Polyneuroradiculitis, type Guillain-Barré
This acutely occurring form of polyneuropathy is probably based on an overreaction of the immune system, which is directed against the body's own nervous tissue. The disease occurs in approximately 1.7 cases per 100, 000 inhabitants per year. Almost exclusively, motor nerve fibers are affected, so that from the appearance of complaints suddenly occurring muscle paralysis in the foreground.
Polyneuroradiculitis: loss of muscle reflexes
The paralysis focuses primarily on the pelvic girdle and shoulder area and is less pronounced on the hand and foot muscles. In more severe cases facial, ocular, gullet and trunk muscles may also be affected. Typically, there is a complete loss of muscle reflexes. Emotional disturbances clearly take a back seat compared to the symptoms of the muscular system.
Course of the polyneuritis Guillain-Barré
Polyneuritis Guillain-Barré belongs to the category of polyneuropathies, which are associated with damage to the nerve isolation layer. Accordingly, it may also be differentiated from other forms of polyneuropathy due to the significantly reduced peripheral nerve conduction velocities.
From the course of the disease, an acute form is usually distinguished with a favorable healing tendency from a chronic form with a worse prognosis. But even in the acute form, there is the possibility of fatal complications due to respiratory paralysis or serious cardiac arrhythmias. Overall, the range of possible manifestations ranging from minor discomfort with mild fatigue and uncharacteristic discomfort on a seemingly isolated paralysis of a muscle, for example, on the leg to suddenly from the legs "ascent" paralysis of the whole body.
Approximately 30 percent of all polyneuropathies are due to diabetes (diabetes mellitus), although polyneuropathy is sometimes only a minor symptom, but in some cases it can also control the symptoms. The basis of nerve damage is chronic vascular changes and circulatory disorders.
In the sensory forms of diabetic polyneuropathy, from the appearance of the symptoms, the focus is usually on the sensory disorders of the legs, which range from numbness to the image of the "burning soles of the feet". In addition, painful muscle cramps in the thigh and lower leg or generally dull, while lying increased pain in the lumbar, groin and thigh area added.
In case of involvement of motor nerve fibers paralysis of the pelvic and shoulder girdle muscles, sometimes also of the hands and feet may occur. All degrees of severity, from early muscle fatigue to severe paralysis with muscle cramps, are found. In some cases, the facial and eye muscles may also be affected.
If the polyneuropathy also affects the fibers of the autonomic nervous system, it can lead to disorders of perspiration and cardiovascular function. The extent of diabetic polyneuropathy is often not directly related to the severity of diabetes. The course of the disease is either creeping with a gradual increase in symptoms or acute, especially in those forms associated with muscle paralysis in the pelvic girdle area.
Alcohol-induced polyneuropathy is either an expression of the direct toxic effect of alcohol on nervous tissue or the sequelae of malnutrition, which is often encountered in alcoholics. The symptoms range from only mild feelings or discomfort mainly on the feet and legs to greater pain, calf cramps and sometimes muscle paralysis.
Particularly characteristic of the alcohol polyneuropathy is the paralysis of the peroneal nerve, which runs on the outside of the lower leg and is responsible for the extensor muscles of the forefoot. As a result, forefoot and toes can not be actively raised, which usually leads to a one-sided striking gait pattern. With severe alcohol abstinence, normalization of eating habits and especially the vitamin intake (vitamin B1), the neurological deficits and symptoms of alcoholic polyneuropathy are usually completely or partially reduced.
A special form of polyneuropathy occurs in chronic lead poisoning. Especially workers in accumulator factories or people who come into contact with manure or lead-based paints in their professional or private lives are at risk of inhaling poisonous amounts of lead by inhalation or through the gastrointestinal tract. In chronic poisoning patients complain about:
- a headache
- intestinal colic
Her skin is pale to grayish yellow.
The polyneuropathy characteristically manifests itself by a paralysis of the extensor musculature on the hands, more rarely also on the legs. Under certain circumstances, paralysis and muscle atrophy in the area of the thumb and small-finger bale or dysfunctions in the area of those muscles that are responsible for the spreading of the fingers and toes can also occur. The sensibility is usually less disturbed than the motor skills, pain does not occur. Hearing loss and vision problems can also be symptoms of lead polyneuropathy.
The nerve damage is reversible after excretion of the excess concentrations of lead and leaves only minor functional restrictions on the muscles.
Thallium poisoning occurs mainly after oral intake of certain rat or Mäusegiftmittel. General symptoms of poisoning are insomnia, increased salivation, palpitations and hair loss. The resulting polyneuropathy is accompanied by discomfort and sometimes severe pain in the feet and hands.
Very characteristic is a hypersensitivity of the soles, even the slightest touch causing unbearable pain. In addition, pelvic girdles may cause descending paralysis, muscle weakness, and facial discomfort. Even after excretion of thallium from the body, the neurological deficits of Thalliumpolyneuropathie partially persist.
The rare arsenic poisoning can damage the peripheral nervous system in the sense of polyneuropathy. Similar to thallium poisoning, there are unpleasant sensations and pain in the hands and feet. However, in contrast to thallium polyneuropathy, the signs of paralysis focus more on the hand and foot region than on the pelvic and shoulder girdles. A complete regression of neurological deficits is usually not.
Polyneuropathy in immune disorders of the vascular system
In particular, a special form of immune-related vascular disease, panarteritis nodosa, often occurs in combination with polyneuropathy. Like all other organ symptoms of the disease, polyneuropathy is an expression of circulatory disorders in the peripheral nervous system. The first symptom is often sensitive symptoms of irritation such as severe muscle and nerve pain. In the further course it comes to muscle paralysis and muscle wasting.
Polyneuropathy in rheumatoid arthritis
In the course of rheumatoid arthritis, symptoms may also arise, primarily due to circulatory disorders of the peripheral nervous system. The symptoms range from sensory or motor deficits in the supply area of individual nerves (for example, the hands) to isolated sensory disorders of the fingers without involvement of the thumb to acute pain and discomfort on the legs with subsequent paralysis.
The prognosis of this polyneuropathy is more unfavorable in combined infestations of the sensory and motor nervous systems than in purely emotional disorders.