Peripheral neuropathy is associated with numerous systemic diseases. It is often the heralding finding, which can lead to earlier diagnoses and better outcomes. An understanding of the epidemiology and clinical features of these diseases is paramount to their diagnosis and management. This article will focus on neuropathy associated with connective tissue diseases, monoclonal gammopathies, paraneoplastic disorders, medications including chemotherapeutic agents, nutritional deficiencies, alcohol, and toxins.

IntroductionOur aim in this study was to determine whether intravenous immunoglobulin (IVIg) or plasma exchange (PLEx) for treatment of neurologic disease is a trigger for thrombotic events.MethodsUsing administrative data from 2005 to 2014, we identified index admissions for thrombotic events. We performed case‐crossover analyses for these admissions with previous admissions for neurologic disease with IVIg or PLEx using exposure periods of between 7 and 120 days.ResultsWe identified 1.9 million admissions for venous thrombosis embolism, myocardial infarction, or acute ischemic stroke. The odds ratio for venous thrombosis embolism within a 30‐day window after exposure to IVIg was 3.33 (1.34–8.30, P = .0097) and for PLEx was 4.29 (1.88–9.76, P = .0005). Myocardial infarction and acute ischemic stroke admissions were not associated with exposure to either therapy.DiscussionPatients admitted for venous thrombosis embolism (but not acute ischemic stroke or myocardial infarction) were more likely exposed to either IVIg or PLEx during previous admission for neurologic disease.

Objectives:To compare skin biopsy sensitivity for diagnosing small fiber sensory neuropathy in Chinese American and non-Chinese American patients.Methods:We screened our skin biopsy database and performed chart review to identify Chinese and non-Chinese American patients with a high clinical suspicion for a distal small fiber sensory neuropathy, and compared the skin biopsy sensitivity.Results:Twenty-three Chinese American and 32 non-Chinese American patients with the presence of distal small fiber sensory symptoms and signs were studied. Intraepidermal nerve fiber density (IENFD) (fibers/mm) at the distal leg was higher (7.1 ± 3.9), and the diagnostic sensitivity using the worldwide normative reference values of IENFD at the distal leg was lower (26.1%) in the Chinese American group than in the non-Chinese American group (5.1 ± 3.0, P < 0.05; 62.5%, P < 0.05).Conclusions:There may be ethnic differences in IENFD at the distal leg, and a different set of IENFD normative values may be developed for ethnic Chinese to improve the skin biopsy sensitivity.

Background In older adults with stroke, there is an increased risk of cardiovascular events in the intermediate period, up to one year after stroke. The risk of cardiovascular events in this period in young adults after stroke has not been studied. We hypothesized that in the intermediate risk period, young adults with ischemic stroke have an increased risk of recurrent stroke and a smaller increase of cardiac events. Methods Using the National Readmissions Database during the year 2013, we identified ischemic stroke admissions among those aged 18-45 years using International Classification of Disease, Ninth Revision, Clinical Modification codes to identify index vascular events and risk factors. Primary outcomes were readmission for cardiac events and stroke. Multivariable Cox proportional hazard models and Kaplan-Meier analysis were used to estimate risk of primary outcomes. Results We identified 12,392 young adults with index stroke. The readmission rate due to recurrent stroke was higher than for cardiac events (2913.3.1 vs. 1132.4 per 100,000 index hospitalizations at 90 days). There was a higher cumulative risk of both cardiac events and recurrent stroke in the presence of baseline diabetes and hypercholesterolemia. Conclusion In a large, nationally representative database, the intermediate risk of recurrent stroke after index stroke in young adults was higher than the risk of cardiac events. The presence of vascular risk factors augmented this risk but did not entirely account for it. The aggressive control of hypercholesterolemia and diabetes may play an important role in secondary prevention in young adults with stroke.