DR Medhat MRCP

2. Predominantly sensory :
o Friedrich`s ataxia
o DM.
o Vit B12 deficiency,B1↓,Niacin ↓ (pellagra).
o Uraemia.
o Alcoholism.
o Amyloidosis.
o Leprosy.
o Paraneoplastic syndrome
Alcoholic neuropathy:
Secondary to both direct toxic effects and reduced absorption of B vitamins.
Sensory symptoms typically present prior to motor symptoms
Vitamin B12 deficiency:
Subacute combined degeneration of spinal cord.
Dorsal column usually affected first (joint position, vibration) prior to distal
paraesthesia.
• Typical general C/P of peripheral neuropathy:
A. Polyneuropathy
Most common presentation:
Lower limbs :
1. Tingling,burning or band-like sensation in the toes or soles of the feet (sensory)
2. Then These sensations extends to include both dorsum & sole of the feet(stock)
Ankle reflex becomes lost.
3. Then Foot drop & high stepping gait (motor LMN paralysis ,extensors > flexors)
Loss of knee reflex.
Upper limbs (start later after LL ascends to the knee level) :
1. Sensory symptoms in the finger tips then palm &dorsum of the hands (glove)
2. Sensory symptoms extend to the arms.
Final picture :
[Distal, symmetrical , sensori (stock & glove) -motor axonal polyneuropathy of LL/UL]
1. Sensory dysfunction : stock & glove pattern of sensory symptoms.
2. Unsteady gait due to loss of deep sensations (proprioceptions).
3. Motor dysfunction progress in arms & legs (LMN , distal > proximal, extensors
> flexors)
4. In advanced stages , respiratory muscles involved leading to respiratory failure.
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