Classification EXAMINATION FINDINGS Purely Motor or Sensory or Sensorimotor? Proximal or distal? Symmetric or asymmetric? Multifocal, generalized, regional? Upper limbs, lower limbs, neck, trunk? TIMING Acute or chronic?
ASSOCIATED FINDINGS Painful or painless? Hereditary or sporadic? ELECTRODIAGNOSIS Axonal or demyelinating? LABORATORYParaprotein present? Type? Antibody against nerve? CSF protein level? HISTOLOGY Inflammatory Cells
Epidemiology Prevalence ~ 2.4% ~ 8% in people older than 55 years DM is most common cause
Labor ator y Screening for“Treatable” Neuropathy? B12 Not truly length-dependent Diabetes This type of neuropathy generally a late finding ANA, chronic disease Screen for connective tissue screen diseases (late finding) TSH If positive, have you proven anything? ESR If onset is recent HIV Risk Factors Review medications Big question
Polyneuropathy Evolution is centripetal Symptoms spread up legs Sensory loss Dysesthesias Ankles jerks are depressed Patients have trouble walking on their heels Foot plantar flexion remains strong
Polyneuropathy Symptoms noticed in fingertips Numbness Dysesthesias Advanced picture is easily recognizable Stocking-glove sensory loss Distal muscle wasting and weakness Absent tendon reflexes
Polyneuropathy Sub classification Historical features are indispensible Other medical conditions Symptoms of systemic disease Recent viral or other infectious diseases Recent vaccinations Institution of new medications
Polyneuropathy Exposure to toxins Alcohol Heavy metals Organic solvents Family history Duration and clinical course are helpful Acute = days to weeks Chronic = months to years
Treatment Preventative and palliative Weight reduction Assiduous foot care Good shoes Ankle-foot orthoses as needed Several organizations provide support
Chronic Length DependentNeuropathy Begins in toes or feet Stocking distribution Progresses rostrally Tops and bottoms of feet Weakness begins in ankles when sensation reaches calves Sometimes diagnosable, Never treatable?
Multifocal MotorNeur opathy (MMN) Almost always in hands and wrists Pattern of weakness is in the distribution of individual peripheral nerves i.e. severe involvement in ulnar distribution sparing median Lack of atrophy in weak muscles No pathological reflexes
Uncertainty Many cases are not easily definable because of multiplicity of patterns Cases that are not clearly untreatable are possibly treatable