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Asymmetric Peripheral Neuropathy

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1. Tiny Tips: “TREADMILLS” Peripheral Neuropathy mnemonic

Tiny Tips: “TREADMILLS” Peripheral Neuropathy mnemonic Tiny Tips: “TREADMILLS” Peripheral Neuropathy mnemonic - CanadiEM Tiny Tips: “TREADMILLS” Peripheral Neuropathy mnemonic In , by Sean Patrick February 20, 2018 Peripheral neuropathy is prevalent in up to 2.4% of the general population 1 . It is often characterized by an asymmetric distribution with sensory symptoms following a dermatomal pattern. Initial investigations include a complete blood count (CBC), metabolic panel (electrolytes (...) , glucose, urea, creatinine), and thyroid stimulating hormone (TSH) 2 . There are many causes for peripheral neuropathy, so when considering the etiology, think “TREADMILLS.” T oxins Ethanol, Heavy metals, Tetanus, Organophosphates, Diphtheria R enal Failure E ndocrine Diabetes, Hypothyroidism A cquired Immunodeficiency Syndrome (AIDS) D rugs/ D eficiency Amiodarone, Procainamide, Digoxin, Hydralazine, Statins, Isoniazid, Chloroquine, Misoprostol, Metronidazole, Nitrofurantoin Vitamin B6 deficiency

2018 CandiEM

2. Practice Advisory for the Prevention of Perioperative Peripheral Neuropathies

Practice Advisory for the Prevention of Perioperative Peripheral Neuropathies Practice Advisory for the Prevention of Perioperative Peripheral Neuropathies 2018:An Updated Report by the American Society of Anesthesiologists Task Force on Prevention of Perioperative Peripheral Neuropathies* | Anesthesiology | ASA Publications 4113640588 ASA Publications Log in to access full content You must be logged in to access this feature. ASA members enjoy complimentary access to ASA publications, as well (...) as a variety of educational resources. Non-ASA Members Login Free Practice Parameter | January 2018 Practice Advisory for the Prevention of Perioperative Peripheral Neuropathies 2018: An Updated Report by the American Society of Anesthesiologists Task Force on Prevention of Perioperative Peripheral Neuropathies* Author Notes This article is featured in “This Month in Anesthesiology,” page 1A. This article is featured in “This Month in Anesthesiology,” page 1A. Supplemental Digital Content is available

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2018 American Society of Anesthesiologists

3. Asymmetric Peripheral Neuropathy

Asymmetric Peripheral Neuropathy Asymmetric Peripheral Neuropathy Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Asymmetric (...) Peripheral Neuropathy Asymmetric Peripheral Neuropathy Aka: Asymmetric Peripheral Neuropathy , Mononeuropathy , Mononeuropathy Multiplex From Related Chapters II. Causes: Proximal and distal sensorimotor Neuropathy (Type 3) Radiculopathy (e.g. ) Plexopathy Brachial (e.g. , ) Lumbosacral (e.g. HSV, VZV, CMV, HIV) III. Causes: Distal Neuropathy Mixed Motor and Sensory Sensorimotor Mononeuropathy (Type 4) Sensorimotor Mononeuropathy Multiplex (Type 5) Vaculitis (RA, SLE, ) Pure Pure Motor (Type 6) (ALS

2018 FP Notebook

4. A “Triple Trouble” Case of Facioscapulohumeral Muscular Dystrophy Accompanied by Peripheral Neuropathy and Myoclonic Epilepsy (PubMed)

A “Triple Trouble” Case of Facioscapulohumeral Muscular Dystrophy Accompanied by Peripheral Neuropathy and Myoclonic Epilepsy Facioscapulohumeral muscular dystrophy (FSHD) is characterized by asymmetric muscular deficit of facial, shoulder-girdle muscles, and descending to lower limb muscles, but it exists in several extramuscular manifestations or overlapping syndromes. Herein, we report a "complex disease plus" patient with FSHD1, accompanied by peripheral neuropathy and myoclonic (...) A, which corresponded with D4Z4 hypomethylation status in the family. Both the patient's mother and brother only presented the typical FSHD but lacked overlapping syndromes. However, no mutations for hereditary peripheral neuropathy and myoclonic epilepsy were discovered by MLPA and WES.The present study described a "tripe trouble" with FSHD, peripheral neuropathy, and myoclonic epilepsy, adding the spectrum of overlapping syndromes and contributing to the credible diagnosis of atypical phenotype

