The concept of polyneutropathy includes a group of diseases, the causes of which may be different. The feature that combines these ailments in one row is the abnormal functioning of the peripheral nervous system or individual nerve bundles.
Characteristic features of polyneutropathy are the symmetrical disruption of the muscles of the upper and lower extremities. At the same time, there is a slowdown in blood flow and a deterioration in the sensitivity of arms and legs. Mostly this disease affects the lower limbs.
ICD10 toxic polyneuropathy
One of the most common types of this disease is toxic polyneuropathy. From the name of the disease, it becomes clear that it is a consequence of exposure to the nervous system of various toxic substances. Toxins can enter the body from the outside or be a consequence of the disease.
In order to facilitate the determination of the type of this ailment, it was proposed to consider the causes of toxic polyneuropathy. ICD 10, or the International Classification of Diseases of the 10th revision, offers a very convenient form of disease separation. The bottom line is to assign a code to a particular type of ailment, based on the reasons for its occurrence. Thus, toxic neuropathies are designated according to the list of ICD 10 code G62. The following is a more refined classification:
- G62.0 - designation for drug polyneuropathy with the possibility of specifying a medication;
- G62.1 - this code refers to the alcoholic form of the disease;
- G62.2 - code for polyneuropathy caused by other toxic substances (toxin code may be entered);
- G62.8 - designation for other specified polyneuropathies, which include the radiation form of the disease;
- G62.9 - code for an unspecified form of neuropathy (NOS).
As noted earlier, toxic polyneuropathy can be caused by two types of causes:
- To have exogenous prerequisites (diphtheria, herpetic, caused by HIV infection, lead, arsenic, alcoholic, caused by poisoning of FOS, medicamentous, radiation neuropathy belong to this type).
- Be a consequence of endogenous factors (for example, diabetic caused by paraproteinemia or dysproteinemia, diffuse lesions of the connective tissue).
Toxic neuropathy has recently become a fairly common ailment due to the increasing contact of a person with toxins of various origins. These dangerous substances surround us everywhere: they are in food, in consumer goods, medicines and in the environment. Infectious diseases also often cause this disease. Microorganisms secrete toxins that affect the human body, affect the nervous system.
Exogenous Toxic Polineutropathies
As noted earlier, these types of diseases occur when an external factor is exposed to the human body: toxins of viruses and bacteria, heavy metals, chemicals, drugs. Like another type of polyneutropathy, these ailments can be chronic or acute.
Diphtheria polyneuropathy
From the name of the disease it is clear that it arises as a result of 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 shells of the nerves of the skull and their destruction. Symptoms of the disease manifest themselves either in the first week (especially dangerous 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, symptoms begin to disappear after 2-4 weeks or after a few months.
Herpetic polyneutropathy
This type of disease occurs due to the activity of the Epstein-Barr herpes simplex viruses of types I and II, chickenpox, cytomegalovirus. Infection with these infections occurs in childhood, and after an illness, immunity occurs. If the body's defenses are weakening, then polyneuropathy may develop with characteristic rashes throughout the body.
HIV polyneuropathy
In two of the three cases, patients with HIV infection show neurological complications, most often they occur 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 impaired normal functioning of the body. As a result, encephalopathy, meningitis, and polyneutropathy of the cranial nerves 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 fraught with fatal complications.
Lead polyneuropathy
This type of disease occurs due to lead poisoning, which can penetrate the human body through breathing or through the digestive tract. It is deposited in the bones and liver. Lead toxic polyneuropathy (ICD code 10 - G62.2) is expressed in the patient in the form of lethargy, high fatigue, "dull" headache, decreased memory and attention, encephalopathy, anemia, colitis, pain in the extremities, tremor of the hands. This disease is characterized by damage to the radial and peroneal nerves. Therefore, often there are syndromes of the “hanging hand” and “cock's gait”. In these cases, contact with lead is completely limited. The prognosis of getting rid of the disease is favorable.
Arsenic polyneuropathy
Arsenic can penetrate the human body along with insecticides, drugs, paints. This disease is a professional smelter. If the exposure to the poison was one-time, vascular hypotension, nausea, and vomiting develop. After 2-3 weeks, polyneuropathy manifests itself, expressed in weakness of the leg muscles. If re- poisoning occurs with arsenic, symmetrical distal sensorimotor manifestations of the disease occur. In case of chronic intoxication with a toxic substance, hypersalivation, trophic and vascular disorders (hyperkeratosis of the skin on the soles and palms, rashes, stripes on the nails, pigmentation on the abdomen in the form of drops, desquamation), ataxia are observed. Arsenic polyneuropathy is diagnosed by analyzing the composition of urine, hair and nails. Recovery of a patient after a disease lasts for months.
Alcoholic neuropathy
In medicine, there is an opinion that toxic polyneuropathy with alcohol is not well understood, the mechanism of its development is not fully understood.
The main reason is the lack of thiamine in the body and gastroduodenitis arising from the abuse of alcohol. In addition, alcohol itself has a toxic effect on the nervous system.
