Skip to Main Content

++

Probability diagnosis

++

Diabetic peripheral neuropathy

++

Nutritional peripheral neuropathy esp. alcohol, B12, folate

++

Hyperventilation with anxiety

++

Nerve root pressure e.g. sciatica, cervical spondylosis

++

Nerve entrapment esp. carpal tunnel syndrome

++

Neurotoxic drugs

++

Serious disorders not to be missed

++

Vascular:

++

  • CVA/TIA

  • Peripheral vascular disease

++

Infection:

++

  • AIDs

  • Lyme disease

  • Leprosy

  • Some viral infections

++

Tumour/cancer:

++

  • Disseminated malignancy

  • Cerebral/spinal cord tumours

++

Other:

++

  • CKF: uraemia

  • Guillain–Barré syndrome

  • Trauma to spinal cord

  • Marine fish toxins e.g. toadfish, Ciguatera

++

Pitfalls (often missed)

++

Migraine variant with focal signs

++

Multiple sclerosis/transverse myelitis

++

Hypocalcaemia

++

Rarities:

++

  • Chronic inflammatory polyneuropathy

  • Charcot–Marie–Tooth syndrome

  • Amyloidosis

  • Heavy metal toxicity e.g. lead

++

Masquerades checklist

++

Diabetes

++

Drugs e.g. cytotoxic agents, interferon (see list)

++

Anaemia: pernicious anaemia

++

Thyroid/other endocrine: hypothyroid?

++

Spinal dysfunction

++

Is the patient trying to tell me something?

++

Consider conversion reaction (hysteria), severe anxiety disorder. Some cases may be idiopathic.

++

Key history

++

Analyse symptoms: the nature, distribution, onset and associated neurological symptoms (motor, sensory), such as vertigo, seizures, vision. Check for other associated general symptoms such as fever, weight loss, pruritus, rash, weakness.

++

History of diabetes, migraine, cancer, spinal problems, injury, possible bites, fever/sweating and other symptoms. Take a travel and diet history, incl. nutrition and alcohol. Gather a drug history, particularly cancer therapy, interferon, colchicine, thalidomide, statins, alcohol or any illicit drugs.

++

Check the patient’s occupational history, e.g. exposure to lead, and psychiatric history, esp. anxiety states.

++

Key examination

++

  • General health and nutritional status.

  • Focused neurological especially sensory, motor function, reflexes.

  • Look for ‘glove and stocking’ distribution, muscle wasting e.g. thenar eminence.

  • Peripheral vasculature.

++

Key investigations

++

First line:

++

  • urinalysis

  • blood sugar

  • FBE

  • ESR/CRP

++

Consider:

++

  • serum calcium

  • B12 and folate

  • LFTs (γGT)

  • U & E

  • TFTs

  • KFTs

  • nerve conduction studies

++

According to clinical findings (refer):

++

  • imaging e.g. spine, carotid vessels, CT or MRI, angiography

  • specific blood tests for infection

  • lumbar puncture (CSF protein, oligoclonol Ig G, etc)

++

Diagnostic tips

++

Take a detailed drug history including the above, alcohol and OTC medications. Intermittent perioral paraesthesia indicates hypocalcaemia associated with hyperventilation. In many cases of peripheral neuropathy or a sensory symptoms, the diagnosis is not only elusive but may not be identified.

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

Murtagh Collection Full Site: One-Year Subscription

Connect to a suite of general practice resources from one of the most influential authors in the field. Learn the breadth of general practice, including up-to-date information on diagnosis and treatment, as well as key clinical skills like communication.

$145 USD
Buy Now

Pay Per View: Timed Access to all of Murtagh Collection

48 Hour Subscription $34.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.