Peripheral neuropathy causes: Difference between revisions

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{{Peripheral neuropathy}}
{{Peripheral neuropathy}}


{{CMG}} {{AE}} {{SME}}
{{CMG}} {{AE}} {{MMJ}} {{SME}}
==Causes==
Peripheral neuropathy may be either inherited or acquired. Causes of acquired peripheral neuropathy include physical injury (trauma) to a nerve, tumors, toxins, autoimmune responses, nutritional deficiencies, alcoholism, and vascular and metabolic disorders. Acquired peripheral neuropathies are grouped into three broad categories: those caused by systemic disease, those caused by trauma from external agents, and those caused by infections or autoimmune disorders affecting nerve tissue. One example of an acquired peripheral neuropathy is trigeminal neuralgia (also known as tic douloureux), in which damage to the trigeminal nerve (the large nerve of the head and face) causes episodic attacks of excruciating, lightning-like pain on one side of the face. In some cases, the cause is an earlier viral infection, pressure on the nerve from a tumor or swollen blood vessel, or, infrequently, multiple sclerosis. In many cases, however, a specific cause cannot be identified. Doctors usually refer to neuropathies with no known cause as idiopathic neuropathies.


*Physical injury (trauma) is the most common cause of injury to a nerve. Injury or sudden trauma, such as from automobile accidents, falls, and sports-related activities, can cause nerves to be partially or completely severed, crushed, compressed, or stretched, sometimes so forcefully that they are partially or completely detached from the spinal cord. Less dramatic traumas also can cause serious nerve damage. Broken or dislocated bones can exert damaging pressure on neighboring nerves, and slipped disks between vertebrae can compress nerve fibers where they emerge from the spinal cord.
==Overview==
[[Diabetes mellitus]] is the most common cause of peripheral neuropathy in developed countries. As a summary; aside from diabetes (see [[Diabetic neuropathy]]), the common causes of neuropathy are [[herpes zoster]] infection, HIV-AIDS, toxins, alcoholism, chronic trauma (such as repetitive motion disorders) or acute trauma (including surgery), various neurotoxins and [[autoimmune]] conditions such as [[celiac disease]], which can account for approximately 16% of small fiber neuropathy cases. Neuropathic pain is common in [[cancer]] as a direct result of the cancer on [[peripheral nerves]] (e.g., compression by a [[tumor]]), as a side effect of many[[chemotherapy]] drugs, and as a result of [[electrical injury]]. In many cases the neuropathy is idiopathic, meaning no cause is found.  A form of spinal nerve entrapment called [[Posterior Rami Syndrome]] can led to neuropathic pain. Other common causes of peripheral neuropathy may include: [[Friedreich's ataxia]], [[Charcot-Marie-Tooth syndrome]], [[Chronic renal failure]], [[Porphyria]], [[Amyloidosis]], [[Liver failure]], [[Hypothyroidism]], [[Alcoholism]], [[Vincristine]], [[Phenytoin]], [[Procarbazine]], [[Isoniazid]], [[Altretamine]], [[Guillain-Barré syndrome]], [[Systemic lupus erythematosus]], [[Leprosy]], [[Sjögren's syndrome]], Vitamin deficiency states([[Vitamin B12|vitamin B<sub>12</sub>]], [[Vitamin A]], [[vitamin E]], [[Thiamin|thiamin)]], malignant disease and [[Radiation]].


*Systemic diseases :- Disorders that affect the entire body —often cause peripheral neuropathy. These disorders may include: Metabolic and endocrine disorders. Nerve tissues are highly vulnerable to damage from diseases that impair the body's ability to transform nutrients into energy, process waste products, or manufacture the substances that make up living tissue. Diabetes mellitus, characterized by chronically high blood glucose levels, is a leading cause of peripheral neuropathy in the United States. About 60 percent to 70 percent of people with diabetes have mild to severe forms of nervous system damage.
==Causes==
 
[[Diabetes mellitus]] is the most common cause of peripheral neuropathy in developed countries.<ref name="pmid19893645">{{cite journal| author=Misra UK, Kalita J, Nair PP| title=Diagnostic approach to peripheral neuropathy. | journal=Ann Indian Acad Neurol | year= 2008 | volume= 11 | issue= 2 | pages= 89-97 | pmid=19893645 | doi=10.4103/0972-2327.41875 | pmc=2771953 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19893645  }} </ref>
*Kidney disorders can lead to abnormally high amounts of toxic substances in the blood that can severely damage nerve tissue. A majority of patients who require dialysis because of kidney failure develop polyneuropathy. Some liver diseases also lead to neuropathies as a result of chemical imbalances.
 
*Hormonal imbalances can disturb normal metabolic processes and cause neuropathies. For example, an underproduction of thyroid hormones slows metabolism, leading to fluid retention and swollen tissues that can exert pressure on peripheral nerves. Overproduction of growth hormone can lead to acromegaly, a condition characterized by the abnormal enlargement of many parts of the skeleton, including the joints. Nerves running through these affected joints often become entrapped.
 
*Vitamin deficiencies and alcoholism can cause widespread damage to nerve tissue. Vitamins E, B1, B6, B12, and niacin are essential to healthy nerve function. Thiamine deficiency, in particular, is common among people with alcoholism because they often also have poor dietary habits. Thiamine deficiency can cause a painful neuropathy of the extremities. Some researchers believe that excessive alcohol consumption may, in itself, contribute directly to nerve damage, a condition referred to as alcoholic neuropathy.
 
