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MK is a 57 year old woman who recently retired and relocated to a farm in the country.

She decided to take up
gardening/farming as a new hobby. About a week ago, she sprayed her plants and garden with pesticides,
however, she removed her protective gear because it was “hot and obscured my vision”. The past few days she has
had increasing loss of sensation in her hands and feet, impaired coordination of both hands (“clumsy”) and feet
(“tripping a lot”), and weakness of grip and pinch. She was referred to a neurologist who diagnosed her with a
polyneuropathy secondary to exposure to a toxic substance (pesticide). A diagnostic work-up revealed that MK’s
polyneuropathy is a result of demyelination of the peripheral nerves.

QUESTIONS:
1. What is the pathophysiology associated with demyelinating disorders, i.e., how does the pathology lead to
sensory and motor changes?
Myelin is necessary component of the nervous system because it covers the axon so it may transmit
electrical impulses throughout the length of that axon. Without that electrical insulation, the signal will slow down
and may become lost. While it is true that signals can carry across demyelinated nerve fibers, they move at a
much slower pace and do not store the energy as well as a myelin sheath will.
Without the Schwann cells, transmitted information does not reach the intended target as fast or in some
cases, it doesn’t reach it at all. Because of this, patients may have issues in proprioception; not knowing where
their body is in relation to space. With portions of the body losing the ability to receive sensory signals, patients
may not feel the sensations of pain, discomfort, affective touch, and/or temperature. With muscles not receiving
the signals to induce movement, MK’s muscles become weak from disuse and will tire easily.

2. Is this a CNS or PNS problem and how might that impact her recovery? Discuss the differences that may or may
not exist in terms of recovery.
Schwann cells myelinate the PNS neurons, while Oligodendrocytes are responsible for myelination of the
CNS axons. In this case, the cells affected were the Schwann cells. MK’s exposure to toxins has caused PNS
issues.
Damage to the PNS is preferable over the alternative, damage to the CNS. If the CNS oligodendrocytes
became demyelinated, MK would experience direct problems in the brain and spinal cord. CNS issues are often
slow to recover from and do not always recover due to cell death. Research is improving all the time to generate
methods of regeneration such as using stem cells, but this is a long difficult expensive journey. In the PNS, most
issues can resolve naturally with time, but not without the proper rehabilitation treatment and removing the source
of the irritant.

3. Assuming that MK has learned her lesson and will not expose herself to toxic substances in the future, what is
her prognosis in terms of sensorimotor function? Provide a rationale, based on your understanding of neuroscience,
to support your answer.
MK can expect a gradual recovery if this was not a serious case that escalated into affecting breathing and heart
functions. As you have mentioned, it is important that she learn her lesson, but also a scan of the home and work
environments should be completed to ensure she is being exposed to any other toxins that could compound the
damage. She may have been exposed unknowingly. We must eliminate all exposure to harmful toxins!.
The potential for skin damage such as burns and bruising can occur due to the numbing of the skin that MK is
experiencing. Her muscles may be weak and atrophied. Practitioners can work with her to regain strength in these
muscles while her nerve cells are regenerating their schwann sheaths. She can also be trained to use assistive
devices in order to be as independent as possible. If safety precautions and training is provided for her, her
outlook is good to be fully functional again.

Ekman-Lundy, L. (2007). Neuroscience: Fundamentals for Rehabilitation (3rd). St. Louis, Missouri:
42-48

OTHER DISCUSSION:
polyneuropathy. A single oligodendrocyte can extend its processes to 50 axons, wrapping around approximately
1 μm of myelin sheath around each axon; Schwann cells, on the other hand, can wrap around only 1 axon.