Neuropathy

Causes

Appropriate Tests

 

Review clinical features, including distribution of sensory and/or motor abnormalities: it is important to distinguish peripheral neuropathy from spinal cord disease eg, subacute combined degeneration of the cord, tabes dorsalis.

Pathology tests may assist in defining underlying disorders.

Nerve biopsy if diagnosis uncertain, or confirmation required.

Neurophysiological studies.

Mononeuritis multiplex

 

Diabetes mellitus

 

Polyarteritis nodosa

 

Systemic necrotising vasculitis

See under Vasculitis

Sarcoidosis

 

Amyloidosis

 

Leprosy

 

Polyneuropathy

 

Alcoholism

 

Drug reactions

  • Amiodarone
  • Cis-platinum
  • Didanosine (ddl)
  • Zalcitabine (ddC)
  • Stavudine (d4T)
  • Phenytoin
  • Vincristine

 

Guillain-Barré syndrome

Cerebrospinal fluid examination - microscopy, Protein, Protein electrophoresis.

There is characteristically a marked increase in CSF protein, with oligoclonal bands and a normal, or only slightly increased, CSF cell count.

Chronic inflammatory demyelinating polyneuropathy

 

HIV infection

 

Syphilis (tabes dorsalis)

 

Systemic disease, especially

  • Renal failure - chronic
  • Diabetes mellitus
  • Connective tissue diseases

 

  • Amyloidosis

 

Associated with neoplasia, including

  • Carcinoma, especially
    • Carcinoma lung
  • Lymphoma (classification)
  • Plasma cell myeloma

Neuronal Ab.

See Lung carcinoma

Paraproteinaemia

 

Cryoglobulinaemia

 

Toxins, especially

  • Lead
  • Organophosphates
  • Arsenic
  • Thallium

 

See Lead poisoning
See under Poisoning
See under Heavy metal exposure/toxicity
See under Heavy metal exposure/toxicity

Hereditary, including

  • Refsum disease
  • Charcot-Marie-Tooth disease
  • Acute neurological porphyria

 

Phytanate.
Molecular genetics - genetic disorders.
See Charcot-Marie-Tooth disease testing