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Peripheral Neuropathy

 

Peripheral neuropathy is a primary condition of the peripheral nerves most commonly causing length dependent symmetrical motor and / or sensory symptoms and signs in the four limbs.

The usual sensory change is a symmetrical glove and stocking loss to all modalities. This pattern of sensory loss is unlike that of individual nerve or nerve root disease. In the latter cases the sensory loss is asymmetrical or confined to one limb.

In demyelinating peripheral neuropathies, such as Guillain Barre Syndrome, the weakness may be proximal and thus simulates myopathic disease.

Consider restless legs if symptoms but no signs on examination. Think about a central cause if sphincter involvement

Investigations for peripheral neuropathy can include:

  • FBC
  • ESR
  • Glucose
  • T4
  • LFTs,EUC and bone profiles
  • B12 and folate
  • Plasma Electrophoresis/Ig levels
  • Auto Antibody Screen (please specify for Peripheral Neuropathy on form)
  • CXR

 Referral: to Neurology

Neurophysiology is not usually required in a typical symmetrical sensory neuropathy with a clear diagnosis e.g. diabetes.