*Vascular damage and blood diseases can decrease oxygen supply to the peripheral nerves and quickly lead to serious damage to or death of nerve tissues, much as a sudden lack of oxygen to the brain can cause a stroke. Diabetes frequently leads to blood vessel constriction. Various forms of vasculitis (blood vessel inflammation) frequently cause vessel walls to harden, thicken, and develop scar tissue, decreasing their diameter and impeding blood flow. This category of nerve damage, in which isolated nerves in different areas are damaged, is called mononeuropathy multiplex or multifocal mononeuropathy.
 
*Connective tissue disorders and chronic inflammation can cause direct and indirect nerve damage. When the multiple layers of protective tissue surrounding nerves become inflamed, the inflammation can spread directly into nerve fibers. Chronic inflammation also leads to the progressive destruction of connective tissue, making nerve fibers more vulnerable to compression injuries and infections. Joints can become inflamed and swollen and entrap nerves, causing pain.
 
*Cancers and benign tumors can infiltrate or exert damaging pressure on nerve fibers. Tumors also can arise directly from nerve tissue cells. Widespread polyneuropathy is often associated with the neurofibromatoses, genetic diseases in which multiple benign tumors grow on nerve tissue. Neuromas, benign masses of overgrown nerve tissue that can develop after any penetrating injury that severs nerve fibers, generate very intense pain signals and sometimes engulf neighboring nerves, leading to further damage and even greater pain. Neuroma formation can be one element of a more widespread neuropathic pain condition called complex regional pain syndrome or reflex sympathetic dystrophy syndrome, which can be caused by traumatic injuries or surgical trauma. Paraneoplastic syndromes, a group of rare degenerative disorders that are triggered by a person's immune system response to a cancerous tumor, also can indirectly cause widespread nerve damage.
 
*Repetitive stress frequently leads to entrapment neuropathies, a special category of compression injury. Cumulative damage can result from repetitive, forceful, awkward activities that require flexing of any group of joints for prolonged periods. The resulting irritation may cause ligaments, tendons, and muscles to become inflamed and swollen, constricting the narrow passageways through which some nerves pass. These injuries become more frequent during pregnancy, probably because weight gain and fluid retention also constrict nerve passageways.
 
*Toxins can also cause peripheral nerve damage. People who are exposed to heavy metals (arsenic, lead, mercury, thallium), industrial drugs, or environmental toxins frequently develop neuropathy. Certain anticancer drugs, anticonvulsants, antiviral agents, and antibiotics have side effects that can include peripheral nerve damage, thus limiting their long-term use.


*Infections and autoimmune disorders can cause peripheral neuropathy. Viruses and bacteria that can attack nerve tissues include herpes varicella-zoster (shingles), Epstein-Barr virus, cytomegalovirus, and herpes simplex-members of the large family of human herpes viruses. These viruses severely damage sensory nerves, causing attacks of sharp, lightning-like pain. Postherpetic neuralgia often occurs after an attack of shingles and can be particularly painful.
As a summary; aside from diabetes (see [[Diabetic neuropathy]]), the common causes of neuropathy are [[herpes zoster]] infection, HIV-AIDS, toxins, alcoholism, chronic trauma (such as repetitive motion disorders) or acute trauma (including surgery), various neurotoxins and [[autoimmune]] conditions such as [[celiac disease]], which can account for approximately 16% of small fiber neuropathy cases.<ref>{{cite web
 
*The human immunodeficiency virus (HIV), which causes AIDS, also causes extensive damage to the central and peripheral nervous systems. The virus can cause several different forms of neuropathy, each strongly associated with a specific stage of active immunodeficiency disease. A rapidly progressive, painful polyneuropathy affecting the feet and hands is often the first clinically apparent sign of HIV infection.
 
*Lyme disease, diphtheria, and leprosy are bacterial diseases characterized by extensive peripheral nerve damage. Diphtheria and leprosy are now rare in the United States, but Lyme disease is on the rise. It can cause a wide range of neuropathic disorders, including a rapidly developing, painful polyneuropathy, often within a few weeks after initial infection by a tick bite.
 
*Viral and bacterial infections can also cause indirect nerve damage by provoking conditions referred to as autoimmune disorders, in which specialized cells and antibodies of the immune system attack the body's own tissues. These attacks typically cause destruction of the nerve's myelin sheath or axon (the long fiber that extends out from the main nerve cell body).
 
*Some neuropathies are caused by inflammation resulting from immune system activities rather than from direct damage by infectious organisms. Inflammatory neuropathies can develop quickly or slowly, and chronic forms can exhibit a pattern of alternating remission and relapse. Acute inflammatory demyelinating neuropathy, better known as Guillain-Barré syndrome, can damage motor, sensory, and autonomic nerve fibers. Most people recover from this syndrome although severe cases can be life threatening. Chronic inflammatory demyelinating polyneuropathy (CIDP), generally less dangerous, usually damages sensory and motor nerves, leaving autonomic nerves intact. Multifocal motor neuropathy is a form of inflammatory neuropathy that affects motor nerves exclusively; it may be chronic or acute.
 
