Sensory neuropathy of the lower and upper extremities

Peripheral nerve impairment with impaired sensitivity is sensory neuropathy. Consider the main causes of the disease, types, symptoms, methods of treatment.

Neuropathy is a disease that occurs when nerve function is impaired. According to the International Classification of Diseases ICD-10, this pathology belongs to category VI. Diseases of the nervous system.

G60-G64 Polyneuropathy and other lesions of the peripheral nervous system:

• G60 Hereditary and idiopathic neuropathy.
• G61 Inflammatory polyneuropathy.
• G62 Other polyneuropathies.
• G63 Polyneuropathy in diseases classified elsewhere.
• G64 Other disorders of the peripheral nervous system. Peripheral nervous system disorder NOS.

Structural abnormalities in the central and peripheral parts of the nervous system are manifested by trophic and vascular disorders in the distal extremities, impaired sensitivity, and peripheral paralysis. In severe cases, the trunk and neck muscles are involved in the pathological process.

[1], [2], [3], [4]

Epidemiology

According to medical statistics, sensory neuropathy is diagnosed in 2% of people. In elderly patients, polyneuropathy rate is more than 8%. One of the main causes of the disease is diabetes mellitus, genetic predisposition, chronic vitamin B deficiency, traumatic injuries and severe intoxication of the body.

[5], [6], [7], [8], [9], [10]

Causes of the sensory neuropathy

Neuropathy develops due to many factors. In most cases, peripheral nerve damage is caused by the following reasons:

• Violations of the body's immune system. Immunity produces antibodies, attacks its own immune cells and nerve fibers.
• Metabolic disorders.
• Intoxication.
• Tumor diseases.
• Various infections.
• Systemic pathology.

Isolated sensitivities are extremely rare. Their appearance is most often caused by damage to thin and / or thick nerve fibers.

Sensory Neuropathy in Diabetes

One of the serious complications of type 1 and type 2 diabetes is sensory neuropathy. In diabetes, about 30% of patients experience this problem. Pathology is characterized by sharp burning pains, crawling on the skin, numbness of the legs and their muscular weakness.

Diabetic neuropathy has several types:

• Peripheral - symmetrical (sensory, distal), asymmetrical (motor, proximal), radiculopathy, mononeuropathy, visceral.
• Central - encephalopathy, acute neuropsychiatric disorders due to decompensation of metabolism, acute violation of cerebral circulation.

The process of therapy begins with a comprehensive diagnosis aimed at determining the causes and mechanism of disease development. Patients are shown a clear regulation of the concentration of sugar in the blood, the use of antioxidant, vascular, metabolic drugs. In case of severe pain syndrome, an anesthetic is prescribed. Early diagnosis and treatment can reduce the risk of complications. It is impossible to completely cure the pathology.

[11], [12]

Risk factors

The development of neuropathy can be triggered by such factors:

• Acute deficiency of vitamins of group B - these substances are necessary for the full functioning of the nervous system. A deficiency of nutrients over an extended period of time leads to polyneuropathy and other pathologies.
• Genetic predisposition - some metabolic disorders of hereditary nature can cause damage to nerve fibers.
• Endocrine diseases - diabetes mellitus disrupts the vessels that are responsible for the nutrition of the nerves. This leads to metabolic changes in the myelin sheath of nerve fibers. If the disease is caused by diabetes, then neuropathy affects the lower limbs.
• Intoxication of the body - nerve damage can be triggered by chemicals, various medications, and alcohol. The risk group includes people with infectious diseases. When poisoning the body with carbon monoxide or arsenic, the disease develops over a very short period of time. In some cases, the disease is a complication / side effect of medication.
• Traumatic injuries - various injuries and surgical interventions in which there was damage to the nerve fibers, can cause not only sensory neuropathy, but also polyneuropathy. Most often, the pathological symptoms are observed in diseases of the spine (osteochondrosis, herniated intervertebral discs).
• Pregnancy - a specific reaction of the immune system to the fetus, a deficiency of vitamins and minerals, toxicosis and other factors can cause nerve damage. Neuropathy occurs at any stage of pregnancy.

To reduce the risk of developing the disease should be eliminated or to minimize the effect of the above factors.

