The most common cause of mononeuropathy is by physical compression of the nerve, known as compression neuropathy. Carpal tunnel syndrome and axillary nerve palsy are examples of this. The "pins-and-needles" sensation of one's "foot falling asleep" paresthesia is caused by a compression mononeuropathy, [ citation needed ] albeit a temporary one which can be resolved merely by moving around and adjusting to a more appropriate position.
Direct injury to a nerve, interruption of its blood supply ischemiaor inflammation can also cause mononeuropathy. Mononeuritis multiplex is simultaneous or sequential involvement of individual noncontiguous nerve trunks, either partially or completely, evolving over days to years and typically presents with acute or subacute loss of sensory and motor function of individual nerves. The pattern of involvement is asymmetric; however, as the disease progresses deficit s becomes more confluent and symmetrical, making it difficult to differentiate from polyneuropathy.
Therefore, attention to the pattern of early symptoms is important. Mononeuritis multiplex may also cause pain, which is characterized as deep, aching pain that is worse at night, is frequently in the lower back, hip, or leg. In people with diabetes mellitusmononeuritis multiplex is typically encountered as acute, unilateral, severe thigh pain followed by anterior muscle weakness and loss of knee reflex. Electrodiagnostic studies will show multifocal sensory motor axonal neuropathy. Polyneuropathy is a pattern of nerve damage which is quite different from mononeuropathy, and often more serious and affecting more areas of the body.
The term "peripheral neuropathy" is sometimes used loosely to refer to polyneuropathy. In distal axonopathyone common pattern is that the cell bodies of neurons remain intact, but the axons are affected in proportion to their length. Diabetic neuropathy is the most common cause of this pattern. In demyelinating polyneuropathies, the myelin sheath around axons is damaged, which affects the ability of the axons to conduct electrical impulses.
The third and least common pattern affects the cell bodies of neurones directly.
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This usually picks out either the motor neurones known as motor neurone disease or the sensory neurones known as sensory neuronopathy or dorsal root ganglionopathy. The effect of this is to cause symptoms in more than one part of the body, often on left and right sides symmetrically. As for any neuropathy, the chief symptoms include weakness or clumsiness of movement motor ; unusual or unpleasant sensations such as tingling or burning; reduction in the ability to feel texture, temperature, etc.
In many polyneuropathies, these symptoms occur first and most severely in the feet. Autonomic symptoms may also occur, such as dizziness on standing up, erectile dysfunction and difficulty controlling urination.
Polyneuropathies are usually caused by processes that affect the body as a whole. Diabetes and impaired glucose tolerance are the most common causes. Other causes relate to the particular type of polyneuropathy, and there are many different causes of each type, including inflammatory diseases such as lyme disease, vitamin deficiencies, blood disorders, and toxins including alcohol and certain prescribed drugs.
Most types of polyneuropathy progress fairly slowly, over months or years, but rapidly progressive polyneuropathy also occurs. It is important to recognize that glucose levels in the blood can spike to nerve-damaging levels after eating even though fasting blood sugar levels and average blood glucose levels can still remain below normal levels currently typically considered below for fasting blood plasma and 6.
Studies have shown that many of the cases of peripheral small fiber neuropathy with typical symptoms of tingling, pain and loss of sensation in the feet and hands are due to glucose intolerance before a diagnosis of diabetes or pre-diabetes. Such damage is often reversible, particularly in the early stages, with diet, exercise and weight loss.
The treatment of polyneuropathies is aimed firstly at eliminating or controlling the cause, secondly at maintaining muscle strength and physical function, and thirdly at controlling symptoms such as neuropathic pain. Autonomic neuropathy is a form of polyneuropathy which affects the non-voluntary, non-sensory nervous system i. These nerves are not under a person's conscious control and function automatically.
Autonomic nerve fibers form large collections in the thorax, abdomen and pelvis outside spinal cordhowever they have connections with the spinal cord and ultimately the brain. Most commonly autonomic neuropathy is seen in persons with long-standing diabetes mellitus type 1 and 2.
In most but not all cases, autonomic neuropathy occurs alongside other forms of neuropathy, such as sensory neuropathy. Autonomic neuropathy is one cause of malfunction of the autonomic nervous system, but not the only one; some conditions affecting the brain or spinal cord can also cause autonomic dysfunctionsuch as multiple system atrophyand therefore cause similar symptoms to autonomic neuropathy. Neuritis is a general term for inflammation of a nerve [ 6 ] or the general inflammation of the peripheral nervous system.
