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The peripheral nervous system consists of the nerves that branch out from the brain and spinal cord.

Your peripheral nervous system (PNS) is one of two main parts of your body’s nervous system.

The primary function of the peripheral nervous system is to connect the brain and spinal cord to the rest of the body and the external environment. The peripheral nervous system transmits information to and from the CNS.

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1.) What are the primary anatomical components of the peripheral nervous system (PNS)?

2.) Which of the following branches of a spinal nerve have somas of solely sensory neurons?

3.) What are the two main divisions of the nervous system in the human body?

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Diagnostic test for peripheral nervous system

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Diagnostic test for peripheral nervous system

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NYU Langone neurologists perform a neurological exam, imaging tests, and a nerve conduction study to diagnose peripheral neuropathy. Learn more.

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Diseases of the Peripheral Nervous Systems 

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Diseases of the Peripheral Nervous Systems 

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What are the symptoms of peripheral neuropathy?

There are many different symptoms of peripheral neuropathy. This condition can affect a single nerve, a connected group of related nerves, or many nerves in multiple places throughout your body. The symptoms also depend on the type of nerve signals affected, and multiple signal types may be involved.

The symptom types (with more about them below) are:

Motor symptoms

Your peripheral nervous system carries motor signals, which are commands sent from your brain to your muscles. These signals are what make it possible for you to move around. Your muscles need nerve connections to the brain to stay healthy and work properly.

Motor symptoms include:

Muscle weakness and paralysis. Nerve deterioration from peripheral neuropathy weakens the connected muscles. That can cause paralysis, which may cause difficulty moving the toes, foot drop and hand weakness. Weakness can also affect muscles in the thighs, arms and elsewhere.

Muscle atrophy. Loss of nerve connection can cause muscles to shrink in size, as well as weaken. This especially happens in the feet, lower legs and hands with peripheral neuropathy. Sometimes there are deformities of the feet and hands because of muscle loss.

Uncontrolled muscle movements. Sometimes, nerves that lose their connection to the brain because of peripheral neuropathy become hyperactive on their own, causing cramps.

Sensory symptoms

Your peripheral nerves convert information about the outside world into nerve signals. Those signals then travel to your brain, which processes those signals into what you can sense of the world around you. Peripheral neuropathy can disrupt what your senses pick up from the outside world or the ability of those senses to communicate with your brain.

The sensory symptoms of peripheral neuropathy include:

Tingling. This happens when there's a problem with nerves that carry signals to your brain. This is like radio static you hear when you're too far from the broadcasting station.

Numbness. This happens when nerves can't send or relay sensory signals, causing the loss of specific types of sensations. An example of this would be picking up a cold pop can, but not feeling the smoothness or coldness of the can, or not being able to feel the texture of carpet or the temperature of the floor through your feet.

Imbalance and clumsiness. Nerves also carry sensations that your brain uses to keep track of the location of your hands and feet. You're not consciously aware of these sensations, but they're critical for balance and coordination. Without these sensations, you can experience a loss of balance, especially in the dark, and clumsiness with your hands.

Pain. Nerve damage from peripheral neuropathy can cause malfunctions in how and when nerves send pain signals, making pain signals more intense (hyperalgesia) or happen too easily (allodynia). It can even cause nerves to generate pain signals spontaneously. This is known as "neuropathic" pain, and it's the most noticeable and disruptive symptom of peripheral neuropathy.

Autonomic symptoms

Your body has several autonomic processes. These are the automatic functions of your body that happen without your thinking or even being aware of them. They include things like sweating, digestion, blood pressure control, etc. Autonomic nerve fibers carry autonomic signals. Disruptions in autonomic signals mean your body's automatic processes can't work correctly. Some may work off and on, while others may not work at all.

Autonomic symptoms of peripheral neuropathy can include:

Blood pressure changes. Your body automatically manages blood pressure, but damage to your peripheral nerves can disrupt this. That can cause sudden drops in blood pressure or increases in heart rate, especially when you stand up.