[13], [14], [15], [16], [17],

Pathogenesis

The mechanism of development of neuropathy depends on its root cause, therefore, pathogenesis is represented by two pathological processes:

• Damage to the axon (axial cylinder of the nerve fiber) - in this case, the process of functioning of the nerve and muscle cells is disturbed. The nerves with long axons are involved in the pathological process, which leads to denervation changes in the muscle. Occurs due to the impact on the nerves of genetic, exogenous or endogenous factors.
• Nerve fiber demyelination is a violation of the nerve impulse, which leads to a decrease in the speed of the nerve. Against this background, muscular weakness develops, earlier loss of tendon reflexes without muscular atrophy. In most cases, demyelination is associated with autoimmune processes, the formation of antibodies to immune cells, genetic abnormalities, and intoxication.

Both pathological processes are interrelated. As in the case of an axonal lesion, secondary demyelination occurs, and in the demyelination of the nerve fiber an axonal disorder develops. Diabetic sensory neuropathy develops after an acute disorder of carbohydrate metabolism or rapid compensation of insulin hyperglycemia.

[18], [19]

Symptoms of the sensory neuropathy

Impaired sensitivity develops due to various causes and factors. Pathology has several types and forms, but they all have similar symptoms:

• Muscle weakness of the upper and lower extremities.
• Swelling of the legs and arms.
• Goosebumps, burning, paresthesia and other strange sensations in the limbs.
• Decreased sensitivity of the arms and legs.
• The emergence of unexplained pain and discomfort.
• Trembling fingers, involuntary muscle twitching.
• Increased sweating.
• Coordination disorder, dizziness.
• Slow wound healing.
• Heart palpitations.
• Respiratory disorders.

Sensory neuropathy begins to manifest itself from the fingers, feet. Gradually, the pathological process rises. In severe cases, patients have atrophied both arms and legs, which leads to their disability.

Sensory manifestations of the disease can be positive and negative. The first are:

• Heightened perception of pain.
• Burning.
• Paresthesias.
• Hypersensitivity to tactile stimuli.
• Acute pain syndrome.

As for negative sensory symptoms, this is a decrease in sensitivity in the limbs and lower abdomen. Most often, the negative form develops with acute deficiency of vitamins E and B12. Patients are observed movement disorders and severe weakness in the limbs. The muscles of the head, neck, throat, upper body can be involved in the pathological process. Patients have painful cramps, uncontrolled muscle twitching.

The above symptoms can be either pronounced or mild. In most cases, neuropathy develops within a few years, but it can occur suddenly, in a couple of weeks.

Sensory signs of neuropathy completely depend on the degree of involvement of nerve fibers in the pathological process.

• If large peripheral nerves are affected, then there is a decrease in sensitivity to a light touch. Patients develop unstable atactic gait, weakness of the deep muscles of the limbs.
• With the defeat of small nerve fibers there is a decrease in temperature and pain sensitivity. Because of this, the level of injury increases.

Many patients note spontaneous pain and contact paresthesias, which indicate the simultaneous destruction of all types of nerve fibers. As the disease progresses, the end of the short nerves of the trunk, chest and abdomen are involved in the pathological process.

Motor sensory neuropathy

Charcot-Marie-Tut disease or motor-sensory neuropathy is peripheral nerve damage with impaired sensitivity. Pathology is characterized by progressive polyneuropathy with damage to the muscles of the distal extremities. In most cases, the disease has a genetic origin.

The first signs of a violation occur at the age of 15-30 years. There is a weakness and atrophy of the muscles of the distal upper extremities. Gradually, the muscles of the distal legs are involved in the pathological process. The tendon reflexes from the hands quickly atrophy, the knee and Achilles reflexes are reduced. All patients develop deformity of the feet.

As the pathology progresses, all types of sensitivity decrease. A number of patients show signs of static and dynamic cerebellar ataxia. In the pathological process may be involved proximal leg, the development of scoliosis.

[20], [21]

Hereditary sensory neuropathy

According to studies, about 70% of neuropathies are hereditary. Genetically heterogeneous disease occurs with a progressive lesion of peripheral nerves.

Clinical manifestations of the disease:

• Weakness and atrophy of the muscles of the distal extremities.
• Deformation of the limbs.
• Impaired sensitivity.
• Tendon hypo / areflexia.
• Coordination Disorders.

