What Is Nutritional Neuropathy?

Dystrophic polyneuropathy is a common type of polyneuropathy. It is characterized by nutritional deficiencies or metabolic disorders, which are characterized by symmetrical sensory disturbances in the distal limbs, paramotor motility, and / or autonomic nerve disorders. Nutrient deficiency caused by various reasons, especially the lack of specific nutrients (such as vitamins) can affect some functions of the central nervous system and / or peripheral nerves or cause pathological damage to produce some neuropsychiatric symptoms.

Basic Information

English name: Dystrophic polyneuropathy
Visiting department: Internal medicine
Common causes: Nutritional deficiencies such as chronic alcoholism, pregnancy, chronic gastrointestinal diseases, and post-operative deficiency of B vitamins and pantothenic acid

Common symptoms: Distal symmetry of the distal limbs, paramotor inferior motor neurons and / or autonomic disorders

Causes of Dystrophic Polyneuropathy

It is caused by nutritional deficiencies such as chronic alcoholism, pregnancy, chronic gastrointestinal diseases, and postoperative surgery. The typical disease is vitamin B ₁ deficiency caused by vitamin B ₁ deficiency disease (beriberi). Some people think that vitamin B ₆ And pantothenic acid deficiency can also cause peripheral neurodegenerative metabolic disorders, such as diabetes, uremia, hematoporphyria, etc., and can also cause polyneuropathy due to secondary nutritional disorders.

Clinical manifestations of dystrophic polyneuropathy

1. Mainly manifested as dyskinesia, part of which is paresthesia and pain, manifested as persistent dull pain in the feet or lower limbs, transient laceration or tingling similar to spinal cord crest, foot or gastrocnemius squeezing or tightness, both lower limbs The feeling of strapping, etc., patients feel cold feet or hot soles of the soles of the feet, the degree of abnormality is fluctuating, and some patients can not walk because they can not tolerate the friction of clothing, the touch can be aggravated.

2. Physical examination shows abnormal motor sensation and reflexes, and most of the signs are symmetrical. The distal end is heavier than the proximal part, the lower limbs are heavier, the foot is drooping or the wrist is drooping, and sometimes the proximal muscles are weak. As a result, exercise cannot be performed. Deep gastrocnemius and foot tenderness are specific signs. The tendon reflexes of the lower limbs disappear early. A small number of patients with mild muscle weakness are mainly paresthesia and pain symptoms. Knee reflexes and ankle reflexes retain signs of peripheral sympathetic nerve involvement. Including excessive sweat secretion from the soles of the feet and palms and orthostatic hypotension, most patients are affected only by the limbs, and hoarseness and dysphagia may occur in the late stage of the vagus nerve involvement.

3. Severe patients have stasis edema, pigmentation and skin thinning in the lower extremities; and plantar penetrating ulcers and painless destruction of foot bones and joints. Repeated trauma and co-infection appear in the dull areas. Some asymptomatic patients require physical examination or electromyography to find mild signs of lower limb muscle tenderness, decreased muscle volume, and weakened or disappeared tendon reflexes.

Check for dystrophic polyneuropathy

Laboratory inspection

(1) No abnormalities in cerebrospinal fluid examination, CSF protein slightly increased in a few patients.

(2) Routine hematuria, blood glucose, electrolytes, blood vitamin B family levels, and detection of suspected toxicants are of diagnostic significance.

2. Other auxiliary inspections

The electromyogram showed mild to moderate motion, slowed sensory conduction velocity, significantly reduced amplitude of sensory action potential, normal motor motor conduction velocity at the proximal end, slowed distal, and fibrillation potentials in denervated muscles.

Diagnosis of dystrophic polyneuropathy

1. Mainly based on medical history, such as chronic alcoholism, pregnancy, chronic gastrointestinal diseases, and postoperative nutrition deficiency due to various reasons; or metabolic disorders such as diabetes, uremia, cachexia and other secondary nutritional disorders .

2. There are clinical symptom manifestations such as symmetrical sensory disturbance in the distal extremities, paralysis of lower motor neurons and / or autonomic nerve disorders.

3. EMG examination can help diagnosis.

Differential diagnosis of dystrophic polyneuropathy

Attention must be paid to the identification of polyneuropathy caused by immune diseases and certain metal poisoning.

Treatment of dystrophic polyneuropathy

1. Intake a balanced diet, ensure adequate nutrition, and supplement B vitamins. If frequent vomiting or gastrointestinal complications prevent eating, parenteral nutrition should be given and sufficient vitamins given intramuscularly or intravenously.

2. Patients with pain or sensation in both feet, can place a brace on the lower limbs to reduce the pressure and friction of the clothes. Prolonged inactivity of the limb is also the cause of pain, and the limb should be passively moved. Hyperalgesia can be given acetaminophen or aspirin, and codeine if necessary.

3. Peripheral nerve regeneration takes several months and can be treated with physical therapy. During this period, to avoid muscle and joint contractures, critically ill patients can use splints to fix the soles of the feet, lower limbs, upper limbs, and hands to maintain a fixed position to avoid shortening of the tendons. Nutritional disorders often recover slowly. For several weeks, severe illness can take several months, and you must quit drinking during the recovery period.