Semin Neurol 2009; 29(2): 124-135
DOI: 10.1055/s-0029-1213733
© Thieme Medical Publishers

Peripheral Nerve Complications of Medical Disease

Hannah R. Briemberg1
  • 1Department of Medicine, Division of Neurology, Neuromuscular Disorders Unit, University of British Columbia, Vancouver, British Columbia, Canada
Further Information

Publication History

Publication Date:
15 April 2009 (online)

ABSTRACT

Neuropathies are associated with several systemic diseases. This article provides a general overview of the clinical presentation and management of the various neuropathies associated with common medical illnesses. The term “neuropathy” is used relatively broadly to encompass pathology from the level of the cell body to the terminal axon. Peripheral nerve disorders associated with diabetes, thyroid disease, connective tissue disease, cancer, and infection are discussed. The relationship between the various neuropathies and systemic illness is important to recognize because neuropathy may be the initial presentation of one of these underlying medical conditions. Alternatively, the presence of a known associated medical condition in a patient presenting with neuropathy may affect management decisions and limit unnecessary investigations.

REFERENCES

  • 1 Centers for Disease Control and Prevention .National Diabetes Surveillance System. Available at: http://www.cdc.gov/diabetes/statistics/index.htm Accessed August 20, 2008
  • 2 Singleton J R, Smith A G, Bromberg M B. Painful sensory polyneuropathy associated with impaired glucose tolerance.  Muscle Nerve. 2001;  24(9) 1225-1228
  • 3 Martyn C N, Hughes R AC. Epidemiology of peripheral neuropathy.  J Neurol Neurosurg Psychiatry. 1997;  62 310-318
  • 4 Winkler A S, Ejskjaer N, Edmonds M et al.. Dissociated sensory loss in diabetic autonomic neuropathy.  Diabet Med. 2000;  17(6) 457-462
  • 5 Behse F, Buchthal F, Carlsen F. Nerve biopsy and conduction studies in diabetic neuropathy.  J Neurol Neurosurg Psychiatry. 1977;  40 1072-1082
  • 6 The Diabetes Control and Complications Trial Research Group . The effect of intensive treatment of diabetes on the development and progression of long-term complications of insulin-dependent diabetes mellitus.  N Engl J Med. 1993;  329(14) 977-986
  • 7 Azad N, Emanuele N V, Abraira C et al.. The effects of intensive glycemic control on neuropathy in the VA cooperative study on type II diabetes mellitus (VA CSDM).  J Diabetes Complications. 1999;  13(5–6) 307-313
  • 8 Weber R B, Daroff R B, Mackey E A. Pathology of oculomotor nerve palsy in diabetics.  Neurology. 1970;  20 835-838
  • 9 Al-Qattan M M, Manktelow R T, Bowen C V. Outcome of carpal tunnel release in diabetic patients.  J Hand Surg [Br]. 1994;  19(5) 626-629
  • 10 Chaudhuri K R, Wren D R, Werring D. Unilateral abdominal muscle herniation with pain: a distinctive variant of diabetic radiculopathy.  Diabet Med. 1997;  14(9) 803-807
  • 11 Dyck P J, Norell J E, Dyck P J. Microvasculitis and ischemia in diabetic lumbosacral radiculoplexus neuropathy.  Neurology. 1999;  53 2113-2121
  • 12 Barohn R J, Sahenk Z, Warmolts J R, Mendell J R. The Bruns-Garland syndrome (diabetic amyotrophy). Revisited 100 years later.  Arch Neurol. 1991;  48(11) 1130-1135
