Peripheral Neuropathy

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Disorders of the Peripheral Nerves/Peripheral Neuropathy

Four types of pathophysiological changes can affect peripheral nerves:
1) Wallerian degeneration:
• develops after injury to nerve
• interruption or transection of axon  pathological changes (Wallerian degeneration)
• axonal segment and myelin sheath distal to injury breakdown and conduction fails  followed by attempts at regeneration (depends on proximity of nerve ends, the extent of Schwann tube and surrounding tissue damage)

2) Axonal atrophy and degeneration:
• distal part of axon breaks down due to a metabolic disturbance
• results in denervation of muscle  atrophy (reinnervation from surrounding nerves can occur)
• changes usually have a sensory loss in ‘glove-and-stocking’ distribution

3) Neuronal degeneration (neuronopathy):
• destruction of nerve cell body
• loss of axons and degeneration of myelin sheath
• (often difficult to distinguish from axonal atrophy degeneration)

4) Demyelination:
• develops after damage to myelin sheath, with sparing of axons
• nerve conduction is slowed
• no muscle atrophy (muscle is not dennervated)

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