Diarrhea and Neuro Sx• Seizures (shigella)• Blurred vision, diplopia, dysarthria,

dysphagia, descending paralysis (Clostridium botulinum

• Headache, dizziness (scombroid fish)• Paresthesias and hot-cold sensation reversal

(ciguatera)• Respiratory paralysis (paralytic shellfish

poisoning) • Fatalities and respiratory depression

(tetrodotoxin from puffer fish)

Paresthesias

• Definition– A spontaneous and abnormal sensory

aberration • Problem

– abnormality along the sensory pathway from the peripheral nerves to the sensory cortex.

• Described as a pins-and-needles sensation• May be confused w/ weakness

Paresthesias

• Transient paresthesias are common in normal

• Persistent paresthesias imply an abnormality of sensory pathways.

Paresthesias• Peripheral

neuropathy– Diabetes– ETOH– Thiamine deficiency

• Peripheral nerve entrapment– Trauma– Disc– Carpal tunnel

• Spinal cord disease– MS– Demyelination

• Metabolic– Hypocalcemia– Resp. Alkalosis– Toxins/drugs– Infectious

• Vascular– PVD– Vasculitis

Paresthesias

• Other– Sarcoid/Lupus– Amyloidosis– Myxedema– Leprosy– Multiple myeloma– Guillain-Barre– Mononucleousis– Viral hepatitis– Porphyria

• Toxins– Arsenic– Mercury– Thalium– Lithium– Gold– Lead

• Drugs– Nitrofurantoin– Hydralazine– Phenytoin– INH– Disulfiram– Amiodorone

Multiple symmetric peripheral neuropathy

• Stocking – glove distribution• Feet alone or with the hands;

– hands are rarely affected alone.

• Neuropathies may be:– Sensory (paraneoplastic)– Motor (Guillian-Barre)– Mixed sensorimotor (diabetes)

• There is overlap

• Motor and sensorimotor neuropathies – motor abnormalities, weakness, wasting , loss of

tendon reflexes.

Guillian-Barre

• Acute inflammatory demyelinating neuropathy– Viral resp., GI infection, immunization,

surgery often precedes sx by 5d –3 weeks– Rapid, progressive weakness, loss of

reflexes, oropharyngeal and respiratory paresis, impared sensation of hands and feet.

Guillian-Barre

• Etiology– ? Immune mediated– Focal demyelination

• Incidence – 0.6 – 1.9 / 100,000– M=W– Increases w/ age

Guillian-Barre

• Signs and Sx– Limb weakness, paresthesias– > 50% have facial nerve plegias (facial,

ocular, oropharyngeal muscles)– Loss of reflexes (may be nl first days)– Variable sensory loss

• Lab– Elevated CSF protein– Increased Ig to GM1 ganglioside

Guillian-Barre• Diagnosis

1. Symmetric motor/sensory motor neuropathy after a viral illness, surgery, or delivery

2. Slowing of nerve conductions3. High CSF protein

• Treatment– Plasmapheresis, IV IG– Mechanical ventilation