Presentation is loading. Please wait.

Presentation is loading. Please wait.

Metabolic, toxic, paraneoplastic, neuropathic disorders affecting NS M. Bojar Charles University Prague, 2nd Medical School, Dpt. of Neurology, FN Motol.

Similar presentations


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:

1 Metabolic, toxic, paraneoplastic, neuropathic disorders affecting NS M. Bojar Charles University Prague, 2nd Medical School, Dpt. of Neurology, FN Motol

2 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 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 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 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 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 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

8 8 Subjective complaints, troubles – motor, movement functions Motor neuropathic symptoms 1. Irritative, positive : spasms- crampi, fasciculations. 2. Failure, negative : fatigue, heaviness, weakend UE,LE, palsy, unstable gait

9 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 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 11 Myotatic reflex – old, but useful…

12 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 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.

14 14 Impairment of the NS of toxic-metabolic origin Toxic – addiction : alcoholism, nicotinism, drugs+ medicaments Exogennous – toxic substances – environmental, industry, agriculture - organofosfates, intoxications - org.sbst. Iatrogennous – cytostatics, antibiotics, immunomodulans, neuropharma drugs Metabol. & organ impairment – liver, renal, amyloidosis…

15 15 Renal, uremic polyneuropathy Chronic renal insuficiency – late stage Distal symmetrical sensitive and motor form – slowly progressive. Koincidence with DM, myeloma, vasculitis Mononeuropathy affecting dialysed pts. Mainly n.medianus, n.ulnaris + n.peroneus.

16 16 Hepatal polyneuropathy Acute – viral hepatitis B, C. Guillain Barré syndrom- like polyradiculoneuritis. Chronic – hepatopathy, postinfectious, toxic- metabolic, combined. Mononeuropathy multiplex. Th. hepatoprotectives, INFa,vitamins (B1,6,12). Abstinency, diet. Rhb., physiotherapy, balneotherapy.

17 Metabolic, toxic, paraneoplastic, infectious impairment of CNS a PNS Therapy Causative - against metab. dysfunction, agent, noxa, toxin. Neuroprotection.Vasoactive. SSRI. NMD. AED Symptomatic- circulation,nutrition. Diet, psychotherapy. Physiotherapy. Balneotherapy. Spa therapy. Prognosis – >> chronic-progressive, > deficit. Letality - toxic encefalomyelopathy, infectious, limbic - paraneoplast. encx


Download ppt "Metabolic, toxic, paraneoplastic, neuropathic disorders affecting NS M. Bojar Charles University Prague, 2nd Medical School, Dpt. of Neurology, FN Motol."

Similar presentations


Ads by Google