00:01
Causes of metabolic neuropathy.
00:03
Diabetes is always on top of that list as is thyroid disease.
00:07
Hepatic failure, your kidneys' failing, uremic neuropathy. That's an important one.
00:14
At the end of this entire section, I wanna walk you through a very, very important,
what I call a polyneuropathy nirvana diagram, as we shall see.
00:25
Porphyric neuropathy. What does that mean? You know about -- by chemistry.
00:31
Did you know about your porphyria pathway on your way to produce your heme?
And in that porphyria pathway, there are a couple of diseases or biochemical pathologies as you should be familiar with.
00:43
One of them being acute intermittent porphyria.
00:46
Vitamin deficiencies, either B1, B6, or B12.
00:50
Once again, remember B1, that's a problem, thymine.
00:54
B6 require for once again, proper myelination and of course B12.
01:00
Critical care neuropathy. These are metabolic neuropathies. Important ideologies.
01:05
Let's quickly walk through diabetic neuropathy.
01:09
Chronic, progressive, distal, symmetric diabetic polyneuropathy.
01:13
Every single one of there, incredibly important.
01:17
Diabetes in the US, type II diabetes of course, extremely common.
01:22
Chronicity, decades have gone by, and now at this point, you're gonna have symmetric and distal neuropathy taken place.
01:32
Don't we?
Most common presentation: small and large fiber involvement.
01:37
Neuropathic pain is usually prominent.
01:40
For example, what about the nerves in the stomach? Would they be lost?
Well, absolutely. So, you have paralysis of the stomach. We call this gastroparesis.
01:49
Or maybe your patient has suffered a myocardial infarction and there is no chest pain.
01:54
A silent myocardial infarction. Nerves have been lost.
01:58
Or down in the feet and here once again, the nerves.
02:04
You're worried about decubitus ulcers, aren’t you?
The diabetic neuropathy, small, large fibers.
02:09
Neuropathic pain, usually prominent.
02:11
If you're actually wondering about what's happening to your nerves.
02:15
Clinical features. Initial symptoms are severe thigh and back pain with diabetic neuropathy
and with diabetic proximal motor neuropath is what we're referring to specifically or diabetic glutinous amyotrophy.
02:31
Followed by hip and thigh muscle weakness and atrophy
so you begin initially with thigh and back pain
and then followed by hip and thigh muscle weakness and atrophy.
02:43
You put all this together and you call it amyotrophy. Proximal motor.
02:48
We have the diabetic proximal motor neuropathy.
02:53
Continuing with our discussion, acute axonal diabetic polyneuropathy
and then with diabetes, remember there's no discrimination here
and by that, I mean you could have diabetic mononeuropathy. What's that mean?
You could have one nerve that is being affected.
03:09
Maybe radial nerve, maybe the ulnar nerve, maybe the median nerve, maybe the common peroneal nerve.
03:14
You could have the nerves coming out of the spinal cord, radiculopathy, polyradiculopathy, compression neuropathy.
03:24
All are significantly much more common in patients that are diabetic.
03:28
Every single nerve just about in a patient with diabetes over a long period of time,
if not properly managed, is at risk for injury.
03:38
Plain and simple. To a pathologist, maybe. Through a doctor, possibly.
03:44
But for the patient, it's a lot of education, isn't it?
Management. Well, the most important thing is going to be glycemic control.
03:54
That's your best measure of treatment, and by this we mean what?
Lifestyle modification: lose weight, watch your diet.
04:01
And why do I roll my eyes when I do that, because you know,
if you've done your rotations or for those of you that are practicing, it's easier said than done.
04:10
The symptomatic management.
04:12
Well, now if you're actually getting into diabetic neuropathy, you need to treat the symptoms.
04:19
Antidepressants. Antiepileptics, especially carbamazepine and perhaps gabapentin.
04:25
Remember carbamazepine?
It was actually a first-line drug for trigeminal neuralgia
so we know that carbamazepine definitely helps out with people that have neuropathies.
04:35
Tramadol. Opiates, maybe perhaps because of refractory cases.
04:41
The pain is actually intolerable sometimes and -- oh, this is a deadly road, isn't it?
The opioid, huge discussion, behavioral science.
04:49
And NSAIDS for entrapment neuropathies as well.