This form of sensory neuropathy has a strong resemblance to other types of this disease, therefore it requires differentiation at the clinical level. Treatment and prognosis of the disease depends on its early diagnosis.

[22], [23]

Peripheral sensory neuropathy

Peripheral nerve damage leads to impaired sensitivity. The disease develops due to many reasons, among which are the most common:

• Trauma to the nerve.
• Tumor lesions.
• Immune disorders.
• Intoxication.
• Acute deficiency of vitamins in the body.
• Vascular diseases.
• Vasculitis.
• Blood diseases.
• Metabolic disorders.

Peripheral nerve damage occurs in endocrine diseases, viral and bacterial infections, drug intoxication. The presence of a huge number of possible risk factors significantly complicates the process of identifying the root cause.

Signs of peripheral nerve damage:

• Atrophy of the muscles of the limbs.
• Weakness in arms and legs.
• The sensation of burning and paresthesia of the arms and legs.
• Reduction of reflexes or their loss.
• Peripheral paralysis.

For diagnosis, a comprehensive examination of the patient. The patient is prescribed CT, MRI, neuroelectromyography, biopsy of the skin / nerve. For the treatment of used drugs, physiotherapy and various rehabilitation techniques aimed at the restoration of motor function and nervous sensitivity.

Distal sensory neuropathy

This type of disease most often acts as a form of diabetic polyneuropathy and occurs in 33% of people with diabetes. Pathology is manifested symmetric lesion of the lower extremities. Loss of sensation occurs, pain and tingling of varying intensity occur. Atrophy of the muscles of the foot is also possible.

Sensory symptoms and pathological signs dominate over motor ones. With the defeat of large fibers there is a decrease in sensitivity to a light touch. This leads to a lack of coordination, the development of weakness of the deep muscles of the limbs.

If the small nerve fibers are damaged, then there is a decrease in pain and temperature sensitivity. The disease develops slowly, therefore, with early detection reduces the risk of ulceration and other life-threatening complications.

[24], [25]

Sensory Neuropathy of the Limbs

One of the possible causes of impaired limb sensitivity is sensory neuropathy. Nerve disease most often occurs against the background of metabolic disorders of the body. Damage to nerve fibers is characterized by the following symptoms:

• Loss of sensation
• Numbness of the arms, legs.
• Immunity of cold, heat, tactile impact.

But in some cases, the sensitivity on the contrary becomes acute and pronounced. Neuropathy of the lower limbs is more common than the upper. This is due to the increased load on the legs. At the same time, the causes and symptoms of lesions in both upper and lower extremities are similar.

In most cases, muscle cramps occur, due to malnutrition of the skin dryness appears and protective functions are reduced. In combination, this leads to slower healing of various injuries, minor purulent processes. Treatment begins by identifying the cause of the disease. Often it is diabetes and a hereditary predisposition. All patients are prescribed B vitamins, painkillers and anti-depressants.

[26], [27]

Sensory neuropathy of the lower extremities

Nerve fibers are divided into several types: motor, sensitive and vegetative. The defeat of each of them has its own symptoms. For sensory neuropathy of the lower extremities is characterized by damage to the sensory nerve fibers.

The main causes of the disease include:

• Hereditary predisposition
• Autoimmune diseases.
• Tumor lesions.
• Medicated intoxication.
• Metabolic disorders.
• Alcohol abuse.
• Diabetes.
• Poisoning the body.
• Impaired renal function and liver.

Depending on the cause of the peripheral nerve fibers, these types of foot neuropathy are distinguished: dismetabolic, toxic, diabetic, alcoholic. The success of treating a pathology depends on determining and eliminating its root cause.

[28], [29]

Sensory axonal neuropathy

Sensory-type axonal neuropathy is a disease with damage to sensory nerve fibers. It develops against the background of endocrine pathologies, vitamin deficiency, failure of the immune system, after acute intoxications and for a number of other reasons.

The main manifestations of axonal neuropathy:

• Spastic and flaccid paralysis of the limbs.
• Muscle twitching and cramps.
• Change in sensitivity: tingling, burning, paresthesia.
• Circulatory disorders: limb swelling, dizziness.
• Coordination violation.
• Changing tactile, temperature and pain.

