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Evaluation of the patient with peripheral neuropathi 1.ppt
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Evaluation of the patient with Peripheral NeuropathyNani Kurniani
Three basic challenges
Complaints and the physical finding are the result of the peripheral neuropathy Type and cause of neuropathyThe Apropiate theraphy.
Table. 1. Anatomic Distribution of Neuropathies and differential Diagnosis
Table. 1. Anatomic Distribution of Neuropathies and differential Diagnosis
Table. 1. Anatomic Distribution of Neuropathies and differential Diagnosis
History and Examination of the Patient Historical information :Chief complaint and History of present illnessPast medical historyFamily historySosial historyReview systems
Table. 2. Drugs Causing Peripheral Neuropathy
Table. 3. Occupation and Habits Predisposing to Peripheral Neuropathy
Table. 3. Occupation and Habits Predisposing to Peripheral Neuropathy
Table. 4. Neuropathies Associated with Organ System Impairment
Examining the patientGeneral physical ExaminationNeurological Examination
General physical Examination
General physical examinationSkeletal abnormalitiesChanges in skin hair and nailsLesions of the tongue and the oral and genital mucosaOcular manifestationOrganomegaly
Table. 5. Neuropathies Commonly Associated with Painless Injuries
Table. 6. Skin, Hair, and Nail Changes Associated with Peripheral Neuropathies* POEMS = polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (chapter 14) Chronic inflammatory demylinating polyradiculoneuropathy
Table. 7. Oral and Genital Mucosal, Tongue, and Salicary Gland Changes
Table. 8. Ocular findings Associated with Peripheral Neuropathies
Neurogical Examination
Neurological ExaminationCranial nerve findingsMuscle weaknessMuscle stretch reflex changesSensory abnormalityAutonomic Nervous System Abnormalities
Table. 9. Causes of Tonic Pupil
Table. 10. Causes of Facial Weakness and Peripheral Neuropathy
Table. 11. Large-Fiber Neuropathies Causing Loss of Kinesthetic Function
Table. 12. Causes of Painful Neuropathies
Table. 12. Causes of Painful Neuropathies Guillain-Barre syndrome differ from most others because of its predominant motoro component and rapid evolution; however, some cases are thought to be mainly sensory.* Perhexilene, paclitaxel (taxol), suramin, zalcitabine, didanosine, stavudine, nitrofurantoin, thalidomide, gold, almitrine, disulfiram, misonidazole, metronidazole
Table. 13. Neuropathies with Prominent Autonomic Dysfunction
Evaluation of the peripheral neuropathyElectrodiagnostic testingQuantitative sensory testingAutonomic reflexs testAutoantibody testing .Skin biopsi
Somatoform disorderDorsal radiculopathyMyelopathyA few axonal neuropathies with sensory predominance Recovered Guillain-Barre syndromeIgM monoclonal gammopathyRare cases of active Guillain-Barre syndrome, chronic inflammatory demylinating polyradicaloneuropathy, and the Fisher syndromeFriedreichs ataxiaIdiopathic sensory neuropathyCarcinomatous sensory neuropathySjgrens syndrome with ataxic neuropathySome neurotoxic disordersNormal electrodiagnostic studiesAxonal sensorimotor neuropathyDemyelinating neuropathyPure sensory fiber lossFig. 1. Electrodiagnostic differentiation of ataxic neuropathies