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2018 Chinese medical journal

5. Peripheral Neuropathy

Peripheral Neuropathy Peripheral Neuropathy Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Peripheral Neuropathy Peripheral (...) Neuropathy Aka: Peripheral Neuropathy , Neuropathy From Related Chapters II. Pathophysiology: Injury affects one of four components al or Axonal Neuropathy Affects cell body or axon of nerve See ( ) See ( ) See Demyelinating Neuropathy (Myelinopathy) Affects myelin swan cell sheath around axon See ( ) See ( ) Infiltrative Neuropathy: Affects supporting tissue Appears similar to demyelinating Neuropathy tosis Ischemic Neuropathy: Affects nerve vascular supply Collagen vascular disease III. History What

2018 FP Notebook

6. Cranial Neuropathy

Cranial Neuropathy Revised 2017 ACR Appropriateness Criteria ® 1 Cranial Neuropathy American College of Radiology ACR Appropriateness Criteria ® Cranial Neuropathy Variant 1: Anosmia and abnormalities of the sense of smell. (Olfactory nerve, CN I.) Radiologic Procedure Rating Comments RRL* MRI head without and with IV contrast 8 This procedure is performed in conjunction with MRI of the orbit, face, and neck. O MRI orbit face neck without and with IV contrast 8 This procedure is performed (...) Appropriateness Criteria ® 2 Cranial Neuropathy Variant 2: Weakness or paralysis of the mastication muscles. Sensory abnormalities of the head and neck. Trigeminal neuralgia. (Trigeminal nerve, CN V.) Radiologic Procedure Rating Comments RRL* MRI head without and with IV contrast 8 This procedure is performed in conjunction with MRI of the orbit, face, and neck. O MRI orbit face neck without and with IV contrast 8 This procedure is performed in conjunction with MRI of the head. O MRI head without IV contrast

2017 American College of Radiology

7. Asymmetric Peripheral Neuropathy

Asymmetric Peripheral Neuropathy Asymmetric Peripheral Neuropathy Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Asymmetric (...) Peripheral Neuropathy Asymmetric Peripheral Neuropathy Aka: Asymmetric Peripheral Neuropathy , Mononeuropathy , Mononeuropathy Multiplex From Related Chapters II. Causes: Proximal and distal sensorimotor Neuropathy (Type 3) Radiculopathy (e.g. ) Plexopathy Brachial (e.g. , ) Lumbosacral (e.g. HSV, VZV, CMV, HIV) III. Causes: Distal Neuropathy Mixed Motor and Sensory Sensorimotor Mononeuropathy (Type 4) Sensorimotor Mononeuropathy Multiplex (Type 5) Vaculitis (RA, SLE, ) Pure Pure Motor (Type 6) (ALS

2015 FP Notebook

8. CRACKCast 107 – Peripheral Nerve Disorders

into: Single lesion = simple mononeuropathies versus Multiple lesions = multiple mononeuropathies = mononeuropathy multiplex Nonfocal = Polyneuropathies Refer to figure 97.1 in Rosen’s 9 th Edition for the cardinal 7 categories of peripheral neuropathies ***Focus your History and physical to answer the following 3 questions:*** Are the sensorimotor signs and symptoms symmetrical or asymmetrical? Are the sensorimotor signs and symptoms distal or both proximal and distal? Is the modality involved exclusively (...) 9 th Edition for an approach to peripheral neuropathy, and for the patterns and prototypes of peripheral neuropathies, respectively Patterns and Prototypes of Peripheral Neuropathies: Type Pattern Distribution Prototypical disease modalities 1 Proximal and distal, symmetrical, sensorimotor polyneuropathy Proximal and distal Motor > sensory GBS Symmetrical 2 Distal, symmetrical, sensorimotor polyneuropathy Distal Sensory > motor Diabetic DSPN Symmetrical 3 Proximal and distal, asymmetrical

