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Homocystein and Neuropathy
Homocystein and Neuropathy
Homocystein and Neuropathy
F I T R I O C TAV I A N A
C L I N I C A L N E U R O P H Y S I O L O G Y D I V I S I O N - N E U R O L O G Y D E PA RT M E N T
FA C U LT Y O F M E D I C I N E U N I V E R S I TA S I N D O N E S I A /
D R . C I P T O M A N G U N K U S U M O H O S P I TA L
Outline
Introduction
Clinical Approach of Neuropathy
Isolated Elevated Homocysteine Induced Peripheral Neuropathy
Introduction
Peripheral neuropathy refers to disorders of the peripheral nervous system which may be caused either
by diseases of the nerve or from the side effect of the systemic illness
The overall prevalence of peripheral neuropathy is 2.4%, increases to 8% in individuals aged above 55
years
Clinical Examination
Approach
Electrodiagnostic Evaluation
Laboratory test
History
Acute
• <4 weeks
Sub-acute
• 4-12 weeks
Chronic
• > 12 weeks
Sensory
History Motor
• Weakness
Autonomic
Sensory Involvement
◦ Pain, loss of temperature sensation and autonomic symptoms small fiber
◦ Ataxia in the dark large fiber
Neuropathy
Pattern
Nerve fibers
in peripheral
neuropathy
Muscle Power
Tendon Reflexes
Sensory examination
F-wave
Late response H-reflex
Neurogenic Changes
EMG Spontaneous activity
Laboratory Test
First line screening test for neuropathy
◦ Blood count, ESR
◦ Blood sugar
◦ Liver and renal function tests
◦ Serum vitamin B12
◦ Thyroid function test
◦ Vasculitis profile
◦ Paraprotein
Drug and Toxin: Alcohol, vincristine, phenytoins, statins
Endocrine: Hypohyroidism