Generality
Polinevrite is the medical term that defines the simultaneous inflammation of several peripheral nerves.
Polyneuritis can be the result of: infections (eg, diphtheria), autoimmune diseases (eg Guillain-Barré syndrome), the intake of certain drugs (eg chemotherapy), exposure to certain toxic substances (eg: insecticides), diabetes mellitus, alcoholism, some vitamin deficiencies etc.
Acute or chronic, polyneuritis is responsible for different symptoms, depending on whether the inflamed nerves are sensitive, motor or mixed.
Diagnosing a polyneuritis requires a thorough investigation, a survey that usually begins with an physical examination and anamnesis, and ends with instrumental examinations such as electromyography and biopsy.
The presence of a polyneuritis requires causal therapy, accompanied by symptomatic therapy.
A brief review of what a nerve is
Nerves are important structures of the nervous system, resulting from the grouping of several axons and having the important task of transporting nerve impulses.
An axon is the characteristic extension of neurons (the cells of the nervous system), which allows the spread of nerve signals even at long distances.
Nerves can carry information in three ways:
- From the central nervous system (CNS) to the periphery . The nerves with this property are called efferent . The efferent nerves control the movement of the muscles, so I am in charge of the motor sphere.
- From the periphery to the CNS . Nerves with this capacity are called afferent . The afferent nerves signal to the CNS what they detected in the periphery, therefore they cover a sensitive (or sensory) function.
- From the SNC to the periphery and vice versa . Nerves with this double capacity are called mixed . Mixed nerves have a dual function: motor and sensory.
What is Polinevrite?
Polinevrite is the medical term that indicates the simultaneous inflammation of several peripheral nerves, followed by a malfunction of the latter.
Peripheral nerves are the nerves that make up the so-called peripheral nervous system .
What is the peripheral nervous system?
The peripheral nervous system (PNS) is the "arm" of the central nervous system (CNS), that is the "mind". Its function, in fact, consists in transmitting to the CNS all that is picked up inside (organs) and outside (skin) of the organism, and in spreading all the elaborations with origin in the CNS towards the periphery. In other words, the peripheral nervous system carries information from the peripheral districts of the human body to the central nervous system and vice versa.
Without the SNP, the central nervous system could not function properly.
Acute Polinevrite and Chronic Polinevrite: what are they and what differentiates them?
A polyneuritis can have the characteristics of a condition:
- Acute, if symptoms appear quickly and are very severe, or
- Chronic, if the clinical manifestations arise gradually and possess a moderate intensity.
Understand what Polinevrite is from the name
The definition of polinevrite is in the same term "polinevrite"; indeed:
- "poli-" means "much" (from the ancient Greek " polus "),
- "nevr-" is the word that refers to nerves (from the ancient Greek " neuron ") and
- "-ite" is the suffix which, in medicine, refers to the inflammatory process.
Causes
The causes of polyneuritis are numerous, so that doctors, in order to simplify the consultation, have decided to distinguish them in two categories: the causes of acute polyneuritis and the causes of chronic polyneuropathy.
Causes of Acute Polinevrite
In the category "causes of acute polyneuritis", belong:
- Some infectious diseases, including Lyme disease, diphtheria, syphilis, typhoid, tuberculosis, botulism, herpes zoster and AIDS . These are diseases whose origin is bacteria or viruses, capable of invading, inflaming and sometimes even destroying nerve cells;
- Some autoimmune diseases, including Guillain-Barré syndrome, rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome and chronic inflammatory demyelinating polyneuropathy . Those who suffer from an autoimmune disease have an aggressive immune system towards the organism, which they should actually protect;
- Prolonged intake of certain drugs . Among the incriminated medicines, there are: chemotherapy for the treatment of cancer (vinblastine and vincristine), some sedatives (barbital and esobarbital), some antibiotics (sulfonamide and nitrofurantoin) and anticonvulsants for the treatment of epilepsy (phenytoin);
- Tumors such as lymphoma or multiple myeloma . A lymphoma is a malignant tumor of the glandular apparatus that constitutes the lymphatic system (lymph nodes). Multiple myeloma is a malignant tumor that affects certain cells of the immune system. The latter, in fact, begins to produce an abnormal protein that causes kidney problems and damages other organs and tissues in the body;
- Exposure to toxic substances, such as organophosphorus insecticides, tricresile phosphate or thallium .
Causes of Chronic Polinevrite
Under the heading "Chronic polyneuritis causes" are:
- Diabetes mellitus. Caused by a defect in insulin secretion / action, diabetes mellitus is a metabolic disease that causes hyperglycemia.
