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Complex Regional Pain Syndrome Definition
Pain syndrome accompanied by loss of function and autonomic dysfunction usually occuring after trauma.
Complex Regional Pain Syndrome Presentation
Diffuse pain out of proportion to the initial injury often in a nonanatomic distribution.
Pain can occur atanytime relative to the initial injury.
Loss of function of affected limb is seen.
Sympathetic dysfunction occurs and may be documented by skin, soft tissue or blood flow changes.
Skin temperature, hair growth and nail growth may increase or decreae, edema maybe present.
Complex Regional Pain Syndrome Treatment
- Low dose TCAs
- Chemical sympathetic blockage
- Physical Therapy
- No oral medication are consisently effective
Diabetic Neuropathy- Symmetrical polyneuropathies
Distal polyneuropathy- stocking glove distribution of loss of distal sensation with accompany numbness and tingling which is worse at night.There can also be loss of distal reflexes,position and vibratory sensation.
- Autonomic Neuropathy
- abnormal pupillary reaction - difficulty with adaptation to dark, which may affect nigt driving
- Postural hypotension
- Exercise intolerance
- Peripheral edema
- Abnormal GI Motility
- Bladder Dysfunction
Assymmetric and focal and multifocal diabetic polyneuropathies.
- 1. Trunk and Limb
- 2.Cranial Neuropathies- affects extraoccular muscles CN 3,4, 6- most common - present as eye pain or diplopia.
- 3. Asymmetric proximal lower extremity motor neuropathy- sudden onset of unilateral pain and proximal weakness progress > 2 weeks, unilateral reflex lost, proximal atophy occurs. Prognosis is Good.
Nerve Root responsible for Biceps Reflexes
Nerve Root responsible for Tricep reflexes
Nerve Root responsible for Patella Reflexes
Nerve Root responsible for Achilles Reflexes
- Acute onset of focal neurologic deficits resulting from disruption of cerebral circulation.
- Ischemic- 80%