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Key Features

  • Axonal polyneuropathy may follow exposure to

    • Industrial agents or pesticides, such as acrylamide, organophosphorus compounds, hexacarbon solvents, methyl bromide, and carbon disulfide

    • Metals, such as arsenic, thallium, mercury, and lead

    • High doses of such certain medications, such as phenytoin, amiodarone, perhexiline, isoniazid, nitrofurantoin, vincristine, and pyridoxine

  • Bulbar and distal sensorimotor polyneuropathy may follow diphtheria

Clinical Findings

  • Diphtheritic neuropathy

    • Results from a neurotoxin released by the causative organism and is common in many areas

    • Palatal weakness may develop 2–4 weeks after infection of the throat

    • Infection of the skin may similarly be followed by focal weakness of neighboring muscles

    • Disturbances of visual accommodation may occur about 4–5 weeks after infection

    • Distal sensorimotor demyelinating polyneuropathy may occur after 1–3 months

Diagnosis

  • Detailed occupational, environmental, and medical histories and recognition of clusters of cases are important in suggesting the diagnosis

Treatment

  • Prevent further exposure to the causal agent

  • Isoniazid neuropathy is prevented by pyridoxine supplementation

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