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Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation01:21

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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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 The nursing management of a patient with peripheral artery disease (PAD) begins with a thorough assessment of the patient’s health history and clinical manifestations.AssessmentHealth History: Evaluate the patient’s history of hypertension, hyperlipidemia, family history of cardiovascular issues, and lifestyle factors such as dietary patterns, smoking, and physical activity.Physical Examination:Assess the affected extremity for decreased or absent peripheral pulses,...
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Peripheral artery disease (PAD) predominantly results from atherosclerosis, which involves the accumulation of fatty deposits, or plaques, within the walls of arteries. This causes them to narrow and harden, significantly reducing blood flow. PAD predominantly affects the legs, particularly the arteries supplying the thighs and calves. In rare cases, it may involve other arteries, including those in the arms.Etiology of PAD:The principal cause of PAD is atherosclerosis, which results from fatty...
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Atherosclerosis is a progressive disorder that leads to the thickening and narrowing of arterial walls due to plaque buildup. This condition can cause various symptoms depending on the arteries affected:Coronary Artery Disease (CAD): This condition affects the coronary arteries and may lead to chest pain (angina), shortness of breath (dyspnea), heart attacks, and other heart disease symptoms.Cerebrovascular Disease: This affects blood flow to the brain, causing transient ischemic attacks (TIAs)...
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Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
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Diagnosis of peripheral neuropathy.

Helmar C Lehmann1, Gilbert Wunderlich1,2, Gereon R Fink1,3

  • 1Department of Neurology, Faculty of Medicine and University Hospital of Cologne, Kerpener Straße 62, D-50937 Köln, Germany.

Neurological Research and Practice
|December 16, 2020
PubMed
Summary

Recognizing clinical patterns of peripheral neuropathy (PN) and using nerve conduction studies (NCS) helps identify causes. A structured, two-tiered diagnostic approach improves efficiency and cost-effectiveness for PN patients.

Keywords:
CIDPDiabeticDiagnosisEMGHereditary amyloid transthyretin (ATTRv) amyloidosisNerve conduction studiesPeripheral neuropathyUltrasound

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Area of Science:

  • Neurology
  • Clinical Neuroscience

Background:

  • Peripheral neuropathy (PN) encompasses diverse etiologies, including diabetes, toxins, autoimmune diseases, and genetic mutations.
  • Prompt identification of treatable causes requires a comprehensive diagnostic workup.

Purpose of the Study:

  • To propose a diagnostic flowchart for peripheral neuropathy based on common clinical phenotypes.
  • To enhance diagnostic yield and cost-effectiveness through a structured, two-tiered approach.

Main Methods:

  • Classification of peripheral neuropathy into five common clinical patterns.
  • Integration of clinical history, neurological examination, and nerve conduction studies (NCS).
  • Stratification of diagnostic workup based on identified phenotypes and NCS results.

Main Results:

  • Characteristic clinical phenotypes of peripheral neuropathy can be distinguished.
  • Nerve conduction studies are crucial for determining neuropathy phenotype (axonal vs. demyelinating) and severity.
  • A proposed flowchart guides differential diagnosis for underlying causes of PN.

Conclusions:

  • Recognizing clinical phenotypes and utilizing NCS are key to effective peripheral neuropathy diagnosis.
  • A two-tiered diagnostic strategy incorporating NCS and further tests improves efficiency.
  • This approach enhances diagnostic accuracy and cost-effectiveness for patients with peripheral neuropathy.