Sweating too much or not enough. Your body automatically manages its internal temperature, using sweating to shed heat. Peripheral nerve damage can cause you to sweat too much or not enough. That can lead to dryness and scaling on your feet, or excessive sweating after eating.

Bowel and bladder problems. Autonomic signals control your bowel and bladder without you having to think about them. Nerve fiber disruption can affect bowel movements (constipation or diarrhea), and can occasionally affect bladder control, too.

Sexual dysfunction. Your autonomic nervous system controls sexual arousal. That's why autonomic problems can cause sexual dysfunction.

Other symptoms. Autonomic changes from peripheral neuropathy can also cause skin color changes, swelling, changes in the pupils of the eyes and blurry vision.

What causes peripheral neuropathy?

Peripheral neuropathy can happen for many reasons. These include:

Type 2 diabetes. The most common cause of peripheral neuropathy is unmanaged type 2 diabetes. When your blood sugar is too high for too long, it damages your peripheral nerves. That's why people with type 2 diabetes can lose feeling in their feet and lower legs.

Alcohol use disorder. Excessive intake of alcohol, especially over long periods of time, can damage nerves. Alcohol use disorder is a common cause of peripheral neuropathy, and it can also contribute to vitamin deficiencies that lead to peripheral neuropathy.

Vitamin and nutrient deficiencies. People can develop nerve damage because they have deficiencies in certain vitamins. The deficiencies that are most likely to cause this are copper and vitamins B1, B6, B9, B12, folic acid (B9) and E. Too much vitamin B6 can also cause this.

Autoimmune and inflammatory conditions. Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP) can cause severe weakness. They're also very treatable. Neuropathy can happen due to lupus, rheumatoid arthritis, Sjögren syndrome, vasculitis and more.

Medications and toxins. Chemotherapy and certain other medications (antibiotics, and medications that treat arrhythmia and gout) can cause peripheral neuropathy. Exposure to some heavy metals and industrial chemicals can also cause it.

Tumors. Malignant tumors (cancer) and benign (noncancerous) tumors can both disrupt your peripheral nervous system.

Genetic conditions. Genetic conditions are ones you inherit from one or both parents. Examples of these causing peripheral neuropathy include amyloidosis, Fabry disease and Charcot-Marie-Tooth disease. There are treatments for familial amyloidosis and Fabry disease.

Infections. Nerve damage from infections can happen because of viruses, such as HIV, or bacteria - such as Borrelia burgdorferi, which causes Lyme disease. Another common example is having shingles, which can lead to lingering nerve pain.

Hansen disease (better known as leprosy). While the effects of this disease - which is rare in developed countries - are most visible on the skin, it also damages your peripheral nerves. It's a very common cause of peripheral neuropathy in developing nations. worldwide

Trauma and surgery. Injuries and damage directly to nerves can happen from trauma or from medical procedures. Swelling or stretching can also damage nerves. This kind of damage is usually only in one location. It can be long-term or even permanent.

Vascular disorders (circulation-related problems). Lack of blood flow can cause peripheral neuropathy. A harmless, temporary form of this happens when you sit or lay a certain way and an arm or leg falls asleep. This goes away quickly if you shift position enough for circulation to return. More severe circulation problems can cause serious and permanent nerve damage.

Idiopathic neuropathy. It's common for peripheral neuropathy to happen for unknown reasons. This type of neuropathy is known as "idiopathic" or "cryptogenic" (hidden or obscure cause).

Is peripheral neuropathy contagious?

Peripheral neuropathy isn't contagious. While it can happen because of infectious diseases, this condition doesn't spread from person to person on its own. The only exception is Hansen disease, which can spread from person to person but doesn't spread easily.

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Peripheral Neuropathy: What It Is, Symptoms & Treatment

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Peripheral neuropathy is a term for any condition that affects the nerves outside your brain and spinal cord. This condition and its symptoms are often treatable.

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Peripheral nervous system EXPLAINED: A comprehensive guide to PNS.

