A Clinician's Approach to Peripheral Neuropathy

Abstract

Peripheral neuropathies are a group of disorders that affect the peripheral nervous system, for which hundreds of etiologies have been identified. This article presents a stepwise approach to the evaluation and workup of peripheral neuropathy, which starts with a detailed history of symptoms, family and occupational history, and a neurological as well as general physical exam. Pattern recognition of various neuropathies can help to build a differential diagnosis based on the presentation. Such patterns include acute versus chronic, primary demyelinating versus axonal, hereditary versus acquired, asymmetric versus symmetric, presence of facial palsies, sensory or motor predominant, and presence of prominent autonomic symptoms. Early categorization of the type of neuropathy can help focus the workup for peripheral neuropathy. Nerve conduction studies and electromyography (NCS/EMG) is the primary diagnostic tool in the evaluation of patients with large-fiber polyneuropathy. One of the most important roles of NCS/EMG is to help categorize polyneuropathy as primary axonal versus primary demyelinating. The finding of a primary demyelinating polyneuropathy narrows the differential diagnosis of polyneuropathy dramatically and increases the chances of finding a treatable etiology. Laboratory workup includes serum studies and potentially cerebrospinal fluid, genetic studies, immunological markers, and fat pad biopsy for select patients. Skin biopsy may be used to assess intraepidermal nerve fiber density if small-fiber neuropathy is suspected, and nerve biopsy may be useful in select cases. In recent years, magnetic resonance imaging and neuromuscular ultrasound have also shown promise in the evaluation of peripheral neuropathy. Identification of the etiology of neuropathy is crucial and often time-sensitive, as an increasing number of causes are now reversible or treatable.

Robotic-Assisted Peripheral Nerve Surgery: A Systematic Review

“…1 The common pattern of neuropathy of the PNS includes traumatic rupture or avulsion, external compression, viral infection related neuritis, or neurogenic tumor formation. 2,3 When it comes to PNS reconstruction, motor nerve reconstruction is the most commonly encountered; this includes brachial plexus reconstruction, facial reanimation, and extremity reconstruction. 4 Nerve reconstruction is most commonly performed by reinnervating the denervated muscles by coapting the motor nerve in the acute stage, or palliative reconstruction with functioning free muscle transplantation or tendon transfers in chronic stage.…”

Leprous Neuropathy: Observational Study Highlighting the Role of Electrophysiology in Early Diagnosis

“…Always clinical examination should be followed by electrophysiology if neuropathy is suspected. 13 14 Electrophysiology is indicated for workup of all cases of peripheral neuropathy after a very basic hematological and biochemical workup. Hence, it is indicated in all leprosy suspects and patients, because in all leprosy cases, there is subclinical neuropathy.…”

“…It was mosaic pattern of 68% demyelinating and 36% axonal with overlap. 13 Electrophysiological abnormalities reported were reduced amplitude of motor and sensory potential (axonopathy) or prolonged latencies and slowing of conduction velocity (demyelination). 7 8 Different authors have found varying pattern of neurophysiological abnormalities in leprous neuropathy.…”

Inpatient Diagnosis and Management of Neuromuscular Disorders

“…Diphtheria and certain toxic neuropathies (amiodarone) are among rare causes. 75 Acute axonal neuropathies may result from porphyria, critical illness neuromyopathy, vasculitis, infection, and certain variants of GBS. 75 3A.…”