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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