*Inherited forms of peripheral neuropathy are caused by inborn mistakes in the genetic code or by new genetic mutations. Some genetic errors lead to mild neuropathies with symptoms that begin in early adulthood and result in little, if any, significant impairment. More severe hereditary neuropathies often appear in infancy or childhood. The most common inherited neuropathies are a group of disorders collectively referred to as Charcot-Marie-Tooth disease. These neuropathies result from flaws in genes responsible for manufacturing neurons or the myelin sheath. Hallmarks of typical Charcot-Marie-Tooth disease include extreme weakening and wasting of muscles in the lower legs and feet, gait abnormalities, loss of tendon reflexes, and numbness in the lower limbs.
 
As a summary; aside from diabetes (see [[Diabetic neuropathy]]), the common causes of neuropathy are [[herpes zoster]] infection, HIV-AIDS, toxins, alcoholism, chronic trauma (such as repetitive motion disorders) or acute trauma (including surgery), various neurotoxins and [[autoimmune]] conditions such as [[celiac disease]], which can account for approximately 16% of small fiber neuropathy cases.<ref>
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</ref> Neuropathic pain is common in [[cancer]] as a direct result of the cancer on peripheral nerves (e.g., compression by a tumor), as a side effect of many[[chemotherapy]] drugs, and as a result of [[electrical injury]]. In many cases the neuropathy is "idiopathic," meaning no cause is found.  A form of spinal nerve entrapment called [[Posterior Rami Syndrome]] can led to neuropathic pain.
</ref> Neuropathic pain is common in [[cancer]] as a direct result of the cancer on [[peripheral nerves]] (e.g., compression by a [[tumor]]), as a side effect of many[[chemotherapy]] drugs, and as a result of [[electrical injury]]. In many cases the neuropathy is idiopathic, meaning no cause is found.  A form of spinal nerve entrapment called [[Posterior Rami Syndrome]] can led to neuropathic pain.


===Common Causes===
===Common Causes===
 
Other common causes of peripheral neuropathy may include:<ref name="pmid18615140">{{cite journal| author=Marchettini P, Lacerenza M, Mauri E, Marangoni C| title=Painful peripheral neuropathies. | journal=Curr Neuropharmacol | year= 2006 | volume= 4 | issue= 3 | pages= 175-81 | pmid=18615140 | doi= | pmc=2430688 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18615140  }} </ref><ref name="pmid26141332">{{cite journal| author=Watson JC, Dyck PJ| title=Peripheral Neuropathy: A Practical Approach to Diagnosis and Symptom Management. | journal=Mayo Clin Proc | year= 2015 | volume= 90 | issue= 7 | pages= 940-51 | pmid=26141332 | doi=10.1016/j.mayocp.2015.05.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26141332  }} </ref><ref name="pmid11859051">{{cite journal| author=Hughes RA| title=Peripheral neuropathy. | journal=BMJ | year= 2002 | volume= 324 | issue= 7335 | pages= 466-9 | pmid=11859051 | doi= | pmc=1122393 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11859051  }} </ref><ref name="pmid28205574">{{cite journal| author=Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D et al.| title=Neuropathic pain. | journal=Nat Rev Dis Primers | year= 2017 | volume= 3 | issue=  | pages= 17002 | pmid=28205574 | doi=10.1038/nrdp.2017.2 | pmc=5371025 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28205574  }} </ref><ref name="pmid27158461">{{cite journal| author=Juster-Switlyk K, Smith AG| title=Updates in diabetic peripheral neuropathy. | journal=F1000Res | year= 2016 | volume= 5 | issue=  | pages=  | pmid=27158461 | doi=10.12688/f1000research.7898.1 | pmc=4847561 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27158461  }} </ref><ref name="pmid16461471">{{cite journal| author=Bansal V, Kalita J, Misra UK| title=Diabetic neuropathy. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 964 | pages= 95-100 | pmid=16461471 | doi=10.1136/pgmj.2005.036137 | pmc=2596705 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16461471  }} </ref><ref name="pmid27637963">{{cite journal| author=Hanewinckel R, Ikram MA, Van Doorn PA| title=Peripheral neuropathies. | journal=Handb Clin Neurol | year= 2016 | volume= 138 | issue=  | pages= 263-82 | pmid=27637963 | doi=10.1016/B978-0-12-802973-2.00015-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27637963  }} </ref><ref name="pmid219931">{{cite journal| author=Argov Z, Mastaglia FL| title=Drug-induced peripheral neuropathies. | journal=Br Med J | year= 1979 | volume= 1 | issue= 6164 | pages= 663-6 | pmid=219931 | doi= | pmc=1598252 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=219931  }} </ref><ref name="pmid24195230">{{cite journal| author=Remiche G, Kadhim H, Maris C, Mavroudakis N| title=[Peripheral neuropathies, from diagnosis to treatment, review of the literature and lessons from the local experience]. | journal=Rev Med Brux | year= 2013 | volume= 34 | issue= 4 | pages= 211-20 | pmid=24195230 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24195230  }} </ref><ref name="pmid7745415">{{cite journal| author=Phan T, McLeod JG, Pollard JD, Peiris O, Rohan A, Halpern JP| title=Peripheral neuropathy associated with simvastatin. | journal=J Neurol Neurosurg Psychiatry | year= 1995 | volume= 58 | issue= 5 | pages= 625-8 | pmid=7745415 | doi= | pmc=1073498 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7745415  }} </ref><ref name="pmid2153610">{{cite journal| author=Cohen JA, Gross KF| title=Peripheral neuropathy: causes and management in the elderly. | journal=Geriatrics | year= 1990 | volume= 45 | issue= 2 | pages= 21-6, 31-4 | pmid=2153610 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2153610  }} </ref>
 
