Neuropathy and other systemic diseases
Hypothyroidism:
entrapment neuropathies are common – could be due to compression from swelling or the deposition of acid mucopolysaccharide protein complexes in nerve
polyneuropathy – rare – commonly affects feet first, then hands. Feet are painful, tired and feel weak initially – then may develop paraesthesias and numbness
recovery is often complete after thyroid replacement therapy
Porphyria:
polyneuropathy may develop
sensory loss is variable
Renal failure:
half those on renal dialysis develop a neuropathy; earliest signs are loss of vibration sense and loss of reflexes
uraemic polyneuropathy (associated with chronic renal failure) – distal, symmetric, mixed motor and sensory neuropathy; feet more involved than hands; restless leg syndrome can occur; painful burning of soles of feet in up to 10%; early, can have unpleasant sensations (shooting pains, tingling) on stimulation of skin on toes and/or fingers; tendon reflexes lost early; vibration perception threshold increased
renal transplant often results in improvement
Liver disease:
• chronic demyelinating neuropathy in chronic liver failure; often subclinical, but painful form can occur in primary biliary cirrhosis
Respiratory disease:
• distal polyneuropathy was described in 7 of 8 patients with advanced chronic obstructive disease
• several studies have described a subclinical neuropathy in those with obstructive respiratory diseases
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