  • 13 Kelkar P, Masood M, Parry G J. Distinctive pathologic findings in proximal diabetic neuropathy (diabetic amyotrophy).  Neurology. 2000;  55 83-88
  • 14 Llewelyn J G, Thomas P K, King R H. Epineurial microvasculitis in proximal diabetic neuropathy.  J Neurol. 1998;  245 159-165
  • 15 Kawagashira Y, Watanabe H, Oki Y et al.. Intravenous immunoglobulin therapy markedly ameliorates muscle weakness and severe pain in proximal diabetic neuropathy.  J Neurol Neurosurg Psychiatry. 2007;  78(8) 899-901
  • 16 Ogawa T, Taguchi T, Tanaka Y, Ikeguchi K, Nakano I. Intravenous immunoglobulin therapy for diabetic amyotrophy.  Intern Med. 2001;  40(4) 349-352
  • 17 Krendel D A, Costigan D A, Hopkins L C. Successful treatment of neuropathies in patients with diabetes mellitus.  Arch Neurol. 1995;  52(11) 1053-1061
  • 18 Zochodne D W, Isaac D, Jones C. Failure of immunotherapy to prevent, arrest or reverse diabetic lumbosacral plexopathy.  Acta Neurol Scand. 2003;  107(4) 299-301
  • 19 Kececi H, Degirmenci Y. Hormone replacement therapy in hypothyroidism and nerve conduction study.  Neurophysiol Clin. 2006;  36(2) 79-83
  • 20 Van Dijk M A, Reitsma J B, Fischer J C, Sanders G T. Indications for requesting laboratory tests for concurrent diseases in patients with carpal tunnel syndrome: a systematic review.  Clin Chem. 2003;  49(9) 1437-1444
  • 21 Beghi E, Delodovici M L, Bogliun G et al.. Hypothyroidism and polyneuropathy.  J Neurol Neurosurg Psychiatry. 1989;  52(12) 1420-1423
  • 22 Nemni R, Bottacchi E, Fazio R et al.. Polyneuropathy in hypothyroidism: clinical, electrophysiological and morphological findings in four cases.  J Neurol Neurosurg Psychiatry. 1987;  50(11) 1454-1460
  • 23 Hawke S H, Davies L, Pamphlett R, Guo Y P, Pollard J D, McLeod J G. Vasculitic neuropathy. A clinical and pathological study.  Brain. 1991;  114 2175-2190
  • 24 Said G, Lacroix-Ciaudo C, Fujimura H, Blas C, Faux N. The peripheral neuropathy of necrotizing arteritis: a clinicopathological study.  Ann Neurol. 1988;  23 461-465
  • 25 Kissel J T, Slivka A P, Warmolts J R, Mendell J R. The clinical spectrum of necrotizing angiopathy of the peripheral nervous system.  Ann Neurol. 1985;  18 251-257
  • 26 Moore P M, Richardson B. Neurology of the vasculitides and connective tissue diseases.  J Neurol Neurosurg Psychiatry. 1998;  65(1) 10-22
  • 27 Ng K K, Yeung H M, Loo K T, Chan H M, Wong C K, Li P C. Acute fulminant neuropathy in a patient with Churg-Strauss syndrome.  Postgrad Med J. 1997;  73(858) 236-238
  • 28 Terrier B, Lacroix C, Guillevin L et al.. Diagnostic and prognostic relevance of neuromuscular biopsy in primary Sjögren's syndrome-related neuropathy.  Arthritis Rheum. 2007;  57(8) 1520-1529
  • 29 Delalande S, de Seze J, Fauchais A L et al.. Neurologic manifestations in primary Sjögren syndrome: a study of 82 patients.  Medicine (Baltimore). 2004;  83(5) 280-291
  • 30 Mellgren S I, Conn D L, Stevens J C, Dyck P J. Peripheral neuropathy in primary Sjögren's syndrome.  Neurology. 1989;  39(3) 390-394