*Genetic diseases:
*Genetic diseases:
:*[[Friedreich's ataxia]],
:*[[Friedreich's ataxia]]  
:*[[Charcot-Marie-Tooth syndrome]]
:*[[Charcot-Marie-Tooth syndrome]]
*Metabolic / Endocrine:
*Metabolic / Endocrine:
:*[[Siabetes mellitus]],
:*[[Chronic renal failure]]  
:*[[Chronic renal failure]],
:*[[Porphyria]]  
:*[[Porphyria]],
:*[[Amyloidosis]]
:*[[Amyloidosis]],
:*[[Liver failure]]  
:*[[Liver failure]],
:*[[Hypothyroidism]]
:*[[Hypothyroidism]]
*Toxic causes:
*Toxic causes:
:*[[Alcoholism]],
:*[[Alcoholism]]  
:*[[drug]]s  
:*[[drug]]s  
:*:*[[Vincristine]],
:*:*[[Vincristine]]  
:*:*[[Phenytoin]],
:*:*[[Phenytoin]]  
:*:*[[Isoniazid]],
:*:*[[Procarbazine]]
:*Organic metals,
:*:*[[Isoniazid]]
:*:*[[Altretamine]]
:*Organic metals
:*:*[[Heavy metals]]
:*:*[[Heavy metals]]
*Inflammatory diseases:
*Inflammatory diseases:
:*[[Guillain-Barré syndrome]],
:*[[Guillain-Barré syndrome]]
:*[[Systemic lupus erythematosus]],
:*[[Systemic lupus erythematosus]]
:*[[Leprosy]],
:*[[Leprosy]]  
:*[[Sjögren's syndrome]]
:*[[Sjögren's syndrome]]
*Vitamin deficiency states:  
*Vitamin deficiency states:  
:*[[Vitamin B12|vitamin B<sub>12</sub>]],
:*[[Vitamin B12|vitamin B<sub>12</sub>]]
:*[[Vitamin A]],
:*[[Vitamin A]]
:*[[vitamin E]],
:*[[vitamin E]]
:*[[Thiamin]]
:*[[Thiamin]]
*Others:
*Others:
*Malignant disease,
*Malignant disease  
*[[Radiation]]
*[[Radiation]]


===Causes by Organ System===
===Causes by Organ System===
 
{| style="width:82%; height:100px" border="1"
 
