Polyneuropathy Of Unknown Etiology In An Adult Female With Anatomic Variants

Polyneuropathy Of Unknown Etiology In An Adult Female With Anatomic Variants

Ricardo Senno,^1,2 Dylan Tookey,¹ Erin Dominiak³

¹Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois, USA
²Sennogroup Wellness and Rehabilitation, Northbrook, Illinois, USA
³Family Medicine, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA

One of the earliest descriptions of neuralgia dates back to John Fothergill in 1773.¹ However, the concept of nerve pain can be traced to physicians like Rhazes (d. 925), Haly Abbas (d. 982), Avicenna (d. 1037), and Jorjani (d. 1137) who discussed multiple aspects of neuropathic pain including its classification, etiology, differentiating characteristics, qualities, and pharmacologic and nonpharmacologic treatments.² Currently, neuropathy is a general term describing many signs and symptoms caused by dysfunction of the nervous system.³ Peripheral neuropathies are largely associated with pins and needles sensation, but can also include a range of symptoms from paresthesias to severe chronic dysesthesia. The burning pain of severe polyneuropathy can become so intense that it significantly impacts quality of life. In order to effectively treat neuropathy, it is essential to determine the underlying mechanism.³

According to Levine (2018), neuropathy can be caused by diabetes mellitus, impaired glucose tolerance, primary systemic amyloidosis, familial amyloidosis, Fabry disease, Lupus, vitamin B12 deficiency, celiac disease, Sjögren’s syndrome, sarcoidosis, paraproteinemia, HIV, or paraneoplastic syndrome. In addition, neuropathy can also be produced by various immune-mediated responses, inherited diseases, alcohol abuse, chemotherapy, medications, and trauma.⁴ Recently, SARS CoV-2 (COVID-19) has been reported to produce possible neuropathic pain in up to 2.3% of patients hospitalized with COVID-19, but this prevalence is probably underestimated because chronic neuropathic pain may develop months after injury to the nervous system.⁵ Prevalence of neuropathy ranges from 0.8 to 17.9%, with an estimated male-to-female ratio of 1:2; about 8% of adults over 65 report some degree of neuropathy.^7,8

Current treatment options for neuropathies include: tricyclic antidepressants (i.e., amitrip-tyline), serotonin norepinephrine reuptake inhibitors (i.e., duloxetine), anticonvulsants (i.e., carbamazepine), antispasticity agents (i.e., baclofen), weak opioid agents (i.e., tramadol), topical agents (i.e., lidocaine, capsaicin), and antiarrhythmics (i.e., mexiletine). Opioids are becoming controversial in treatment of neuropathy due to increasing concerns of public abuse, as well as adverse effects on gastrointestinal function.⁴ Surgical treatments include spinal cord stimulator, nerve decompression, and sympathetic blocks. Rehabilitation modalities include desensitization, cardiovascular exercise, and biofeedback. In most cases, the goals in treating chronic neuropathy are 50% reduction of pain and resultant increase in function.

IVIg has had positive results in treating neuropathic pain caused by idiopathic small fiber neuropathy and current studies are looking at blocking angiotensin II (type 2) receptors and the use of erythropoietin.⁴ Treatment choice should be based on side effect profile, patient choice, medication interaction, pathophysiology, and pharmacogenomics.

Keywords: Polyneuropathy; Unknown Etiology; Anatomic Variants

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How to cite this article:

Ricardo Senno, Dylan Tookey,Erin Dominiak. Polyneuropathy Of Unknown Etiology In An Adult Female With Anatomic Variants. International Journal of Case Reports, 2023, 7:286. DOI: 10.28933/ijcr-2023-01-1005dt

References:

1. Akyuz G, & Bektaşoğlu P (2019). Neuropathic pain. Mitra R(Ed.), Principles of Rehabilitation Medicine. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=2550&sectionid=206762899
2. Heydari M, Shams M, Hashempur MH, Zargaran A, Dalfardi B, Borhani-Haghighi A. THE ORIGIN OF THE CONCEPT OF NEUROPATHIC PAIN IN EARLY MEDIEVAL PERSIA (9TH-12TH CENTURY CE). Acta Med Hist Adriat. 2015;13 Suppl 2:9-22. PMID: 26966748.
3. Colloca, L., Ludman, T., Bouhassira, D. et al. Neuropathic pain. Nat Rev Dis Primers 3, 17002 (2017). https://doi.org/10.1038/nrdp.2017.2
4. Levine T. D. (2018). Small Fiber Neuropathy: Disease Classification Beyond Pain and Burning. Journal of central nervous system disease, 10, 1179573518771703. https://doi.org/10.1177/1179573518771703
5. Attal, N., Martinez, V., & Bouhassira, D. (2021). Potential for increased prevalence of neuropathic pain after the COVID-19 pandemic. Pain reports, 6(1), e884. https://doi.org/10.1097/PR9.0000000000000884
6. Smith, B.H., Torrance, N. Epidemiology of Neuropathic Pain and Its Impact on Quality of Life. Curr Pain Headache Rep 16, 191–198 (2012). https://doi.org/10.1007/s11916-012-0256-0
7. Fillingim, R. B., King, C. D., Ribeiro-Dasilva, M. C., Rahim-Williams, B., & Riley, J. L., 3rd (2009). Sex, gender, and pain: a review of recent clinical and experimental findings. The journal of pain, 10(5), 447–485. https://doi.org/10.1016/j.jpain.2008.12.001
8. Cleveland Clinic. (2021, December 16). Neuropathy (peripheral neuropathy). Cleveland clinic. https://my.clevelandclinic.org/health/diseases/14737-neuropathy
9. Admera Health. (2020). PGxOneTM Plus Pharmacogenetic test results.
10. NIH. (2022). National library of medicine. Retrieved January 26, 2022, from https://www.ncbi.nlm.nih.gov/gene/
11. INVITAE. (2021). Comprehensive Neuropathies Panel test results.
12. Mohammadabadi, M., Bordbar, F., Jensen, J., Du, M., & Guo, W. (2021). Key Genes Regulating Skeletal Muscle Development and Growth in Farm Animals. Animals : an open access journal from MDPI, 11(3), 835. https://doi.org/10.3390/ani11030835
13. Monk KR, Oshima K, Jors S, Heller S, Talbot WS. Gpr126 is essential for peripheral nerve development and myelination in mammals. Development. 138(13). July 2011.
14. Sherif H. M. (2014). Heterogeneity in the Segmental Development of the Aortic Tree: Impact on Management of Genetically Triggered Aortic Aneurysms. Aorta (Stamford, Conn.), 2(5), 186–195. https://doi.org/10.12945/j.aorta.2014.14-032