ABSTRACT
INTRODUCTION: Electrophysiological exploration of neuropathies is a standard method of investigating the dysfunction of myelinated larger fibers (Aalpha, Abeta). However, this method cannot test dysfunctions in other fibers. To evaluate the smaller (Adelta) and unmyelinated fiber (C-fibers) lesions a quantitative method has been perfected: the study of the sensory thresholds (quantitative sensory testing: QST). It allows the investigation of the sensory symptoms and is a reproducible, non-invasive and painless method. It is used above all in patients suffering from diabetic neuropathy ('Diabetes Care 9 (1987) 432'). PATIENTS AND METHODS: We used the QST testing in comparison with nerve conduction velocities in 40 Non-Insulin-Dependent Diabetes Mellitus (NIDDM or Type II) patients in their 60s (+/-10 years). Depending on the duration of their diabetes (dd), we distinguished three groups: dd < 5 years (GI) dd from 5 to 15 years (GII) and dd > 15 years (GIII). All the patients underwent a clinical neurological examination, which enabled us to establish a gravity score comparable to the NDS (Neuropathy Disability Score: 'Muscle Nerve 10 (1988) 21'). RESULTS: Nerve conduction velocities and QST were studied for each group of patients. Electrophysiological alterations were connected to the gravity clinical score and in some asymptomatic patients a higher QST heat threshold could be observed. DISCUSSION: These results indicate that QST can detect the early dysfunction of the unmyelinated fibers in this kind of neuropathy. Subclinical detection can reduce severe neurological complications and make possible an early and effective treatment.
Subject(s)
Diabetic Neuropathies/diagnosis , Diabetic Neuropathies/physiopathology , Nerve Fibers/physiology , Aged , Female , Humans , Male , Middle Aged , Nerve Fibers, Unmyelinated/physiology , Neural Conduction , Sensory ThresholdsSubject(s)
Guillain-Barre Syndrome , Neurosyphilis , Adult , Diagnosis, Differential , Electromyography , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/immunology , Humans , Magnetic Resonance Imaging , Male , Neurosyphilis/complications , Neurosyphilis/diagnosis , Neurosyphilis/immunology , Spinal Cord/pathologyABSTRACT
Localized vasculitic neuropathies are increasingly reported. We describe 3 cases of peripheral neuropathy with necrotizing vasculitis confined to nerves and muscles without systemic involvement. These neuropathies were severe and relapsing, in contrast to a usually benign prognosis. Our cases appear to be isolated vasculitic neuropathies, with vasculitis strictly limited to the peripheral neuromuscular system without nonspecific clinical and/or biological systemic involvement.
Subject(s)
Mononeuropathies/pathology , Vasculitis/pathology , Aged , Biopsy , Fatal Outcome , Female , Humans , Male , Middle Aged , Mononeuropathies/etiology , Muscle, Skeletal/blood supply , Muscle, Skeletal/pathology , Necrosis , Peripheral Nerves/blood supply , Peripheral Nerves/pathology , Recurrence , Vasculitis/complicationsABSTRACT
A 58-year-old laboratory-glassware manufacturer was referred to hospital because of coarse "tremor" of the upper extremities of 16-months-duration. Examination showed severe intention and action myoclonus, confirmed by electromyographic recording, slight memory impairment but was otherwise normal. Mercury levels were high in blood and urine (not in CSF) and, as other causes of myoclonus were excluded, inorganic mercury poisoning, was diagnosed. Only slight unilateral intention tremor persisted after dimercaprol treatment. Inhalation of mercury vapor was the mode of contamination. Myoclonus is the hallmark of severe inorganic mercury intoxication, the main clinical and pathological aspects of which are briefly discussed.