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
 
| style="width:75%" bgcolor="Beige" ; border="1" |[[Atherosclerosis]]
{|style="width:80%; height:100px" border="1"
|-
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|- bgcolor="LightSteelBlue"
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |  
| '''Chemical/Poisoning'''
| bgcolor="Beige" |[[Toxins]], [[Thallium]], Inorganic [[lead]], [[Arsenic]], [[Alcoholic polyneuropathy]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Dental'''
|bgcolor="Beige"|
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"|
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"|   
| bgcolor="Beige" |[[Acrylamide]], [[Ado-trastuzumab emtansine]], [[Amiodarone]], [[Amphotericin B]], [[Bortezomib]], [[Cisplatin]], [[Colchicine]], [[Dapsone]], [[Didanosine]], [[Disulfiram]], [[Eribulin]], [[Ethambutol]], [[Gentamicin]], [[Glycerol phenylbutyrate]],[[Hydralazine]], [[Isoniazid]], [[Ixabepilone]], [[Lamivudine]], [[Leflunomide]], [[Linezolid]], [[Lomefloxacin hydrochloride]], [[Metronidazole]], [[Miglustat]], [[Nitrofurantoin]], [[Nucleoside analogues]], [[Organophosphates]], [[Paclitaxel]],[[Oxaliplatin]], [[Palbociclib]], [[Pentamidine Isethionate]], [[Pertuzumab]], [[Phenytoin]], [[Pyridoxine]], [[Radiation exposure]], [[Sodium aurothiomalate]], [[Stavudine]], [[Sulfasalazine]], [[Suramin]], [[Taxol]], [[Telbivudine]], [[Thalidomide]], [[Vincristine]], [[Vincristine sulfate liposome]] [[Zalcitabine]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
|bgcolor="Beige"|
| bgcolor="Beige" | No underlying causes
|-  
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Hypothyroidism]], [[Hypoglycemia]], [[Diabetes mellitus]], [[Acromegaly]]
|-  
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"|
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Sprue]], [[Primary biliary cirrhosis]], [[Malabsorption ]] , [[Haemochromatosis]], [[Chronic liver disease]], [[Celiac disease]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"|
| bgcolor="Beige" |Hereditary [[sensory neuropathy]] type II (HSN-II), Hereditary [[sensory neuropathy]] type I (HSN-I), Hereditary [[sensory]] and [[autonomic neuropathy]] type 4, Hereditary [[neuropathies]], Hereditary liability to [[pressure palsy]], Hereditary [[Ataxia]], Hereditary [[amyloid]] [[polyneuropathies]], Arylsulphatase A deficiency, Alpha-methylacyl-CoA racemase deficiency
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"|
| bgcolor="Beige" |Solitary [[plasmacytoma]], [[Polycythemia vera]], [[Pernicious anemia]], [[Non-Hodgkin's lymphoma]], [[Multiple myeloma]], [[Monoclonal gammopathy]], [[Mixed essential cryoglobulinaemia]], [[Lymphoma]] including [[Hodgkin's]], [[Leukemia]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"|
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Viral Hepatitis]], [[Typhoid Fever]], [[Tuberculosis]], [[Syphillis]], [[Mycoplasma pneumoniae]], [[Malaria]], [[Leprosy]], [[HIV infection]], [[Herpes zoster]], [[Diptheria]], [[Diphtheria toxin]], Critical illness [[sepsis]], [[Brucellosis]], [[Botulism]]
|-
|- bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
| '''Musculoskeletal / Ortho'''
| bgcolor="Beige" | No underlying causes
|bgcolor="Beige"|
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Spinocerebellar ataxia]] Machado-Joseph type III, [[Shy-Drager syndrome]], [[Neurofibromatosis]] type 1, Nerve entrapment,
Idiopathic small fiber [[neuropathy]], Giant [[axonal]] [[neuropathy]], [[Friedrich's ataxia]], [[Charcot-Marie-Tooth]] disease type 4A, [[Charcot-Marie-Tooth]] disease type 2, [[Charcot-Marie-Tooth]] disease type 1B, [[Charcot-Marie-Tooth]] disease type 1, [[x-linked]], [[Charcot-Marie-Tooth]] (CMT) disease type 1A, [[Ataxia telangiectasia]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional/Metabolic'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Vitamin B12 deficiency]], [[Vitamin B1 deficiency]], [[Thiamine (Vitamin B1) deficiency]], [[Porphyria]], [[Familial alphalipoprotein deficiency]], [[Beri-Beri]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Paraneoplastic]] [[sensory neuropathy]], [[Carcinoma]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| '''Ophthalmologic'''
|bgcolor="Beige"|
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| '''Overdose/Toxicity'''
|bgcolor="Beige"|
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"|
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"|
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal/Electrolyte'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Uremia]], [[Renal failure, chronic]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"|
| bgcolor="Beige" |Vasculitic [[neuropathy]], [[Systemic Lupus Erythematosus]], [[Sjogren's Syndrome]], [[Scleroderma]], [[Sarcoidosis]], [[Rheumatoid arthritis]], [[Polyrediculitis]], [[Polyarteritis nodosa]], [[Microscopic Polyangiitis ]] , [[Connective tissue disease]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
|bgcolor="Beige"|
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Trauma]], Penetrating injuries, Nerve Compression
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"|
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"|
| bgcolor="Beige" |[[Superior orbital fissure]] syndrome, [[Refsum's disease]], [[Primary systemic amyloidosis]], [[Paraproteinemia]], [[Metachromatic leukodystrophy]], [[Klumpke paralysis]], Familial or acquired amyloid [[polyneuropathy]], [[Fabry's disease]], [[Dysproteinemia]], Déjerine-Sottas neuropathy, types A and B (HMSN-III), [[Cryoglobulinemia]], [[Compartment syndrome]], [[Carpal tunnel syndrome]], [[Aurothioglucose]], Amyloid [[neuropathy]], [[Adrenomyeloneuropathy]], [[Abetalipoproteinemia]]
|-
|-
|}
|}


===Causes in Alphabetical Order===  
===Causes in Alphabetical Order===  
 
{{Multicol}}
 
*[[Abetalipoproteinemia]]
 