Hyperglycemia has various effects on the human body, including damage to the blood vessels responsible for supplying peripheral nerves and which are fundamental for the health of the latter.
- State of serious alcoholism . Alcoholics do not adequately absorb ingested foods and are often subjected to episodes of diarrhea and vomiting; this determines a state of malnutrition, which also affects the vitamins essential for the good health of the peripheral nervous system. These vitamins are B12, B1, B6, niacin and E.
- Vitamin deficiencies due to causes other than alcoholism . The exclusion from the diet of the aforementioned vitamins (B12, B1 etc.), by choice or lack of availability, has the same effects, on peripheral nerves, of alcoholism.
- State of hypothyroidism . A poorly active thyroid produces insufficient amount of thyroid hormones for the body's needs, including peripheral nerves.
- Chronic kidney diseases . The malfunctioning of the kidneys involves an accumulation of toxic substances in the body, which cause inflammation and damage also to peripheral nerves.
- Exposure to toxic substances, such as heavy metals or mercury.
- Excessive intake of vitamin B6 . This is a rare but possible circumstance.
Types of Polinevrite
Depending on the task to which the inflamed peripheral nerves are placed, a polyneuritis can be of the type: sensory, motor or mixed .
SENSITIVE POLINEVRITE
Physicians call polyneuritis sensory polyneuritis characterized by the simultaneous inflammation of several peripheral nerves with sensory function.
POLINEVRITE MOTORIA
The definition of motor polyneuropathy refers to polyneuritis characterized by the simultaneous inflammation of several peripheral nerves with motor function.
MIXED POLINEVRITE
The term "mixed polyneuritis" includes all forms of polyneuritis marked by contemporary inflammation of both sensory and motor nerves.
Epidemiology
According to statistics, people aged 20 to 40 suffer most from polyneuropathy.
Except when the cause is diphtheria, polyneuritis rarely affects children.
Symptoms and Complications
The symptoms and signs of a polyneuritis vary according to the type of inflamed nerves; in practice, this means that the disorders related to a sensory polinevrite will be different from the sufferings deriving from a motor polyneuritis or from a mixed polinevrite.
Typical symptoms of a Sensitive Polinevrite
The episodes of sensory polinevrite produce symptoms where, on the skin, the inflamed spinal nerves possess their dendrites and surface receptors.
Virtually all parts of the body can show the results of sensory polyneuropathy; however, the upper limbs and lower limbs are the areas most affected in absolute terms.
Among the typical clinical manifestations of sensory polinevrite are:
- Tingling and tingling ;
- Sense of numbness and reduced ability to feel pain and temperature changes;
- Burning pain and like pains;
- Allodynia, or pain caused by a stimulus that, under normal conditions, would be completely harmless and without consequences;
- Loss of balance and coordination skills .
The painful sensation that characterizes sensory polyneuropathy represents a form of neuropathic pain (or peripheral neuropathic pain ).
Neuropathic pain is a different feeling from that caused by a physical insult; in fact, it originates directly in the structures constituting the nervous system (nerves, in the case of SNP, and brain and spinal cord, in the case of the CNS).
Typical symptoms of a Polinevrite Motoria
The episodes of motor polyneuritis cause symptoms where the muscles controlled by the peripheral nerves subject to inflammation reside.
The typical manifestations of motor polyneuritis are:
- Spasms and muscle cramps ;
- Muscular weakness and / or paralysis of a series of muscles;
- Inability to use muscles dependent on inflamed peripheral nerves;
- Reduction of muscle mass due to unused forced.
Motor polyneuropathy mainly affects the upper limbs and lower limbs, which, in the light of the aforementioned manifestations, can lead to difficulties in holding objects or walking problems.
Did you know that ...
A typical symptom of motor polyneuropathy of the lower limbs is the sagging foot, that is the inability to keep the front of the foot raised.
Typical symptoms of a Mixed Polinevrite
Episodes of mixed polyneuritis include the typical symptoms of sensitive polyneuritis and chronic polyneuropathy.
Complications
In the absence of adequate care, the peripheral nerves suffering from a polyneitis can be damaged ; damage to peripheral nerves has irreversible consequences, that is they undermine its integrity without the possibility of recovery.
When it results in damage to peripheral nerves, polyneuritis can give rise to various complications, including for example gangrene (it is the massive putrefaction of one or more tissues of the body).
Did you know that ...
In the diabetes mellitus patient, inadequately treated polyneuritis leads to the so-called diabetic foot .
When should I go to the doctor?
