Polyneuritis - multiple nerve damage. Polyneuritis can occur after infections (influenza, flu, diphtheria, dysentery, tifa), exogenous intoxication (alcohol poisoning, arsenic, lead, chlorophos), endogenous intoxication (diabetes, jade), while occupational hazards (work in the cold, with vibrating tools), vitamin B1.
The disease begins with a sense of crawling, cold and numbness in hands and feet, aching or shooting pains in the limbs, feeling of chilliness in the hands and feet, even in hot weather. Gradually joins legs are weak, unstable gait, developed paresis stop, it becomes difficult to keep the subject in hand, later comes the atrophy of the muscles of the limbs. The patient ceases to feel the touch of spicy and hot objects, resulting develop poorly healing ulcers. Sensitivity disorders are observed more often in the distal extremities by type of gloves and socks." The skin on the hands and feet thin, takes a bluish-purple color, flakes, edemas feet and hands. Nails become brittle, dull, streaked.
Infectious polyneuritis occurs on a background of a respiratory catarrh, a flu, quinsy, accompanied by malaise, fever, inflammatory changes in the blood.
Diphtheria polyneuritis can develop when late or insufficient introduction serum - 2-3 weeks from the onset of the disease or toxic forms on 5-6-th day of illness. There is paralysis of the soft palate, nasalized speech, podergivani eating in the result of the defeat of the vagus nerve. Can be damaged nerves of extremities. When gipertoniceski the form of illness, paralysis of the respiratory muscles and the defeat of the heart of wandering nerve fibers.
Lead polyneuritis often occurs when domestic poisoning by eating sour jam (cranberry, cowberry), kept in the glazed pottery. Apparent defeat of the radial nerve (the hanging brush), combined with abdominal pain, anemia, lead hem on the gums.
Arsenic polyneuritis can be professional and household (mishandling possible for seeds, pesticides poisoning). Manifested vomiting, diarrhea, stomach pain, paralysis of limbs.
Diabetic polyneuritis often. Usually affects the nerves of the feet, rarely hands and face.
The patients experience burning sensation and pain in the legs, sensitivity to cold and cold feet, appear stop swelling, itching, peeling skin.
Professional polyneuritis arise for persons working with vibrating tools, in the cold, when professions requiring strong muscle tension (milkmaids, seamstresses, laundress). Pain in the hands, burning sensation, tingling, cold, excessive sweating, blanching of the ends of the fingers. Symptoms persist alone, at night, decrease in movement.
Treatment. Intravenous 40% glucose 5% solution of thiamine chloride (vitamin B1) - 1 ml intramuscularly cyanocobalamin (vitamin B12) 200 mcg daily, 20 injections, inside nicotinic acid 0.03-0.05 g ascorbic acid (vitamin C) 0.3 g 3 times a day, pangamat calcium (vitamin B15) tablets 0.05 g 3 times a day inside. Beneficial use of yeast, liver, rye bread, which contain a lot of vitamin B1. Pain intravenous administration of 0.25 to 1% solution novokaina 5-10 ml, 10 injections. Shows massage, medical gymnastics, 4-chamber baths, paraffin, mud. When diphtheria polinevrita treatment with massive doses of diphtheria serum, subcutaneously 0.1% solution of strychnine to 1 ml daily. Diabetic polinevrita - restricted diet of carbohydrates and insulin therapy.
The prognosis depends on timely treatment, in most cases favourable.
Preventive measures include reasonable tempering of the body, classes, physical therapy, proper organization of labour, observance of sanitary engineering activities at enterprises using arsenic and other toxic substances.
Polyneuritis (from the Greek. poly - lot + neuritis; synonym: symmetrical peripheral neuritis, multiple neuritis) - multiple inflammation of the nerves. In the past inflammatory nerve damage (primary) was denied in connection with the dominant view about the absence in the nerves of the vessels. Krouvila (J. Cruveilhier) for the first time admitted the possibility of inflammation of the membranes of nerves (epineurial).
At various etiological forms polinevrita occurs or simultaneous injury of the spinal cord and peripheral nerves, or sequential, in which the peripheral nerves are the primary place and in a certain phase of the disease dominant destruction. Gien and Barr (G. Guillain, J. A. Barre) has allocated special nosological form polinevrita, called forms of Guillain - Barre. Very frequent simultaneous destruction of roots and peripheral nerves called polyradiculoneuritis. Pathological and clinical differences between polyneuritis and polyneuritis almost there.
The etiology and pathogenesis. The reasons polinevrita diverse. They can be divided into two groups: poisoning and infection. Intoxication can be exogenous (lead, arsenic and others) and endogenous arising from violations of metabolic processes in the body, internal diseases (diabetes, kidney disease, liver, gastrointestinal tract, intoxication, pregnancy and lactation, depletion of chronic diseases). Much emphasis in the etiology P. deficiency diseases. Alcohol is, obviously, only one of the factors contributing to chronic disease of liver and gastrointestinal tract.
