Neuropathy

What is neuropathy?

Nerves power your entire body, but those nerves can be damaged by injury or an illness. The term neuropathy is a disorder that causes nerve damage and affects your ability to feel and move. Exactly how your body and your movement are affected depends on where in the body the damaged nerves are located.

There are many different types of neuropathy:

Cranial Neuropathy

When nerves in the brain or brainstem are affected, it is called cranial neuropathy.

The cranial nerves are those that arise directly from your brain or brainstem and often affect areas like the face and eyes. Some of the different types of cranial neuropathies include:

  • Bell's palsy. This condition occurs when the facial nerve (seventh cranial nerve) is affected.
  • Microvascular cranial nerve palsy. This condition affects the nerves in the eye. It is most common in people who have diabetes and in those who have high blood pressure.
  • Third nerve palsy. This condition affects the third cranial nerve. This nerve helps to manage a muscle that controls eye movement.
  • Fourth nerve palsy. This is also called superior oblique palsy. It affects the superior oblique muscle, which also helps control eye movement. That muscle is controlled by the fourth cranial nerve.
  • Sixth nerve palsy. This is also called cranial nerve VI palsy. It affects the sixth cranial nerve, which also helps control eye movement.
  • If several different cranial nerves are affected, it is called multiple cranial neuropathies (MCN).

What causes cranial neuropathies?

Cranial neuropathy can develop for many different reasons. For example:

  • Bell's palsy is often caused by a virus that causes swelling. This puts pressure on the facial nerve.
  • Microvascular cranial nerve palsy can develop in people who have high blood pressure.
  • Children are sometimes born with third nerve palsy. But it may also be caused by a head injury or an infection. A disorder affecting the brain, such as an aneurysm or brain tumor, may also cause third nerve palsy. Diabetes and migraines are other possible causes.
  • Fourth nerve palsy is often a congenital birth defect, which means that a baby is born with it. But a head injury, stroke, or tumor can also cause fourth nerve palsy.
  • The sixth cranial nerve can be damaged by infection, a stroke or tumor, increased pressure in the brain, and even migraines.

What are the symptoms of cranial neuropathies?

Different types of neuropathies can cause different symptoms, based on which nerves are damaged and where they are located. Generally, neuropathies can cause:

  • Pain
  • A tingling sensation
  • Numbness
  • Skin that feels sensitive to the touch
  • Weak or paralyzed muscles

Some of the symptoms of different types of cranial neuropathies include:

  • Bell's palsy can cause drooping of part of the face. It usually only affects one side of the face.
  • Microvascular cranial nerve palsy can cause double vision and other problems with eyesight.
  • Third nerve palsy can cause an eyelid to sag and droop, double vision, difficulty moving the eye, and a pupil that is bigger than normal.
  • Fourth nerve palsy causes the eye or eyes to turn abnormally. It sometimes makes you see double.
  • Sixth nerve palsy can cause abnormal movement of the eye and double vision.

How are cranial neuropathies diagnosed?

A health care provider will usually do a variety of tests to diagnose neuropathy. Depending on the type of cranial neuropathy your doctor suspects, tests may include:

  • Neurological exam to test sensation, reflexes, balance and metal status.
  • Electromyography (EMG), which measures the electrical activity of muscles when working and at rest.
  • CT or MRI scans. These are imaging techniques that allow health care providers to see the brain.
  • Nerve conduction velocity tests to help find out how and where the nerve is damaged.
  • Biopsies of the skin and nerves to find out how severely nerves are damaged.
  • Hearing tests.
  • Angiography. This is a special X-ray that uses contrast dye and takes pictures of your heart and blood vessels.

Peripheral Neuropathy?

Peripheral neuropathy is a type of damage to the nervous system -- more specifically, a problem with your peripheral nervous system. This is the network of nerves that transmits information from your central nervous system (your brain and spinal cord) to the rest of your body.

There are more than 100 types of peripheral neuropathy, each with its own set of symptoms and prognosis. To help doctors classify them, they are often broken down into the following categories:

  • Motor neuropathy. This is damage to the nerves that control muscles and movement in the body, such as moving your hands and arms or talking.
  • Sensory neuropathy. Sensory nerves control what you feel, such as pain, temperature or a light touch. Sensory neuropathy affects these groups of nerves.
  • Autonomic nerve neuropathy. Autonomic nerves control biological functions that you are not conscious of, such as breathing and heartbeat. Damage to these nerves can be serious.
  • Combination neuropathies. You may have a combination of two or three of these other types of neuropathies, such as a predominantly motor neuropathy or a sensory-motor neuropathy.

What causes peripheral neuropathy?

Peripheral neuropathy has many different causes. Some people inherit the disorder from their parents, and others develop it because of an injury or another disorder.

In many cases, a different type of medical problem, such as a kidney condition or a hormone imbalance, leads to peripheral neuropathy. One of the most common causes of peripheral neuropathy in the U.S. is diabetes.

What are the risks for peripheral neuropathy?

The following are risk factors for peripheral neuropathy:

  • Diabetes
  • Kidney disease
  • Hormone imbalance
  • Family history of peripheral neuropathy

What are the symptoms of peripheral neuropathy?

