Sensory neuropathies including painful and toxic neuropathies

Wokke, John H. J.; Dijk, Gert W van

doi:10.1007/s004150050075

“…In some of them, the amplitude of SNAPs in the upper limbs was even lower than that in the lower limbs, as observed in other studies [2, 6, 21]. Overall, this pattern reflects a nonlength-dependent axonal degeneration and allows to differentiate ganglionopathy from more common ‘dying back’ axonal polyneuropathies, in which an earlier impairment of lower limb sensory nerves typically occur [19, 20]. …”

Section: Discussionsupporting

confidence: 53%

Neurophysiological Diagnosis of Acquired Sensory Ganglionopathies

Lauria

¹

,

Pareyson

²

,

Sghirlanzoni

³

2003

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We examined 29 patients with chronic progressive ganglionopathy of different etiology. Neurophysiological abnormalities were dominated by a widespread decrease in sensory nerve action potential amplitudes, which involved both upper and lower limb nerves, even in patients with asymmetrical or patchy clinical presentation. This impairment of sensory nerve conduction, reflecting a nonlength-dependent pattern of peripheral axon degeneration, should be considered the hallmark of ganglionopathies. The evidence of central sensory pathway impairment, which allows to localize the pathology to the dorsal root ganglion neurons, could be better confirmed by cervical magnetic resonance imaging, which showed a diffuse hyperintensity in the posterior columns in all patients, than by somatosensory evoked potentials, which were undetectable in most of the patients. Few patients showed an impairment of individual motor nerves, which appeared more severe in paraneoplastic associated ganglionopathies. Neurophysiological abnormalities did not appear significantly changed at the 4-year follow-up. We emphasize that distinct abnormalities allow to differentiate ganglionopathies from axonal sensory neuropathies on routine neurophysiological examination.

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“…If these disorders have been excluded and systemic disease is unlikely, a diagnosis of chronic idiopathic sensory neuropathy remains. 13 In the group of patients with a sensorimotor neuropathy, chronic idiopathic axonal neuropathy is by far the most frequent subtype. These patients are characterised by clinical signs and symptoms of a chronic polyneuropathy, and a slowly progressive course.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Investigation of Patients With Chronic Polyneuropathy: Evaluation of a Clinical Guideline

Rosenberg

¹

,

Portegies

²

,

Visser

³

et al. 2002

J Peripheral Nervous Sys

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Objective-(1) To evaluate a clinical guideline for the diagnostic investigation of patients presenting with signs and symptoms (present for longer than 6 weeks) suggesting a chronic polyneuropathy. (2) To investigate the contribution of electrophysiological studies to a focused search for aetiology in these patients. Methods-A chart review was carried out of a consecutive group of outpatients in 1993-7 at a university department of neurology, with signs and symptoms suggesting a polyneuropathy in whom the diagnostic investigation had been carried out according to a recently introduced guideline. Diagnostic tests were performed and final diagnoses were made. Results-Unnecessary investigations were carried out in 108 (51%) of 213 patients and too few tests in 23 (11%) of these patients. In 82 (48%) of the 172 patients who fulfilled the inclusion criteria neurophysiological tests did not contribute to the final diagnosis. Neurophysiological criteria for demyelination were fulfilled in only 13 (8%) of the 172 patients. Conclusion-In patients presenting with signs and symptoms of chronic polyneuropathy the number of tests in the diagnostic investigation can be considerably reduced. In patients with signs and symptoms of polyneuropathy, providing the clinical phenotype is typical, in the presence of diabetes mellitus, renal failure, HIV infection, alcoholism, or use of potentially neurotoxic drugs further investigations are non-contributory. The significance of electrophysiological studies in the investigation of patients with polyneuropathy is rather to separate sensorimotor neuropathies from pure sensory neuropathies than to distinguish between demyelinating and axonal neuropathies. (J Neurol Neurosurg Psychiatry 2001;71:205-209)

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“…This distinction between pure sensory and sensorimotor neuropathy has important diagnostic consequences (table3). 13 14…”

Section: Discussionmentioning

confidence: 99%

Diagnostic investigation of patients with chronic polyneuropathy: evaluation of a clinical guideline

Rosenberg

¹

,

Portegies

²

,

Visser

³

et al. 2001

Journal of Neurology, Neurosurgery &Amp; Psychiatry

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Objective-(1) To evaluate a clinical guideline for the diagnostic investigation of patients presenting with signs and symptoms (present for longer than 6 weeks) suggesting a chronic polyneuropathy. (2) To investigate the contribution of electrophysiological studies to a focused search for aetiology in these patients. Methods-A chart review was carried out of a consecutive group of outpatients in 1993-7 at a university department of neurology, with signs and symptoms suggesting a polyneuropathy in whom the diagnostic investigation had been carried out according to a recently introduced guideline. Diagnostic tests were performed and final diagnoses were made. Results-Unnecessary investigations were carried out in 108 (51%) of 213 patients and too few tests in 23 (11%) of these patients. In 82 (48%) of the 172 patients who fulfilled the inclusion criteria neurophysiological tests did not contribute to the final diagnosis. Neurophysiological criteria for demyelination were fulfilled in only 13 (8%) of the 172 patients. Conclusion-In patients presenting with signs and symptoms of chronic polyneuropathy the number of tests in the diagnostic investigation can be considerably reduced. In patients with signs and symptoms of polyneuropathy, providing the clinical phenotype is typical, in the presence of diabetes mellitus, renal failure, HIV infection, alcoholism, or use of potentially neurotoxic drugs further investigations are non-contributory. The significance of electrophysiological studies in the investigation of patients with polyneuropathy is rather to separate sensorimotor neuropathies from pure sensory neuropathies than to distinguish between demyelinating and axonal neuropathies. (J Neurol Neurosurg Psychiatry 2001;71:205-209)

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Sensory neuropathies including painful and toxic neuropathies

Cited by 25 publications

References 72 publications

Neurophysiological Diagnosis of Acquired Sensory Ganglionopathies

Neurophysiological Diagnosis of Acquired Sensory Ganglionopathies

Diagnostic Investigation of Patients With Chronic Polyneuropathy: Evaluation of a Clinical Guideline

Diagnostic investigation of patients with chronic polyneuropathy: evaluation of a clinical guideline

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