Sarcoid/Lupus Amyloidosis Myxedema Leprosy Multiple myeloma Guillain-Barre Mononucleousis Viral hepatitis Porphyria Toxins Arsenic Mercury Thalium Lithium Gold Lead Drugs Nitrofurantoin Hydralazine Phenytoin INH Disulfiram Amiodorone Paresthesias
Multiple symmetric peripheral neuropathy • Stocking – glove distribution • Feet alone or with the hands; • hands are rarely affected alone. • Neuropathies may be: • Sensory (paraneoplastic) • Motor (Guillian-Barre) • Mixed sensorimotor (diabetes) • There is overlap • Motor and sensorimotor neuropathies • motor abnormalities, weakness, wasting , loss of tendon reflexes.
Guillian-Barre • Acute inflammatory demyelinating neuropathy • Viral resp., GI infection, immunization, surgery often precedes sx by 5d –3 weeks • Rapid, progressive weakness, loss of reflexes, oropharyngeal and respiratory paresis, impared sensation of hands and feet.
Guillian-Barre • Etiology • ? Immune mediated • Focal demyelination • Incidence • 0.6 – 1.9 / 100,000 • M=W • Increases w/ age
Guillian-Barre • Signs and Sx • Limb weakness, paresthesias • > 50% have facial nerve plegias (facial, ocular, oropharyngeal muscles) • Loss of reflexes (may be nl first days) • Variable sensory loss • Lab • Elevated CSF protein • Increased Ig to GM1 ganglioside
Guillian-Barre • Diagnosis • Symmetric motor/sensory motor neuropathy after a viral illness, surgery, or delivery • Slowing of nerve conductions • High CSF protein • Treatment • Plasmapheresis, IV IG • Mechanical ventilation