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Peripheral Polyneuropathy (Examination (Motor (Bilateral, symmetrical, LMN…
Peripheral Polyneuropathy
Examination
Sensory
Bilateral, symmetrical
Glove and stocking distribution: length dependent
↓ tendon reflexes: loss of ankle jerks in DM
Signs of trauma or joint deformity (Charcot’s joints)
Loss of proprioception → +ve Romberg’s
Motor
Bilateral, symmetrical
LMN weakness
Wasting and fasciculation
↓ tone
Hyporeflexia
Completion
Drug chart
Dipstick: glucose
Gait + Romberg’s test
CN
Causes
Mainly Sensory
DM
Alcohol
B12 deficiency
CRF and Ca (paraneoplastic)
Vasculitis
Drugs: e.g. isoniazid, vincristine
Mainly Motor
HMSN / CMT
Paraneoplastic: Ca lung, RCC
Lead poisoning
Acute: GBS and botulism
Viva
Hx
Time-course
Precise symptoms
Ataxia: B12
Painful dysesthesia: EtOH, DM
Assoc. events
D&V: GBS
↓wt: Ca
Arthralgia: connective tissue
Travel, EtOH, drugs
Ix
Dipstick: glucose
Bloods
DM: Glucose, HBA1c
EtOH: FBC ± Film, LFTs, GGT
CRF: U+E
B12, folate
Vasculitis: ESR, ANA, ANCA
Thyroid disease: TFTs
Imaging
CXR: exclude paraneoplastic phenomena
Other
Nerve conduction studies
Demyelination → ↓ conduction speed
Axonal degeneration → ↓ conduction amplitude
Electromyography
Genetic: PMP22 gene in CMT
Nerve biopsy
Mx
General
MDT: GP, neurologist, specialist nurses, physio, OT
Foot care and careful shoe choice
Splinting joints can prevent contractures
Specific
Optimise glycaemic control: DCCT, UKPDS trials
Replace nutritional deficiencies
Avoid EtOH or other precipitants
Vasculitis: steroids and other immunosuppressants
Neuropathic pain: amitriptyline, gabapentin
GBS: IVIg