Distal Neuropathy

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Distal neuropathy

Distal neuropathy is a fairly common complication that is considered irreversible. It manifests itself as a significant symmetrical lesion in diseased lower extremities. The patient feels a loss of sensitivity, varying intensity of tingling and pain. Distal chronic neuropathy, which is a complication of diabetes mellitus, is often accompanied by atrophy of the muscles of the foot. Experts call this condition the development of the so-called peculiar diabetic foot.

Distal neuropathy is diagnosed in half of all diabetic patients. The main clinical manifestations can vary widely, ranging from pediatrics to dermatology, from cardiology to urology. It can be noted the presence of some symptoms or certain signs in patients. A dangerous dysfunction of an important peripheral nervous system is possible if other causes of the disease are excluded. The diagnosis of the presented disorder can be established only after a preliminary and thorough examination.

It should be mentioned that the absence of specific symptoms of distal neuropathy cannot completely rule out the disease. Asymptomatic distal neuropathy is common. The diagnosis of this most dangerous disorder is competent, as a rule, in the presence of at least two deviations. Either there must be certain symptoms, or serious and sufficiently noticeable disturbances in sensitivity or nerve conduction.

The clinical picture of distal neuropathy

The main signs of the development of distal neuropathy are numbness, paresthesia, as well as pain and chilliness in the hands or feet. In some cases, symmetrical disturbances of different types of sensitivity are possible: temperature, pain, vibration and tactile. In many patients, these manifestations are sometimes expressed rather weakly.

And in severe cases, paresthesias and pains that worsen only at night are often characteristic, as well as an unpleasant burning sensation in the hands and feet. This pathology is usually aggravated in the absence of proper treatment. Patients complain of various initial symptoms of the disease with the progression of the proximal process, which are determined only in the toes. Then they show an additional symptom - a strong decrease in sensitivity in all fingers. In this case, the distal parts of the arms are never the first to suffer.

In distal neuropathy, unmyelinated and myelinated nerve fibers are primarily affected. The predominant lesion of simple thin fibers is always characterized by loss of heat and pain sensitivity. The speed of conduction of the necessary nerve impulse decreases when thick fibers are involved in this process. Also, vibration and tactile sensitivity is somewhat reduced or completely lost. In extremely rare cases, this can lead to dangerous sensory ataxia.

Usually, signs of such lesions of thin nerve fibers in patients are observed earlier in comparison with thick fibers. Approximately 40-45% of patients with diabetes mellitus have symptoms of distal neuropathy. The main symptom is pain syndrome of varying intensity.

In addition, the very period of occurrence of such pains is characteristic. This happens when you are overworked or at rest, sometimes during times of stress, and often at night. The intensity of pain when walking is often reduced, and the change in the position of the arm or leg has practically no effect. Pain syndrome in acute form can be attributed to a clinical independent unit, which is characterized by hyperalgesia and hypersensitivity.

At the same time, all nerve motor fibers are perfectly preserved, and many sensitive functions suffer only slightly. Often, acute pain syndrome of distal neuropathy is observed with normalization of glycemia and insulin therapy. As a rule, the regeneration of the immediate nerve affects the pain symptoms. The progression of diabetic signs usually leads to severe damage to the motor fibers, leading to weakness and muscle atrophy in the distal parts of the lower extremities only.

It should be mentioned that with the involvement of nerve autonomous fibers, sweating sharply decreases, while the patient's skin becomes noticeably dry and prone to hyperkeratosis, and Achilles and knee reflexes decrease, then various bone deformities appear. The disease usually develops slowly over several months. Early detection of signs of distal diabetic neuropathy is very important to significantly reduce the risks of ulceration and even possible limb amputation.

Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist

Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".