  • 31 Ramos-Casals M, Nardi N, Lagrutta M et al.. Vasculitis in systemic lupus erythematosus: prevalence and clinical characteristics in 670 patients.  Medicine (Baltimore). 2006;  85(2) 95-104
  • 32 Moore P M. Vasculitic neuropathies.  J Neurol Neurosurg Psychiatry. 2000;  68(3) 271-274
  • 33 Collins M P, Mendell J R, Periquet M I et al.. Superficial peroneal nerve/peroneus brevis muscle biopsy in vasculitic neuropathy.  Neurology. 2000;  55(5) 636-643
  • 34 Griffin J W, Cornblath D R, Alexander E et al.. Ataxic sensory neuropathy and dorsal root ganglionitis associated with Sjögren's syndrome.  Ann Neurol. 1990;  27(3) 304-315
  • 35 Malinow K, Yannakakis G D, Glusman S M et al.. Subacute sensory neuronopathy secondary to dorsal root ganglionitis in primary Sjögren's syndrome.  Ann Neurol. 1986;  20(4) 535-537
  • 36 Molina J A, Benito-Leon J, Bermejo F, Jiménez-Jiménez F J, Oliván J. Intravenous immunoglobulin therapy in sensory neuropathy associated with Sjögren's syndrome.  J Neurol Neurosurg Psychiatry. 1996;  60(6) 699
  • 37 Takahashi Y, Takata T, Hoshino M, Sakurai M, Kanazawa I. Benefit of IVIG for long-standing ataxic sensory neuronopathy with Sjögren's syndrome.  Neurology. 2003;  60 503-505
  • 38 Hagen N A, Stevens J C, Michet C J. Trigeminal sensory neuropathy associated with connective tissue diseases.  Neurology. 1990;  40 891-896
  • 39 Wasserstrom W R, Glass J P, Posner J B. Diagnosis and treatment of leptomeningeal metastasis from solid tumors: experience with 90 patients.  Cancer. 1982;  49 759-772
  • 40 DeAngelis L M. Current diagnosis and treatment of leptomeningeal metastasis.  J Neurooncol. 1998;  38 245-252
  • 41 Kori S H, Foley K M, Posner J B. Brachial plexus lesions in patients with cancer: 100 cases.  Neurology. 1981;  31 45-50
  • 42 Mullins G M, O'Sullivan S S, Neligan A et al.. Non-traumatic brachial plexopathies, clinical, radiological and neurophysiological findings from a tertiary centre.  Clin Neurol Neurosurg. 2007;  109(8) 661-666
  • 43 Ahmad A, Barrington S, Maisey M, Rubens R D. Use of positron emission tomography in evaluation of brachial plexopathy in breast cancer patients.  Br J Cancer. 1999;  79(3–4) 478-482
  • 44 Ampil F L. Radiotherapy for carcinomatous brachial plexopathy: a clinical study of 23 cases.  Cancer. 1985;  56 2185-2188
  • 45 Jaeckle K A, Young D F, Foley K M. The natural history of lumbosacral plexopathy in cancer.  Neurology. 1985;  35 8-15
  • 46 Kelly J J, Kyle R A, Miles J M et al.. The spectrum of peripheral neuropathy in myeloma.  Neurology. 1981;  31 24-31
  • 47 Sumi S M, Farrell D F, Knauss T A. Lymphoma and leukemia manifested by steroid-responsive polyneuropathy.  Arch Neurol. 1983;  40 577-582
  • 48 Krendel D A, Stahl R L, Chan W C. Lymphomatous polyneuropathy. Biopsy of clinically involved nerve and successful treatment.  Arch Neurol. 1991;  48 330-332
  • 49 Kuwabara S, Misawa S, Kanai K et al.. Neurologic improvement after peripheral blood stem cell transplantation in POEMS syndrome.  Neurology. 2008;  71 1691-1695
  • 50 Chalk C H, Windebank A J, Kimmel D W, McManis P G. The distinctive clinical features of paraneoplastic sensory neuronopathy.  Can J Neurol Sci. 1992;  19 346-351
