Polyneuropathy
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Polyneuropathy is a neurological disorder that occurs when many peripheral nerves throughout the body malfunction simultaneously. It may be acute and appear without warning, or chronic and develop gradually over a longer period of time. Many polyneuropathies have both motor and sensory involvement and some have autonomic dysfunction. These disorders are often symmetric and frequently involve distal extremities. There is a very large differential for polyneuropathy.
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Evaluation
Evaluation and classification of polyneuropathies begins with a history and physical exam in order to document what the pattern of the disease process is (arms, legs, distal, proximal, symmetric), when they started, how long they've lasted, if they fluctuate, and what deficits are involved. One also needs to know what disorders are already present within the family and what diseases the patient may currently have. This is vital in forming a differential diagnosis.
Diagnosis/testing
Although often diseases are suggested by the physical exam and history alone, testing is still a large part of the diagnosis. Tests which may be employed include: electrodiagnostic testing using electromyography, repetitive nerve stimulation testing, nerve conduction testing, muscle biopsy, serum creatine kinase (CK), antibody testing, . Nerve biopsy is not used much. Other tests may be used, especially tests for specific disorders associated with polyneuropathies.
Differential
There is a large differential for polyneuropathies: vitamin deficiency, cancer, toxins, infections (ex. Guillain-Barré Syndrome), liver disease, endocrine disease (inc. diabetes with diabetic neuropathy), amyloidosis, genetic disorders, motor neuron disorders, motor neuropathies, paraneoplastic, polio, porphyria (some types), spinal muscle atrophy, catecholamine disorders, and many others. This is not a complete list.
External link
- Merck Manual overview (http://www.merck.com/mrkshared/mmanual_home2/sec06/ch095/ch095h.jsp)
- Diagram Diagnosis page (http://www.neuroland.com/nm/pn_evaluate.htm)
- Wash U. Neuro website, very complete (http://www.neuro.wustl.edu/neuromuscular/naltbrain.html)
- Discussion of diabetic polyneuropathy with spanish translation (http://www.familydoctor.org)