Saraf Perifer

dr. Gea Pandhita S, M.Kes, SpS

Bagian Ilmu Penyakit Saraf

Motor unit, Radiks, Nervus-perifer, Myoneural-junction, & Otot

Saraf Perifer

Peripheral Nerve Disorders

Mononeuropathy Mononeuritis multiplex Polyneuropathy (peripheral neuropathy)

Peripheral Nerve Disorders

The spectrum of peripheral nerve disorders includes
Mononeuropathies (entrapment, trauma, etc)
CTS, Bells palsy (?)

Mononeuritis multiplex (DM, vasculitis) Plexopathies (immune, neoplastic) Radiculopathies (discs, immune) Peripheral Neuropathies

Normal peripheral motor nerve anatomy and responses to injury

(Quan, 1999)

Peripheral Nerve Disorders

Mononeuropathy
Pattern of weakness and sensory loss conforms to the distribution of a single nerve
Carpal tunnel syndrome Peroneal palsy at the fibular head

Mononeuritis multiplex
Multiple nerves affected in a random pattern
Acute onset, frequently painful Diabetes mellitus, vasculitis

Polyneuropathy (peripheral neuropathy)

Distal, symmetric

Polyneuropathies
Can affect different types of fibers
Autonomic Motor Sensory
Large well myelinated Small poorly myelinated or unmyelinated

Symptoms of a Polyneuropathy
Sensory symptoms
Start in feet, move proximally Hand sxs appear when LE sxs up to knees Positive
Pins and needles Tingling Burning

Negative
Numbness Deadness Like Im walking with thick socks on

Polyneuropathy Symptoms
Motor
Weakness first in feet
Tripping Turn ankles

Progress to weakness in hands

Trouble opening jars Trouble turning key in lock

Polyneuropathy: Signs
Distal sensory loss
Large fiber Small fiber

Distal weakness and atrophy Decreased or absent reflexes

Ankle jerks lost first

Classification of Polyneuropathies
By types of fibers involved
Pure sensory Sensory motor Pure motor Autonomic

By pathology
Demyelinating Axonal Mixed

By tempo
Acute Subacute Chronic

Acute Polyneuropathies
Guillain Barre Syndrome Porphyria
Neuropathy, psychiatric disorder, unexplained GI complaints

Toxins
Glue sniffing (n-hexane) Arsenic

Guillain Barre Syndrome

Definition of GBS
acute demyelinating disorder, primarily involving the peripheral nervous system (PNS) degree and location of disability depends on the myelinated nerves involved: MOTOR

Guillain Barre Syndrome

an inflammatory disease of the peripheral nervous system characterized by lymphocytic and macrophagic infiltration with destruction of myelin. The condition is often designated as the Landry-Guillain-Barr-Strohl syndrome in recognition of the descriptions provided by these authors

Guillain Barre Syndrome

Guillain Barre Syndrome

Most common cause of rapidly progressive weakness Demyelinating neuropathy Ascending weakness which may include cranial neuropathies Exam reveals symmetric weakness with areflexia and large fiber sensory loss Bowel and bladder usually preserved

Guillain Barre Syndrome

Respiratory failure can be precipitous Other causes of morbidity and mortality
Autonomic instability DVT Infection

Immune mediated, may be post infectious Treatment

Plasma exchange Intravenous immunoglobulin

Guillain Barre Syndrome

Subacute Polyneuropathies
Vasculitis
Can be isolated to peripheral nerves or part of a more systemic process

Paraneoplastic
May be presenting symptom of the cancer

Chronic inflammatory demyelinating polyneuropathy

With or without a gammopathy

Toxins Drug

Chronic Polyneuropathies
Metabolic
Diabetes mellitus Chronic renal failure Chronic liver failure Thyroid disease

Nutritional
B12 deficiency

Infections
HIV Leprosy

Inherited

Evaluation of a Polyneuropathy
Lab work Nerve conduction study/electromyography
Distinguishes between axonal and demyelinating Helps ascertain severity

Nerve biopsy
Frequently non-diagnostic Can establish the dx in certain disorders, such as vasculitis and amyloidosis

Extremity Weakness ALS Polyneuropathy LEMS Random Distal> Proximal LE > UE Prox>distal UE>LE +/-prox>distal Prox>distal

CN

Reflexes

Sensation

yes rare

Increased Decreased distally Decreased or absent Normal or dec

Normal Lost distally > proximally Normal

rare

MG

yes

Normal

Myopathy

occ

Normal or dec

Normal

Terima Kasih