To diagnose the pathological process and identify its localization is conducted electroneuromyography. With this procedure, it is possible to establish the degree of damage to the nervous tissue. Treatment is complex, aimed at eliminating the cause of the disease and preventing possible complications.

 

[30],

Forms

There are several forms of neuropathy, one of them is sensory, which is characterized by the involvement of sensory nerve fibers (numbness, pain, burning) in the pathological process. Most often, sensory impairment is distal and symmetrical.

Consider the main types of neuropathy, taking into account the types of affected sensory fibers:

1. Sensory neuropathy in the defeat of thick nerve fibers:

• Diphtheria
• Diabetic
• Acute Sensory Atactic
• Dysproteinemic
• Chronic inflammatory demyelinating
• Against the background of biliary cirrhosis
• In critical conditions.

2. With predominant lesion of fine nerve fibers:

• Hereditary (amyloid, autonomous)
• Idiopathic
• Diabetic
• MGUS-neuropathy
• In diseases of the connective tissue
• Vasculitis
• Paraneoplastic pathology
• Against the backdrop of renal failure
• With sarcoidosis
• Intoxication
• HIV infection.

Each type of disease requires a comprehensive diagnosis with the study of pathogenesis. The treatment process depends on the stage and severity of the pathology.

[31], [32]

Motor sensory neuropathy type 1

This type of isolated nerve damage is a congenital degenerative disease. Motor-sensory neuropathy type 1 is a demyelinating or pseudo-hypertrophic pathology. It is characterized by a decrease in the rate of impulse conduction with the formation of thickening in the myelin sheath, which alternate with remyelinization and demyelinated areas.

Another feature of this form of nerve disease is its mild course, when the patient has a slight deformity of the foot and areflexia due to the patient’s symptoms.

To confirm the diagnosis, the doctor carefully examines the dissociation between the existing symptoms and the absence of active complaints. Also, an analysis of family history, a complex of laboratory and instrumental studies. Treatment and prognosis depend on the stage of the disease, its causes, the presence of complications.

[33], [34]

Motor sensory neuropathy type 2

The second type of motor-sensory sensitivity disorder is axonal neuropathy. It is characterized by a normal or reduced rate of conduction of impulses along the median nerve. Symptoms of the disease may be blurred, and changes in the myelin sheath absent.

The first pathological symptoms manifest themselves in adolescence or early adulthood. The severity of the disorder is determined by family history. In some cases, the second type of motor-sensory impairment leads to disability and disability of the patient.

[35], [36], [37]

Complications and consequences

Nerve damage is a rather dangerous disease. It does not go away on its own, and if left untreated, it will lead to serious consequences. Possible complications of the disease:

• Decreased muscle tone.
• Muscular atrophy.
• Formation of ulcerative lesions on the skin.
• Paralysis of the limbs.
• Respiratory disorders due to dysfunction of the nerves responsible for the functioning of the respiratory muscles.

Progressive pathology completely changes the habitual way of life of a person. The patient loses the ability to self-serve and work. Disability often leads to anxiety and depression. In severe cases, when the function of the nerves that regulate the functioning of the heart is impaired, death is possible due to a heart rhythm disorder.

[38], [39], [40]

Diagnostics of the sensory neuropathy

For the detection of sensory nerve disease is carried out a comprehensive comprehensive examination. Diagnosis consists of:

1. History taking and analysis of patient complaints:

• When painful symptoms first appeared.
• The presence of intoxication, alcohol abuse.
• The presence of diabetes.
• Nutrition features.
• Recent medication intake.
• The presence of infectious and any other diseases of the body.
• Hereditary predisposition
• Features of the profession (whether the work is related to chemicals).

2. Careful physical and neurological examination with identification of abnormalities characteristic of the disease. The study of pain, temperature and deep sensitivity.
3. Laboratory tests: glucose level, urea, creatine, blood test for toxins and heavy metal salts.
4. Instrumental diagnostics: X-ray, electroneuromyography, nerve biopsy.

A number of specialists deal with the diagnosis of the disease. Special attention is paid to therapeutic and endocrinological research.

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Analyzes

A standard laboratory test for suspected sensory neuropathy consists of:

• General blood analysis.
• ESR.
• Analysis of urine.
• Assessment of changes in plasma glucose levels after and before meals.
• Electrophoresis of whey proteins.

