Peripheral Neuropathy

3

1. Axonal polyneuropathy : axon, length

dependent neuropathy, foot > hand, gloves

and stockings pattern,

2. Demyelinating polyneuropathy : myelin

sheath, distal or proximal

, hyporeflexia

a. Hereditary polyneuropathy

b. Immune-mediated polyneuropathy

i. Guillain-Barre syndrome

(GBS)

ii. Chronic demyelinating

polyneuropathy (CIDP)

3. Multiple mononeuropathy, mononeuropathy

multiplex :

a. Vasculitis

b. Chronic granulomatous infection

c. Tumor infiltration

1.

a. Focal neuropathy or peripheral

polyneuropathy

b. Focal neuropathy : nerve, root,

plexus, peripheral nerve

c. Polyneuropathy :

i. Motor nerve

ii. Sensory nerve

iii. Motor and sensory nerve

iv. Autonomic nerve

v. Small fiber sensory nerve

vi. Dorsal root ganglion

2.

Peripheral polyneuropathy :

Neuro: motor system, DTR, sensory system

(pinprick, light touch, temperature, vibration,

proprioceptive)

3

1. Bilateral symmetrical distal weakness and

sensory loss () axonal neuropathy,

(length dependent),

glove and stocking

a. Bilateral symmetrical distal weakness

and sensory loss motor + sensory

i. DM, Thyroid, ESRD

ii. Toxin

iii. Vit def

iv. Charcot-Marie-Tooth,

amyloidosis (genetic)

b. Bilateral symmetrical or asymmetrical

distal weakness without sensory loss

motor

i. Lead neuropathy

ii. dapsone

c. Bilateral symmetrical sensory loss

without weakness sensory

a

d. Bilateral proprioceptive sensory loss

without weakness sensory

dorsal root ganglion (sensory

neuronopathy, ganglionopathy)

proprioception vibration

i. Paraneoplastic syndrome

ii. Sjogrens syndrome

iii. Cisplatinum

iv. HIV

e. Prominent autonomic symptom and

sign

i. DM

ii. Amyloidosis

iii. GBS (some)

iv. Vincristine

v. Porphyria

vi. HIV

vii. Idiopathic pandysautonomia f. Pure loss of temperature, pinprick

sensation (small fiber involvement)

myelin

autonomic

i. DM

ii. Amyloidosis

iii. Toxin, alcohol

iv. Hereditary sensory

neuropathy, Tangiers

disease, Fabrys disease

(genetic)

v. HIV

vi. Idiopathic

2. Bilateral asymmetrical weakness and sensory

loss

(mononeuropathy

multiplex)

median peroneal

a. Vasculitis : Wegener granulomatosis/

Polyarthritis nodusa/ Churg Strauss

syndrome/ SLE/ RA/

cryoglobulinemia/ HepB & C

b. Demyelinating polyneuropathy : CIDP

c. Infect : , HIV

d. Tumor infiltration : hematologic

malignancy

e. Sarcoidosis

f. Entrapment neuropathy

3. Bilateral symmetrical distal and proximal

weakness and sensory loss myelin sheath

length dependence DTR

primal distal

a. GBS (immune) : acute

polyradiculoneuropathy

autonomic DTR LP

Protein

b. CIDP (immune) :

length dependence 3-8 wk DTR

i. Idiopathic CIDP

ii. CIDP immune

1. Monoclonal

gammopathy of

undetermined

significant (MGUS)

2. Osteosclerotic

myeloma

3. Multiple myeloma

4. Waldenstromm

macroglobulinemia

5. Cryoglobulinemia

6. Hep C

Lab

EMG neuropathy/

root, plexus. Focal/ axonal or demyelinating/

motor nerve or sensory nerve or both (

small fiber myelin pure

small fiber neuropathy )

o Nerve conduction study

o Needle electromyography

Nerve biopsy

o Vasculitis

o Amyloidosis

o Leprosy

o Chronic granulomatous inflammation

ex sarcoidosis

o Hereditary polyneuropathy