  • 51 Camdessanché J-P, Antoine J-C, Honnorat J et al.. Paraneoplastic peripheral neuropathy associated with anti-Hu antibodies. A clinical and electrophysiological study of 20 patients.  Brain. 2002;  125 166-175
  • 52 Sagar H J, Read D J. Subacute sensory neuropathy with remission: an association with lymphoma.  J Neurol Neurosurg Psychiatry. 1982;  45 83-85
  • 53 Gabriel C M, Gregson N A, Hughes R AC. Sensory neuropathy and anti-Hu antibodies in a patient with seminoma.  Eur J Neurol. 1996;  3 471-474
  • 54 Verschuuren J, Twijnstra A, De Baets M et al.. Hu antigens and anti-Hu antibodies in a patient with myxoid chondrosarcoma.  Neurology. 1994;  44 1551-1552
  • 55 Oh S J, Dropcho E J, Claussen G C. Anti-Hu-associated paraneoplastic sensory neuropathy responding to early aggressive immunotherapy: report of two cases and review of literature.  Muscle Nerve. 1997;  20 1576-1582
  • 56 Titulaer M J, Wirtz P W, Kuks J B et al.. The Lambert-Eaton myasthenic syndrome 1988: a clinical picture in 97 patients.  J Neuroimmunol. 2008;  201-202 153-158
  • 57 O'Neill J H, Murray N M, Newsom-Davis J. The Lambert-Eaton myasthenic syndrome. A review of 50 cases.  Brain. 1988;  111 577-596
  • 58 Tim R W, Massey J M, Sanders D B. Lambert-Eaton myasthenic syndrome: electrodiagnostic findings and response to treatment.  Neurology. 2000;  54 2176-2178
  • 59 Lennon V A, Kryzer T J, Griesmann G E et al.. Calcium-channel antibodies in Lambert-Eaton and other paraneoplastic syndromes.  N Engl J Med. 1995;  332 1467-1474
  • 60 Oguro-Okano M, Griesmann G E, Wieben E D, Slaymaker S J, Snutch T P, Lennon V A. Molecular diversity of neuronal-type calcium channels identified in small cell lung carcinoma.  Mayo Clin Proc. 1992;  67 1150-1159
  • 61 Jenkyn L R, Brooks P L, Forcier R J, Maurer L H, Ochoa J. Remission of Lambert-Eaton syndrome and small cell anaplastic carcinoma of the lung induced by chemotherapy and radiotherapy.  Cancer. 1980;  46 1123-1127
  • 62 Newsom-Davis J. Autoimmune neuromyotonia (Isaacs' syndrome): an antibody-mediated potassium channelopathy.  Ann N Y Acad Sci. 1997;  835 111-119
  • 63 Fathers E, Thrush D, Huson S M, Norman A. Radiation-induced brachial plexopathy in women treated for carcinoma of the breast.  Clin Rehabil. 2002;  16 160-165
  • 64 Lederman R J, Wilbourn A J. Brachial plexopathy. Recurrent cancer or radiation?.  Neurology. 1984;  34 1331-1335
  • 65 Harper C M, Thomas J E, Cascino T L, Litchy W J. Distinction between neoplastic and radiation-induced brachial plexopathy, with emphasis on the role of EMG.  Neurology. 1989;  39 502-506
  • 66 Bowen J, Gregory R, Squier M, Donaghy M. The post-irradiation lower motor neuron syndrome: neuronopathy or radiculopathy?.  Brain. 1996;  119 1429-1439
  • 67 Maier J G, Perry R H, Saylor W, Sulak M H. Radiation myelitis of the dorsolumbar spinal cord.  Radiology. 1969;  93 153-160
  • 68 Thomas J E, Cascino T L, Earle J D. Differential diagnosis between radiation and tumor plexopathy of the pelvis.  Neurology. 1985;  35 1-7
  • 69 Postma T J, Vermorken J B, Liefting A J, Pinedo H M, Heimans J J. Paclitaxel-induced neuropathy.  Ann Oncol. 1995;  6 489-494