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Overview

Guillain-Barre (gee-YAH-buh-RAY) syndrome is a rare disorder in which your body's immune system attacks your nerves. Weakness and tingling in your extremities are usually the first symptoms.

These sensations can quickly spread, eventually paralyzing your whole body. In its most severe form Guillain-Barre syndrome is a medical emergency. Most people with the condition must be hospitalized to receive treatment.

The exact cause of Guillain-Barre syndrome is unknown. But two-thirds of patients report symptoms of an infection in the six weeks preceding. These include respiratory or a gastrointestinal infection or Zika virus.

There's no known cure for Guillain-Barre syndrome, but several treatments can ease symptoms and reduce the duration of the illness. Although most people recover from Guillain-Barre syndrome, the mortality rate is 4% to 7%. Between 60-80% of people are able to walk at six months. Patients may experience lingering effects from it, such as weakness, numbness or fatigue.

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Symptoms

Guillain-Barre syndrome often begins with tingling and weakness starting in your feet and legs and spreading to your upper body and arms. In about 10% of people with the disorder, symptoms begin in the arms or face. As Guillain-Barre syndrome progresses, muscle weakness can evolve into paralysis.

Signs and symptoms of Guillain-Barre syndrome may include:

Prickling, pins and needles sensations in your fingers, toes, ankles or wrists

Weakness in your legs that spreads to your upper body

Unsteady walking or inability to walk or climb stairs

Difficulty with facial movements, including speaking, chewing or swallowing

Double vision or inability to move eyes

Severe pain that may feel achy, shooting or cramplike and may be worse at night

Difficulty with bladder control or bowel function

Rapid heart rate

Low or high blood pressure

Difficulty breathing

People with Guillain-Barre syndrome usually experience their most significant weakness within two weeks after symptoms begin.

Types

Once thought to be a single disorder, Guillain-Barre syndrome is now known to occur in several forms. The main types are:

Acute inflammatory demyelinating polyradiculoneuropathy (AIDP), the most common form in North America and Europe. The most common sign of AIDP is muscle weakness that starts in the lower part of your body and spreads upward.

Miller Fisher syndrome (MFS), in which paralysis starts in the eyes. MFS is also associated with unsteady gait. MFS is less common in the U.S. but more common in Asia.

Acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN) are less common in the U.S. But AMAN and AMSAN are more frequent in China, Japan and Mexico.

When to see a doctor

Call your doctor if you have mild tingling in your toes or fingers that doesn't seem to be spreading or getting worse. Seek emergency medical help if you have any of these severe signs or symptoms:

Tingling that started in your feet or toes and is now moving up your body

Tingling or weakness that's spreading rapidly

Difficulty catching your breath or shortness of breath when lying flat

Choking on saliva

Guillain-Barre syndrome is a serious condition that requires immediate hospitalization because it can worsen rapidly. The sooner appropriate treatment is started, the better the chance of a good outcome.

Causes

The exact cause of Guillain-Barre syndrome isn't known. The disorder usually appears days or weeks after a respiratory or digestive tract infection. Rarely, recent surgery or vaccination can trigger Guillain-Barre syndrome. Recently, there have been cases reported following infection with the Zika virus. Guillain-Barre syndrome may also occur after infection with the COVID-19.

In Guillain-Barre syndrome, your immune system - which usually attacks only invading organisms - begins attacking the nerves. In AIDP, the most common form of Guillain-Barre syndrome in the U.S., the nerves' protective covering (myelin sheath) is damaged. The damage prevents nerves from transmitting signals to your brain, causing weakness, numbness or paralysis.

Risk factors

Guillain-Barre syndrome can affect all age groups. But your risk increases as you age. It's also more common in males than females.

