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 polyneuropathyb. Immune-mediated polyneuropathyi. Guillain-Barre syndrome (GBS)ii. Chronic demyelinating polyneuropathy (CIDP)3. Multiple mononeuropathy, mononeuropathy multiplex : a. Vasculitisb. Chronic granulomatous infectionc. Tumor infiltration1. a. Focal neuropathy or peripheral polyneuropathyb. Focal neuropathy : nerve, root, plexus, peripheral nerve c. Polyneuropathy : i. Motor nerveii. Sensory nerveiii. Motor and sensory nerveiv. Autonomic nervev. Small fiber sensory nervevi. Dorsal root ganglion2. 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 + sensoryi. DM, Thyroid, ESRDii. Toxiniii. Vit defiv. Charcot-Marie-Tooth, amyloidosis (genetic)b. Bilateral symmetrical or asymmetrical distal weakness without sensory loss motor i. Lead neuropathyii. dapsonec. Bilateral symmetrical sensory loss without weakness sensory ad. Bilateral proprioceptive sensory loss without weakness sensory dorsal root ganglion (sensory neuronopathy, ganglionopathy) proprioception vibration i. Paraneoplastic syndromeii. Sjogrens syndromeiii. Cisplatinumiv. HIVe. Prominent autonomic symptom and sign i. DMii. Amyloidosisiii. GBS (some)iv. Vincristinev. Porphyriavi. HIVvii. Idiopathic pandysautonomia f. Pure loss of temperature, pinprick sensation (small fiber involvement) myelin autonomic i. DMii. Amyloidosisiii. Toxin, alcoholiv. Hereditary sensory neuropathy, Tangiers disease, Fabrys disease (genetic)v. HIVvi. Idiopathic2. Bilateral asymmetrical weakness and sensory loss (mononeuropathy multiplex) median peroneal a. Vasculitis : Wegener granulomatosis/ Polyarthritis nodusa/ Churg Strauss syndrome/ SLE/ RA/ cryoglobulinemia/ HepB & Cb. Demyelinating polyneuropathy : CIDPc. Infect : , HIVd. Tumor infiltration : hematologic malignancye. Sarcoidosis f. Entrapment neuropathy 3. Bilateral symmetrical distal and proximal weakness and sensory loss myelin sheath length dependence DTR primal distala. GBS (immune) : acute polyradiculoneuropathy autonomic DTR LP Protein b. CIDP (immune) : length dependence 3-8 wk DTR i. Idiopathic CIDPii. CIDP immune 1. Monoclonal gammopathy of undetermined significant (MGUS)2. Osteosclerotic myeloma3. Multiple myeloma4. Waldenstromm macroglobulinemia5. Cryoglobulinemia6. 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 ) Nerve conduction study Needle electromyography Nerve biopsy Vasculitis Amyloidosis Leprosy Chronic granulomatous inflammation ex sarcoidosis Hereditary polyneuropathy