Causes include:. Those with diseases or dysfunctions of their nerves can present with problems in any of the normal nerve functions. In terms of sensory function, there are commonly loss of function negative symptoms, which include numbnesstremorand gait abnormality. Gain of function positive symptoms include tinglingpainitchingcrawling, and pins and needles.
Pain can become intense enough to require use of opioid narcotic drugs i. Skin can become so hypersensitive that patients are prohibited from having anything touch certain parts of their body, especially the feet.
People with this degree of sensitivity cannot have a bedsheet touch their feet or wear socks or shoes, and eventually become housebound. Motor symptoms include loss of function negative symptoms of weakness, tirednessheaviness, and gait abnormalities ; and gain of function positive symptoms of crampstremor, and muscle twitch fasciculations.
There is also pain in the muscles myalgiacramps, etc. During physical examinationspecifically a neurological examinationthose with generalized peripheral neuropathies most commonly have distal sensory or motor and sensory loss, though those with a pathology problem of the nerves may be perfectly normal; may show proximal weakness, as in some inflammatory neuropathies like Guillain—Barré syndrome ; or may show focal sensory disturbance or weakness, such as in mononeuropathies.
Ankle jerk reflex is classically absent in peripheral neuropathy. Many of the diseases of the peripheral nervous system may present similarly to muscle problems myopathiesand so it is important to develop approaches for assessing sensory and motor disturbances in patients so that a physician may make an accurate diagnosis. Many treatment strategies for peripheral neuropathy are symptomatic. Some current research in animal models has shown that neurotrophin-3 can oppose the demyelination present in some peripheral neuropathies.
A range of drugs that act on the central nervous system such as drugs originally intended as antidepressants and antiepileptic drugs have been found to be useful in managing neuropathic pain.
Commonly used treatments include using a tricyclic antidepressant such as amitriptyline and antiepileptic therapies such as gabapentin or sodium valproate. These have the advantage that besides being effective in many cases they are relatively low cost. A great deal of research has been done between and which indicates that synthetic cannabinoids and inhaled cannabis are effective treatments for a range of neuropathic disorders. Pregabalin is an anticonvulsant drug used for neuropathic pain.
It has also been found effective for generalized anxiety disorder. It was designed as a more potent successor to gabapentin but is significantly more expensive, especially now that the patent on gabapentin has expired and gabapentin is available as a generic drug.
Pregabalin is marketed by Pfizer under the trade name Lyrica. Duloxetinea serotonin-norepinephrine reuptake inhibitoris also being used to reduce neuropathic pain. Transcutaneous electrical nerve stimulation therapy may be effective and safe in the treatment of diabetic peripheral neuropathy. A recent review of three trials involving 78 patients found some improvement in pain scores after 4 and 6 but not 12 weeks of treatment, and an overall improvement in neuropathic symptoms at 12 weeks.
The treatment remains effective even after prolonged use, but symptoms return to baseline within a month of treatment cessation. Neuropathy has been reported to make winter weather more perilous for older adults. M : PNS. This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors see full disclaimer. Donate to Wikimedia. Toutes les traductions de Peripheral neuropathy.
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Changer la langue cible pour obtenir des traductions. As with many conditions without clear physical or laboratory diagnosis, TN is unfortunately sometimes misdiagnosed. A TN sufferer will sometimes seek the help of numerous clinicians before a firm diagnosis is made. There is evidence that points towards the need to quickly treat and diagnose trigeminal neuralgia TN.
It is thought that the longer a patient suffers from TN, the harder it may be to reverse the neural pathways associated with the pain. Dentists who suspect TN should proceed in the most conservative manner possible and should ensure that all tooth structures are "truly" compromised before performing extractions or other procedures. Many patients cannot tolerate medications for years, and an alternative treatment is to take a drug such as gabapentin and apply it externally.
This preparation is prepared extemporaneously by pharmacists. Also helpful is taking a "drug holiday" when remissions occur and rotating medications if one becomes ineffective. Surgery may be recommended, either to relieve the pressure on the nerve or to selectively damage it in such a way as to disrupt pain signals from getting through to the brain.
In trained hands, surgery has been reported to have an initial success rate approaching 90 percent. However, some patients require follow-up procedures if a recurrence of the pain begins. Of the five surgical options, the microvascular decompression is the only one aimed at fixing the presumed cause of the pain. The nerve is then explored for an offending blood vessel, and when one is found, the vessel and nerve are separated or "decompressed" with a small pad, usually made from an inert surgical material such as Gore-Tex [ 16 ] [ 17 ].
