Patients with numblimbs in March, these 9 diseases which do you consider?

As a neurologist, it is often difficult to diagnose the disease definitively due to the many causes of peripheral neuropathyThe causes and related knowledge of peripheral neuropathy are now known through one casecasepatient woman, 72 years old, because of "the numbness of limbs in March" hospitalthe current medical history: before March, the patient has no obvious cause stoic inexorable numbness, no swallowing difficulty, drinking cough, no joint pain, no mouth ulcer, no rash, no mouth dry, dry eye, symptoms of progressive aggravation, from the far end of the limbs gradually spread to the near end, has been to External hospital consultation, nutrition nerve, improve microcirculation and other treatment, the patient's symptoms are still gradually aggravated, the performance is not able to stand, double hand-held object can not, for treatment to our hospital outpatient consultation, to check the electromyography "extensive peripheral nerve damage, double lower limbs are tired of the heavy", for further diagnosis and treatment of outpatient income hospitalpatients since the onset of disease, the spirit, appetite, sleep in general, stool 2-4 times / day, normal urination, weight loss of more than 10 poundshas a history of denying chronic diseases such as diabetesDeny a history of alcoholismDenied a history of toxic contactDeny family historycheck body: clear mind, normal cognitive function, clear tone, cranial nerve did not see positive signs, elbow and knee below the pain of the weakened, double upper limb near-end muscle strength 5-level, far-end muscle strength 4, double lower limb near-end muscle strength 4-level, far-end muscle force 3, quadriplegum tendon reflexes did not lead, double-sided characteristic negative, brain attack negativeMild edema of the lower extremitiesauxiliary examination: myoelectric illustration: extensive peripheral nerve damage, both lower limbs are severely affectedthe incidence of chronic multiple neuropathy in the elderly need to consider the following:1, endocrine metabolic diseases: diabetes, uremia, hypothyroidism;3, chronic inflammatory demyelinator multiple neuropathy;4, connective tissue disease: systemic lupus (SLE), dry syndrome (SS), rheumatoid arthritis (RA), vasculitis, etc.;5, HIV, syphilis;6, amyloid peripheral neuropathy;7, paratumor peripheral neuropathy;8, POEMS syndrome;to improve the relevant examination after admission, urine routine, stool routine, blood biochemistry, glycated hemoglobin, rheumatic triumphonism, AFP, CEA, CA199, ENA peptides, antinuclear antibody screening, folic acid, VitB12, homocysteine normalHIV, syphilis antibodies (-)Anti-neutral granulocytes plasma antibodies (-)Urine week protein (-)Blood routine: PLT 399 x 109/LESR 26mm/hthyroid function: T3 1.86 pg/mL, T4 0.80 ng/dL, TSH 12.99mIU/Lwaist: pressure 200mmH2O, red blood cell count 4 x 106/L, white blood cell count 5 x 106/L, protein 3125.14 mg/L, sugar 4.47mmol/L, chloride 126.3mmol/Labdominal and urological and gynaecological color overshow: large spleen, left kidney cyst bone marrow smear show: bone marrow hyperplasia active, granules: red s 1.49:1, granules, red, giant three-line hyperplasia active, platelets scattered in piles, easily seen, myelin plasma cells slightly increased, part of the volume is slightly larger, and see double-core pulp cells immunofixed electrophoresis: IgA-type M proteinemia serum vascular endothelial growth factor 427.5 pg/mL (20 to 65 pg/mL) patients had multiple peripheral neuropathy, IgA-type M protein, elevated serum vascular endothelial growth factor, swelling of the spleen, hypothyroidism, double lower limb edema, diagnosed as POEMS syndrome treatment: Patients and their families refused chemotherapy and did not improve their symptoms in patients treated with supplementation of l-thyroxine tablets and B vitamins POEMS syndrome is a rare multi-system disease characterized by multiple peripheral neuropathy (P), organ enlargement (O), endocrine lesions (E), M protein (M), and skin change (S) The prevalence rate is low, about 0.3 per 100,000, but the disability rate is high, the median survival of patients is about 5 to 7 years PATIENTS WITH POEMS SYNDROME HAVE PERIPHERAL NERVE DAMAGE, AND MANY PATIENTS ARE TREATED IN NEUROLOGY FOR THEIR PERIPHERAL NEUROPATHY As a neurologist, proper diagnosis of the disease at an early stage is beneficial to patients' prognosis The following is introduced in the poemS syndrome of multiple peripheral neuropathy characteristics (clinical manifestations, neuroelectrophysiology, neuropathic), cerebrospinal fluid performance, diagnostic criteria and treatment multiple peripheral neuropathy clinical manifestations: , the appearance of the distant end of the limbs symmetrical sensory disorder (numbness, tingling and chill) and muscle weakness, the lower limbs more obvious, gradually to the near end of the development, the initial weakness of the symptoms is not serious, but with the progress of the disease, the inability to feel symptoms more prominent Some patients may develop muscle atrophy at the far end of the limbs The autonomic nerve is less affected, except for the visual nipple edema, not tired of the brain nerve neuroelectrophysiology: 1 The movement and sensory nerve conduction slow down, there can be a decrease in the motion potential wave; neuropathy: the fibula nerve biopsy can be seen in varying degrees of axial degeneration and segmented demyelin, with axial degeneration and new angiogenesis of the nerve exosome as the main manifestation cerebrospinal fluid performance: Cerebral spinal fluid pressure is normal or slightly increased, cell count is normal or slightly increased, protein quantification is often increased (cell-protein separation, but no specificity) Attention should be paid to the identification of chronic inflammatory demyelinating multiple neuropathy diagnostic criteria: PoemS syndrome can be diagnosed with at least 1 primary standard, including the necessary conditions 2 mandatory standards and at least 1 secondary standard Table 1 POEMS syndrome diagnostic criteria and symptoms treatment: treatment of the cause of monoclonal plasma cell disease: 1 Only patients with bone marrow disease (2 in-patient lesions) were not found: observation, every 3 to 6 months assessment; 2 Patients with a number of pure bone marrow lesions greater than or equal to 3 or more or who have found evidence of cloned plasma cell disease: treatments such as glucocorticoids, macfarge-dexamethasone, cyclophosphamide-dexamethasone, salidoamine-dexamethasone, boronitami, bevamono-resistance, autologous stem cell transplantation, etc treatment of peripheral neuropathy: b vitamin supplementation, and, if necessary, nerve pain support treatment: rehabilitation exercise, alternative treatment, diuretic deflator, antiplatelet aggregation, etc author: Jane?
Source: , Medical Neurology Channel