Guillain-Barre syndrome may be triggered by:

Most commonly, infection with campylobacter, a type of bacteria often found in undercooked poultry

Influenza virus

Cytomegalovirus

Epstein-Barr virus

Zika virus

Hepatitis A, B, C and E

HIV, the virus that causes AIDS

Mycoplasma pneumonia

Surgery

Trauma

Hodgkin's lymphoma

Rarely, influenza vaccinations or childhood vaccinations

Complications

Guillain-Barre syndrome affects your nerves. Because nerves control your movements and body functions, people with Guillain-Barre may experience:

Breathing difficulties. The weakness or paralysis can spread to the muscles that control your breathing, a potentially fatal complication. Up to 22% of people with Guillain-Barre syndrome need temporary help from a machine to breathe within the first week when they're hospitalized for treatment.

Residual numbness or other sensations. Most people with Guillain-Barre syndrome recover completely or have only minor, residual weakness, numbness or tingling.

Heart and blood pressure problems. Blood pressure fluctuations and irregular heart rhythms (cardiac arrhythmias) are common side effects of Guillain-Barre syndrome.

Pain. One-third of people with Guillain-Barre syndrome experience severe nerve pain, which may be eased with medication.

Bowel and bladder function problems. Sluggish bowel function and urine retention may result from Guillain-Barre syndrome.

Blood clots. People who are immobile due to Guillain-Barre syndrome are at risk of developing blood clots. Until you're able to walk independently, taking blood thinners and wearing support stockings may be recommended.

Pressure sores. Being immobile also puts you at risk of developing bedsores (pressure sores). Frequent repositioning may help avoid this problem.

Relapse. From 2% to 5% of people with Guillain-Barre syndrome experience a relapse.

Severe, early symptoms of Guillain-Barre syndrome significantly increase the risk of serious long-term complications. Rarely, death may occur from complications such as respiratory distress syndrome and heart attacks.

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Guillain-Barre syndrome - Symptoms and causes

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Guillain-Barre (gee-YAH-buh-RAY) syndrome is a rare disorder in which your body's immune system attacks your nerves. Weakness and tingling in your extremities are usually the first symptoms. These sensations can quickly spread, eventually paralyzing your whole body. In its most severe form Guillain-Barre syndrome is a medical emergency.

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Overview

What is Sjögren's syndrome?

Sjögren's syndrome is a lifelong autoimmune disorder that reduces the amount of moisture produced by glands in the eyes and mouth. It is named for Henrik Sjögren, a Swedish eye doctor who first described the condition. While dry mouth and dry eyes are the primary symptoms, most people who have these problems don't have Sjögren's syndrome. Dry mouth is also called xerostomia.

There are two forms of Sjögren's syndrome:

1. Primary Sjögren's syndrome develops on its own, not because of any other health condition.

2. Secondary Sjögren's syndrome develops in addition to other autoimmune diseases like rheumatoid arthritis, lupus and psoriatic arthritis.

Who might get Sjögren's syndrome?

An estimated one to four million Americans have Sjögren's syndrome. The disease affects people of all races, ethnicities and ages. However, women are nine times more likely to develop this condition than men.

Symptoms and Causes

What causes Sjögren's syndrome?

Sjögren's syndrome is an autoimmune disease, which means something triggers your immune system to attack healthy cells. This attack damages the tear system in your eyes and the salivary glands in your mouth.

Exactly what causes this abnormal immune system response is not clear. These factors may play a role:

Environmental factors.

Genetics.

Sex hormones (the condition affects more women than men).

Viral infections.

What are the symptoms of Sjögren's syndrome?

In addition to extremely dry eyes and mouth, some people experience muscle pain and joint pain all over the body, similar to fibromyalgia. Other symptoms include:

Diagnosis and Tests

How is Sjögren's syndrome diagnosed?

If you have dry mouth, dry eyes or other signs of Sjögren's syndrome, your doctor may use these methods to confirm a diagnosis:

Blood tests: These tests detect specific antibodies in the blood. They look for anti-nuclear antibodies (ANA), anti-Sjögren's syndrome antibodies (anti-SSA, also called anti-Ro) and anti-Sjögren's syndrome type B (anti-SSB, also called anti-La). A blood test can also detect rheumatoid factor, an antibody found in many people who have rheumatoid arthritis.

