Presentation of Chronic Neuropathy

 

Pattern 1: Symmetrical distal and proximal sensory loss then consider CIDP,vasculitis

Pattern 2:Symmetrical distal weakness with sensory loss consider metabolic disorder(eg. DM),drugs & toxin,hereditary neuropathy (eg. CMT l & ll,amyloidosis)

Pattern 3: Asymmteric distal weakness with sensory loss then if

       *Single nerve or root: Consider compressive lesions and radiculopathy

       *Multiple nerve involvement: Consider vasculitis,HNPP,Infections(eg Lyme disease,leprosy),HIV,infiltration with lymphoma,carcinoma, Sarcoidosis.

Pattern 4: Asymmetric distal or proximal weakness without sensory loss.Consider MND,MMM-CB,neuralgic amyoyrophy

 Pattern 5: Asymmetric proximal and distal weakness with with sensory loss.Consider polyradiculopathy or plexopathy due to DM,malignant infiltration,neuralgic amyotrophy,HNPP

Pattern 6: Symmetric sensory neuropathy without weakness(mainly small fibre involvement with pain and temperature dysfunction).Consider diabetes,HIV,amyloidosis,Fabrys disease,idiopathic

Pattern 7:Symmetric sensory loss  without weakness(large and small fibre dysfunction).Consider diabetes,drugs,toxins.

Pattern 8: Marked prorioceptive sensory loss.Consider gangliopathy due to paraneoplastic disorders,Sjogren's syndrome,B6 &  cis-platinum toxicity,HIV.

Pattern 9: Neuropathy with autonomic involvement.Consider diabetes,amyloid,porphyria,GBS.

Pattern 10: Neuropathy with cranial nerve involvement(most often facial nerve).Consider Lyme disease,HIV,CIDP,sarcoidosis,malignant infiltration,Tangier disease.

(CIDP: Chronic demyelinating polyneuropathy,CMT: Charcot Marie tooth disease, MMNCB:multifocal motor neuropathy with conduction block)

Reference:

Oxford Handbook of Neurology