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Peripheral Neuropathy guidelines                         
Table 5.  Signs and Symptoms of Peripheral-Nerve Disorders
SystemPositiveNegative
MotoraCramps
Fasciculations
Myokymia (quivering)
Restless legs
Tightness
Weakness
Fatigability
Hypotonia
Areflexia
Deformities (pes cavus, claw hand)
Sensory (large fiber)bParesthesias
Tingling
Loss of vibration sense
Loss of joint position sense
Areflexia
Sensory ataxia (positive Romberg test)
Hypotonia
Sensory (small fiber)cBurning, jabbing pain (dysesthesias)Loss of pain sense
Loss of temperature sense
AutonomicdHyperhidrosis
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
DrugSpecial features
Antibiotics
ChloramphenicolDistal, primarily sensory neuropathy, optic neuritis during prolonged high-dose use
DapsonePredominantly motor neuropathy
Dideoxycytidine, dideoxyinosine,
Dideoxythmidine
Painful sensory neuropathy
EthambutolOptic neuritis
IsoniazidDistal axonal neuropathy, paresthesiae are prominent. Prevented by vitamin B6
MetronidazoleDistal sensory neuropathy
NitrofurantoinDistal sensorimotor neuropathy; occurs in renal failure
SuraminDistal sensorimotor and demyelinating neuropathy
Antineoplastics
CisplatinSensory ataxia
CytarabineSensorimotor neuropathy; rare
MisonidazolePainful sensory neuropathy
ProcarbazineDistal paresthesias
PaclitaxelDistal sensorimotor neuropathy
Vinca alkaloids: vincristine, vinblastine, vindesine, vinorelbineDistal sensorimotor neuropathy
Antirheumatics
ChloroquineNeuromyopathy
ChlochicineMild sensory neuropathy, myopathy
Organic goldDemyelinating sensorimotor neuropathy
PenicillamineDemyelinating sensorimotor neuropathy
Other pharmaceuticals
AmiodaroneMild sensorimotor neuropathy
DisulfiramDistal sensorimotor neuropathy
ErgotsDistal paresthesiae and dysesthesiae
FK 506Axonal neuropathy
HydralazinePrevented by vitamin B6
Nitrous oxideAssociated with myelopathy
PerhexilineDemyelinating neuropathy
PhenytoinMild distal sensory loss
ProcainamideDemyelinating neuropathy; rare
PyridoxineSensory ataxia
ThalidomidePainful axonal neuropathy, primarily sensory
L-TryptophanAssociated eosinophilia, fasciitis
Nonpharmaceutical toxic agents
AcrylamideExcessive sweating
Allyl chlorideDistal numbness
ArsenicElevated hair, urine, and fingernail levels
BuckthornMotor neuron syndrome causing bulbar and limb paralysis
CadmiumSensory neuronopathy
Propionitriles (e.g., dimethylaminopropionitrile)Urinary hesitancy, sexual dysfunction
Ethylene oxideAssociated cognitive impairment
Hexacarbons (n-hexane, methyl n-butyl ketone)Distal axonopathy
LeadPredominantly motor; associated anemia
MercuryAssociated central nervous system manifestations
Methyl bromideCalf-muscle tenderness
Organophosphorus estersDiarrhea, sweating, fasciculations
Polychlorinated biphenylsAcne, brown-pigmented nails
ThalliumGastrointestinal symptoms, delayed alopecia
TrichlorethyleneFacial numbness
VacorAcute diabetes mellitus
Based on Lynn and Mendell [11].
 


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