Peripheral neuropathy

55 Peripheral neuropathy



Instruction


Examine this patient’s legs.


Carry out a neurological examination of this patient’s legs.



Salient features



History




• Progressive and symmetrical numbness in the hands and feet that spreads proximally in a glove and stocking distribution


• Distal weakness, which also ascends


• History of diabetes, alcohol, connective tissue disorder, malignancy.



Examination




• Bilateral symmetrical sensory loss for all modalities with or without motor weakness


• Proceed by looking for evidence of the following (mnemonic: DAD,RUM):


• Diabetes mellitus (diabetic chart, insulin injection sites, insulin pump)

• Alcoholic liver diease (palmar erythema, spider naevi, tender liver)

• Drug history

• Rheumatoid arthritis

• Uraemia

• Malignancy.

• Palpate for thickened nerves and look for Charcot’s joints


• Tell the examiner that you would like to do the following:


• Look for anaemia and jaundice (vitamin B12 deficiency)

• Check urine for sugar

• Take a history of alcohol consumption and a drug history.


Diagnosis


This patient has symmetrical, bilateral sensory loss for touch and pain (lesion) caused by diabetes mellitus (aetiology).



Questions




How are polyneuropathies classified?




• Polyneuropathies can be classified as demyelinating or axonal


• Demyelinated: acute inflammatory demyelinating polyradiculoneuropathy (subtype of Guillain-Barré syndrome), diphtheria, chronic inflammatory polyradiculoneuropathy, Charcot-Marie-Tooth disease type 1

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Peripheral neuropathy

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