Toxic alcoholic polyneuropathy can be subacute, acute, but most often there is a subclinical form detected during examination of the patient. It is expressed in a slight violation of the sensitivity of the feet, degradation or lack of reflexes of the Achilles tendon, soreness of the calf muscles during palpation. Often toxic polyneuropathy is expressed in symmetrical paresis, atrophy of the flexor muscles of the feet and fingers, decreased sensitivity of the “gloves” and “socks” zones, pain in the feet and lower legs of a constant or shooting type, burning in the soles, swelling, 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 is recovering slowly. The success of treatment depends on the return or refusal to drink alcohol. The ICD code toxic polyneuropathy against alcoholism has G62.1.
Polyneuropathy and poisoning FOS
FOS, or organophosphorus compounds, can enter the human body along with insecticides, lubricants and plasticizers. In acute poisoning with these substances, the following symptoms occur: sweating, hypersalivation, miosis, gastrointestinal tract disorders, bronchospasm, urinary incontinence, fasculation, convulsions, death is possible. A few days later, polyneuropathy with motor defects develops. Paralysis is quite difficult to recover.
Drug polyneuropathy
This type of neurological disorder is caused by taking the following medications:
- When treating with Pergexylene in 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 limbs. In these cases, the drug is stopped, the patient's condition is eased.
- Isoniazid polyneuropathy develops with a deficiency of vitamin B 6 in people with a genetic impairment of its metabolism. In this case, pyridoxine is prescribed orally.
- Excess "Pyridoxine" (50-300 mg / day) leads to the formation of sensory polyneutropathy, severe headache, fatigue and irritability.
- Long-term treatment with "Hydrolazine" can lead to dysmetabolic polyneutropathy and needs to be taken with vitamin B 6 .
- Reception of the Teturam preparation in a dose of 1.0-1.5 g / day can be expressed in paresis, loss of sensation, optic neuritis.
- Treatment with Cordarone in a dosage of 400 mg / day for a period of more than a year can cause toxic polyneutropathy.
- With a lack of vitamins B 6 and E, polyneutropathy also occurs, as well as with their excess.
Toxic drug polyneuropathy ICD 10 is indicated by 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 necessary hormones or in violation of the functions of other internal organs of a person. The following types are distinguished:
- Diabetic polyneuropathy can begin acutely, progress slowly or fairly quickly. It manifests itself first in the form of pain and loss of sensation in the limbs.
- Polyneuropathy associated with paraproteinemia 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 diseases of the connective tissue of a diffuse type: periarthritis nodosa, rheumatoid arthritis, systemic lupus erythematosus, scleroderma.
- Hepatic polyneuropathy is a consequence of diabetes and alcoholism and has similar clinical manifestations.
- Neurological disorders in diseases of the gastrointestinal tract are associated with the pathology of the digestive system, leading to vitamin deficiencies. Celiac disease can provoke polyneuropathy, which is expressed in psychomotor disorders, epilepsy, visual disturbances, ataxia.
Polyneuropathy after chemotherapy
Toxic polyneuropathy after chemotherapy is allocated in a separate group of diseases, since it can be a side effect of taking medications or may result from 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 disease is expressed in violation of sensitivity and motor disorders, decreased muscle tone of the limbs. Polyneuropathy after chemotherapy, the symptoms of which are described above, can also cause the appearance of motor dysfunctions. Violations of the autonomic and central nervous system are less common.
Treatment of this type of disease is reduced to symptomatic therapy. The patient may be prescribed anti-inflammatory, painkillers, immunosuppressants, hormones, vitamins “Neuromultivit” and “Thiamine”.
Diagnosis of the disease
Toxic polyneuropathy of the lower extremities is diagnosed through the following studies:
- Ultrasound and x-ray of internal organs;
- cerebrospinal fluid analysis;
- study of reflexes and the speed of its passage through nerve fibers;
- biopsy.
The accuracy and timeliness of diagnosis depends on the success of the treatment of polyneuropathy.
Features of the treatment of the disease
Toxic polyneuropathy, the treatment of which primarily comes down to eliminating the causes of its occurrence, should be considered comprehensively.
The following medications are prescribed depending on the type of disease and the severity of its course:
- "Tramadol" and "Analgin" - with severe pain.
- "Methylprednisalon" - with a particularly severe course of the disease.
- "Pentoxifylline", "Wasonite", "Trental" - to enhance blood flow in the vessels of nerve fibers.
- Vitamins of group B.
- "Piracetam" and "Mildronate" - to enhance tissue absorption of nutrients.
As physiotherapeutic methods can be applied:
- electrical stimulation of the nervous system;
- massotherapy;
- magnetic stimulation of the nervous system;
- indirect effects on organs;
- hemodialysis, blood purification.
- Exercise therapy.
The method of treating polyneuropathy is most appropriate in a particular case, the doctor must decide. It is absolutely impossible to ignore the symptoms of the disease. Acute polyneuropathy can turn into chronic, which threatens with loss of sensitivity of the limbs, muscle atrophy and complete immobility.