  • 70 Chaudhry V, Cornblath D R, Corse A, Freimer M, Simmons-O'Brien E, Vogelsang G. Thalidomide-induced neuropathy.  Neurology. 2002;  59(12) 1872-1875
  • 71 Richardson P G, Briemberg H, Jagannath S et al.. Frequency, characteristics, and reversibility of peripheral neuropathy during treatment of advanced multiple myeloma with bortezomib.  J Clin Oncol. 2006;  24(19) 3113-3120
  • 72 Roelofs R I, Hrushesky W, Rogin J, Rosenberg L. Peripheral sensory neuropathy and cisplatin chemotherapy.  Neurology. 1984;  34 934-938
  • 73 Igarashi M, Thompson E, Rivera G K. Vincristine neuropathy in type I and type II Charcot-Marie-Tooth disease (hereditary motor sensory neuropathy).  Med Pediatr Oncol. 1995;  25 113-116
  • 74 Mercuri E, Poulton J, Buck J et al.. Vincristine treatment revealing asymptomatic hereditary motor sensory neuropathy type 1A.  Arch Dis Child. 1999;  81 442-443
  • 75 Naumann R, Mohm J, Reuner U, Kroschinsky F, Rautenstrauss B, Ehninger G. Early recognition of hereditary motor and sensory neuropathy type 1 can avoid life-threatening vincristine neurotoxicity.  Br J Haematol. 2001;  115 323-325
  • 76 Hildebrandt G, Holler E, Woenkhaus M et al.. Acute deterioration of Charcot-Marie-Tooth disease 1A (CMT 1A) following 2 mg of vincristine chemotherapy.  Ann Oncol. 2000;  11 743-747
  • 77 Lacomis D, Petrella J T, Giuliani M J. Causes of neuromuscular weakness in the intensive care unit: a study of ninety-two patients.  Muscle Nerve. 1998;  21 610-617
  • 78 Zochodne D W, Bolton C F, Wells G A et al.. Critical illness polyneuropathy. A complication of sepsis and multiple organ failure.  Brain. 1987;  110 819-842
  • 79 Gonzalez-Duarte A, Robinson-Papp J, Simpson D M. Diagnosis and management of HIV-associated neuropathy.  Neurol Clin. 2008;  26(3) 821-832
  • 80 Cornblath D R, McArthur J C. Predominantly sensory neuropathy in patients with AIDS and AIDS-related complex.  Neurology. 1988;  38 794-796
  • 81 Simpson D M, Kitch D, Evans S R et al.. HIV neuropathy natural history cohort study: assessment measures and risk factors.  Neurology. 2006;  66 1679-1687
  • 82 Morgello S, Estanislao L, Simpson D et al.. HIV-associated distal sensory polyneuropathy in the era of highly active antiretroviral therapy.  Arch Neurol. 2004;  61 546-551
  • 83 Berger A R, Arezzo J, Schaumburg H et al.. 2',3'-dideoxycytidine (ddC) toxic neuropathy: a study of 52 patients.  Neurology. 1993;  43 358-362
  • 84 Brannagan 3rd T H, Zhou Y. HIV-associated Guillain-Barré syndrome.  J Neurol Sci. 2003;  208(1–2) 39-42
  • 85 Leger J M, Bouche P, Bolgert F et al.. The spectrum of polyneuropathies in patients infected with HIV.  J Neurol Neurosurg Psychiatry. 1989;  52(12) 1369-1374
  • 86 Roullet E, Assuerus V, Gozlan J et al.. Cytomegalovirus multifocal neuropathy in AIDS: analysis of 15 consecutive cases.  Neurology. 1994;  44 2174-2182
  • 87 Miller R F, Fox J D, Thomas P et al.. Acute lumbosacral polyradiculopathy due to cytomegalovirus in advanced HIV disease: CSF findings in 17 patients.  J Neurol Neurosurg Psychiatry. 1996;  61(5) 456-460
  • 88 Corral I, Quereda C, Casado J L et al.. Acute polyradiculopathies in HIV-infected patients.  J Neurol. 1997;  244(8) 499-504
