Presentation on theme: "Metabolic, toxic, paraneoplastic, neuropathic disorders affecting NS M. Bojar Charles University Prague, 2nd Medical School, Dpt. of Neurology, FN Motol."— Presentation transcript:
Metabolic, toxic, paraneoplastic, neuropathic disorders affecting NS M. Bojar Charles University Prague, 2nd Medical School, Dpt. of Neurology, FN Motol
I. Metabolic, toxic, paraneoplastic, disorders of the CNS a PNS Incidence, prevalence -high, rising due to many factors Etiology – diabetes, thyroid gland DM neuropathy 10% in the manifestation, 50% of px after 25 l.,thg endocrinopathy. Inter. disorders- liver, kidney. Abuse + spirits – alcohol, drugs 15%? Inflammatory + infections. Compression + vibrations (P.C., musicians). Medicaments + env. toxins and noxae. Heredity - HSMN, SCA, inherited metabolic encephalopx PA – axonopathy (demyel., mixed), neuropathy, neuronopathy, (angiopathy). Encefalo/myelopathy - atrophy, leukoencefalopathy.
3 Metabolic, toxic, paraneoplastic, disorders of the CNS a PNS Metabolic - inherited - acquired Toxic ( industry, environment, drugs, food and water) Paraneoplastic ( autoimmunity, therapy …) Hereditary – various inherit.disorders of NS Combined with hereditary disposition and infectious +parainfectious disorders
4 Diabetic polyneuropathy – Treated diabetic pts in ČR n DM I.type : yr - 18%, > 30 yr 58% DM II.type :at time of dg. 8.3%, after 10 yr 32 % Cca 50% diabetes pts have DN, out of them 18% px are symptomatic. ČR cca diabetes px with symptomatic DN (Pelikánová,Bartoš:Diabetes mellitus minimum pro praxi, Perušičová:Trendy soudobé diabetologie, Rušavý:Diabetická noha)
5 5 II. Metabolic, toxic, paraneoplastic, disorders of the CNS a PNS Clin. symptoms – Sensitive Motor Combined Distribution Cr.nn, radiculo/neuropathic. sy - spinal roots, peripher.nn. Encefalo/myelopathy Combined
6 What is typical for polyneuropathies ? 1. PNP – typical features: 2. affect mainly long nn – LE, but UE, too. Entreppement sy – „narrow channels“- carpal tunnel sy, elbow tunnel sy 3. manifest mainly distally. 4. start typically and „silently“ in rest, in night, sleep …
7 Subjec. problems, complaints - impaired sensitivity and vegetative system Sensitive neuropathic symptoms – start typically when resting, in the night. Rarely during the day. 1. Irritative, positive : neuropathic pain, itching- paresthesias, hot, dysesthesias, oversensitivity. Restless legs sy, usually night + „fire“ feeling. Sy canalis carpi, entrempement sy… 2. Failure, negative : strange, cold, icy, numb, „wooden“ LE
9 Neuritis vs. neuropathy... Neuritis – inflammatory impairment of peripheral nerves Sensu lato even neurons. Neuropathy – impairment of neurons and axons. Only non-inflammat. origin – metabol., toxic, mechanical... But…
10 III. Metabolic, toxic, paraneoplastic, disorders of the CNS a PNS Diagnostics Illness hist.- Fam H, Epi H, Proff H, ToxH, Travel H. Biochemistry, CSF. Immunology. Serology, virology X- rays + NIM - MRI,CaT, US. EF - EMG, EP - VEP, BAEP, MEP.EEG. ENG. Stabilometry Biopsy. Clinical examination, neurostatus
11 Myotatic reflex – old, but useful…
12 Neurologic finding, neurostatus Impaired function of muscles, movements, trophic functions 1. Hyporeflex y or areflex y L5/S2, later areflexi a L2/4 2. Hypotoni a and atro phy of dist al muscles, mainly LE, espec. msc. interossei 3. Diminished msc. strenght- LE ( gate ), later UE ( PET bottles, locks, zips )
13 Paraneoplastic impairment of the NS Reactivity of the immune system against Tumor tissue/disease and its treatment. Anticancer „surveillance“. Autoimmune reactions – pre/post tumor manifestation and therapy modifying effx. Combined reactions – drug-induced, opportune - superinfections, actinotherapy, metabolic disorders, hypovitaminosis, hypo/dyssimunity.