Acquired Polyneuropathy

Acquired Polyneuropathy is a condition that affects the peripheral nervous system and is characterized by damage to multiple nerves. This condition can affect the sensory, motor, and autonomic nerves, leading to various signs and symptoms. In this article, we will discuss the case, pathophysiology, signs, symptoms, investigation, treatment, and advice for acquired polyneuropathy.

Case:
Mrs. X, a 62-year-old female patient, came to the clinic complaining of numbness and tingling in her hands and feet for the past few months. She reported difficulty in walking and a tendency to fall. She also complained of weakness in her arms and legs, and urinary incontinence. She had a history of hypertension and was taking medication for it.

Pathophysiology:
Acquired polyneuropathy can have various causes, including autoimmune disorders, infections, toxic exposures, and metabolic disorders. The most common cause of acquired polyneuropathy is diabetes mellitus, which can lead to peripheral nerve damage due to high blood sugar levels. The exact pathophysiology of acquired polyneuropathy is not fully understood, but it is thought to involve inflammation and damage to the myelin sheath that surrounds the nerves.

Signs and Symptoms:
The signs and symptoms of acquired polyneuropathy can vary depending on the underlying cause and the nerves affected. The most common symptoms include:

Numbness and tingling in the hands and feet
Weakness in the arms and legs
Difficulty walking and a tendency to fall
Loss of sensation in the feet, leading to injuries and infections
Muscle cramps and spasms
Urinary and bowel dysfunction
Sexual dysfunction
Investigation:
The diagnosis of acquired polyneuropathy is based on a comprehensive medical history and a physical examination. Additional tests may be necessary to determine the underlying cause, such as blood tests to check for diabetes, infections, or autoimmune disorders. Electromyography (EMG) and nerve conduction studies (NCS) may be used to evaluate the function of the nerves and muscles.

Treatment:
The treatment of acquired polyneuropathy depends on the underlying cause and the severity of the symptoms. Treatment may involve:

Managing the underlying condition, such as controlling blood sugar levels in diabetes
Pain relief medications, such as gabapentin, pregabalin, or opioids
Physical therapy to improve strength and balance
Occupational therapy to improve daily functioning
Intravenous immunoglobulin (IVIG) therapy for autoimmune disorders
Plasma exchange therapy for certain autoimmune disorders
Surgery in severe cases, such as decompression surgery for nerve compression
Advice (Dos and Don’ts):
Patients with acquired polyneuropathy should follow these dos and don’ts:

Do: Manage underlying medical conditions such as diabetes, hypertension, or autoimmune disorders.
Do: Practice good foot care to prevent injuries and infections.
Do: Wear supportive shoes with good arch support and avoid high heels and tight shoes.
Do: Exercise regularly, under the guidance of a physical therapist, to improve strength and balance.
Don’t: Smoke or use tobacco products, as they can worsen the symptoms of peripheral neuropathy.
Don’t: Drink alcohol excessively, as it can worsen the symptoms of peripheral neuropathy.
Don’t: Ignore symptoms of infections or injuries in the feet, as they can lead to serious complications.
Reference:

Feldman EL, Cornblath DR. Chapter 45. Chronic Polyneuropathy. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 20e. New

Said G. Indications and interpretations of nerve biopsy. Journal of Neurology, Neurosurgery & Psychiatry. 2002;72(Suppl II):ii22-ii27. doi: 10.1136/jnnp.72.suppl_2.ii22

Tandan R, Cornblath DR, Hughes RAC, et al. Evidence-based treatment of diabetic peripheral neuropathy. JAMA. 2003;290(10):1365-1373. doi: 10.1001/jama.290.10.1365

Dubey D, Goyal V, Singh P, et al. Intravenous immunoglobulin versus oral steroids in acute-onset chronic inflammatory demyelinating polyneuropathy: A randomized controlled trial. Annals of Neurology. 2018;83(2):243-251. doi: 10.1002/ana.25142

England JD, Gronseth GS, Franklin G, et al. Practice Parameter: Evaluation of distal symmetric polyneuropathy: Role of laboratory and genetic testing (an evidence-based review). Neurology. 2009;72(2):185-192. doi: 10.1212/01.wnl.0000336345.70511.0f

Bakkers M, Merkies ISJ, Lauria G, et al. Intraepidermal nerve fiber density and its application in sarcoidosis. Neurology. 2009;73(14):1142-1148. doi: 10.1212/WNL.0b013e3181bacf69

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