The symptoms of peripheral neuropathy vary based on the type that you have and what part of the body is affected. Symptoms can range from tingling or numbness in a certain body part to more serious effects such as burning pain or paralysis.

  • Muscle weakness
  • Cramps
  • Muscle twitching
  • Loss of muscle and bone
  • Changes in skin, hair, or nails
  • Numbness
  • Loss of sensation or feeling in body parts
  • Loss of balance or other functions as a side effect of the loss of feeling in the legs, arms, or other body parts
  • Emotional disturbances
  • Sleep disruptions
  • Loss of pain or sensation that can put you at risk, such as not feeling an impending heart attack or limb pain
  • Inability to sweat properly, leading to heat intolerance
  • Loss of bladder control, leading to infection or incontinence
  • Dizziness, lightheadedness, or fainting because of a loss of control over blood pressure
  • Diarrhea, constipation, or incontinence related to nerve damage in the intestines or digestive tract
  • Difficulty eating or swallowing
  • Life-threatening symptoms, such as difficulty breathing or irregular heartbeat

The symptoms of peripheral neuropathy may resemble other conditions or medical problems. Always consult your health care provider for a diagnosis.

How is peripheral neuropathy diagnosed?

The symptoms and body parts affected by peripheral neuropathy are so varied that it may be difficult to make a diagnosis. If your health care provider suspects nerve damage, he or she will take an extensive medical history and do a number of neurological tests to determine the location and extent of your nerve damage. These may include:

  • Blood tests
  • Spinal fluid tests
  • Muscle strength tests
  • Tests of the ability to detect vibrations

Depending on what basic tests reveal, your health care provider may want to perform more in-depth scanning and other tests to get a better look at your nerve damage. Tests may include:

  • CT scan
  • MRI scan
  • Electromyography
  • Nerve and skin biopsy

Treatments

How are cranial neuropathies treated?

Many types of neuropathies will get better with time, without any treatment. Sometimes medicines can be used to treat an infection, help reduce swelling in or near a nerve, or help if the neuropathy is causing pain. For some types of neuropathies and in some cases, surgery may help. Other times, the nerve damage can't be treated or repaired.

But it's important to diagnose and treat any health conditions that are causing the neuropathy. Treating common causes like high blood pressure, infections, and diabetes can help to treat the neuropathy. Eating nutritious foods, avoiding smoking, and limiting alcohol can also help manage neuropathy.

Can cranial neuropathies be prevented?

Cranial neuropathy can't always be prevented. But controlling common causes can help to reduce the risk of developing neuropathy. Reducing your risk factors for stroke and head injury, managing your diabetes well, and lowering high blood pressure can all be helpful in preventing neuropathy.

Living with cranial neuropathy

Cranial neuropathies are usually not dangerous and may get better on their own with time. But they can certainly be bothersome for the people who have them.

Your best strategy for managing a cranial neuropathy is to manage possible causes. These include diabetes, high blood pressure, infections, and brain tumors. You should also prevent head injury.

If the symptoms do not go away on their own, your health care team might recommend physical therapy, occupational therapy, or other options to help with them. Talk with your health care provider about other possible options, such as surgery, if a cranial neuropathy is affecting your quality of life.

When should I call my health care provider?

If you have been diagnosed with a cranial neuropathy, talk with your health care providers about when you might need to call them. They will likely advise you to call if your symptoms get worse or if you develop new symptoms such as pain, numbness, weakness, or changes in vision.

How is peripheral neuropathy treated?

Usually a peripheral neuropathy can’t be cured, but you can do a lot of things to prevent it from getting worse. If an underlying condition like diabetes is at fault, your health care provider will treat that first and then treat the pain and other symptoms of neuropathy.

In some cases, over-the-counter pain relievers can help. Other times, prescription drugs are needed. Some of these drugs include mexiletine, a medication developed to correct irregular heart rhythms; antiseizure drugs, such as gabapentin, phenytoin, and carbamazepine; and some classes of antidepressants, including tricyclics such as amitriptyline.

Lidocaine injections and patches may help with pain in other instances. And in extreme situations, surgery can be used to destroy nerves or repair injuries that are causing neuropathic pain and symptoms.

Can peripheral neuropathy be prevented?

Lifestyle choices can play a role in preventing peripheral neuropathy. You can lessen your risk for many of these conditions by avoiding alcohol, correcting vitamin deficiencies, eating a healthy diet, losing weight, avoiding toxins, and exercising regularly. If you have kidney disease, diabetes, or other chronic health condition, it is important to work with your health care provider to control your condition, which may prevent or delay the onset of peripheral neuropathy.

Living with peripheral neuropathy

Even if you already have some form of peripheral neuropathy, healthy lifestyle steps can help you feel your best and reduce the pain and symptoms related to the disorder. You’ll also want to quit smoking, not let injuries go untreated, and be meticulous about caring for your feet and treating wounds to avoid complications, such as the loss of a limb.

In some cases, non-prescription hand and foot braces can help you compensate for muscle weakness. Orthotics can help you walk better. Relaxation techniques, such as yoga, may help ease emotional as well as physical symptoms.

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