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Nerve Ultrasound Protocol to Detect Dysimmune Neuropathies
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Porphyric neuropathy.

Rachana K Gandhi Mehta1, James B Caress1, Sean R Rudnick2

  • 1Department of Neurology, Wake Forest Baptist Health, Winston Salem, North Carolina, USA.

Muscle & Nerve
|March 31, 2021
PubMed
Summary
This summary is machine-generated.

Acute hepatic porphyrias can cause severe neuropathy. Early diagnosis via urine tests and prompt treatment with intravenous heme can prevent paralysis and death.

Keywords:
acute hepatic porphyriaacute motor neuropathyautonomic neuropathyaxonalperipheral neuropathyporphyric neuropathyradial nerve

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Area of Science:

  • Biochemistry
  • Neurology
  • Genetics

Background:

  • Acute hepatic porphyrias (AHPs) are inherited metabolic disorders.
  • AHPs can manifest as polyneuropathy, potentially leading to severe outcomes like quadriparesis and respiratory failure if diagnosis is delayed.
  • Porphyric neuropathy presents as a rapid, motor-dominant axonal neuropathy, often preceded by autonomic dysfunction.

Purpose of the Study:

  • To describe the clinical presentation and diagnostic approach to porphyric neuropathy.
  • To differentiate porphyric neuropathy from Guillain-Barré syndrome.
  • To highlight the importance of timely treatment in managing AHP-related neurological complications.

Main Methods:

  • Review of clinical features of porphyric neuropathy.
  • Comparison with Guillain-Barré syndrome based on diagnostic criteria.
  • Emphasis on spot urine testing for delta-aminolevulinic acid and porphobilinogen.
  • Discussion of treatment modalities including intravenous heme and carbohydrate loading.

Main Results:

  • Porphyric neuropathy is characterized by motor-predominant axonal damage, affecting upper extremities, and preceded by autonomic neuropathy.
  • Key distinctions from Guillain-Barré syndrome include the absence of CSF albuminocytologic dissociation and progression beyond 4 weeks.
  • Urine porphyrin precursor levels are crucial for rapid diagnosis during acute attacks.

Conclusions:

  • Early identification of porphyric neuropathy through biochemical markers is critical.
  • Prompt administration of intravenous heme and supportive care can avert severe neurological damage and mortality.
  • Understanding the distinct features of porphyric neuropathy aids in its differentiation from other neuropathies.