Pattern-Recognition Approach to Neuropathy and Neuronopathy

Abstract

Synopsis Neuropathic disorders encompass those that affect the neuron’s cell body or neuronopathies, those affecting the peripheral process, or peripheral neuropathies. The peripheral neuropathies can be broadly subdivided into the myelinopathies and axonopathies. These conditions can be hereditary or acquired. Each of these disorders has distinct clinical features that enable neurologists to recognize the various patterns of presentation. Once a particular pattern is established, further laboratory studies can be performed to confirm the clinical impression.

Rare case of bilateral wrist and foot drop from SLE-related vasculitic polyneuropathy

“…Peripheral neuropathy can present in various patterns that can give clues about the differential diagnosis which needs to be considered. Table 1 shows the various patterns of peripheral neuropathy and their differential diagnoses 6…”

Clinical Reasoning: A 74-year-old woman with bilateral foot pain and a palmar rash

“…Disorders to consider in the setting of a palmar rash with neuropathy include Crohn disease, psoriasis, toxins such as arsenic (which can cause palmar hyperkeratosis), infections such as syphilis and human T-lymphotropic virus-1 (HTLV-1), vasculitides such as polyarteritis nodosa, and chemotherapeutic agents such as vincristine. [1][2][3][4][5] Other systemic issues that could be responsible for palmar erythema, but unrelated to the neuropathy, include rheumatoid arthritis, cirrhosis, and drug eruptions. ª 2017 American Academy of Neurology.…”

“…Causes of neuropathy with an acute onset and associated pain include diabetes, amyloidosis, vasculitis, medications, toxins (e.g., arsenic and thallium), Sjögren disease, paraneoplastic disorders, and HIV. 5 Further investigations included laboratory studies, spinal imaging, and skin biopsy. Normal laboratory studies included hemoglobin A1c, thyroid-stimulating hormone, free T4, antinuclear antigen, antineutrophil cytoplasmic antibodies panel, rapid plasma reagin, HIV, HTLV-1, vitamin B 12 , heavy metal screen (including arsenic and thallium), complement components 3 and 4, serum protein electrophoresis, Sjögren antibodies (SSa/b), and paraneoplastic antibodies (anti-Hu and anti-Yo).…”

Patterns of Weakness, Classification of Motor Neuron Disease, and Clinical Diagnosis of Sporadic Amyotrophic Lateral Sclerosis

“…1 Motor neuron diseases are neuronopathies. When approaching the patient with a suspected neuropathies or neuronopathies there are a number of key questions that can help further categorize the disorder:

What parts of the nervous system are involved: motor, sensory, autonomic, or combinations of more than 1 system?

Where is the weakness (proximal, distal, or both) and is it symmetric or asymmetric?

If there is sensory involvement is there pain, or proprioceptive loss?

Over what timeframe did symptoms evolve: acute (<4 weeks), subacute (4-8 weeks), or chronic?

Is there a family history of a similar disorder?

If there is motor involvement, is it upper motor neuron, lower motor neuron, or both?

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