The concept of polyneuropathy includes a group of diseases, the causes of which may be different. The feature that unites these ailments in one row is the abnormal functioning of the peripheral nervous system or individual nerve bundles.
Characteristic features of polyneuropathy are symmetrical disruption of the muscles of the upper and lower extremities. In this case, there is a slowdown in blood flow and a deterioration in the sensitivity of the hands and feet. Mostly this disease affects the lower extremities.
Polyneuropathy of toxic genesis according to ICD10
One of the most common types of this disease is toxic polyneuropathy. From the name of the disease, it becomes clear that it is the result of exposure to the nervous system of various toxic substances. Toxins can enter the body from outside or be the result of a disease.
In order to facilitate the identification of the type of this ailment, it has been proposed to consider the causes by which toxic polyneuropathy was caused. ICD 10,or the International Classification of Diseases, 10th Revision, offers a very convenient form of division of the disease. The bottom line is to assign a code to a particular type of ailment, based on the causes of its occurrence. Thus, toxic neuropathies are designated according to the ICD 10 list with code G62. The following is a more refined classification:
- G62.0 - designation for drug-induced polyneuropathy with the possibility of specifying the drug;
- G62.1 - this code is called the alcoholic form of the disease;
- G62.2 - code for polyneuropathy caused by other toxic substances (toxin code can be affixed);
- G62.8 - designation for other specified polyneuropathies, which include the radiation form of the disease;
- G62.9 is code for neuropathy unspecified (NOS).
As noted earlier, toxic polyneuropathy can be caused by two types of causes:
- Have exogenous conditions (this type includes diphtheria, herpetic, HIV-related, lead, arsenic, alcohol, caused by FOS poisoning, drug, radiation neuropathy).
- Be the result of endogenous factors (eg, diabetic, caused by paraproteinemia or dysproteinemia, diffuse connective tissue lesions).
Toxic neuropathy has recently become a fairly common disease due to the increasing contact of a person with toxins of various origins. These dangerous substances surround us everywhere: they are in food, in goodsconsumption, medicines and the environment. Infectious diseases are also often the cause of this disease. Microorganisms produce toxins that affect the human body and affect the nervous system.
Exogenous toxic polyneutropathies
As noted earlier, these types of diseases occur when the human body is exposed to an external factor: toxins from viruses and bacteria, heavy metals, chemicals, medicines. Like other types of polyneutropopathy, these ailments can be chronic or acute.
Diphtheria polyneuropathy
From the name of the disease it is clear that it occurs as a result of a severe form of diphtheria, accompanied by exposure to exotoxin. Most often, this phenomenon occurs in adult patients. In this case, there is an effect on the sheaths of the nerves of the skull and their destruction. Symptoms of the disease manifest themselves either in the first week (especially dangerous with cardiac arrest and pneumonia), or after the 4th week from the moment of infection.
They are expressed by lesions of the functions of the eyes, speech, swallowing, difficulty breathing and tachycardia may occur. Almost always, the symptoms begin to disappear after 2-4 weeks or after a few months.
Herpetic polyneutropopathy
This type of disease occurs due to the activity of Epstein-Barr viruses of herpes simplex types I and II, chicken pox, cytomegalovirus. Infection with these infections occurs in childhood, and after the illnessimmunity occurs. If the body's defenses weaken, then polyneuropathy may develop with characteristic rashes throughout the body.
Polyneuropathy due to HIV
Two out of three cases of HIV infection develop neurological complications, most often in the last stages of the disease.
The toxic effect of the virus, autoimmune reactions, secondary infection, the development of tumors and the consequences of taking drugs in combination lead to disruptions in the normal functioning of the body. As a result, encephalopathy, meningitis, and cranial nerve polyneutropopathy occur. The latter ailment is often expressed in a decrease in the sensitivity of the feet, pain in the lumbosacral region. They are treatable but can be fatal.
Lead polyneuropathy
This type of disease occurs due to lead poisoning, which can enter the human body through breathing or through the gastrointestinal tract. It is deposited in the bones and liver. Lead toxic polyneuropathy (ICD code 10 - G62.2) is expressed in a patient in the form of lethargy, high fatigue, "dull" headache, decreased memory and attention, encephalopathy, anemia, colitis, pain in the limbs, tremor of the hands. This disease is characterized by damage to the radial and peroneal nerves. Therefore, the syndromes of "hanging hand" and "cock's gait" often occur. In these cases, contact with lead is completely limited. The prognosis for getting rid of the disease is favorable.
Arsenic polyneuropathy
Arsenic can enter the human body along with insecticides, drugs, paints. This disease is professional in smelters. If the effect of the poisonous substance was single, then vascular hypotension, nausea and vomiting develop. After 2-3 weeks, polyneuropathy manifests itself, expressed in the weakness of the leg muscles. If re-poisoning with arsenic occurs, then symmetrical distal sensorimotor manifestations of the disease occur. In the case of chronic intoxication with a poisonous substance, hypersalivation, trophic and vascular disorders (skin hyperkeratosis on the soles and palms, rashes, stripes on the nails, pigmentation on the abdomen in the form of drops, peeling), ataxia are observed. Arsenic polyneuropathy is diagnosed by analyzing the composition of urine, hair and nails. The recovery of a patient after a disease lasts for months.
Alcoholic neuropathy
In medicine, there is an opinion that toxic polyneuropathy on the background of alcohol has not been studied enough, the mechanism of its development is not fully understood.
The main reason is the lack of thiamine in the body and gastroduodenitis, which occur against the background of alcohol abuse. In addition, alcohol itself has a toxic effect on the nervous system.