Most often polyneuritis occurs when diphtheria, dysentery, introducing diseases. Under certain infections caused by P. toxins secreted by the bacteria (diphtheria, dysentery) or vacated in their mass decay [in critical end illness (fever, pneumonia and other)]; in other infections should be assumed penetration into the nerves of infection. Viral P., in which the virus elective affects the peripheral nervous system, have not yet been proven, although as a component in some lesions of the nervous system polyneuritis described in a number of viral diseases (lethargic encephalitis, poliomyelitis).
Special group of allergic P., emerging after the introduction of sera, vaccines when rabies vaccination and in the result of a number of infectious diseases, giving allergic reactions. To include allergic and P. arising as a result of some chemical (medicinal) agents, often sulfa drugs, rarely penicillin and others also Described P. in diseases of the blood (anaemia, myeloid leukemia).
The variety of etiological factors polinevrita does not give rise to the selection of this disease in nosological unit. P. should be regarded as a kind of symptoms, the occurrence of which plays the role of a number of different reasons. So, a lack of vitamin B1 in itself can cause P. (beriberi). In other cases, it's failure in the body that are created or because of external conditions, or due to internal reasons, is paretologic.com moment, which in combination with other causes P. This is confirmed by the significant increase of diseases P. in case of insufficient nutrition. Such an origin of the epidemic., in the years of wars in different countries.
A considerable role in the pathogenesis polinevrita play external influences (which upset normal functioning of the nervous system, in particular its peripheral level), function load (leading to its depletion), the effects of temperature, injury, etc., Response of the nervous system on hazards, their course and outcome depend on a number of conditions. Among the most significant of these conditions - the biochemical processes in the body and endocrine functions, the main background nervous activity, comorbidities and above external influence. It can be noted that, while infections and allergic forms of reaction is more likely to occur of polyradiculoneuritis.
Pathological anatomy. When polinevrita in nerve trunks there are changes in the lung (degenerate) and interstitial (inflammatory). The first should be considered as a subsequent phase of the inflammatory process in the interstitium. But it is possible that in some etiological forms parenchymal changes occur without prior inflammatory component, or the latter is of very short duration, leaving no visible changes. So, apparently, is the case in some neurotropic poisons (chemical), avitaminoses the polinevrita, diphtheria intoxication.
Parenchymal changes are limited to or the collapse of the myelin sheath (pereexali neuritis), or degeneration of axial cylinders (axial neuritis). Changes of the myelin sheath are often intermittent, segmental character (segmental pereexali polyneuritis Gombo).
When periciales the polinevrita axial cylinders are not always exposed to death, then conductivity of them is saved, but quality varies. When axial P. rebirth axial cylinders occurs malerovskogo type (the death of all elements of nerve fibers down from the affected area of the nerve). In the affected areas are usually not all nerve fibers beam subjected to decay; along with the damaged fibers remain intact, in some fibers is only the breakdown of myelin, others are killed and axial cylinders. The most stable are sympathetic fibers. Along with the degeneration of nerve fibers quickly comes to their regeneration in the form of splitting axial cylinders on a separate fibrils, education clavate swellings, laterals, spirals Peranchito. If the activity causing the disease poison continues, regenerating fibrils die.
When interstitial polinevrita most clearly acts as an inflammatory reaction from the mesenchymal formations nerve membranes and blood vessels. In cases where the reaction on the part of the connective tissue join the changes described above nerve fibers, use the terms intersticialna-parenchymal P. or inflammatory-degenerative P. inflammation is characterized Morphologically or exudative reaction to the accumulation of leukocytes and edema, or inflammatory-proliferative process. Consequences ended process are the proliferation of fibrous tissue in epinephrine, thickening of perimetre and vascular walls with multiple sclerosis and hyalinosis last. Quite often inflammatory phenomena are also in radicular nerves, spinal knots, occasionally in soft shells next to the roots or the spinal cord (myeloradiculopathy).
The clinical picture polyneuritis and polyneuritis consists of a motor, sensory and trophic disorders; they are often joined by disorders of the autonomic nervous system. Musculoskeletal disorders are characterized by paresis or paralysis with muscular atrophy, decreased muscle tone and reflection (flaccid paralysis); sensitive - pain, paresthesia and off sensitivity; trophic violations are localized in the skin, nails and limb joints. Depending on the etiology of the disease and the extent of involvement of these disorders are combined in different ways. In the relatively rare cases in process involving cranial nerves: wandering (often with diphtheria paralysis), oculomotor, facial, motor branch of the trigeminal nerve. defeat these are bilateral or unilateral. In some etiological forms polinevrita (mainly in endogenous intoxication and Beri) observed a kind of mental disorder (see Korsakov syndrome). On the spinal nodes (preganglionarnah) and on the spinal cord (myeloradiculopathy) process spreads rare.
