Table 1 Criteria for making etiological diagnosis of peripheral neuropathies [7]
From: Etiological profile of peripheral neuropathies in an academic hospital in southern Morocco
Diagnosis | Definition of neuropathy |
|---|---|
Diabetes | Patient with diabetes mellitus presenting peripheral neuropathy in whom workup finds no alternative cause |
Acute polyradiculoneuropathy | Acute (< 4 weeks) of ascending bilateral symmetric peripheral neuropathy. Deep tendon reflexes are abolished or diminished; with prolonged distal latencies and F waves, and reduced motor conduction velocities |
Motor neuron disease | Association of upper and lower motor neuron impairment in diffuse distribution with fasciculations; neuronopathy on electrophysiological evaluation; absence of compressive or other secondary cause |
Immunologic | Peripheral neuropathy in the context of (either inaugurating or associated with) an autoimmune condition such as Lupus, sarcoidosis, Sjogren’s… |
Idiopathic | Peripheral neuropathy with negative paraclinical findings despite extensive workup |
Medication-induced | Peripheral neuropathy in the context of exposure to a medication known to cause neuropathy. Neuropathy is either inaugural or an underlying neuropathy is worsened when medication is started. Typically patients are undergoing anti-cancer medications such vincristine, cisplatine, nucleosidic analogue anti-retroviral agents, dapsone and phenytoin. Etiologic workup is unremarkable, and patients tend to stabilize or recover upon medication retraction |
Infective | Neuropathy in the context of infection diagnosed on cerebrospinal fluid (CSF) analysis. CSF evaluation includes cell count, protein, glucose levels, soluble antigens, culture, and polymerase chain reaction (PCR) |
Friedreich ataxia | Typical sensory peripheral neuropathy in a patient diagnosed with Friedreich ataxia |
Alcohol neuropathy | Typical sensory neuropathy in patients who consume alcohol. Patients describe painful (burning) sensations in limbs |
Paraneoplastic | Subacute peripheral neuropathy in patients with neoplasm. The neuropathy could be the initial complaint for which the workup reveals the neoplasm. Positivity of onconeuronal antibodies, the finding of a tumor, and recuperation after removal of tumor align with the diagnosis |
Critical illness polyneuropathy | Polyneuropathy in patients with prolonged stay in intensive care unit. Typically, patients would have received neurotropic drugs such as curare. Workup is usually unremarkable or could reveal metabolic anomalies |
Chronic polyradiculoneuropathy | A Guillain–Barré-type presentation with chronic onset. Patients report tingling in extremities and then motor impairment in a length-dependent fashion |
Deficiency neuropathy | Peripheral neuropathy in the context of vitamin deficiency. Patients present marked sensory signs with tingling and loss of proprioception. Vitamin B 12 deficiency might be associated with upper motor impairment (subacute combined degeneration of spinal cord) |
Amyloid | Peripheral neuropathy in the context of amyloidosis, primary or secondary. Biopsy is required to show infiltration by the abnormal protein |
Toxic | Peripheral neuropathy in a patient with known exposure to a toxin with potential to cause neuropathy. After excluding other etiologies, toxic neuropathy is retained. Patients are typically workers in manufacturing plants, painters, farmers, to name a few. Patients may also be drug-addicts (example: paint-thinner sniffers) |