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Peripheral Nervous System Overview

The peripheral nervous system consists of nerves outside the central nervous system, including 31 pairs of somatic nerves and 12 pairs of cranial nerves. Peripheral neuropathies can be classified anatomically based on whether the myelin sheath, axon, blood vessels, or connective tissue are affected. They can also be classified functionally based on whether sensory, motor, or autonomic nerves are involved; or based on onset (acute, subacute, chronic) and number of nerves involved (mononeuropathy, mononeuritis multiplex, polyneuropathy). Investigation may include nerve conduction studies, electromyography, and nerve biopsy. Treatment focuses on the underlying cause and symptomatic relief using medications, nerve blocks, or local

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143 views4 pages

Peripheral Nervous System Overview

The peripheral nervous system consists of nerves outside the central nervous system, including 31 pairs of somatic nerves and 12 pairs of cranial nerves. Peripheral neuropathies can be classified anatomically based on whether the myelin sheath, axon, blood vessels, or connective tissue are affected. They can also be classified functionally based on whether sensory, motor, or autonomic nerves are involved; or based on onset (acute, subacute, chronic) and number of nerves involved (mononeuropathy, mononeuritis multiplex, polyneuropathy). Investigation may include nerve conduction studies, electromyography, and nerve biopsy. Treatment focuses on the underlying cause and symptomatic relief using medications, nerve blocks, or local

Uploaded by

Shafiq Zahari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Peripheral Nervous System (PNS)

Definition
 Nerves that arise outside the central nervous system (CNS).
 31 pairs of somatic nerves and 12 pairs of cranial nerves.

Classification
1. Anatomical classification
 Myelin sheath problem
i. Demyelination
 Axon problem
i. Axonopathy
 Blood problem
i. Vasculitis
 Connective tissue problem
i. SLE
ii. Rheumatoid arthritis

2. Functional/ physiological classification


 Sensory nerve involvement
i. Numbness, paraesthesia, hyperesthesia, tingling sensation, loss
of sensation (touch, proprioception, vibration)
ii. Loss of temperature and pain (when there is loss of small
fibres)
iii. Sensory ataxia (Romberg’s sign positive)
iv. In polyneuropathy, sensory and motor nerve involvement are
symmetrical
v. In mononeuritis multiplex, sensory and motor nerve
involvement are patchy and scattered over the body
vi. Glove and stocking pattern is a characteristic of diabetic patient

 Motor nerve involvement


i. Muscle weakness (LMN type), muscle wasting, fasciculation,
loss of reflex (either proximal or distal),

 Mixed nerve involvement

 Autonomic nerve involvement


i. Trophic changes will be present which include Cutaneous hair
loss, Brittle nails, Temperature change, Abnormal/Gustatory
sweating, Resting Tachycardia, Postural hypotension, Cold
Periphery, Incontinence of stool/urine, Impotency
3. According to mode of onset
 Acute (days to weeks, but < 7 days)
i. Infective cause: Diphtheria
ii. Post-infective cause: GBS, AIDP
iii. Metabolic cause: Porphyria

 Subacute (weeks to months, < 4 weeks)


i. Drug cause: Isoniazid, metronidazole, ciprofloxacin,
vincristine, dapsone)
ii. Toxin cause: Alcohol, lead, OPC, heroin)
iii. Deficiency cause: Vitamin B12

 Chronic (months to years)


i. Metabolic cause: DM, hypothyroidism, hyperthyroidism
ii. Post-infective cause: CIDP
iii. Paraneoplastic syndrome: Vasculitis, sarcoidosis, connective
tissue disorders

4. According to number of nerve involvement


 Mononeuropathy (single nerve involvement)
i. Trauma: Saturday night palsy, crutch palsy
ii. Entrapment neuropathy: Hyperthyroidism, pregnancy,
acromegaly
iii. Diabetes
iv. Leprosy

 Mononeuritis multiplex (asymmetrical involvement of > 1 nerve)


i. Leprosy (usually in developing country)
ii. DM (in developed country)
iii. Vasculitis
iv. HIV
v. Sarcoidosis
vi. Multifocal multineuropathy

 Polyneuropathy (symmetrical involvement of > 1 nerve)


i. Metabolic cause: DM
ii. Post-infective cause: GBS, AIDP, CIDP
iii. Toxin
iv. Uraemia
v. Infective cause: Leprosy, Lyme disease
Predominantly Motor Neuropathy Causes
1. GBS / AIDP / CIDP
2. Diphtheria
3. Porphyria
4. Critically illness neuropathy (long-standing bedridden ICU patients)
5. Lead poisoning
6. Lyme infection

Predominantly Sensory Neuropathy Causes


1. DM
2. Paraneoplastic syndrome / malignancy
3. Leprosy
4. Vitamin B12 deficiency
5. Vitamin B6 intoxication
6. Syphilis (tertiary syphilis / neurosyphilis)

Predominantly Autonomic Neuropathy Causes


Acute Chronic
GBS DM
Drugs Paraneoplastic syndrome
Vitamin B12 deficiency Amyloidosis

Painful Neuropathy Causes (Motor nerve involvement + pain)


1. DM
2. Alcohol
3. Paraneoplastic syndrome
4. Vitamin B12 deficiency
5. Porphyria
Investigation
1. Routine investigation
 Full blood count
 Peripheral blood film
 Fasting blood glucose / random plasma glucose

2. Specific investigation
 Nerve conduction studies (NCV) + electromyogram (aka
electroneurophysiology)
 Nerve biopsy (done in sural nerve)
 Other investigation to find out the cause

Management
Aim: To treat the underlying cause and the symptoms of the patient
1. Drug management of Neuropathic Pain

Dose : start with low dose


Tramadol (synthetic ADR : vomiting, nausea

Tricyclic antidepressant
(Amitriptyline, Non-triptyline)

Selective serotonin reuptake


inhibitor
(Fluoxetine, Paroxetin, Sertraline)

Anti-epileptic
(Carbamazepine, Valproate,
Gabapentin)
Contraindication : COPD and Asthma
Morphine / Pethidine
Given together with anti-emetic

Nerve block

2. Local management
 Capcassin

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