*[[Acromegaly]]
*[[Acromegaly]]
*Acrylamide
*[[Ado-trastuzumab emtansine]]
*[[Adrenomyeloneuropathy]]
*AIDs
*[[Alcoholic polyneuropathy]]
*[[Alcoholic polyneuropathy]]
*Alpha-methylacyl-CoA racemase deficiency
*[[Amiodarone]]
*[[Amphotericin B]]
*Amyloid [[neuropathy]]
*[[Arsenic]]
*Arylsulphatase A deficiency
*[[Ataxia telangiectasia]]
*[[Atherosclerosis]]
*[[Atherosclerosis]]
*[[Amyloidosis]]
*[[Aurothioglucose]]
*[[Benign monoclonal gammopathy]]
*[[Beri-Beri]]
*[[Bortezomib]]
*[[Botulism]]
*[[Botulism]]
*[[Brucellosis]]
*[[Brucellosis]]
*[[Carpal Tunnel Syndrome]]
*[[Carcinoma]]
*[[Charcot-Marie-Tooth Disease]]
*[[Carpal tunnel syndrome]]
*Compression
*[[Celiac disease]]
*[[Diabetic polyneuropathy]]
*[[Charcot-Marie-Tooth]] (CMT) disease type 1A
*[[Diabetes Mellitus]]
*[[Chronic liver disease]]
*[[Chronic obstructive lung disease]]
*[[Cisplatin]]
*[[Charcot-Marie-Tooth]] type 1, x-linked
*[[Charcot-Marie-Tooth]] type 1B
*[[Charcot-Marie-Tooth]] type 2
*[[Charcot-Marie-Tooth]] type 4A
*[[Colchicine]]
*[[Compartment syndrome]]
*Nerve Compression
*[[Connective tissue disease]]
*Critical illness [[sepsis]]
*[[Cryoglobulinemia]]
*[[Dapsone]]
*Déjerine-Sottas neuropathy, types A and B (HMSN-III)
*[[Diabetes mellitus]]
*[[Didanosine]]
*[[Diphtheria toxin]]
*[[Diptheria]]
*[[Diptheria]]
*[[Drugs]]
*[[Disulfiram]]
*[[Dysentery]]
*[[Dysproteinemia]]
*[[Dysproteinemia]]
*[[Fabry's Disease]]
*[[Emtricitabine]]
*[[German Measles]]
*[[Eribulin]]
*[[Ethambutol]]
{{ColBreak}}
*[[Fabry's disease]]
*Familial alphalipoprotein deficiency
*Familial or acquired amyloid [[polyneuropathy]]
*Friedrich's [[ataxia]]
*Gamma-Diketone hexacarbons 
*Giant [[axonal]] [[neuropathy]]
*[[Glycerol phenylbutyrate]]
*[[Haemochromatosis]]
*Hereditary amyloid [[polyneuropathies]]
*Hereditary [[Ataxia]]
*Hereditary [[Ataxia]]
*[[Herpes Zoster]]
*Hereditary liability to pressure palsy
*[[HIV]]
*Hereditary [[neuropathies]]
*Hereditary [[sensory]] and [[autonomic neuropathy]] type 4
*Hereditary [[sensory neuropathy]] type I (HSN-I)
*Hereditary [[sensory neuropathy]] type II (HSN-II)
*[[Herpes zoster]]
*[[HIV infection]]
*[[Hydralazine]]
*[[Hypoglycemia]]
*[[Hypothyroidism]]
*[[Hypothyroidism]]
*[[Infectious Mononeucliosis]]
*[[Hypothyroidism]]
*Idiopathic small fiber [[neuropathy]]
*Inorganic [[lead]]
*[[Isoniazid]]
*[[Ixabepilone]]
*[[Klumpke paralysis]]
*[[Lamivudine]]
*[[Leflunomide]]
*[[Leprosy]]
*[[Leukemia]]
*[[Leukemia]]
*[[Lyme Disease]]
*[[Linezolid]]
*[[Lymphoma]]
*[[Lymphoma]], including [[Hodgkin's]]
*[[Lomefloxacin hydrochloride]]
*[[Malabsorption]] ([[sprue]], [[celiac disease]])
*[[Malaria]]
*[[Malaria]]
*[[Metachromatic leukodystrophy]]
*[[Metachromatic leukodystrophy]]
*[[Multiple Myeloma]]
*[[Metachromatic leukodystrophy]]
*[[Mycosis]]
*[[Metronidazole]]
*[[Paraneoplasia]]
*[[Microscopic Polyangiitis ]]
*[[Mixed essential cryoglobulinaemia]]
*[[Monoclonal gammopathy]]
*[[Multiple myeloma]]
*[[Mycoplasma pneumoniae]]
*Nerve entrapment
*[[Neurofibromatosis type 1]]
*[[Nitrofurantoin]]
*[[Non-Hodgkin's lymphoma]]
*[[Nucleoside analogues]]
{{ColBreak}}
*[[Organophosphates]]
*[[Oxaliplatin]]
*[[Paclitaxel]]
*[[Palbociclib]]
*[[Paraneoplastic]] [[sensory neuropathy]]
*[[Paraproteinemia]]
*[[Paraproteinemia]]
*[[Paratyphus]]
*Penetrating injuries
*[[Pernicious anemia]]
*[[Pernicious anemia]]
*[[Polyarteritis Nodosa]]
*[[Phenytoin]]
*[[Polyarteritis nodosa]]
*[[Polycythemia vera]]
*[[Polyrediculitis]]
*[[Polyrediculitis]]
*[[Porphyria]]
*[[Porphyria]]
*Post-[[tetanus]] shot
*[[Primary biliary cirrhosis]]
*[[Primary biliary cirrhosis]]
*[[Refsum's Disease]]
*[[Primary systemic amyloidosis]]
*[[Rheumatoid Arthritis]]
*[[Pyridoxine]]
*[[Radiation exposure]]
*[[Refsum's disease]]
*[[Renal failure, chronic]]
*[[Rheumatoid arthritis]]
*[[Sarcoidosis]]
*[[Sarcoidosis]]
*[[Scleroderma]]
*[[Scleroderma]]
*[[Shy-Drager syndrome]]
*[[Sjogren's Syndrome]]
*[[Sjogren's Syndrome]]
*Spinal process
*Solitary [[plasmacytoma]]
*[[Spotted Fever]]
*[[Spinocerebellar ataxia]], Machado-Joseph type III
*[[Sprue]]
*[[Sprue]]
*[[Stavudine]]
*Superior orbital fissure syndrome
*[[Suramin]]
*[[Syphillis]]
*[[Syphillis]]
*[[Systemic Lupus Erythematosus]]
*[[Systemic Lupus Erythematosus]]
*[[Thiamine deficiency]]
*[[Taxol]]
*[[Tenofovir]] disoproxil fumarate
*[[Thallium]]
*[[Thiamine (Vitamin B1) deficiency]]
*[[Toxins]]
*[[Trauma]]
*[[Trauma]]
*[[Tuberculosis]]
*[[Tuberculosis]]
*[[Typhoid Fever]]
*[[Typhoid Fever]]
*Uremic/[[Chronic Renal Failure]]
*[[Uremia]]
*Viral [[Hepatitis]]
*Vasculitic [[neuropathy]]
*[[Vitamin B1]] deficiency
*[[Vincristine]]
*[[Vitamin B6]] deficiency
*[[Viral Hepatitis]]
*[[Vitamin B1 deficiency]]
*[[Vitamin B6 deficiency]]
*[[Vitamin B12 deficiency]]
*[[Vitamin B12 deficiency]]
*[[Zalcitabine]]
{{EndMultiCol}}


