Can stroke cause peripheral neuropathy
Psychiatry, Psychosomatics & Psychotherapy
Diabetic polyneuropathy is different in every patient. However, the many manifestations can be divided into groups:
1. The symmetrical polyneuropathy
With this form, the complaints first appear in the feet before the legs and hands finally become ill (distally symmetrical, sensitive form).
The main complaints are:
- Tingling of hands and feet,
- burning and stabbing pain mainly in the feet or cramps in the calves,
- Numbness and insensitivity to pain or temperature differences,
- severe sensitivity to touch even with light touch,
- Muscle weakness in the feet, lower legs and hands,
- Loss of body balance and coordination of movements (atactic form).
Symptoms are mostly noticed at rest or at night. In some diabetics, the abnormal sensations are so strong that they can no longer bear the duvet on their feet at night. Due to the lack of pain perception, patients often do not notice the smallest wounds on their feet. If the injuries are not recognized and treated, the affected foot can become dangerously inflamed because of the increased risk of infection and the poor immune system. If the infection progresses to the bone, there is a risk of amputation in the worst case. Loss of feeling and progressive muscle weakness lead to a disruption of the gait pattern and deformation of the arch of the foot.
2. The autonomic neuropathy
Up to 50% of diabetics suffer from autonomic neuropathy after 20 years of illness. The nerves that control the heartbeat, blood pressure and blood sugar are damaged here. But other internal organs can also be affected, so that, for example, digestion, bladder emptying or sexuality are impaired.
The main complaints are:
- Lack of typical symptoms of hypoglycaemia,
- Cardiovascular disorders,
- Dizziness and fainting when standing up,
- Indigestion with bloating, diarrhea and constipation,
- uncontrolled urination,
- Erectile dysfunction,
- violent sweats, especially at night,
- Visual disturbances.
The nerve functions that regulate heart rate and blood circulation are often impaired. The resting heart rate can be increased up to the rapid heartbeat and / or the heartbeat increases only insufficiently under exertion. When standing up, the blood "sinks" in the legs, the blood pressure can no longer be maintained and the diabetic becomes sick or even faints. In addition, there is always the risk of a painless and therefore difficult to detect myocardial infarction in these patients because of the pain sensation disorder.
Normally, a drop in blood sugar leads to increased sweating, inner restlessness and a feeling of hunger. In autonomic neuropathy, these typical symptoms are often absent, so that those affected do not even notice when the blood sugar level is too low (hypoglycaemia). The result: If blood sugar falls further, it can lead to confusion, drowsiness, and in the worst case to seizures and coma.
Nerve damage to the esophagus makes swallowing difficult. Gastric emptying is slowed, so that patients often complain of nausea and vomiting. If the stomach is delayed in moving the food into the intestine, the injected insulin can get into the bloodstream faster than the carbohydrates from the food. Hypoglycaemia is the result. Most often, however, blood sugar patients complain of constipation, which can alternate with diarrhea. The latter are particularly noticeable at night and are sometimes uncontrollable.
Nerve damage to the urinary bladder can mean that the bladder can no longer be completely emptied. Bacteria settle in the bladder and urinary tract infections occur. Often the diabetics no longer have any feeling of how full the urinary bladder is. The result is uncontrolled urination. The sexual organs are often affected and cause potency problems in men (difficulties with erection and ejaculation). Women can experience arousal and orgasm difficulties.
The activity of the sweat glands is also controlled by autonomous nerves. Damage then usually leads to reduced sweating. Overheating can occur on hot summer days.
Autonomic neuropathy slows the pupil's ability to respond to light. There are visual disturbances when entering dark rooms or when leaving the house. Night vision is also disturbed.
Usually, diabetic polyneuropathy develops slowly over years and affects many nerves. Sudden complaints are the main feature of all focal neuropathies, which typically develop in the vascular environment ("nerve stroke").
The most common diabetic focal neuropathy is lumbosacral plexus neuropathy (diabetic amyotrophy), in which the circulatory disorder of a leg nerve plexus leads to severe pain in the thigh, buttock, or leg in older patients. This form of neuropathy usually occurs on one side and leads to weakness in the leg with muscle wasting, so that the patient can no longer climb stairs with the affected leg.
In diabetic eye muscle palsy, double vision and pain behind the eye and, as the process progresses, the upper eyelid fall down.
Severe pain in the chest, abdomen, or flanks can also be signs of focal neuropathy. In exceptional cases, this neuropathy can be mistaken for a heart attack or appendicitis.
The listed complaints usually disappear after a few weeks to months without permanent damage.
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