2017 CandiEM

9. CRACKCast E087 – Peripheral Arteriovascular Disease

atheromas, etc. Most of these patients should have good peripheral pulses, asymmetric distribution of these lesions, and no evidence of systemic vasculitis. Treatment includes identification and removal of the proximal source. Usually CT-angiography is the test of choice to identify the proximal lesion. Definitive treatment includes local endarterectomy, vascular bypass, angioplasty, etc. Medical management is with antiplatelets and anticoagulant to prevent further thrombosis. 5) Differentiate between (...) , MSK shoulder disease, peripheral neuropathies, MS, ETOH abuse, diabetes, and many others! Management depends on the severity and type: Nerve compression only = physio, shoulder rehab, then maybe surgery Arterial compression is a BIG deal: Risk for thrombosis, thromboembolism, acute ischemia, rupture, etc. Acute thrombosis = see the first few questions above. 17) List four anatomic abnormalities associated with thoracic outlet syndrome. See Rosen’s Fig 87-3. Think muscle, ligament, and bone

2017 CandiEM

10. Descriptive Analysis of Morphological Aspects of Nerve by Ultra-high Frequency Ultrasound (30-50MHZ) in Demyelinating Neuropathies: Inflammatory Demyelinating Polyneuropathy Chronic (IPDC), Neuropathy Multifocal Motor Block of Conducting (NMMBC) and Neuro

subjects with no signs of neuropathy at the EMG examination. Condition or disease Intervention/treatment Phase Polyradiculoneuropathy, Chronic Inflammatory Demyelinating Other: Ultrasound UHF peripheral nerves Other: Electro myography surface nerves Not Applicable Detailed Description: The use of nerve ultrasound for the diagnosis and monitoring of neuromuscular diseases is a promising growing field (1). Non-invasive and painless, ultrasound provides additional data electroneuromyography (EMG (...) provided by the National Library of Medicine related topics: Arms and Interventions Go to Arm Intervention/treatment Active Comparator: NMMCB patient with Neuropathies with Motrices Multifocal Conduction Block Other: Ultrasound UHF peripheral nerves Ultrasound UHF peripheral nerves Other: Electro myography surface nerves Electro myography surface nerves Active Comparator: PICD patient with Inflammatory demyelinating polyneuropathy Chronicle Other: Ultrasound UHF peripheral nerves Ultrasound UHF

2016 Clinical Trials

11. Multifocal demyelinating motor neuropathy and hamartoma syndrome associated with a de novo <i>PTEN</i> mutation. (PubMed)

diseases.We performed whole-exome sequencing in the patient's genomic DNA validated by Sanger sequencing. Immunoblotting, in vitro enzymatic assay, and label-free shotgun proteomic profiling were performed in the patient's fibroblasts.The predominant clinical presentation of the patient was a childhood onset, asymmetric progressive multifocal motor neuropathy. In addition, he presented with macrocephaly, autism spectrum disorder, and skin hamartomas, considered as clinical criteria for PTEN-related (...) hypermyelination leading to peripheral neuropathy has been reported in PTEN-deficient mice.We describe a novel phenotype, PTEN-associated multifocal demyelinating motor neuropathy with a skin hamartoma syndrome. A similar mechanism may potentially underlie other forms of Charcot-Marie-Tooth disease with involvement of the phosphatidylinositol pathway.Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

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2018 Neurology

12. Preliminary crystallographic analysis of the N-terminal PDZ-like domain of periaxin, an abundant peripheral nerve protein linked to human neuropathies (PubMed)

Preliminary crystallographic analysis of the N-terminal PDZ-like domain of periaxin, an abundant peripheral nerve protein linked to human neuropathies Periaxin (PRX) is an abundant protein in peripheral nerves and contains a predicted PDZ-like domain at its N-terminus. The large isoform, L-PRX, is required for the maintenance of myelin in the peripheral nervous system and its defects cause neurological disease. Here, the human periaxin PDZ-like domain was crystallized and X-ray diffraction data (...) were collected to 2.85 Å resolution using synchrotron radiation. The crystal belonged to the primitive hexagonal space group P3121 or P3221, with unit-cell parameters a = b = 80.6, c = 81.0 Å, γ = 120° and either two or three molecules in the asymmetric unit. The structure of PRX will shed light on its poorly characterized function in the nervous system.