==References==
==References==
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Latest revision as of 23:39, 29 July 2020

Peripheral neuropathy Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2] Saumya Easaw, M.B.B.S.[3]

Overview

Diabetes mellitus is the most common cause of peripheral neuropathy in developed countries. As a summary; aside from diabetes (see Diabetic neuropathy), the common causes of neuropathy are herpes zoster infection, HIV-AIDS, toxins, alcoholism, chronic trauma (such as repetitive motion disorders) or acute trauma (including surgery), various neurotoxins and autoimmune conditions such as celiac disease, which can account for approximately 16% of small fiber neuropathy cases. Neuropathic pain is common in cancer as a direct result of the cancer on peripheral nerves (e.g., compression by a tumor), as a side effect of manychemotherapy drugs, and as a result of electrical injury. In many cases the neuropathy is idiopathic, meaning no cause is found. A form of spinal nerve entrapment called Posterior Rami Syndrome can led to neuropathic pain. Other common causes of peripheral neuropathy may include: Friedreich's ataxia, Charcot-Marie-Tooth syndrome, Chronic renal failure, Porphyria, Amyloidosis, Liver failure, Hypothyroidism, Alcoholism, Vincristine, Phenytoin, Procarbazine, Isoniazid, Altretamine, Guillain-Barré syndrome, Systemic lupus erythematosus, Leprosy, Sjögren's syndrome, Vitamin deficiency states(vitamin B12, Vitamin A, vitamin E, thiamin), malignant disease and Radiation.

Causes

Diabetes mellitus is the most common cause of peripheral neuropathy in developed countries.[1]

As a summary; aside from diabetes (see Diabetic neuropathy), the common causes of neuropathy are herpes zoster infection, HIV-AIDS, toxins, alcoholism, chronic trauma (such as repetitive motion disorders) or acute trauma (including surgery), various neurotoxins and autoimmune conditions such as celiac disease, which can account for approximately 16% of small fiber neuropathy cases.[2] Neuropathic pain is common in cancer as a direct result of the cancer on peripheral nerves (e.g., compression by a tumor), as a side effect of manychemotherapy drugs, and as a result of electrical injury. In many cases the neuropathy is idiopathic, meaning no cause is found. A form of spinal nerve entrapment called Posterior Rami Syndrome can led to neuropathic pain.

Common Causes

Other common causes of peripheral neuropathy may include:[3][4][5][6][7][8][9][10][11][12][13]

  • Genetic diseases:
  • Metabolic / Endocrine:
  • Toxic causes:
  • Inflammatory diseases:
  • Vitamin deficiency states:

Causes by Organ System

Cardiovascular Atherosclerosis
Chemical/Poisoning Toxins, Thallium, Inorganic lead, Arsenic, Alcoholic polyneuropathy
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Acrylamide, Ado-trastuzumab emtansine, Amiodarone, Amphotericin B, Bortezomib, Cisplatin, Colchicine, Dapsone, Didanosine, Disulfiram, Eribulin, Ethambutol, Gentamicin, Glycerol phenylbutyrate,Hydralazine, Isoniazid, Ixabepilone, Lamivudine, Leflunomide, Linezolid, Lomefloxacin hydrochloride, Metronidazole, Miglustat, Nitrofurantoin, Nucleoside analogues, Organophosphates, Paclitaxel,Oxaliplatin, Palbociclib, Pentamidine Isethionate, Pertuzumab, Phenytoin, Pyridoxine, Radiation exposure, Sodium aurothiomalate, Stavudine, Sulfasalazine, Suramin, Taxol, Telbivudine, Thalidomide, Vincristine, Vincristine sulfate liposome Zalcitabine
Ear Nose Throat No underlying causes
Endocrine Hypothyroidism, Hypoglycemia, Diabetes mellitus, Acromegaly
Environmental No underlying causes
Gastroenterologic Sprue, Primary biliary cirrhosis, Malabsorption , Haemochromatosis, Chronic liver disease, Celiac disease
Genetic Hereditary sensory neuropathy type II (HSN-II), Hereditary sensory neuropathy type I (HSN-I), Hereditary sensory and autonomic neuropathy type 4, Hereditary neuropathies, Hereditary liability to pressure palsy, Hereditary Ataxia, Hereditary amyloid polyneuropathies, Arylsulphatase A deficiency, Alpha-methylacyl-CoA racemase deficiency
Hematologic Solitary plasmacytoma, Polycythemia vera, Pernicious anemia, Non-Hodgkin's lymphoma, Multiple myeloma, Monoclonal gammopathy, Mixed essential cryoglobulinaemia, Lymphoma including Hodgkin's, Leukemia
Iatrogenic No underlying causes
Infectious Disease Viral Hepatitis, Typhoid Fever, Tuberculosis, Syphillis, Mycoplasma pneumoniae, Malaria, Leprosy, HIV infection, Herpes zoster, Diptheria, Diphtheria toxin, Critical illness sepsis, Brucellosis, Botulism
Musculoskeletal/Orthopedic No underlying causes
Neurologic Spinocerebellar ataxia Machado-Joseph type III, Shy-Drager syndrome, Neurofibromatosis type 1, Nerve entrapment,