Especially for those at risk, it is a valid reason to go to a doctor or go to the nearest hospital for the apparently unjustified appearance of symptoms such as: tingling, numbness, loss of sensitivity, lack of balance, weakness and muscle weakness etc.
Important!
As a rule, the identification of a polyneuritis occurs first and the greater the possibility of limiting the consequences deriving from it.
Diagnosis
For the diagnosis of polyneuritis, doctors must resort to different assessments and tests.
As a rule, the diagnostic procedure begins with an accurate physical examination and a scrupulous medical history . Then, depending on which indications come from the aforementioned evaluations, it can continue with: blood analysis, neurological evaluation, diagnostic imaging tests (CT and MRI), electromyography and / or biopsy of one or more peripheral nerves .
A precise and meticulous diagnostic path allows to establish not only the presence of a polyneuritis, but also the characteristics of the inflammation in progress (if it is motor, sensory or mixed) and the causes that caused it.
Knowing the characteristics of a polyneuritis and, above all, tracing back to its causes is fundamental for planning the most effective therapy.
Blood analysis
In a context of polyneuritis, the analyzes on a blood sample allow us to understand if the patient owes his condition to diabetes mellitus, to some vitamin deficiency or to some thyroid dysfunction.
Neurological evaluation
During a neurological evaluation, the doctor analyzes the tendon reflexes and evaluates the presence or absence of neuromuscular and coordinative disorders.
CT and Magnetic Resonance
CT and nuclear magnetic resonance ( NMR ) are able to highlight peripheral nerves and, if necessary, show the outcome of an inflammation against them.
Electromyography
Electromyography involves the study of the conduction of nerve signals along the manifesting zone of symptoms and, subsequently, the evaluation of the electrical activity of the muscle or of the same area.
In a cotesis of polyneuritis, electromyography clarifies the typology of inflamed peripheral nerves (whether motor, sensory or mixed).
Biopsy of one or more Nerves
A nerve biopsy consists in the collection and subsequent laboratory analysis of some cells of a nerve considered to be responsible for the ongoing symptoms.
It can be useful to trace the causes of inflammation.
Therapy
The treatment of polyneuritis always includes a causal therapy, that is a therapy aimed at contrasting the triggering causes, and a symptomatic therapy, that is a therapy aimed at alleviating the symptoms.
Examples of Causal Therapy
The causal therapy of polyneuritis varies from patient to patient, based on the triggering factor identified during diagnosis; this means that a polyneuritis due to diabetes mellitus will require a causal therapy different from a polyneuritis due to alcoholism.
- If the polyneuritis is related to alcoholism, the causal therapy will consist in immediately stopping the consumption of any alcoholic beverage and following an adequate dietary program (complete with all the vitamins essential to the nervous system).
- If the polyneuritis is due to diabetes mellitus, the causal therapy will include all those remedies (including a balanced diet, exercise, hypoglycemic drugs, etc.) useful for keeping blood sugar under control.
- If polyneuritis is due to an infectious agent, the causal therapy will consist in eliminating the aforementioned infectious agent from the body.
The causal therapy of polyneuritis is fundamental to heal or, at least, to prevent the inflammatory condition from getting worse and to cause irreparable damage to the nerves.
The more the causative treatment of polyneuritis is early and the less likely it is that the inflammation will cause damage to the peripheral nerves involved.
Remember that damage to peripheral nerves is irreparable.
Treatment of Neuropathic Pain
The management of neuropathic pain is one of the fundamental aspects of the symptomatic treatment of the most severe episodes of sensory polyneuropathy.
For its implementation, special drugs are available, whose pain-relieving action is different from that of the drugs indicated in case of pain caused by trauma.
Among the drugs in question, they deserve a quote:
- Some antiepileptics, such as gabapentin and pregabalin;
- Some antidepressants, such as amitriptyline, doxepin, nortriptyline, duloxetine and venlafaxine;
- Tramadol, an opioid-type painkiller ;
- Capsaicin in cream.
For doctors, the main problem when prescribing drugs for neuropathic pain is the indication of the most appropriate dose; in general, the practice is to proceed by trial and error, as each patient responds differently (that is, it represents a case in itself).
Prognosis
The prognosis in case of polyneuritis depends on the timeliness of diagnosis and treatment; as anticipated in part, in fact, an early diagnosis and treatment guarantee greater chances of treating inflammation with good results.
There are forms of polyneuropathy more serious than others, which damage peripheral nerves very quickly.
The prognosis for such circumstances is not very benign even in the presence of an early diagnosis and treatment.
Prevention
Prevention of a condition such as polyneuritis is based on avoiding exposure to those factors that could cause it.