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2013 Acta Crystallographica Section F: Structural Biology and Crystallization Communications

13. Manual acupuncture for treatment of diabetic peripheral neuropathy: a systematic review of randomized controlled trials. (PubMed)

Manual acupuncture for treatment of diabetic peripheral neuropathy: a systematic review of randomized controlled trials. Manual acupuncture has commonly been used in China, either alone or in combination with conventional medicine, to treat diabetic peripheral neuropathy (DPN). The objective of this study was to perform a systematic review to evaluate the potential benefits and harms of manual acupuncture for DPN to justify its clinical use.We searched for published and unpublished randomized (...) ), vitamin B1 and B12 (RR 1.55, 95%CI 1.33 to 1.80), and no treatment (RR 1.56, 95%CI 1.31 to 1.85), and that the combination of manual acupuncture and mecobalamin had better effect compared with mecobalamin alone on global symptom improvement (RR 1.56, 95%CI 1.28 to 1.90). Adverse events were not reported in any trials. The asymmetric funnel plot suggested publication bias.Despite the number of trials of manual acupuncture for DPN and their uniformly positive results, no clinically relevant conclusions

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2013 PloS one

14. Median and Ulnar Neuropathy Assessment in Parkinson's Disease regarding Symptom Severity and Asymmetry (PubMed)

Median and Ulnar Neuropathy Assessment in Parkinson's Disease regarding Symptom Severity and Asymmetry Background. While increasing evidence suggests comorbidity of peripheral neuropathy (PNP) and Parkinson's disease (PD), the pathogenesis of PNP in PD is still a debate. The aim of this article is to search the core PD symptoms such as rigidity and tremor as contributing factors to mononeuropathy development while emphasizing each individual patient's asymmetric symptom severity. Methods. We (...) studied 62 wrists and 62 elbows of 31 patients (mean age 66.48 ± 10.67) and 64 wrists and 64 elbows of 32 age-gender matched healthy controls (mean age 62.03 ± 10.40, p = 0.145). The Hoehn and Yahr disability scale and Unified Parkinson's Disease Rated Scale were used to determine the severity of the disease. Results. According to electrodiagnostic criteria, we confirmed median neuropathy in 16.12% (bilateral in two-thirds of the patients) and ulnar neuropathy in 3.22% of the PD group. While mean age

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2016 Parkinson's disease

15. HyQvia in Multifocal Motor Neuropathy

HyQvia in Multifocal Motor Neuropathy HyQvia in Multifocal Motor Neuropathy - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. HyQvia in Multifocal Motor Neuropathy (HYMMNE) The safety and scientific validity (...) Utrecht Study Details Study Description Go to Brief Summary: Subcutaneous immunoglobulin (SCIG) and recombinant human hyaluronidase (rHuPH20) will be tested in patient witch MMN and currently under maintenance treatment with IVIG for safety, tolerability and efficacy. Condition or disease Intervention/treatment Phase Multifocal Motor Neuropathy Drug: rHuPH20 Not Applicable Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Estimated Enrollment : 20

2016 Clinical Trials

16. Peripheral Neuropathy

Peripheral Neuropathy Peripheral Neuropathy Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Peripheral Neuropathy Peripheral (...) Neuropathy Aka: Peripheral Neuropathy , Neuropathy From Related Chapters II. Pathophysiology: Injury affects one of four components al or Axonal Neuropathy Affects cell body or axon of nerve See ( ) See ( ) See Demyelinating Neuropathy (Myelinopathy) Affects myelin swan cell sheath around axon See ( ) See ( ) Infiltrative Neuropathy: Affects supporting tissue Appears similar to demyelinating Neuropathy tosis Ischemic Neuropathy: Affects nerve vascular supply Collagen vascular disease III. History What