Toxic alcoholic polyneuropathy can be subacute, acute, but the most common subclinical form, detected during examination of the patient. It is expressed inslight violation of the sensitivity of the feet, degradation or absence of reflexes of the Achilles tendon, soreness of the calf muscles on palpation. Often toxic polyneuropathy is expressed in symmetrical paresis, atrophy of the muscles of the flexors of the feet and fingers, decreased sensitivity of the "gloves" and "socks", pain in the feet and legs of a constant or shooting type, burning in the soles, edema, ulcers and hyperpigmentation of the skin of the extremities. Sometimes this ailment can be combined with dementia, cerebellar degeneration, a symptom of epileptiformia. The patient recovers slowly. The success of treatment depends on the return or withdrawal of alcohol. The ICD code for toxic polyneuropathy on the background of alcoholism is G62.1.
Polyneuropathy and FOS poisoning
FOS, or organophosphorus compounds, can enter the human body along with insecticides, lubricating oils and plasticizers. In acute poisoning with these substances, the following symptoms occur: sweating, hypersalivation, miosis, gastrointestinal disorders, bronchospasm, urinary incontinence, fasciculations, convulsions, and death is possible. A few days later, polyneuropathy develops with motor defects. Paralysis is quite difficult to recover.
Medicated polyneuropathy
This type of neurological disorder is caused by the following medications:
- When treated with "Perhexylen" at a dosage of 200-400 mg per day, polyneuropathy occurs after a couple of weeks. It manifests itself in a decrease in sensitivity, ataxia, paresis of the limbs. In these casesthe drug is stopped, the patient's condition is relieved.
- Isoniazid polyneuropathy develops with a deficiency of vitamin B6 in people with a genetic disorder of its metabolism. In this case, pyridoxine is prescribed orally.
- Excess "Pyridoxine" (50-300 mg/day) leads to the formation of sensory polyneutropopathy, severe headache, fatigue and irritability.
- Long-term treatment with Hydrolazine can lead to dysmetabolic polyneuropathy and requires vitamin B supplementation6.
- Acceptance of the drug "Teturam" at a dose of 1.0-1.5 g / day can be expressed in paresis, loss of sensitivity, optic neuritis.
- Treatment with Kordaron at a dosage of 400 mg/day for a period of more than a year can cause toxic polyneutropopathy.
- With a lack of vitamins B6 and E, polyneutropathies also occur, as well as with their excess.
Medicated toxic polyneuropathy ICD 10 designates the code G62.0.
Endogenous toxic polyneutropathies
This type of disease occurs in most cases due to dysfunction of the endocrine glands, as a result of a deficiency of the necessary hormones, or in violation of the functions of other internal organs of a person. There are the following types:
- Diabetic polyneuropathy can start acutely, progress slowly or fairly quickly. It manifests itself first in the form of pain and loss of sensation in the limbs.
- Polyneuropathy associated withparaproteinemia and dysproteinemia, occurs mainly in the elderly and is associated with diseases such as multiple myeloma and macroglobulinemia. Clinical manifestations are expressed in pain and paresis of the lower and upper limbs.
- Polyneuropathy also develops in diffuse connective tissue diseases: periarthritis nodosa, rheumatoid arthritis, systemic lupus erythematosus, scleroderma.
- Hepatic polyneuropathy is a consequence of diabetes and alcoholism and has similar clinical presentations.
- Neurological disorders in diseases of the gastrointestinal tract are associated with the pathology of the digestive organs, leading to beriberi. Celiac disease can provoke polyneuropathy, which is expressed in psychomotor disorders, epilepsy, visual disorders, ataxia.
Polyneuropathy after chemotherapy
Toxic polyneuropathy after chemotherapy has been singled out as a separate group of diseases, as it can be a side effect of taking drugs or be the result of the decay of tumor cells. It causes systemic inflammation, nerve cells and pathways are damaged. This phenomenon can be complicated by the presence of diabetes, alcoholism, liver and kidney dysfunction. This ailment is expressed in a violation of sensitivity and movement disorders, a decrease in the tone of the muscles of the limbs. Polyneuropathy after chemotherapy, the symptoms of which are described above, can also cause motor dysfunctions. Autonomic and central nervous system disorders are less common.
The treatment of this type of disease is reduced tosymptomatic therapy. The patient can be prescribed anti-inflammatory, painkillers, immunosuppressants, hormonal drugs, vitamins Neuromultivit and Thiamine.
Disease diagnosis
Toxic polyneuropathy of the lower extremities is diagnosed through the following tests:
- Ultrasound and X-ray of internal organs;
- cerebrospinal fluid analysis;
- study of reflexes and the speed of its passage through nerve fibers;
- biopsy.
The success of the treatment of polyneuropathy depends on the accuracy and timeliness of diagnosis.
Features of the treatment of the disease
Toxic polyneuropathy, the treatment of which primarily boils down to eliminating the causes of its occurrence, should be considered comprehensively.
Depending on the type of disease and the severity of its course, the following medications are prescribed:
- "Tramadol" and "Analgin" - for severe pain.
- "Methylprednisolone" - in case of a particularly severe course of the disease.
- "Pentoxifylline", "Vazonite", "Trental" - to enhance the blood flow of blood vessels of nerve fibers.
- B vitamins.
- "Piracetam" and "Mildronate" - to enhance the absorption of nutrients by tissues.
As physiotherapeutic methods can be applied:
- electrostimulation of the nervous system;
- therapeutic massage;
- magnetic stimulation of the nervous system;
- indirect effects on organs;
- hemodialysis, blood purification.
- exercise.
What method of treatment of polyneuropathy is most appropriate in a particular case, the doctor should decide. It is absolutely impossible to ignore the symptoms of the disease. Acute polyneuropathy can become chronic, which threatens with loss of sensation in the limbs, muscle atrophy and complete immobility.