Almost always polyneuritis has a mixed type (sensory and motor), but those or other symptoms can dominate. Quantitative dissociation sometimes observed within individual types, predominantly sensitive. In some cases, affected conductors skin sensitivity at a relatively intact muscle and joints, in other cases - on the contrary. This last type P. characterized as a violation of statics and walking tauchschule type, absence of reflexes, pain (pseudotabes neurotica, polyneuritis atactica) and occurs more often when diphtheria paralysis. Described isolated cases where trophic and vasomotor disorders dominated the pattern of disease compared with sensitive and movement disorders; these were usually chronic polyneuritis with slow and progressive course.
In some cases, paralysis of the limbs is one-sided or the process is localized in the proximal limbs, spinal muscles. Sometimes the disease begins with a defeat of cranial nerves, and the paralysis of limbs join later. When serum and vaccination P. affects the nerves sometimes the area of the serum, but then comes the spread of defeat. In most cases simultaneously are struck by the upper and lower extremities, but with the onset of the defeat of the lower extremities (bottom-up nature of the process) occurs in about half the cases. A special form of the rising type of paralysis with acute or over acute onset, which often ends in death, is described Landry (see Landry ascending paralysis). Allocate and so-called ascending neuritis, starting with one limb, then turning to another.
Spinnomozgovu liquid with polinevrita has normal structure. When polyradiculoneuritis it almost always changed. Changes in the nature of protein cellular dissociation with increased levels of protein and are quite persistent. It is the only convincing sign that establishes the distribution process at the binding part of the nerves. Occasionally in the spinal fluid found moderate pleoticus (6-30 cells in 1 mm3), indicating a swelling of the membranes or on the distribution of inflammation in the shell (leningradkoye).
Diagnosis polinevrita not present great difficulties. Only if significant deviations from the classical type and abortifacient forms of P. they should be differentiated from the initial phases of polio (see), with chronic polio adults with diseases of the muscles (see Myositis), neural forms of muscular atrophy (see muscular Atrophy), with hypertrophic neuritis of Dejerine - Cotta (see Dejerine - Cotta disease). Not always easy and etiological diagnosis of the disease. The nature of infections and intoxications (exogenous) apparent when P. develops shortly after or during infection. In cases where the cause is unclear, help thorough study of the entire life history of the patient, illnesses experienced by them in the past and recently (infectious), and the nature of their treatment; detailed examination of internal organs, especially the liver and the gastrointestinal tract, nose, throat, genital organs; acquaintance with conditions of life and work, by the power of the patient.
Treatment first of all should be directed at eliminating the infection or intoxication, which was the reason polyneuritis. His character is determined by the kind of infection. For deducing of toxins from the body use glucose infusion, and saline solution, excessive drinking, diaphoretic means indifferent warm bath or light baths. The nature of the reaction of the organism to infection defines the methods of treatment. Weak current response, it is desirable use tonics: injection of strychnine, non-specific vaccine therapy. With the rapid and allergic reactions it is necessary to use desensitizing funds: infusion of calcium chloride, injections of Dimedrol (1% 2-5 ml or inside of 0.05 g 2 times a day), chlorpromazine (2,5% 1-2 ml) and sedatives (bromides, hypnotics).
From the very beginning of the disease requires the use of vitamins In, and In, in the form of intramuscular injection (1-2 ml of 5% solution, no 30), vitamin C can pour in Vienna together with glucose. As symptomatic means to alleviate pain, in addition to various analgesic funds can be recommended intravenous injections of Novocain (1 - 2% in the number of 5-10 ml), as well as physiotherapy: positive pole of galvanic current, ultraviolet irradiation, diathermy.
For treatment of locomotor disorders - massage, gymnastics, electric procedures: 4-chamber baths, iontophoresis with the introduction of phosphorus, calcium, iodine. To prevent the formation of contractures and inconvenient for the patient commits in the joints, limbs give the most advantageous position: impose Longuet, tires, sand bags, elastic bandages. When significant muscle atrophy with success apply injections aloe ATP.
In the recovery period and for the treatment of residual useful Matsesta baths, mud; inside are phosphates (glitzerofosfata, fopen), lecithin, lipocerin. Shown Spa treatment with hydrogen sulfide, thermal baths, radon, and at mud cure resorts. At occurrence of persistent contractures limbs have to resort to surgery.
Prevention polinevrita stems from the etiology and pathogenesis of disease. It is necessary to avoid any kind of intoxication - household and industrial; to ensure that there was sufficient vitamin nutrition, especially in those conditions, where carbohydrates are the principal food or on working conditions, climate, the need for vitamins is increased (hard work, the hot climate, working in hot shops); the same is required in acute infections. You need to carefully treat all diseases, especially of liver, stomach and intestines, and local chronic infection when production intoksikatziah proper organization and implementation of measures on labour protection, automation of manual work, the implementation of rules of personal and industrial hygiene, food (milk). Mandatory regular prophylactic medical examination of workers for early detection of chronic poisoning.
Cm. also Neuritis.