2015 FP Notebook

17. Peripheral neuropathy in patients with systemic lupus erythematosus. (PubMed)

Peripheral neuropathy in patients with systemic lupus erythematosus. In patients with systemic lupus erythematosus (SLE), to determine 1) the prevalence and clinical features of peripheral neuropathies (PN) and whether they were SLE related, 2) whether there are associations between other SLE features and PN.Patients who met the American College of Rheumatology case definition criteria for SLE peripheral neuropsychiatric syndromes were selected from the University of Toronto Lupus Clinic (...) neuropathy in 13%, and mononeuropathy in 11% of patients. Asymmetric presentation was most common (59%) and distal weakness occurred in 34%. Electrophysiologic studies indicated axonal neuropathy in 70% and signs of demyelination in 20% of patients. Compared with patients without PN, those with PN had significantly more central nervous system involvement, higher SLE-disease activity index 2000 and lower SF-36-PCS.The prevalence of PN is relatively high in SLE and occurs more frequently in patients

2011 Seminars in arthritis and rheumatism

18. Efficacy and Safety of HyQvia (Immunoglobulin 10% With Recombinant Hyaluronidase) in Multifocal Motor Neuropathy (MMN)

Volunteers: No Criteria Inclusion Criteria: Age at onset 18 - 65 years. The presence of asymmetrical limb weakness at onset or motor involvement having a motor nerve distribution in at least two peripheral nerve distributions, predominant upper limb involvement, disabling weakness MRC grade 4 or less in at least one muscle. Decreased or absent tendon reflexes in affected limbs. Electrophysiological evidence of one site with definite motor conduction block or one site with probable conduction block (...) Efficacy and Safety of HyQvia (Immunoglobulin 10% With Recombinant Hyaluronidase) in Multifocal Motor Neuropathy (MMN) Efficacy and Safety of HyQvia (Immunoglobulin 10% With Recombinant Hyaluronidase) in Multifocal Motor Neuropathy (MMN) - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum

2015 Clinical Trials

19. Multifocal Motor Neuropathy Associated with Infliximab. (PubMed)

Multifocal Motor Neuropathy Associated with Infliximab. The anti-tumour necrosis factor [TNF] monoclonal antibody, infliximab, is commonly prescribed in both ulcerative colitis and Crohn's disease. Neurological side effects such as optic neuritis are well recognised, although not as frequently seen as hypersensitivity and serious infections.We present a case of peripheral neuropathy in a young man on infliximab therapy for ulcerative colitis. This presented as an asymmetrical and slowly (...) progressive weakness in his right upper limb, severely impacting on function. Investigations confirmed a diagnosis of multifocal motor neuropathy [MMN]. This has been previously described in patients receiving infliximab for rheumatological conditions. The exact mechanism is unclear, but the neuropathy responds well to intravenous immunoglobulin. In our case, infliximab was discontinued. The patient was treated with immunoglobin for 5 days and recovered rapidly. Mercaptopurine was instituted

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2015 Journal of Crohn's & colitis

20. Neuropathy in elderly: lessons learnt from nerve biopsy. (PubMed)

Neuropathy in elderly: lessons learnt from nerve biopsy. To study the utility of nerve biopsy in providing diagnostic, therapeutic or prognostic information that aid in clinical management in elderly subjects with peripheral neuropathy.Clinico-pathological data of 100 elderly subjects aged 65 and above with peripheral neuropathy who underwent nerve biopsy in the last decade (2002-2011) was reviewed.The study included 100 subjects (M:F 78:22). Mean age at biopsy and symptom duration was 69.62 (...) ±4.8 years and 24.17±40.4 months, respectively. The most common pattern of was distal symmetric sensorimotor polyneuropathy (35%), followed by multiple mononeuropathy (29%) and asymmetric sensorimotor neuropathy (15%). The nerve biopsy was 'diagnostic' in 24%, (definite vasculitis in 12, leprosy in 10 and acute inflammatory demyelinating polyradiculoneuropathy in 2) and proved 'essential' or 'helpful' in therapeutic management in 81% subjects. In 60 (60%) patients, where a pre-biopsy aetiological

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2015 Age and ageing

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