Objectives

• Define the term mononeuropathy, polyneuropathy

• Identify the contribution of electrodiagnosis to the

"positive" and pathophysiological diagnosis of
peripheral neuropathies

• Describe clinical signs, and identify the main causes

of "length-dependent" polyneuropathies
Plan
Introduction

• Clinical semiology of the peripheral nerve (peripheral

neurogenic syndrome):

• All the symptoms and physical signs related to an injury

of the peripheral nervous system

• Peripheral nervous system (PNS) includes:

- Anatomical plan: cranial nerves and spinal nerves

- Functional level: motor, sensory and vegetative nerves

Introduction
Interest :
- Frequent pathologies

- Various clinical presentations

- Difficulty in the diagnosis and interest of

electrodiagnosis
• Nerve fibers : axons (nerve cells), Schwann cells
(myelin) and supporting tissue (vessels and
connective tissue).
Pathophysiology

• Mechanism of nerve fibers lesion :

- Wallerian Degeneration: This occurs after a nerve axon
degenerates due to a lesion or physical compression, the
portion distal to the axon passively wastes away, likely due to
lack of nutrients from the cell body (trauma or infarction of the
nerve)

- Segmental Demyelination: the process of degeneration of the

myelin sheath, with sparing of the nerve axon (inflammatory or
immune-mediated)
Pathophysiology
• Mechanism of nerve fibers lesion:
- Axonal Degeneration, also known as the dying-back phenomenon. The
axon degenerates in a pattern that starts distal and progresses proximally;
because the most distal portion of the axon is particularly vulnerable due
to its distance from the cell body which provides metabolic support.

• This lesions are organized into: primary injury of nerve fibers (axon
or myelin), interstitial neuropathies and conjunctivo-vascular
structures, vascular neuropathies.
 Positive diagnosis
Clinical manifestations

• Initial complain:
Depend on the underlying disease process

- Changes in sensation,

- Weakness,

- Atrophy,

- Pain ,

- numbness, and even autonomic disturbances

 Positive diagnosis
Clinical manifestations

• Motor signs
− Weakness : paralysis or paresis due to an injury of the voluntary,
reflex and automatic motricity, more or less preceded by fatigability
− Hypotonia, amyotrophy

− Decrease or abolition of deep tendon reflexes

− Cramps, fasciculation*, myokimies

− Normal idiomuscular response

− No sign of Babinski

*Fasciculation is a cardinal sign of peripheral neuropathy

 Positive diagnosis
Clinical manifestations

• Sensory symptoms
̶ Pains : burning, shock-like, stabbing, prickling, shooting,
lancinating, allodynia
̶ Worsening factors: coughing, sneezing, defecation

̶ Paresthesias: tingling, numbness, …

̶ Gait imbalance