  • 89 Sejvar J J, Bode A V, Marfin A A et al.. West Nile virus-associated flaccid paralysis.  Emerg Infect Dis. 2005;  11(7) 1021-1027
  • 90 Leis A A, Stokic D S, Polk J L, Dostrow V, Winkelmann M. A poliomyelitis-like syndrome from West Nile virus infection.  N Engl J Med. 2002;  347 1279-1280
  • 91 Glass J D, Samuels O, Rich M M. Poliomyelitis due to West Nile virus.  N Engl J Med. 2002;  347 1280-1281
  • 92 Roos K L. Fever and asymmetrical weakness in the summer: evidence of a West Nile virus-associated poliomyelitis-like illness.  Mayo Clin Proc. 2003;  78(19) 1205-1206
  • 93 Ahmed S, Libman R, Wesson K, Ahmed F, Einberg K. Guillain-Barré syndrome: an usual presentation of West Nile virus infection.  Neurology. 2000;  55(1) 144-146
  • 94 Cepok S, Zhou D, Vogel F et al.. The immune response at onset and during recovery from Borrelia burgdorferi meningoradiculitis.  Arch Neurol. 2003;  60(6) 849-855
  • 95 Halperin J, Luft B J, Volkman D J, Dattwyler R J. Lyme neuroborreliosis. Peripheral nervous system manifestations.  Brain. 1990;  113(Pt 4) 1207-1221
  • 96 Stanek G, Strle F. Lyme disease: European perspective.  Infect Dis Clin North Am. 2008;  22(2) 327-339
  • 97 Kristoferitsch W, Sluga E, Graf M et al.. Neuropathy associated with acrodermatitis chronica atrophicans. Clinical and morphological features.  Ann N Y Acad Sci. 1988;  539 35-45
  • 98 Mygland A, Skarpaas T, Ljostad U. Chronic polyneuropathy and Lyme disease.  Eur J Neurol. 2006;  13(11) 1213-1215
  • 99 Hemrika D J, Schutte M F, Bleker O P. Elsberg syndrome: a neurologic basis for acute urinary retention in patients with genital herpes.  Obstet Gynecol. 1986;  68(3, Suppl) 37S-39S
  • 100 Eberhardt O, Küker W, Dichgans J, Weller M. HSV-2 sacral radiculitis (Elsberg syndrome).  Neurology. 2004;  63(4) 758-759
  • 101 Haanpaa M, Hakkinen V, Nurmikko T. Motor involvement in acute herpes zoster.  Muscle Nerve. 1997;  20(11) 1433-1438
  • 102 Greenberg M K, McVey A L, Hayes T. Segmental motor involvement in herpes zoster: an EMG study.  Neurology. 1992;  42(5) 1122-1123
  • 103 Dworkin R H, Johnson R W, Breuer J et al.. Recommendations for the management of herpes zoster.  Clin Infect Dis. 2007;  44(Suppl 1) S1-S26
  • 104 Acharya J N, Pacheco V H. Neurologic complications of hepatitis C.  Neurologist. 2008;  14(3) 151-156
  • 105 Tsukada N, Koh C S, Inoue A, Yanagisawa N. Demyelinating neuropathy associated with hepatitis B virus infection. Detection of immune complexes composed of hepatitis B virus surface antigen.  J Neurol Sci. 1987;  77(2–3) 203-216
  • 106 Macleod W N. Sporadic non-A, non-B hepatitis and Epstein-Barr hepatitis associated with the Guillain-Barré syndrome.  Arch Neurol. 1987;  44(4) 438-442
  • 107 De Klippel N, Hautekeete M L, De Keyser J, Ebinger G et al.. Guillain-Barré syndrome as the presenting manifestation of hepatitis C infection.  Neurology. 1993;  43(10) 2143
  • 108 Pagnoux C, Cohen P, Guillevin L. Vasculitides secondary to infections.  Clin Exp Rheumatol. 2006;  24(suppl 41) S71-S81

Hannah R BriembergM.D. F.R.C.P.C. 

Neuromuscular Disorders Unit

2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9

Email: hannah.briemberg@vch.ca

    >