The tests reveal diabetes, kidney / liver failure, metabolic disorders, vitamin deficiencies, signs of abnormal activity of the immune system, and other possible causes / complications of the disease.

Further survey tactics depend on the results of physical, instrumental and differential research.

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Instrumental diagnostics

To identify damage to the nerves of different localization and stage, shows a comprehensive instrumental diagnosis.

• Computed tomography - visualizes organs, bone and soft tissue. Allows you to identify bone or vascular changes, tumor lesions, cysts, hernias, spinal stenosis, encephalitis and other disorders.
• Magnetic resonance imaging - is aimed at studying the condition and size of muscle tissue, identifying compression effects on nerve fibers, determining the foci for replacing adipose muscle tissue.
• Electromyography is a measurement of the electrical activity of muscles at rest and under stress. For the procedure, a thin needle is inserted into the muscle. The speed of the impulses along the nerves allows you to determine the degree of damage to large nerve fibers. If there is a blockage of the impulse or a slow transfer rate, this indicates damage to the myelin sheath. A decrease in the level of impulses is one of the signs of axonal degeneration.
• Nerve biopsy - removal and examination of a sample of nerve tissue. The fence is most often carried out in the legs. This procedure is performed in rare cases, as it can itself cause neuropathic complications.
• Skin biopsy - a doctor removes a small piece of tissue to examine the end of nerve fibers. This method is less traumatic than nerve biopsy, is easier to perform and has fewer side reactions.

The above methods are used both for diagnosis and during treatment to control its effectiveness.

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Differential diagnosis

Sensory neuropathy is differentiated with myopathic states, that is, chronic progressive neuromuscular pathologies. The disease is associated with various congenital abnormalities, abnormal development of muscle and bone tissue.

Differentiation between different types of polyneuropathy is also carried out. For diagnosis use a complex of both laboratory and instrumental methods.

Treatment of the sensory neuropathy

Treatment of sensory neuropathy depends on the causes, severity of the painful symptoms and the type of nerve damage.

1. The first stage of treatment begins with the elimination of the causes of the disease:

• Normalization of blood glucose levels.
• Refusal of alcohol.
• Termination of contact with toxic substances.
• Surgical removal of tumors and subsequent chemotherapy.
• Treatment of infectious diseases.

2. At the second stage, non-specific therapy is carried out aimed at improving nutrition and restoring damaged nerve fibers. To do this, patients are prescribed drugs of group B and metabolics, that is, drugs that improve tissue nutrition.
3. The final stage of treatment is symptomatic therapy. If the pathology is accompanied by pain, then the patient is prescribed painkillers. For the normalization of blood pressure using antihypertensive drugs.

In cases of severe muscle weakness and atrophy, orthoses are used, that is, supporting devices that help to move. In some cases, surgery is carried out aimed at releasing the clamped muscle fibers. There are also physiotherapy techniques that accelerate the process of rehabilitation of the patient.

Prevention

To reduce the risk of developing diseases with damage to the nerves, you should follow these recommendations:

1. Minimize the effects of any factors that can cause illness.

• Refusal of alcohol.
• Blood glucose monitoring for diabetics.
• The use of drugs only for medical purposes in compliance with all recommendations for their admission.
• Use of protective equipment during work or prolonged contact with toxic substances.

2. Timely treatment of any diseases of the body. Do not start viral and infectious diseases.
3. Control the quality of food. Constant intoxication triggers the processes of destruction of the body and causes disruptions in the functioning of nerve fibers.
4. Regular exercise, preventive massages.

Prevention is aimed at eliminating the causes of pathology and maintaining a healthy lifestyle. But with hereditary factors, preventive measures are powerless.

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Forecast

Sensory neuropathy has a very low lethality, but full recovery in this pathology rarely occurs. The prognosis of the disease depends on many factors. In hereditary forms of the disease, it is rarely possible to achieve a significant improvement in the disease state, as the pathology slowly progresses, which complicates its early diagnosis. There is a risk of disability of the patient and disability

Impaired sensitivity caused by endocrine pathologies has a favorable prognosis, subject to glycemic control. With proper diagnosis and effective treatment, other types of sensory neuropathy have a positive outcome.

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