Biopsy: Your doctor may remove tissue or cells from a salivary gland or the inside of your lip. This biopsy sample goes to a lab to check for signs of inflammation.

Imaging tests: These include sialometry, which measures how much saliva you produce by using X-rays that can see dye injected into salivary glands. There is also salivary scintigraphy, a way to track how long it takes for a radioactive isotope to travel from an injection point in your vein to your salivary glands.

Health history: If you have a pre-existing autoimmune disease, plus dry eyes and dry mouth, your doctor may conclude that you have developed secondary Sjögren's syndrome.

Management and Treatment

What kind of a doctor treats Sjögren's syndrome?

Many types of doctors might be involved in your care if you have SS. These include your own primary care provider, your dentist, and specialists such as rheumatologists, ophthalmologists and otolaryngologists, also called ear, nose and throat (ENT) doctors.

How is Sjögren's syndrome managed or treated?

There is no cure for Sjögren's syndrome, but treatments can relieve symptoms. Depending on your specific issues, your doctor may recommend one or more of these therapies.
Treatments for dry eyes:

Punctal plugs: An ophthalmologist inserts tiny silicone plugs into the tear ducts. The plugs block the ducts so tears stay on the eyes, keeping them wet.

Surgery: If punctal plugs work for you, your doctor may recommend surgery to close the tear ducts permanently.

Autologous serum drops: Your doctor can make customized artificial tears. The process involves mixing your blood serum (a clear liquid separated from your blood) with a sterile liquid solution. You receive a one-of-a-kind tear substitute unique to your body. While effective, the pricey treatment isn't always covered by insurance.

Treatments for dry mouth: Treatments for joint or organ problems:

Over-the-counter pain relievers: Acetaminophen (Tylenol®) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin®) and naproxen (Aleve®), can relieve joint pain and muscle aches.

Anti-rheumatics: Hydroxychloroquine prescription pills can diminish pain from rheumatoid arthritis or lupus. This medication may also reduce salivary gland swelling.

Immunosuppressants: These prescription medications slow the immune system's response. They lessen inflammation and prevent organ damage.

Steroids: Prednisone prescription pills soothe inflammation of the joints, skin and organs.

Antifungals: These medications treat yeast overgrowth in your mouth (oral thrush) or in your vagina (vaginal yeast infection).

Treatments for vaginal dryness:
If your vagina is always dry, itchy and sore, you should check with your healthcare provider to make sure that the issue is not something more than hormonal changes. You might have some type of infection or skin issue. These conditions would require specific treatments. In general, though, women with Sjögren's syndrome are two to three times more likely to have issues with vaginal dryness and atrophy than women of similar ages around and after menopause. Tips for helping with everyday vaginal dryness include:

Trying vaginal moisturizers or lubricants to add moisture to the vagina daily and to ease sexual intercourse.

Using unscented soaps for cleansing. Perfumes and other additives can cause irritation.

Asking your healthcare provider about vaginal estrogen therapy.

What are the complications of Sjögren's syndrome?

Most people who have Sjögren's syndrome live their lives without any significant problems. However, a dry mouth means that you are more likely to have dental problems, such as tooth decay and infection. Dry eyes can also place you at risk for eye infections.

If you have secondary Sjögren's syndrome, you may also have problems like joint paint caused by rheumatoid arthritis or lupus.

Rarely, people with Sjögren's syndrome develop these complications:

Abnormal liver or kidney function.

Lymphomas (cancerous tumors in the lymph nodes).

Lung problems that may be mistaken for pneumonia.

Neurological problems that cause weakness or numbness.

Skin rashes (red skin).

Prevention

How can I prevent Sjögren's syndrome?

Because no one knows exactly what causes Sjögren's syndrome or other autoimmune diseases, there is no known way to prevent it.

Outlook / Prognosis

What is the prognosis (outlook) for people with Sjögren's syndrome?

Constantly having a dry mouth or dry eyes is certainly uncomfortable. Fortunately, symptoms tend to lessen over time. With the right therapies, you can manage symptoms so they do not interfere with your ability to enjoy life.