Idiopathic small fiber neuropathy, Giant axonal neuropathy, Friedrich's ataxia, Charcot-Marie-Tooth disease type 4A, Charcot-Marie-Tooth disease type 2, Charcot-Marie-Tooth disease type 1B, Charcot-Marie-Tooth disease type 1, x-linked, Charcot-Marie-Tooth (CMT) disease type 1A, Ataxia telangiectasia

Nutritional/Metabolic Vitamin B12 deficiency, Vitamin B1 deficiency, Thiamine (Vitamin B1) deficiency, Porphyria, Familial alphalipoprotein deficiency, Beri-Beri
Obstetric/Gynecologic No underlying causes
Oncologic Paraneoplastic sensory neuropathy, Carcinoma
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte Uremia, Renal failure, chronic
Rheumatology/Immunology/Allergy Vasculitic neuropathy, Systemic Lupus Erythematosus, Sjogren's Syndrome, Scleroderma, Sarcoidosis, Rheumatoid arthritis, Polyrediculitis, Polyarteritis nodosa, Microscopic Polyangiitis , Connective tissue disease
Sexual No underlying causes
Trauma Trauma, Penetrating injuries, Nerve Compression
Urologic No underlying causes
Miscellaneous Superior orbital fissure syndrome, Refsum's disease, Primary systemic amyloidosis, Paraproteinemia, Metachromatic leukodystrophy, Klumpke paralysis, Familial or acquired amyloid polyneuropathy, Fabry's disease, Dysproteinemia, Déjerine-Sottas neuropathy, types A and B (HMSN-III), Cryoglobulinemia, Compartment syndrome, Carpal tunnel syndrome, Aurothioglucose, Amyloid neuropathy, Adrenomyeloneuropathy, Abetalipoproteinemia

Causes in Alphabetical Order


References

  1. ↑ Misra UK, Kalita J, Nair PP (2008). "Diagnostic approach to peripheral neuropathy". Ann Indian Acad Neurol. 11 (2): 89–97. doi:10.4103/0972-2327.41875. PMC 2771953. PMID 19893645.
  2. ↑ "Up to 16% of Patients with Small Fiber Neuropathy May Have Celiac Disease". Celiac.com. Retrieved 2007-26-06. Check date values in: |accessdate= (help)
  3. ↑ Marchettini P, Lacerenza M, Mauri E, Marangoni C (2006). "Painful peripheral neuropathies". Curr Neuropharmacol. 4 (3): 175–81. PMC 2430688. PMID 18615140.
  4. ↑ Watson JC, Dyck PJ (2015). "Peripheral Neuropathy: A Practical Approach to Diagnosis and Symptom Management". Mayo Clin Proc. 90 (7): 940–51. doi:10.1016/j.mayocp.2015.05.004. PMID 26141332.
  5. ↑ Hughes RA (2002). "Peripheral neuropathy". BMJ. 324 (7335): 466–9. PMC 1122393. PMID 11859051.
  6. ↑ Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D; et al. (2017). "Neuropathic pain". Nat Rev Dis Primers. 3: 17002. doi:10.1038/nrdp.2017.2. PMC 5371025. PMID 28205574.
  7. ↑ Juster-Switlyk K, Smith AG (2016). "Updates in diabetic peripheral neuropathy". F1000Res. 5. doi:10.12688/f1000research.7898.1. PMC 4847561. PMID 27158461.
  8. ↑ Bansal V, Kalita J, Misra UK (2006). "Diabetic neuropathy". Postgrad Med J. 82 (964): 95–100. doi:10.1136/pgmj.2005.036137. PMC 2596705. PMID 16461471.
  9. ↑ Hanewinckel R, Ikram MA, Van Doorn PA (2016). "Peripheral neuropathies". Handb Clin Neurol. 138: 263–82. doi:10.1016/B978-0-12-802973-2.00015-X. PMID 27637963.
  10. ↑ Argov Z, Mastaglia FL (1979). "Drug-induced peripheral neuropathies". Br Med J. 1 (6164): 663–6. PMC 1598252. PMID 219931.
  11. ↑ Remiche G, Kadhim H, Maris C, Mavroudakis N (2013). "[Peripheral neuropathies, from diagnosis to treatment, review of the literature and lessons from the local experience]". Rev Med Brux. 34 (4): 211–20. PMID 24195230.
  12. ↑ Phan T, McLeod JG, Pollard JD, Peiris O, Rohan A, Halpern JP (1995). "Peripheral neuropathy associated with simvastatin". J Neurol Neurosurg Psychiatry. 58 (5): 625–8. PMC 1073498. PMID 7745415.
  13. ↑ Cohen JA, Gross KF (1990). "Peripheral neuropathy: causes and management in the elderly". Geriatrics. 45 (2): 21–6, 31–4. PMID 2153610.

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