. Gulllaln-Barre Serum sickness Porphyna (Post-vaccina!) Diphtheria Malignancy Toxic Critical Illness poly neuropathy 2. Predominantly motor- Qullain-

rellexes absent or reduced. Ankle jerk earliest to be affected 5. Trophic changes - Skin glossy, furrowing and falling off of nails, cold extremities. 6. Dissociated anaesthesia - In amyloid -lipoproieln deficiency (Tangier disase) Clinical types 1. Acute onset - 1. Gulllaln-Barre Serum sickness Porphyna (Post-vaccina!) Diphtheria Malignancy Toxic Critical Illness poly neuropathy 2. Predominantly motor- Qullain-Barre Lead Porphyna Botulism Diphtheria Charcol-Marie Tooth cisease. 3 Predorrinantly sensory - Leprosy Heredtary Investigations -1. Basic investigations - Urinanalysis, full blood count ESR. blood glucose, serum electrolytes, serum proteins, serum creatinine, liver Junction tests and chest radiographs 2 Nerve biopsy - Suraf n (or radal n.) biopsy is usually helpful, in chronic demyelinating neuropathy. N. biopsy is atso indcated in suspected vasculitic neuropathies, leprosy or in the diagnosis of amyfoid (AL arid AF). 3. Other Investigations - Urinary porphyrins, and heavy metals, plasma electrophoresis, serum cholesterol and irigiycerides, CSF and radaloglcal and endoscoplc invesiigatlons for occult malignancy. 4. Nerve conduction studes - In generalized symmetrical neuropathies impairment of motor and/or sensory conduction. Management -1. General -(I) Elimination of possible Toxic or Infectious cause. (ii) Control of any existing metabolic or nutritional deficiencies -correction of anaemia with iron or vitamin B12 high protein diet, multivitamins.