Polyneuropathy is a topic covered in the 5-Minute Emergency Consult.

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A peripheral nerve disorder in which many nerves throughout the body malfunction simultaneously:
  • Acute polyneuropathy causes:
    • Infectious (toxin producing bacteria, viruses)
    • Autoimmune (Guillain–Barré)
    • Toxic (heavy metals):
      • Lead
      • Mercury
    • Drugs:
      • Anticonvulsants (phenytoin)
      • Antibiotics (chloramphenicol, nitrofurantoin, sulfonamides)
      • Chemotherapy (vinblastine, vincristine)
      • Sedatives (hexobarbital and barbital)
    • Cancer (multiple myeloma)
  • Chronic polyneuropathy causes:
    • Diabetes (most common)
    • Alcohol abuse
    • Nutritional deficiencies (Thiamine, B12)
    • Hypothyroidism
    • Liver failure
    • Kidney failure
    • Lung cancer
    • Chronic inflammatory demyelinating polyneuropathy (CIDM)


Incidence and Prevalence Estimates
  • In US, the prevalence of polyneuropathy is ∼2% in the general population
  • It is 8% in patients >55 yr of age
  • The most common cause in US is diabetes and it occurs in ∼50% of diabetics on insulin


  • Myelin dysfunction:
    • Parainfectious immune response triggered by antigens that cross-react with antigens in the peripheral nervous system:
      • Encapsulated bacteria (Campylobacter sp., diphtheria)
      • Viruses (enteric or influenza viruses, HIV)
      • Vaccines (influenza)
    • Guillain–Barré syndrome:
      • Acute onset due to myelin dysfunction
      • Rapidly progressive weakness and may lead to respiratory failure
    • CIDM:
      • Chronic illness of myelin dysfunction
      • Symptoms may recur or progress over months and years
  • Vasa nervosum compromise:
    • Vascular supply to nerves compromised leading to nerve infarction
    • Causes:
      • Chronic atherosclerosis
      • Vasculitis
      • Infections
      • Hypercoagulable states
      • Axonopathy
    • Primary dysfunction of the axon
    • Most often the result of toxic–metabolic disorders:
      • Diabetes
      • Nutritional deficiencies
      • Drugs/chemicals

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