Guide: polyneuropathy CIDPUSA.ORG
Table 5. Signs and Symptoms of Peripheral-Nerve Disorders | ||
System | Positive | Negative |
Motora | Cramps Fasciculations Myokymia (quivering) Restless legs Tightness | Weakness Fatigability Hypotonia Areflexia Deformities (pes cavus, claw hand) |
Sensory (large fiber)b | Paresthesias Tingling | Loss of vibration sense Loss of joint position sense Areflexia Sensory ataxia (positive Romberg test) Hypotonia |
Sensory (small fiber)c | Burning, jabbing pain (dysesthesias) | Loss of pain sense Loss of temperature sense |
Autonomic | Hyperhidrosis Excess saliva | Orthostasis Erectile dysfunction Bowel and/or bladder dysfunction Anhidrosis |
a All motor fibers are large fibers. b Mediate vibration, proprioception, touch. c Mediate pain, temperature sensations. d All autonomic fibers are small fibers. |
Table 6. Drugs and Toxins Causing Peripheral Neuropathy | |
Drug | Special features |
Antibiotics | |
Chloramphenicol | Distal, primarily sensory neuropathy, optic neuritis during prolonged high-dose use |
Dapsone | Predominantly motor neuropathy |
Dideoxycytidine, dideoxyinosine, Dideoxythmidine | Painful sensory neuropathy |
Ethambutol | Optic neuritis |
Isoniazid | Distal axonal neuropathy, paresthesiae are prominent. Prevented by vitamin B6 |
Metronidazole | Distal sensory neuropathy |
Nitrofurantoin | Distal sensorimotor neuropathy; occurs in renal failure |
Suramin | Distal sensorimotor and demyelinating neuropathy |
Antineoplastics | |
Cisplatin | Sensory ataxia |
Cytarabine | Sensorimotor neuropathy; rare |
Misonidazole | Painful sensory neuropathy |
Procarbazine | Distal paresthesias |
Paclitaxel | Distal sensorimotor neuropathy |
Vinca alkaloids: vincristine, vinblastine, vindesine, vinorelbine | Distal sensorimotor neuropathy |
Antirheumatics | |
Chloroquine | Neuromyopathy |
Chlochicine | Mild sensory neuropathy, myopathy |
Organic gold | Demyelinating sensorimotor neuropathy |
Penicillamine | Demyelinating sensorimotor neuropathy |
Other pharmaceuticals | |
Amiodarone | Mild sensorimotor neuropathy |
Disulfiram | Distal sensorimotor neuropathy |
Ergots | Distal paresthesiae and dysesthesiae |
FK 506 | Axonal neuropathy |
Hydralazine | Prevented by vitamin B6 |
Nitrous oxide | Associated with myelopathy |
Perhexiline | Demyelinating neuropathy |
Phenytoin | Mild distal sensory loss |
Procainamide | Demyelinating neuropathy; rare |
Pyridoxine | Sensory ataxia |
Thalidomide | Painful axonal neuropathy, primarily sensory |
L-Tryptophan | Associated eosinophilia, fasciitis |
Nonpharmaceutical toxic agents | |
Acrylamide | Excessive sweating |
Allyl chloride | Distal numbness |
Arsenic | Elevated hair, urine, and fingernail levels |
Buckthorn | Motor neuron syndrome causing bulbar and limb paralysis |
Cadmium | Sensory neuronopathy |
Propionitriles (e.g., dimethylaminopropionitrile) | Urinary hesitancy, sexual dysfunction |
Ethylene oxide | Associated cognitive impairment |
Hexacarbons (n-hexane, methyl n-butyl ketone) | Distal axonopathy |
Lead | Predominantly motor; associated anemia |
Mercury | Associated central nervous system manifestations |
Methyl bromide | Calf-muscle tenderness |
Organophosphorus esters | Diarrhea, sweating, fasciculations |
Polychlorinated biphenyls | Acne, brown-pigmented nails |
Thallium | Gastrointestinal symptoms, delayed alopecia |
Trichlorethylene | Facial numbness |
Vacor | Acute diabetes mellitus |
Based on Lynn and Mendell [11]. |
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