Does Sjögren's syndrome cause weight gain?

Sjögren's syndrome doesn't cause weight gain. However, medications (like steroids) used to treat symptoms may cause weight gain. Also, there are conditions like hypothyroidism that may be linked to Sjögren's syndrome that can result in unintended weight gain.

Does Sjögren's syndrome affect ears?

Sjögren's syndrome, like other autoimmune conditions, can affect ears, too. You might have trouble with hearing loss or with balance.

Living With

What should I eat if I have Sjögren's syndrome? What foods should I avoid?

An estimated 90% of people with Sjögren's syndrome have problems related to eating. In some cases, these problems can be enough to cause malnutrition. Troubles can be related to dryness and swelling of the throat, as well as intestinal tract or nerve damage. There also seems to be a significant number of people who have both Sjögren's syndrome and celiac disease and/or symptoms of irritable bowel syndrome (bloating, abdominal pain, diarrhea and/or constipation).

If you have gastrointestinal symptoms, you can work with a registered dietitian (RD) to find out what food sensitivities you have. An RD can then also help you to create a food plan that works well for you and provides the nutrients you need.

Problems with gastroesophageal reflux (GERD) are also common among people in general and among people with Sjögren's syndrome in particular. Your care team can provide you with tips for dealing with GERD. These might include not eating two to three hours before you lie down to sleep and avoiding greasy foods.

There are some recommendations that people who have autoimmune disorders like Sjögren's syndrome should follow an anti-inflammatory diet to help with joint pain and other symptoms. Some people have found relief from a completely plant-based diet.

Here are some tips that might help you manage other types of eating issues:

Eat smaller amounts of food at one time, but eat more frequently throughout the day.

Include soft foods in your diet.

Be sure to chew your food completely.

Avoid cavities by reducing the amount of sugar you eat and drinking only water before you go to bed.

Is Sjögren's syndrome considered a disability?

The U.S. government has awarded disability to people with severe cases of Sjögren's syndrome. However, this is a question that you should discuss with your healthcare provider to see if you are eligible.

Does Sjögren's syndrome cause hair loss?

If you have Sjögren's syndrome, you might see some hair loss, and it might be as a result of the condition. There is a condition known as frontal fibrosing alopecia that is being found in higher numbers in people (mostly women) with autoimmune diseases. This condition causes slow hair loss at the front hairline and sometimes the eyebrows.

However, hair loss can be triggered by many things, including stressful life events and medications. You should ask your dermatologist about problems with hair loss.

When should I call the doctor if I have Sjögren's syndrome?

Severe mouth or gum pain could indicate infection or tooth decay. Itchy eyes, eye pain, or blurred or double vision can signal infections or other vision problems. You should also call your doctor if you notice swollen lymph nodes in your neck, armpits or groin. Enlarged lymph nodes could indicate lymphoma or another health condition.

What questions should I ask my doctor if I have Sjögren's syndrome?

If you have Sjögren's syndrome, you may want to ask your doctor:

What lifestyle measures can I take to make my symptoms more livable?

Can certain medications, drinks or foods dry out the eyes or mouth?

Should I look out for any signs of complications?

A note from Cleveland Clinic
While there isn't a cure for the dry mouth, dry eyes or other problems caused by Sjögren's syndrome, you don't have to live with discomfort or pain. Talk openly with your healthcare provider about how the disease affects your everyday life. Eating, swallowing, speaking and seeing are all critical for enjoying life. Your provider can help you find the right combination of therapies to relieve symptoms.

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Sjögren's Syndrome: Causes, Symptoms, Diagnosis & Treatments

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Sjögren's syndrome is a lifelong autoimmune disorder that reduces the amount of moisture produced by glands in the eyes and mouth. It is named for Henrik Sjögren, a Swedish eye doctor who first described the condition. While dry mouth and dry eyes are the primary symptoms, most people who have these problems don't have Sjögren's syndrome.