SFGH neurology morning report 10.28

Distal symmetric polyneuropathies:

  • symptoms: most frequently burning pain, electrical or stabbing sensations, parasthesia, hyperasthesia, and deep aching pain
  • in symmetric distal polyneuropathies, expect to see hand involvement when the level of LE symptoms reach the knee
  • consider EMG to differentiate axonal from demyelinating physiology
  • Causes of distal symmetric polyneuropathy:
    • metabolic: uremia, B12, hypothyroidism
    • toxic: alcohol, heavy metals (lead, mercury, arsenic)
    • infectious/inflammatory: sarcoid, leprosy, connective tissue diseases
    • other: MM, paraneoplastic, amyloid
  • treatment: optimize DM control/treat the underlying disorder:
    • pain control:
      • Level A: pregabalin
      • Level B: gabapentin, venlafaxine, fuloxetine, amitriptyline

Bril et al. Evidence-based guideline: Treatment of painful diabetic neuropathy: report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabiliation.  Neurology. 2011 May 17; 76(20) 1758-65.

Evernote link: http://www.evernote.com/l/AoPkScN9QU5AhaHoVZuHGMPds4_4CPfUx3s/

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