Chapter

Infectious and Granulomatous Neuropathies

Steven Herskovitz

in Peripheral Neuropathies in Clinical Practice

Published on behalf of Oxford University Press

Published in print November 2008 | ISBN: 9780195183269
Published online April 2013 | e-ISBN: 9780199322947 | DOI: http://dx.doi.org/10.1093/med/9780195183269.003.0009

Series: CONTEMP NEURO

Infectious and Granulomatous Neuropathies

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Infectious and granulomatous neuropathies cause focal, multifocal, and, similar to vasculitic neuropathies, more confluent, distal, symmetric axonal sensorimotor polyneuropathies. Focal neuropathies include cranial neuropathies, particularly of the facial nerve in Lyme disease, sarcoidosis, herpes simplex, and human immunodeficiency virus (HIV) infection, as well as ulnar and superficial radial neuropathies in leprosy. Human immunodeficiency virus infection is also associated with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), as well as superinfection with cytomegalovirus (CMV) causing a severe lumbosacral polyradiculopathy or mononeuropathy multiplex. In infectious cases, direct infection of peripheral nerve is limited to dorsal root and cranial ganglia neurons in varicella-zoster infection and to Schwann cells and macrophages in lepromatous leprosy.1,2 Most neuropathies in infectious and granulomatous diseases relate to local and systemic inflammatory responses. Treatment in infectious cases is directed at the underlying infection, often with concurrent immunosuppressive treatment to lessen a resulting or primary inflammatory response. Sarcoidosis and immune-mediated HIV neuropathies (AIDP, CIDP, and mild multiple mononeuropathies) are treated with immunosuppression.

Chapter.  19825 words.  Illustrated.

Subjects: Neurology

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