When successful, MVD procedures can give permanent pain relief with little to no facial numbness. Three other procedures use needles or catheters that enter through the face into the opening where the nerve first splits into its three divisions. Excellent success rates using a cost effective percutaneous surgical procedure known as balloon compression have been reported [ 18 ].
This technique has been helpful in treating the elderly for whom surgery may not be an option due to coexisting health conditions. Balloon compression is also the best choice for patients who have ophthalmic nerve pain or have experienced recurrent pain after microvascular decompression. Similar success rates have been reported with glycerol injections and radiofrequency rhizotomies.
Glycerol injections involve injecting an alcohol-like substance into the cavern that bathes the nerve near its junction. This liquid is corrosive to the nerve fibers and can mildly injure the nerve enough to hinder the errant pain signals. In a radiofrequency rhizotomy, the surgeon uses an electrode to heat the selected division or divisions of the nerve. Done well, this procedure can target the exact regions of the errant pain triggers and disable them with minimal numbness.
The nerve can also be damaged to prevent pain signal transmission using Gamma Knife or a linear accelerator-based radiation therapy e. Trilogy, Novalis, CyberKnife. No incisions are involved in this procedure. It uses very precisely targeted radiation to bombard the nerve root, this time targeting the selective damage at the same point where vessel compressions are often found. This option is used especially for those people who are medically unfit for a long general anaestheticor who are taking medications for prevention of blood clotting e.
There has only been one prospective clinical trial for surgical therapy for trigeminal neuralgia. In a prospective cohort trial, microvacular decompression was found to be significantly superior to stereotactic radiosurgery in achieving and maintaining a pain-free status in patients with trigeminal neuralgia and provided similar early and superior longer-term patient satisfaction rates compared with those treated with stereotactic radiosurgery [ 20 ].
Most suffers of TN do not present with any outwardly noticeable symptoms, though some will exhibit brief facial spasms during an attack. Some physicians will seek a psychological root cause rather than a physiological abnormality. This is especially true of those suffering from atypical TN, who may not have any compression of the TN and in whom the sole criterion of the diagnosis may be the complaint of severe pain constant electric-like shocks, constant crushing or pressure sensations, or a constant severe ache and in this case trigeminal neuralgia still exists but is not visible to physicians because it was caused by the nerve being damaged during a dental procedure such as root canals, extractions, gum surgeries or it may be a condition secondary to multiple sclerosis.
Many TN sufferers are confined to their homes or are unable to work because of the frequency of their attacks. It is important for friends and family to educate themselves on the intense severity of TN pain and to be understanding of limitations that TN places upon the sufferer. However, at the same time, the TN patient must be extremely proactive in furthering his or her rehabilitative efforts. Enrolling in a chronic pain support group, or seeking one-on-one counseling, can help to teach a TN patient how to adapt to the newfound affliction.
As with any chronic pain syndrome, TN not being the exception, clinical depression has the potential to set in, especially in younger patients who often are undertreated for chronic pain. Friends and family, as well as clinicians, must be alert to the signs of a rapid change in behavior and should take appropriate measures when necessary. It must be constantly reinforced to the sufferer of TN that treatment options do exist.
In one case of trigeminal neuralgia associated with tongue-piercing, the condition resolved after the jewelry was removed. Some patients have reported a correlation between dental work and the onset of their trigeminal nerve pain. Recently, some researchers have investigated the link between neuropathatic pain, such as TN, and coeliac disease.
American radio personality and voice-over artist Dave Mitchell was diagnosed with trigeminal neuralgia after a reported dental accident in Mitchell suffers pain when he speaks for extended periods, which makes doing his job quite difficult. He is currently being treated with tegretol. Australian author Colleen McCullough has trigeminal neuralgia and will under go surgical treatment in Jan Une fenêtre pop-into d'information contenu principal de Sensagent est invoquée un double-clic sur n'importe quel mot de votre page web.
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Dermatology: 2-Volume Set. Louis: Mosby. ISBN Medill Reports Chicago. Oral Surg. Oral Med. Oral Pathol. PMID The Brain. The Classics of Neurology and Neurosurgery Special ed. Birmingham: Gryphon editions. Neurosurgery 28 6 : —7.